Open Access Research article

School nurses’ attitudes and experiences regarding the human papillomavirus vaccination programme in Sweden: a population-based survey

Maria Grandahl1*, Tanja Tydén1, Andreas Rosenblad2, Marie Oscarsson13, Tryggve Nevéus4 and Christina Stenhammar1

Author Affiliations

1 Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-751 22 Uppsala, Sweden

2 Centre for Clinical Research Vasteras, Uppsala University, Central Hospital, Vasteras, Sweden

3 School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden

4 Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden

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BMC Public Health 2014, 14:540  doi:10.1186/1471-2458-14-540

Published: 31 May 2014



Sweden introduced a school-based human papillomavirus (HPV) vaccination programme in 2012, and school nurses are responsible for managing the vaccinations. The aim of the present study was to investigate the attitudes and experiences of school nurses regarding the school-based HPV vaccination programme 1 year after its implementation.


Data were collected using a web-based questionnaire in the spring of 2013, and 83.1% (851/1024) of nurses responded.


There were strong associations between the nurses’ education about the HPV vaccine and their perceived knowledge about the vaccine and a favourable attitude towards vaccination (both p < 0.001). School nurses who received a high level of education were more likely to have a positive attitude to HPV vaccination compared with nurses with little education about HPV vaccination (adjusted odds ratio [OR] = 9.8; 95% confidence interval [CI]: 3.797–25.132). Nurses with high perceived knowledge were more likely to have a positive attitude compared with those with a low level of perceived knowledge (OR = 2.5; 95% CI: 1.299–4.955). If financial support from the government was used to fund an additional school nurse, nurses were more likely to have a positive attitude than if the financial support was not used to cover the extra expenses incurred by the HPV vaccination (OR = 2.1; 95% CI: 1.051–4.010). The majority, 648 (76.1%), had been contacted by parents with questions about the vaccine, mostly related to adverse effects. In addition, 570 (66.9%) stated that they had experienced difficulties with the vaccinations, and 337 (59.1%) of these considered the task to be time-consuming.


A high level of education and perceived good knowledge about HPV are associated with a positive attitude of school nurses to the HPV vaccination programme. Thus, nurses require adequate knowledge, education, skills and time to address the questions and concerns of parents, as well as providing information about HPV. Strategic financial support is required because HPV vaccination is a complex and time-consuming task.

Attitude; Experience; Human papillomavirus; School health; School nurse; Vaccination