{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T03:56:26Z","timestamp":1790567786373,"version":"4.1.0"},"reference-count":39,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T00:00:00Z","timestamp":1788048000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T00:00:00Z","timestamp":1788048000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["sigmapubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Nursing Scholarship"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To compare HPV vaccination policies across eight countries and examine how actors, context, policy content, and implementation processes influence program performance and coverage outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Comparative policy analysis using a qualitative cross\u2010case document analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>Official national HPV vaccination guidelines, technical advisory documents, WHO and UNICEF monitoring reports, and peer\u2010reviewed literature published between January 2006 and December 2024. Sources were identified through structured searches of PubMed, CINAHL, Scopus, and Web of Science.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Health Policy Triangle framework guided analysis across four domains: Actors, Context, Content, and Process. A standardized data extraction template was applied across eight countries: Australia, Brazil, Japan, Nigeria, Rwanda, Sweden, the United Kingdom, and the United States. Data were synthesized in comparative matrices and analyzed using iterative cross\u2010case analysis, with coding verified by a second reviewer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five policy archetypes were identified: school\u2010based universal programs, decentralized federal models, gender\u2010neutral vaccination strategies, resource\u2010constrained but high\u2010performing systems, and the policy recovery model exemplified by Japan. School\u2010based delivery supported by nursing and school health workforces consistently achieved the highest and most equitable coverage. Rwanda achieved 98% coverage despite a girls\u2010only, donor\u2010supported model, indicating that governance quality and community trust may outweigh policy design alone. The global transition to single\u2010dose HPV vaccination schedules requires country\u2010specific adaptation that accounts for population\u2010based eligibility exceptions and evidence gaps, including the absence of clinical trial data on single\u2010dose protection in males and against non\u2010cervical HPV\u2010associated diseases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HPV vaccination outcomes are shaped by governance structures, implementation capacity, nursing workforce infrastructure, and public trust. Strengthening school\u2010based delivery, expanding single\u2010dose schedules where supported by evidence, and investing in nursing\u2010led outreach are critical to accelerating progress toward WHO cervical cancer elimination targets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>Nurses are central to HPV vaccination delivery worldwide. This analysis provides evidence to support nursing leadership in advocating for school\u2010based models, workforce investment, and equitable immunization strategies across diverse health system contexts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jnu.70131","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:07:16Z","timestamp":1788152836000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Comparative Policy Analysis of\n                    <scp>HPV<\/scp>\n                    Vaccination Guidelines: Actors, Context, Content, and Process Across Eight Countries"],"prefix":"10.1111","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7891-9513","authenticated-orcid":false,"given":"Grace K.","family":"Kyei","sequence":"first","affiliation":[{"name":"Department of Nursing College of Nursing and Health Sciences, University of Massachusetts Boston  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingling","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nursing College of Nursing and Health Sciences, University of Massachusetts Boston  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,30]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines11121853"},{"key":"e_1_2_12_3_1","volume-title":"Australian Immunisation Handbook: Human Papillomavirus (HPV)","author":"Australian Technical Advisory Group on Immunisation","year":"2023"},{"key":"e_1_2_12_4_1","volume-title":"Programa nacional de imunizacoes (PNI): Vacinacao Contra o HPV","author":"Brazil Ministry of Health","year":"2023"},{"key":"e_1_2_12_5_1","volume-title":"Implementacao da dose unica de vacina HPV no Brasil","author":"Brazil Ministry of 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