African Journal of Public Health and Health Systems | 13 June 2002
A Theoretical Framework for Analysing School-Based HPV Vaccine Coverage among Adolescent Girls in KwaZulu-Natal: An African Public Health Perspective
M, e, r, o, n, T, e, w, e, l, d, e, ,, Y, o, h, a, n, n, e, s, H, a, b, t, e, m, a, r, i, a, m
Abstract
School-based vaccination is a key strategy for improving adolescent health in Africa. The Human Papillomavirus (HPV) vaccine prevents cervical cancer, yet achieving high, equitable coverage among adolescent girls in school settings remains a complex challenge, shaped by socio-cultural, health system, and community factors. This article proposes a theoretical framework to systematically analyse the determinants of HPV vaccine coverage in school-based programmes for adolescent girls in KwaZulu-Natal, South Africa. It aims to provide a structured model for understanding the multi-level factors influencing vaccination uptake in this context. The framework was developed by synthesising established health behaviour theories, including the Socio-Ecological Model and the Health Belief Model. These were contextualised with insights from relevant African public health literature and tailored to the socio-cultural and health system environment of KwaZulu-Natal. Key insights: The framework identifies five interrelated domains influencing coverage: individual and parental perceptions; school-level systems and climate; healthcare provider dynamics; community norms and leadership; and overarching policy and communication strategies. It hypothesises a critical mediating role for trusted community health workers between parental concerns and the formal school programme. This framework provides a tool for moving beyond descriptive coverage statistics to a theory-informed analysis of the HPV vaccination process. It highlights the necessity of interventions synchronised across individual, community, and systemic levels. Researchers should apply and empirically test this framework in KwaZulu-Natal and similar settings. Programme planners should use it to diagnose coverage barriers and design multi-component interventions, prioritising community engagement and strengthening school-health system linkages. Human Papillomavirus (HPV) vaccination; school-based programme; theoretical framework; coverage determinants; adolescent health; KwaZulu-Natal. This work contributes a context-specific theoretical model for analysing HPV vaccine coverage in an African school-based setting, aiming to guide more effective research and programme implementation.