{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T18:34:59Z","timestamp":1786732499481,"version":"build-2736575974"},"reference-count":120,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100024082","name":"College of Radiographers","doi-asserted-by":"publisher","award":["189"],"award-info":[{"award-number":["189"]}],"id":[{"id":"10.13039\/501100024082","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In the United Kingdom, where a school-based human papillomavirus vaccination programme vaccinates 12\u201313 year old students, parents\/guardians have been the primary decision-makers regarding receipt of the vaccination. As the average age of first sexual intercourse is 15\u201317 years old, education at this time could provide an opportunity for unvaccinated students to self-consent to vaccination. The aim of this study was to develop a HPV intervention, aimed at middle adolescents (15\u201317 years old), using the 3 stages of the Behaviour Change Wheel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review informed target behaviours and populations. Focus groups and interviews were conducted throughout Northern Ireland with immunisation nurses (n\u2009=\u200926), middle adolescents (n\u2009=\u200934), and post-primary school teachers (n\u2009=\u200912) and nurses (n\u2009=\u20096). Data analysis was guided by the COM-B model to inform a Behavioural Diagnosis. Subsequently, appropriate intervention functions, policy categories and Behaviour Change Techniques were selected with consideration of APEASE criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The systematic review highlighted the lack of interventions designed for middle adolescents; existing interventions were sparse, commonly not based on behavioural theory and focused on female cancers. The study identified twelve barriers to three target behaviours which included: empowering students to make decisions about HPV; empowering professionals\u2019 to design and deliver the intervention; and increasing positive public attitudes regarding HPV vaccination. A behaviour change HPV intervention was developed which included school-based HPV education aligned with mandated curriculum changes, alongside vaccination opportunity. The study identified content, mode of delivery and desirable qualities\/characteristics of a professional who could design\/deliver the HPV education. A public media campaign was deemed important in supporting this central education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Discussion and conclusion<\/jats:title>\n                    <jats:p>This study highlights political, social and cultural barriers to HPV intervention success and the need for Public Health Authority and Education Authority support. A feasibility pilot study should be undertaken to assess the real-world practicality of this HPV intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0355229","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T17:57:47Z","timestamp":1786730267000},"page":"e0355229","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development of an intervention for middle adolescents (15\u201317 years old) using the Behaviour Change Wheel (BCW) to empower adolescent decision-making regarding HPV vaccination uptake"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2428-6707","authenticated-orcid":true,"given":"Terri","family":"Flood","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciara M.","family":"Hughes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iseult M.","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian","family":"McLaughlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"pone.0355229.ref001","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1093\/milmed\/usab232","article-title":"Mandatory HPV vaccination; opportunity to save lives, improve readiness and cut costs","volume":"186","author":"CA Sitler","year":"2021","journal-title":"Mil Med"},{"issue":"6","key":"pone.0355229.ref002","doi-asserted-by":"crossref","first-page":"186","DOI":"10.3892\/etm.2020.9316","article-title":"Non-sexual HPV transmission and role of vaccination for a better future (Review)","volume":"20","author":"A Petca","year":"2020","journal-title":"Exp Ther Med"},{"issue":"1","key":"pone.0355229.ref003","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/S1470-2045(18)30682-X","article-title":"Prevalence of human papillomavirus DNA and p16INK4a in penile cancer and penile intraepithelial neoplasia: a systematic review and meta-analysis","volume":"20","author":"TB Olesen","year":"2019","journal-title":"Lancet Oncol"},{"key":"pone.0355229.ref004","doi-asserted-by":"crossref","first-page":"106399","DOI":"10.1016\/j.ypmed.2020.106399","article-title":"HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010\u20132019","volume":"144","author":"L Bruni","year":"2021","journal-title":"Preventive Medicine"},{"key":"pone.0355229.ref005","author":"World Health Organisation WHO","year":"2024"},{"key":"pone.0355229.ref006","author":"GOV.UK","year":"2023"},{"key":"pone.0355229.ref007","volume-title":"Annual HPV vaccine coverage in Northern Ireland: 2018-19","author":"HSCNI","year":"2019"},{"key":"pone.0355229.ref008","volume-title":"Human papillomavirus (HPV) vaccination coverage in adolescents in England: 2021 to 2022","author":"UK Health Security Agency","year":"2022"},{"key":"pone.0355229.ref009","volume-title":"HPV immunisation statistics Scotland; HPV immunisation statistics Scotland school year 2019\/20","author":"Public Health Scotland","year":"2020"},{"key":"pone.0355229.ref010","author":"Jo\u2019s Cervical Cancer Trust","year":"2025"},{"key":"pone.0355229.ref011","author":"Public Health Wales","year":"2024"},{"key":"pone.0355229.ref012","author":"Public Health Scotland","year":"2024"},{"key":"pone.0355229.ref013","author":"GOV.UK","year":"2025"},{"key":"pone.0355229.ref014","author":"Public Health Northern Ireland","year":"2024"},{"issue":"31","key":"pone.0355229.ref015","doi-asserted-by":"crossref","first-page":"4901","DOI":"10.1016\/j.vaccine.2020.04.032","article-title":"Using Facebook to increase coverage of HPV vaccination among Danish girls: an assessment of a Danish social media campaign","volume":"38","author":"LH Loft","year":"2020","journal-title":"Vaccine"},{"key":"pone.0355229.ref016","unstructured":"Buggy D. 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