Ontario's school-based HPV immunization program: school board assent and parental consent.

Objective: To evaluate the implementation of Ontario's publicly-funded, school-based HPV immunization program through a process evaluation.

Participants: The immunization program targets grade 8 females. Ontario vaccine-preventable disease managers were the key informants for this evaluation.

Setting: Ontario, Canada.

Intervention: Ontario's Public Health Units (HUs) are responsible for the local implementation of the immunization program. The process evaluation involved a telephone-based, semi-structured questionnaire which included questions on stakeholder engagement; school and school board participation; communication strategies; and processes for obtaining informed consent.

Outcomes: All 36 HUs participated; 16 (44%) reported difficulties receiving agreement from local school boards to administer HPV vaccine in schools. Two Catholic school boards have not permitted HPV vaccine clinics in their schools: 1 only during the first year and 1 in the second and third years. All HUs request parental consent for students to receive the HPV vaccine and 5/36 also request or encourage student consent; 14 HUs indicated they would immunize a grade 8 girl at a school clinic, in the absence of parental consent, if the student requested immunization and was judged capable of providing informed consent.

Conclusion: Many HUs reported challenges in receiving support from local school boards. Despite this, vaccine clinics have been offered in all but 2 public school boards since 2007. All HUs request parental consent before HPV immunization at school-based clinics; 39% would consider immunizing in absence of parental consent. The results of this process evaluation will inform the HPV immunization program evaluation that is currently underway in Ontario.