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used by school nurses (p=0.045). The mean score from enhanced if nurses are technically supported by district-
school nurses in the West (M=12.4, SD= 5.1) was higher level or school-level administrators in disseminating
compared to those in the Northeast (M=0.4, SD=4.3; see educational information about HPV and HPV vaccination
Table 2). to students and parents. Specifically, interventions should
cover communication strategies to address/counter
concerns or misinformation about HPV or the HPV
DISCUSSION vaccine. Additionally, interventions should provide
opportunities for school nurses to practice engaging in
The purpose of this study was to investigate whether conversations about the HPV vaccine, and thereby
school nurse’s knowledge, attitudes, perception of their increasing their self-efficacy in providing parents with
role as an opinion leader, and professional practice HPV vaccine information (Rosen et al., 2016). This
regarding the HPV vaccine differed by the grade level, content should also help to increase school nurses’ overall
geographic population, and geographic region they serve. perception of role as opinion leader on HPV vaccination.
Previous research revealed schools nurses’ had modest
attitudes toward the HPV vaccine, and views of themselves Another important finding in this study was school
as opinion leaders, which lead to a decrease in their nurses serving PreK through 5th grade had lower HPV
professional practice regarding HPV vaccine education and and vaccine knowledge as well as providing HPV vaccine
information to parents (Rosen, Ashwood, & Richardson, resources and information to parents and students
2016; Rosen et al, 2015). Based on these previous findings, compared to those serving 9th through 12th grade.
the implications of this study results lie in a targeted design Furthermore, school nurses serving 6th through 8th grade
of interventions, based on the populations the school nurses reported providing HPV vaccine resources and information
are serving, to engage the school nurses in promoting HPV to parents and students less often than those serving 9th
vaccine uptake for adolescents. Specifically, interventions through 12th grade. Interventions targeting school nurses
utilizing a lead school nurse serving in a rural area to who serve elementary and middle school aged students
provide professional development addressing should underscore that the vaccine is most effective when
misconceptions about the vaccine for other school nurses administered to youth prior to sexual initiation.
serving rural populations could assist in increasing positive Intervention materials should highlight that the ideal age
HPV vaccine attitudes. Strategies include providing for vaccination, and recommended for those aged 11 or 12,
information about vaccine safety and efficacy in which is the age of 5th and 6th graders. This, in turn, should
preventing certain types of cancer. Students in rural reinforce that school nurses serving elementary or middle
settings may not have contact with any healthcare school age students have a primary responsibility to
professional besides the school nurse; therefore, promote HPV vaccine uptake among this population. One
interventions targeting school nurses serving rural such educational intervention delivered to school-based
populations should reinforce that the school nurse healthcare staff using a community health educator and a
interaction may provide the only opportunity for students HPV vaccine informational handout was an effective
and parents to receive HPV vaccine information. approach to increasing the school-based healthcare staffs’
knowledge and beliefs about HPV and HPV vaccination
Additionally, when compared to school nurses (Reiter et al., 2011). Thus, such interventions have the
serving 9th through 12th grade, PreK through 5th grade potential to be effective in addressing school healthcare
school nurses had lower perceptions of their role as staffs’ knowledge and beliefs, which in turn can influence
opinion leaders as well as school nurses serving urban their professional practice to provide HPV vaccine
areas when compared to those serving metropolitan areas. education and information to parents and students.
Therefore, interventions should aim to increase these
specific school nurses’ perception of role as opinion This study is not without limitations, and these
leaders for the HPV vaccine. School nurses are more limitations should be considered when interpreting these
likely to provide parents with HPV vaccine information if data. First, this was a cross-sectional study design and can
they perceive themselves to be opinion leaders (Rosen et only be used to determine associations and cannot be used
al., 2015). Perception of role as an opinion leader may be to determine causal inferences. Additionally, the sampling
boosted if school nurses are provided with professional method used was systematic sampling, which allows for
development on HPV and HPV vaccination. In addition to systematic bias. Additionally, because this sample was
information about HPV and the vaccine, the training homogenous for race, we cannot generalize these findings
should emphasize that school nurses serve an integral role to other racial and ethnic groups serving as school nurses.
in HPV vaccine uptake, and in turn HPV prevention. The survey was sent through email and there is the
Further, perception of role as an opinion leader may be potential that participants were excluded due to certain
enhanced if school nurses are

THE HEALTH EDUCATION MONOGRAPH SERIES, Volume 34, Number 1, 2017 5