Vaccination and Adolescent Knowledge: Health Education and Disease Prevention

In Brazil, low levels of demand for primary healthcare (PHC) services and adherence to PHC programmes and actions and reluctance to being vaccinated are factors that limit vaccination coverage among adolescents, justifying the choice of this age group as participants in this cross-sectional study. Carried out in conjunction with a health extension programme among adolescents aged between 13 and 18 years from 22 public schools in Divinópolis, Brazil, the study sought to determine the vaccination status of the adolescents and their level of knowledge of communicable and vaccine-preventable diseases (VPDs).

The intended audience of the vaccination and health education interventions undertaken under the health extension programme comprised 6,650 children, adolescents, teachers, and staff from the 22 public schools. The education activities were guided by the "Critical Health Education" intervention model, one of the strategies resulting from the Alma-Ata Declaration to attain the goal of health for all by the year 2000. Critical Health Education seeks to value community participation, which in the case of this study involves dialectical interaction with the school community, in order to develop individual autonomy and a sense of responsibility for adopting healthy lifestyles. In this sense, it is the group that defines the priority themes and individuals who will participate in the educational activities.

Specifically, the method used for the educational activities was group education, lasting an average of 35 minutes, which addressed themes defined by the adolescents. First, a group activity was used to promote interaction between the adolescents, followed by a conversation circle. The group education method allows adolescents to participate actively in the learning process, leading them to build new concepts, reflect upon the theme in question, and exchange knowledge with the researchers and each other, making them feel free to express ideas and opinions. At the end of the group activities, the researchers offered to talk to participants on an individual basis; in some schools, special attention was given to certain adolescents according to their own specific needs.

A subset of the students (605 of them) who had participated in the educational intervention took part in the study. Between September 2013 and February 2015, data were collected using a 28-item structured interview guide comprising questions addressing the following aspects: socioeconomic status and demographic characteristics; knowledge about vaccination, communicable diseases (including sexually transmitted infections - STIs), VPDs included in the National Immunization Program (NIP) child and adolescent schedule, and hepatitis B and its possible forms of transmission and prevention; and fear of injections. Three-stage cluster sampling was used comprising schools, classes, and students.

Vaccination coverage was determined based on the assessment of 475 immunisation record cards (78.8%, confidence interval (CI) 95%: 75.0%-81.7%), since 130 adolescents did not present their cards. Although the majority thought vaccination was important, vaccination coverage was only 45.1%; one factor that could explain the low rate of vaccination coverage found in this study is the lack of knowledge about the vaccines and communicable and vaccination-preventable diseases. The most mentioned diseases when the adolescents were asked which vaccinations they had had were infantile paralysis (60.7%), yellow fever - YF (56%), tetanus (34%), and measles, mumps, and rubella - MMR (28.6%).

The extension programme described above resulted in the administration of a total of 2,334 vaccine doses (Hepatitis B, YF, MMR, and tetanus and diphtheria), of which 1,923 were administered to adolescents. (The majority of adolescents and adults who refused vaccination (0.2% of the sample) reported "fear of injections".) This leads the researchers to assert that "A process of social transformation was observed during the study and extension activities, expanding vaccination coverage among the children, adolescents, staff, and teachers of the 22 public schools to 91%. The activities also had an impact on the education of these age groups through the knowledge shared and acquired regarding the importance of immunization and communicable and vaccination-preventable diseases."

They suggest that strengthening attitudes towards risk and disease prevention is a process that should be ongoing - that is, "health education should be permanent and built, throughout life, within workplace and social relations and between people throughout society. Continuous learning engenders new conceptions, attitudes, and possibilities in recreating one's own way of being and caring for oneself....This study provides important inputs to the field of health by demonstrating that the implementation of risk and disease prevention actions in settings outside the walls of the health center, such as schools, reinforces the concepts of a new way 'doing health', based on the concept of health surveillance, and can change realities."

In the researchers' estimation: "In light of the above, greater attention is needed on the part of health professionals to develop actions that foster the engagement of adolescents in risk and disease prevention and health promotion actions. By adopting a dynamic and proactive approach, the knowledge acquired through these actions helps adolescents develop greater autonomy and therefore become co-responsible for their own health. In this respect, it is necessary to consider incorporating monitoring and follow-up of adolescent vaccination into the everyday practice of PHC services."