1. Which social representations about cancer related to HPV infection and HPV vaccine from teenagers ? Charlotte Bauquier1 & Marie Préau12 1Groupe de Recherche en Psychologie Sociale (GRePS EA 4163), Université Lumière, Lyon 2 2 Institut National de la Santé et de la Recherche Médicale U912 (SESSTIM), Marseille, France
Context
HPV infection, cervical cancer and vaccination
Certain types of papillomavirus (HPV) infection, sexually transmitted, increase the likelihood of an individual developing cancer, mainly cancer of the cervix.
Currently in France, cervical cancer benefits from a prevention strategy that combines vaccination against HPV with cervical pap smears. This vaccine is recommended for young girls between 11 and 14 years old and a vaccination catch-up program exists for young girls between 15 and 19 years old. In addition, cervical pap smears is available for women between 25 and 65 years old. Men who have sex with men can also be vaccinated until the age of 26, to be protected from the risks of other forms of cancer (like anal cancer).
HPV vaccination in France is a real public health issue. Indeed, since the commercialization of the HPV vaccine which dates from 2008, only one in three teenage girls is vaccinated each year.
School health promotion
The school is a relevant space for this project’s construction because :
It allows to address as many teenagers It permits to inform many teenagers
After the primary phase of the children's education and socialization, it also has a health mission of prevention and risks reduction, including mandatory sexuality education sessions
Problematic
Methodology
We want to investigate the social representations and risk’s perception of cancer, especially cervical cancer with an associated vaccination, of young girls and boys in school context.
The scope is young people. Our assumptions:
Talking about cancer with teenagers seems complex with a projection of risks that may be difficult for young people
Cancer of the cervix is at the heart of various fields of prevention: cancer but also sexual
Entry into the present or approaching sexual life for teenagers: projection of risks is easier for young people and more linked with their experiences
Pictures
Workshops
Statistics
Survey
Speech
Focus groups
It is through a mixed methods approach that several tools were created to investigate the social representation. Thus, workshops are based on a participatory action which have been set up with middle school students. Groups of 3 or 4 students were asked to create posters illustrating the theme of cancer related to HPV infection and the associate vaccine. Focus groups and a questionnaire survey were conducted, both exploring cancer and HPV prevention.
The questionnaire is filled by the students before and after the workshop in order to identify these effects on the social representation and the perception of risks.
Risk factors of cancer
Prevention
Onset of disease
During illness
After illness
Risk factors of cancer
Prevention
Onset of disease
During illness
After illness
Results
Social representation of cancer
Social representation of cervical cancer
vaccine
Illness
Behavioral risks
Illness
Medical treatments and checks-up
Women
Medical treatments and checks up
Infertility
Death
Sexual prevention
Severe disease
Severe disease
Sexual intercourses
Death
Localisations
Several localisations
Side effects
HPV and infection
Hospital
Sadness
Close relatives
From the results of the questionnaire and the focus groups, we were able to identify several lexical fields to talk about cancer. We can observe that the majority of lexical fields focus on the phases of the onset of the disease, during and after the illness. We also note that cancer is a severe illness - often fatal outcome – which appears at different localisations and with medical treatments and checks-up (the most typical is the chemotherapy) which have heavy side effects (most cited by young people is the hair loss). These results are consistent with other results of questionnaire survey: indeed, 50% of our sample think that cancer is the disease the most severe, just before HIV/Aids (26,2%). The results of the questionnaire survey indicate that many factors, especially behavioural and environmental factors, may be responsible for the development of cancer for young people. From the results of the focus groups, we can hypothesize that they are almost from the social representation of cancer because each factor of risk seems to be associated with a precise location of the disease.
From the poster’s results built by the students and the questionnaires we can observe a first representation of cervical cancer. First, we find some lexical fields in common with the representation of cancer. Thus, cervical cancer is a severe illness with a possible fatal issue and medical treatments and checks-up (the most typical is surgery). The localisation are important, a lot of schema are on the posters to help to localize the cervix.
Then, we note more new lexical fields to talk about cervical cancer, especially on the phases of the risk factors of cancer and prevention. Indeed, the cervical cancer is a women’s cancer with a risk clearly identified with sexual intercourses. To prevent this cancer, there is a vaccine (against HPV) and a sexual prevention (with the condom for example). We note that 2 last topics both are primary prevention. This is a lack of secondary prevention with the absence of screening and cervical pap smears. However, according to the questionnaire, 30% of our sample knows of the pap smears. The same proportion knows the HPV and the vaccine against cervical cancer. To finish, the risk of infertility appears.
Conclusion & Perspectives
Our study highlights that, despite a lot of therapeutic advances, cancer is still perceived as extremely serious, causing much suffering and often having a fatal outcome among young people. It exists a sexual dimension in the social representation of cervical cancer. So, based on these first results, we believe that times dedicated to sexual health education at school, based on the lay knowledge of adolescents about the HPV vaccine and the cancers related to infection, seems relevant to address the topic of cervical cancer prevention.
Acknowledgments.
I thank the Rectorate of Grenoble for its collaboration, as well as the staff and students of the voluntary colleges who participated in this study.