Human papillomavirus (HPV) vaccines effectively prevent cervical cancer, most of which results from undetected long-term HPV infection. HPV vaccine introduction is particularly sensitive and complicated given widespread misinformation and vaccination of young girls before their sexual debut. Research has examined HPV vaccine introduction in lower- and middle-income countries (LMICs), but almost no studies attend to HPV vaccine attitudes in central Asian countries. This article describes the results of a qualitative formative research study to develop an HPV vaccine introduction communication plan in Uzbekistan. Data collection and analysis were designed using the Capability, Opportunity, and Motivation for Behaviour change (COM-B) mode for understanding health behaviours. This research was carried out with health workers, parents, grandparents, teachers, and other social influencers in urban, semi-urban, and rural sites. Information was collected using focus group discussions (FGDs) and semi-structured in-depth interviews (IDIs), and data in the form of participants’ words, statements, and ideas were thematically analysed to identify COM-B barriers and drivers for each target group’s HPV vaccine-related behaviour. Represented through exemplary quotations, findings were used to inform the development of the HPV vaccine introduction communication plan. Capability findings indicated that participants understood cervical cancer was a national health issue, but HPV and HPV vaccine knowledge was limited among non-health professionals, some nurses, and rural health workers. Results on an opportunity for accepting the HPV vaccine showed most participants would do so if they had access to credible information on vaccine safety and evidence. Regarding motivation, all participant groups voiced concern about the potential effects on young girls’ future fertility. Echoing global research, the study results highlighted that trust in health workers and the government as health-related information sources and collaboration among schools, municipalities, and polyclinics could support potential vaccine acceptance and uptake. Resource constraints precluded including vaccine target-aged girls in research and additional field sites. Participants represented diverse social and economic backgrounds reflective of the country context, and the communication plan developed using research insights contributed to the Ministry of Health (MoH) of the Republic of Uzbekistan HPV vaccine introduction efforts that saw high first dose uptake.

Vaccine-preventable diseases remain a global threat to public health, and despite the proven effectiveness of vaccines in protecting against these diseases, some people still avoid vaccinations for themselves or their children. Since barriers to protective health behaviors are diverse, overcoming them, and thereby reducing immunization gaps, necessitates diverse strategies. One such approach is to leverage health education through digital formats like online platforms and game-based learning, which can be implemented across geographical borders. We report a large-scale test of the World Health Organization’s Immune Patrol, a game-based middle school curriculum on vaccines and immunization. Using a matched quasi-experimental trial, classes in Armenia and the Republic of Moldova were exposed to local language versions of either five fully game-based lessons on topics including immunization, preventable diseases and digital source criticism, or non-game control materials on the same topics matching the digital and physical activities, without overt game elements. Significant learning outcomes were found across both countries, yet with differing gains among the classes within each country. Students assigned to game-based learning were slightly more motivated to learn about vaccine-preventable diseases, and to actively protect people around them through vaccination following the Immune Patrol experience. Qualitative observations highlight how practical and cultural differences can challenge homogenous implementation of learning packages like Immune Patrol across borders, but also how technology-enhanced collaborative classwork is welcomed in different ways across disparate classrooms. Results support the feasibility of global deployment of digital health education, but underscore the need for local support, and sensitivity to variations in culture, resources, teaching approaches and national education systems, when digital education initiatives like WHO’s Immune Patrol are set to transcend global borders.

Background: Human papillomavirus (HPV) infection is the leading cause of cervical cancer, which presents a significant health burden in low- and middle-income settings such as Kosovo^†, where it is the second leading cause of death among women. HPV vaccines are highly effective and integral to global cervical cancer elimination efforts. In 2024, Kosovo^† introduced the HPV vaccine into its immunisation schedule via a school-based program targeting sixth-grade girls. Rapid, theory-based insights supported development of a tailored communication and intervention plan ahead of the introduction. Methods: Over a two-week period, qualitative research was conducted with 102 participants, including healthcare professionals, parents, girls in the target age group, school staff, and community influencers. Data collection, analysis, and intervention development were carried out using the Behaviour Change Wheel (BCW) model, underpinned by the Capability, Opportunity, and Motivation for Behaviour change (COM-B) theoretical framework. Results: Trust in school-based immunisation and healthcare professionals emerged as key drivers, while a predominance of capability- and physical-opportunity-related barriers across target groups underscored the need for targeted communication and capacity-building efforts for all stakeholders. Using the BCW model, communication and intervention activities were developed for implementation by partners. Conclusions: Using rapid insight research grounded in the BCW model enabled the timely identification of behavioural drivers and barriers to HPV vaccine acceptance and supported development of a targeted intervention plan. The findings echoed global research on HPV vaccine introduction, highlighting context-specific needs and enablers and contributing to a successful rollout marked by high uptake within the first six months.

Background: Human papillomavirus (HPV) infections cause cervical cancer, which presents a significant health burden in low- and middle-income contexts like Kosovo1, where it is the second cause of death among women. HPV vaccines are effective and integral to global cervical cancer elimination efforts. In 2024, Kosovo1 introduced the HPV vaccine in the immunization schedule via a school-based introduction for sixth-grade girls. Rapid theory-based insights research supported development of a tailored communication and intervention plan ahead of introduction. Methods: Qualitative research was conducted with 102 participants over two weeks, including healthcare professionals, parents, target-aged girls, school staff, and community influencers. Data collection and analysis, and intervention development were carried out using the Behaviour Change Wheel (BCW) model, grounded in the Capability, Opportunity, and Motivation for Behaviour change (COM-B) theoretical framework. Results: Findings indicated trust in school-based immunization and healthcare professionals as key drivers, while a predominance of capability and physical opportunity-related barriers across target groups underscored a need for targeted communication and capacity-building efforts for all stakeholders. Using the BCW model, communication and intervention activities were developed for implementation by partners. Conclusions: Using rapid insights research grounded in the BCW model supported quickly identifying multiple factors affecting HPV vaccine acceptance and developing a targeted intervention plan. Findings echoed global research in HPV vaccine introduction, highlighting contextual needs and support and contributing to a successful introduction with high uptake in the first six months.