Examining HPV Vaccination for Post-Secondary Students as a System in Ontario: A Multiple Case Study
Bibliographic record
Abstract
To bolster human papillomavirus (HPV) vaccine coverage across Canada, provinces and territories publicly-fund “catch-up” vaccine programs; however, eligibility varies across jurisdictions. Ontario currently publicly funds the HPV vaccine for students until Grade 12 and certain high-risk populations until age 26 only. Existing studies identified post-secondary students as important populations for catch-up vaccination. The objectives of this study were to examine how HPV vaccine access for post-secondary students in Ontario function as a system and identify how features of this system influence equitable vaccine access. This study applied a multiple case study design using qualitative methods amongst three university campuses in Ontario (part of a singular tri-campus institution). Each case consisted of a campus and its surrounding, distinct community; organizations were identified both on-campus and in the community that played some role in HPV vaccine access. The methods consisted of document reviews and individual interviews among 24 key informants from post-secondary, public health, and primary care sectors. Case-specific descriptions were constructed, and cross-case analyses were conducted using thematic analysis, guided by systems theory, the Socio-Ecological Model, and the EEFA (Ethics, Equity, Feasibility, Acceptability) framework for vaccine program recommendations. The Penchansky & Thomas (1981) dimensions of access also guided the analysis. The findings illustrated how features of the constructed system influenced HPV vaccine access based on several features, including: the accessibility of campus vaccination; breadth of student health insurance plans and out-of-pocket costs of the vaccine; outreach for the vaccine both on and off-campus; peer influence for vaccination and level of student involvement in vaccine outreach on-campus; and accessibility for catch-up vaccination across public health units. The case studies also identified several strategies to strengthen equitable vaccine access, with specific considerations for post-secondary institutions, pharmacies, primary care practices, public health units, and provincial government (the Ministry of Health). This study has implications for post-secondary institutions to acknowledge their role in adult catch-up HPV vaccination, for the Ministry of Health to strengthen catch-up HPV vaccination programs for adults across Ontario, and to encourage collaboration across actors over the governance of HPV vaccine programs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.013 | 0.004 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".