Teacher communication style and adolescent human papillomavirus vaccination in Bangkok schools

Background Human papillomavirus (HPV) vaccination is central to cervical cancer prevention, but uptake depends on communication as well as access. Teachers can shape how adolescents and families understand school-linked vaccination, although communication style has been studied less than clinician recommendation. Objective To examine whether teacher advice and communication style were associated with adolescent HPV vaccination and whether associations differed between younger and older adolescents. Study Design We conducted parallel cross-sectional surveys among parents or legal guardians and adolescents aged 13-17 years in 10 Bangkok secondary schools. The primary analysis used parent-reported data. Of 687 parent forms submitted, 30 respondents declined consent and were excluded, leaving 657 consenting records; 604 had complete data for regression. The study-specific Thai-language questionnaire was not a previously validated psychometric instrument. It assessed respondent characteristics, clinician and teacher advice, communication style, information sources, vaccination status, beliefs, and barriers. Multivariable logistic regression evaluated receipt of at least 1 HPV vaccine dose. A post hoc sensitivity analysis used 882 consenting adolescent surveys to compare ages 13-14 and 15-17 years while accounting for clinician advice, sex, and perceived peer influence. Results Among 657 consenting parent respondents, 69.6% (457/657) reported that their adolescent had received at least 1 HPV vaccine dose. In the advice-exposure model, teacher advice was associated with vaccination (odds ratio [OR], 2.03; 95% confidence interval [CI], 1.31-3.14; P=.001), as was clinician advice (OR, 3.64; 95% CI, 2.44-5.42; P<.001). In the fully adjusted model, teacher shared decision-making was associated with vaccination (OR, 4.06; 95% CI, 1.58-10.42; P=.004), whereas teacher advice exposure alone was not (OR, 1.04; 95% CI, 0.57-1.90; P=.889). In adolescent sensitivity analyses, shared decision-making communication was associated with vaccination in both age groups (adjusted OR, 3.32 for ages 13-14 and 6.10 for ages 15-17); the age-by-communication interaction was not statistically significant (P=.151). Conclusion Teacher communication quality may be an actionable component of school-linked HPV vaccination. The findings extend prior teacher-perception literature by linking distinct communication styles with individual-level vaccination behavior, while also showing the need for validated instruments and prospective studies that measure age-specific access, autonomy, and peer networks.