Near-peer Education by Medical Students and Its Association with HPV Vaccination Knowledge and Attitudes among Japanese Adolescents: an Exploratory Intervention Study

Human papillomavirus (HPV) vaccination is a key preventive measure against cervical cancer. In Japan, proactive recommendations for HPV vaccination were suspended from 2013 to 2022, resulting in persistently low coverage. We explored the post-intervention knowledge, attitudes, and short -term self-reported HPV vaccination behavior following a near-peer educational intervention by medical students. Between February 2022 and March 2024, medical students conducted 1-hour sessions covering HPV transmission, cervical cancer prevention, and vaccine efficacy. The sessions incorporated quizzes, discussions, and workshops in which high school students created role-play scenarios or social media messages to promote HPV vaccination. A follow-up survey was administered 1-2 weeks after the sessions to assess vaccination uptake, knowledge, and self-reported explanatory ability. Of 864 junior and senior high school students who participated in the sessions, 332 were included in the followed-up analysis. Of these, 248 were unvaccinated before the session: 134 females and 114 males. Within two weeks, 10 female (7.5%) and one male (0.9%) reported receiving HPV vaccination. Students with positive vaccination intentions demonstrated higher comprehension scores than those without such intentions. Voluntary participants had higher knowledge scores than whole-class attendees. Subjective and objective comprehension scores were positively correlated, although there were some discrepancies. Vaccinated respondents were more likely than unvaccinated respondents to correctly identify HPV-preventable cancers. Near-peer outreach sessions delivered by medical students may represent a useful approach to enhancing adolescents' understanding of HPV vaccination. Leveraging the near-peer position of medical students may be a promising approach to address vaccine hesitancy in Japan.