Rapid Development of a Theory-Based Targeted Intervention and Communication Plan for HPV Vaccine Introduction in Kosovo Using the Behaviour Change Wheel Model

Background: Human papillomavirus (HPV) infections cause cervical cancer, which presents a significant health burden in low- and middle-income contexts like Kosovo1, where it is the second cause of death among women. HPV vaccines are effective and integral to global cervical cancer elimination efforts. In 2024, Kosovo1 introduced the HPV vaccine in the immunization schedule via a school-based introduction for sixth-grade girls. Rapid theory-based insights research supported development of a tailored communication and intervention plan ahead of introduction. Methods: Qualitative research was conducted with 102 participants over two weeks, including healthcare professionals, parents, target-aged girls, school staff, and community influencers. Data collection and analysis, and intervention development were carried out using the Behaviour Change Wheel (BCW) model, grounded in the Capability, Opportunity, and Motivation for Behaviour change (COM-B) theoretical framework. Results: Findings indicated trust in school-based immunization and healthcare professionals as key drivers, while a predominance of capability and physical opportunity-related barriers across target groups underscored a need for targeted communication and capacity-building efforts for all stakeholders. Using the BCW model, communication and intervention activities were developed for implementation by partners. Conclusions: Using rapid insights research grounded in the BCW model supported quickly identifying multiple factors affecting HPV vaccine acceptance and developing a targeted intervention plan. Findings echoed global research in HPV vaccine introduction, highlighting contextual needs and support and contributing to a successful introduction with high uptake in the first six months.