{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T22:57:52Z","timestamp":1780095472772,"version":"3.54.0"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["2022510"],"award-info":[{"award-number":["2022510"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000996","name":"Department of Foreign Affairs and Trade, Australian Government","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000996","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>There is a global need for effective strategies to improve acceptance and uptake of the human papillomavirus (HPV) vaccine, particularly in the Pacific where cervical screening and treatment options are limited. While the Pacific Island nation of Tonga has high routine childhood vaccine coverage, HPV vaccine uptake has remained low since its introduction in 2022. To improve vaccine acceptance and uptake, recent evidence supports the use of community engagement approaches like the Vaccine Champions program, which trains health and community leaders to advocate for vaccines. We assessed the reach, effectiveness, adoption, implementation, and maintenance of the Vaccine Champions program in Tonga. In March 2023 we conducted a co-design workshop with government and non-government stakeholders to adapt the program and establish key features. Diverse Vaccine Champions were trained in June to run vaccine information sessions in their communities until December 2023. We used the RE-AIM framework to evaluate program implementation and impact through surveys and interviews with co-design participants, Vaccine Champions, and community members. Co-design participants (n\u2009=\u200929) agreed to focus on the HPV vaccine, identified leading barriers and potential Vaccine Champions. We trained 27 Vaccine Champions including teachers, local officials, nurses, and representatives from disability, youth, and sports groups. Most were female (19\/27; 70%) and had no health background (25\/27; 93%). Training increased Vaccine Champions\u2019 trust and support for vaccines, and confidence to communicate about vaccines. Vaccine Champions ran 57 vaccine information sessions, reaching 1138 community members. Parent or caregiver intention to vaccinate their daughters against HPV increased from 70% to 88% after attending a community session. The Vaccine Champions program is a culturally tailored community engagement approach to increase HPV vaccine acceptance and uptake, supporting global efforts towards cervical cancer elimination. It is continuing in Tonga in 2025 with strong national support. Implementation and evaluation process findings can support program localisation elsewhere.<\/jats:p>","DOI":"10.1371\/journal.pgph.0005467","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T18:29:46Z","timestamp":1763490586000},"page":"e0005467","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["RE-AIM evaluation of a community-based vaccine education and communication program to improve human papillomavirus vaccine uptake in Tonga"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7406-8639","authenticated-orcid":true,"given":"Yasmin","family":"Mohamed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9710-6113","authenticated-orcid":true,"given":"Isabella","family":"Overmars","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ofakiokalani","family":"Tukia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Luey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u2018Asinate","family":"Toluta\u2019u","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meleane","family":"Lomu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"Vodonaivalu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afu","family":"Tei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reynold","family":"\u2018Ofanoa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u2018Ungatea","family":"Kata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Leask","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1877-5395","authenticated-orcid":true,"given":"Holly","family":"Seale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kylie","family":"Jenkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kshitij","family":"Joshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Halitesh","family":"Datt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonya","family":"Sagan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Dynes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5139-4183","authenticated-orcid":true,"given":"Jessica","family":"Kaufman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margie","family":"Danchin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"issue":"2","key":"pgph.0005467.ref001","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(22)00501-0","article-title":"Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative","volume":"11","author":"D Singh","year":"2023","journal-title":"Lancet Glob Health"},{"key":"pgph.0005467.ref002","unstructured":"World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. Geneva; 2020."},{"issue":"4","key":"pgph.0005467.ref003","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1002\/ijc.25396","article-title":"Human papillomavirus type distribution in 30,848 invasive cervical cancers worldwide: Variation by geographical region, histological type and year of publication","volume":"128","author":"N Li","year":"2011","journal-title":"Int J Cancer"},{"key":"pgph.0005467.ref004","first-page":"645","article-title":"Human papillomavirus vaccines: WHO position paper (2022 update)","volume":"97","author":"Organization World Health","year":"2022","journal-title":"Weekly epidemiological record"},{"key":"pgph.0005467.ref005","author":"World Health Organization","year":"2024"},{"key":"pgph.0005467.ref006","doi-asserted-by":"crossref","first-page":"106335","DOI":"10.1016\/j.ypmed.2020.106335","article-title":"National implementation of HPV vaccination programs in low-resource countries: Lessons, challenges, and future prospects","volume":"144","author":"VD Tsu","year":"2021","journal-title":"Prev Med"},{"key":"pgph.0005467.ref007","author":"The World Bank","year":"2023"},{"key":"pgph.0005467.ref008","author":"Australian Government Department of Foreign Affairs and Trade"},{"key":"pgph.0005467.ref009","author":"Tonga Statistics Department","year":"2021"},{"key":"pgph.0005467.ref010","author":"Tonga Statistics Department","year":"2020"},{"key":"pgph.0005467.ref011","author":"Tonga Ministry of Health, UNICEF, Australian Regional Immunisation Alliance","year":"2021"},{"key":"pgph.0005467.ref012","author":"World Health Organization","year":"2021"},{"key":"pgph.0005467.ref013","unstructured":"Tonga Ministry of Health. HPV Update - Tonga. 2023."},{"issue":"9","key":"pgph.0005467.ref014","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2024-015433","article-title":"Training health workers and community influencers to be Vaccine Champions: a mixed-methods RE-AIM evaluation","volume":"9","author":"J Kaufman","year":"2024","journal-title":"BMJ Glob Health"},{"issue":"10","key":"pgph.0005467.ref015","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0237319","article-title":"Community engagement strategy for increased uptake of routine immunization and select perinatal services in north-west Ethiopia: A descriptive analysis","volume":"15","author":"SD Demissie","year":"2020","journal-title":"PLoS One"},{"key":"pgph.0005467.ref016","doi-asserted-by":"crossref","first-page":"5","DOI":"10.11604\/pamj.supp.2023.45.1.39705","article-title":"Contribution of community champions to accelerate the uptake of COVID-19 vaccination in Rukwa region, Tanzania, February - October 2022","volume":"45","author":"E Msunyaro","year":"2023","journal-title":"Pan Afr Med J"},{"key":"pgph.0005467.ref017","doi-asserted-by":"crossref","first-page":"104894","DOI":"10.1016\/j.healthpol.2023.104894","article-title":"Behavioral interventions for vaccination uptake: A systematic review and meta-analysis","volume":"137","author":"AA Malik","year":"2023","journal-title":"Health Policy"},{"issue":"1","key":"pgph.0005467.ref018","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1186\/s12889-023-15876-5","article-title":"A systematic review of interventions to promote HPV vaccination globally","volume":"23","author":"C Escoffery","year":"2023","journal-title":"BMC Public Health"},{"issue":"11","key":"pgph.0005467.ref019","article-title":"Vaccine Champions Training Program: Empowering Community Leaders to Advocate for COVID-19 Vaccines","volume":"10","author":"J Kaufman","year":"2022","journal-title":"Vaccines (Basel)"},{"key":"pgph.0005467.ref020","doi-asserted-by":"crossref","first-page":"64","DOI":"10.3389\/fpubh.2019.00064","article-title":"RE-AIM Planning and Evaluation Framework: Adapting to New Science and Practice With a 20-Year Review","volume":"7","author":"RE Glasgow","year":"2019","journal-title":"Front Public Health"},{"key":"pgph.0005467.ref021","article-title":"Behavioural and social drivers of vaccination: tools and practical guidance for achieving high uptake","author":"World Health Organization","year":"2022"},{"issue":"2","key":"pgph.0005467.ref022","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1097\/SIH.0000000000000412","article-title":"Peer Role-Play for Training Communication Skills in Medical Students: A Systematic Review","volume":"15","author":"A Gelis","year":"2020","journal-title":"Simul Healthc"},{"issue":"1","key":"pgph.0005467.ref023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/tbm\/ibx067","article-title":"A scoping study of frameworks for adapting public health evidence-based interventions","volume":"9","author":"C Escoffery","year":"2019","journal-title":"Transl Behav Med"},{"key":"pgph.0005467.ref024","volume-title":"Guide for creating self-efficacy scales","author":"A Bandura","year":"2006"},{"key":"pgph.0005467.ref025","article-title":"Ripple Effect Mapping: an empowering participatory learning and evaluation process","author":"B Pamphilon","year":"2021"},{"key":"pgph.0005467.ref026","doi-asserted-by":"crossref","DOI":"10.1037\/e566732013-001","volume-title":"Best practices for mixed methods research in the health sciences","author":"JW Creswell","year":"2011"},{"issue":"1","key":"pgph.0005467.ref027","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/j.1365-2648.2007.04569.x","article-title":"The qualitative content analysis process","volume":"62","author":"S Elo","year":"2008","journal-title":"J Adv Nurs"},{"key":"pgph.0005467.ref028","doi-asserted-by":"crossref","unstructured":"Tonga Ministry of Health. HPV Update - Tonga (January 2024). 2024.","DOI":"10.5089\/9798400293801.002"},{"issue":"3","key":"pgph.0005467.ref029","article-title":"Use of community engagement interventions to improve child immunisation in low- and middle-income countries: A systematic review and meta-analysis","volume":"18","author":"M Jain","year":"2022","journal-title":"Campbell Syst Rev"},{"key":"pgph.0005467.ref030","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-003121","article-title":"Community engagement for successful COVID-19 pandemic response: 10 lessons from Ebola outbreak responses in Africa","volume":"4","author":"JN Anoko","year":"2020","journal-title":"BMJ Glob Health"},{"key":"pgph.0005467.ref031","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1080\/17441692.2021.1900316","article-title":"Beyond command and control: A rapid review of meaningful community-engaged responses to COVID-19","volume":"16","author":"R Loewenson","year":"2021","journal-title":"Glob Public Health"},{"issue":"6","key":"pgph.0005467.ref032","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(17)30184-5","article-title":"Community engagement and integrated health and polio immunisation campaigns in conflict-affected areas of Pakistan: a cluster randomised controlled trial","volume":"5","author":"MA Habib","year":"2017","journal-title":"Lancet Glob Health"},{"issue":"1","key":"pgph.0005467.ref033","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1186\/s12913-017-2414-x","article-title":"\u201cWe and the nurses are now working with one voice\u201d: How community leaders and health committee members describe their role in Sierra Leone\u2019s Ebola response","volume":"17","author":"SA McMahon","year":"2017","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pgph.0005467.ref034","doi-asserted-by":"crossref","DOI":"10.15663\/wje.v23i1.629","article-title":"Embedding indigenous science knowledge and values in higher education: Critical reflexive practice informed by successful Tongan science learners","volume":"23","author":"S Fonua","year":"2018","journal-title":"Waikato Journal of Education"},{"issue":"1","key":"pgph.0005467.ref035","article-title":"A call for the introduction of gender-neutral HPV vaccination to national immunisation programmes in Africa","volume":"7","author":"OG Chido-Amajuoyi","year":"2019","journal-title":"Lancet Glob Health"},{"key":"pgph.0005467.ref036","doi-asserted-by":"crossref","first-page":"127280","DOI":"10.1016\/j.vaccine.2025.127280","article-title":"\u201cThe only vaccine that we really question is the new vaccine\u201d: A qualitative exploration of the social and behavioural drivers of human papillomavirus (HPV) vaccination in Tonga","volume":"59","author":"Y Mohamed","year":"2025","journal-title":"Vaccine"},{"issue":"6","key":"pgph.0005467.ref037","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1007\/s10903-023-01502-4","article-title":"Evaluation of a Community COVID-19 Vaccine Ambassador Train-the-Trainer Program","volume":"25","author":"AMS Corley","year":"2023","journal-title":"J Immigr Minor Health"},{"key":"pgph.0005467.ref038","doi-asserted-by":"crossref","first-page":"636161","DOI":"10.3389\/fdgth.2021.636161","article-title":"HPV Vaccination Champions: Evaluating a Technology-Mediated Intervention for Parents","volume":"3","author":"B Sundstrom","year":"2021","journal-title":"Front Digit Health"},{"issue":"8","key":"pgph.0005467.ref039","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1080\/10494820.2019.1570279","article-title":"Experiential learning \u2013 a systematic review and revision of Kolb\u2019s model","volume":"28","author":"TH Morris","year":"2019","journal-title":"Interactive Learning Environments"},{"key":"pgph.0005467.ref040","doi-asserted-by":"crossref","first-page":"85","DOI":"10.4269\/ajtmh.19-0021","article-title":"Use of Social Mobilization and Community Mobilizers by Non-governmental Health Organizations in Malawi to Support the Eradication of Polio, Improve Routine Immunization Coverage, and Control Measles and Neonatal Tetanus","volume":"101","author":"A Chimpololo","year":"2019","journal-title":"Am J Trop Med Hyg"},{"key":"pgph.0005467.ref041","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1186\/s12889-015-2579-3","article-title":"Implementation of a national school-based Human Papillomavirus (HPV) vaccine campaign in Fiji: knowledge, vaccine acceptability and information needs of parents","volume":"15","author":"SF La Vincente","year":"2015","journal-title":"BMC Public Health"},{"issue":"1","key":"pgph.0005467.ref042","doi-asserted-by":"crossref","first-page":"3640","DOI":"10.1038\/s41598-018-21912-x","article-title":"Factors influencing intention to obtain the HPV vaccine in South East Asian and Western Pacific regions: A systematic review and meta-analysis","volume":"8","author":"D Santhanes","year":"2018","journal-title":"Sci Rep"},{"issue":"1","key":"pgph.0005467.ref043","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1186\/s12889-016-3517-8","article-title":"Social mobilisation, consent and acceptability: a review of human papillomavirus vaccination procedures in low and middle-income countries","volume":"16","author":"S Kabakama","year":"2016","journal-title":"BMC Public Health"},{"key":"pgph.0005467.ref044","doi-asserted-by":"crossref","first-page":"68","DOI":"10.4269\/ajtmh.19-0143","article-title":"The CORE Group Partners Project in North East Nigeria: Community Engagement Strategies to Combat Skepticism and Build Trust for Vaccine Acceptance","volume":"101","author":"S Usman","year":"2019","journal-title":"Am J Trop Med Hyg"},{"issue":"1","key":"pgph.0005467.ref045","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1186\/s12913-017-2588-2","article-title":"A review of Grey and academic literature of evaluation guidance relevant to public health interventions","volume":"17","author":"S Denford","year":"2017","journal-title":"BMC Health Serv Res"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005467","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T18:29:55Z","timestamp":1763490595000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005467"}},"subtitle":[],"editor":[{"given":"Julia","family":"Robinson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,11,18]]},"references-count":45,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0005467","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,18]]}}}