Improving Rural Flu and HPV Vaccination Rates Through School-Based Trusted Messengers

Schools have long played an important role in ensuring students are up to date on government-mandated vaccines, but a new UR CTSI project will test whether schools can help improve rates of non-mandated vaccinations, too. The project, funded by the Centers for Disease Control and Prevention, will focus on improving flu and HPV vaccination rates in rural Western New York schools through education and trust building.

Both the flu and HPV vaccines are highly effective but underutilized—especially in rural areas. According to the CDC,flu vaccination rates were 17 percentage points lower for children in rural areas compared to urban areas and HPV vaccination rates were 15 percentage points lower among rural teens than urban teens.

“Vaccines save lives, but rates of non-mandated vaccination are lower in rural counties than in urban or suburban counties,” said project lead Cynthia Rand, MD, MPH, a professor of Pediatrics at the University of Rochester Medical Center. “Even raising vaccination rates by five percent can have a huge public health impact.”

Over the next three years, Rand and her team will educate school nurses, coaches, teachers, and administrators about flu and HPV vaccination and train them to be trusted vaccine messengers. The training, called Changing the Conversation, will use improvisational theater techniques to teach participants how to have productive conversations about vaccines with students and their parents.

This isn’t the first time this research team has used improv to tackle vaccination issues. Changing the Conversation is adapted from the Theater for Vaccine Hesitancy, which was developed by research team members John P. Cullen, PhD, and Holly Ann Russell, MD, during the COVID pandemic to help health care workers navigate sensitive conversations with vaccine-hesitant patients.

“Our Theater for Vaccine Hesitancy, which was directed toward health care providers, was quite successful,” said Cullen, the UR CTSI’s strategic director for population health and a professor of clinical in the UR CTSI, Department of Health Humanities and Bioethics, and Center for Community Health & Prevention. “For this project, the training is directed at people who aren’t giving vaccines but are trusted members of the community who can help educate students and their parents to make the best decision for their health.”

Both Changing the Conversation and the Theater for Vaccine Hesitancy are based on Self Determination Theory, which states that a person’s need for autonomy, competence, and relatedness determines their motivation to take an action, like getting a vaccine. The improv trainings give participants a chance to practice difficult conversations to ensure they support the psychological needs of the person they are speaking with, be that a patient, student, or parent.

Rand, Cullen, and Russell will train trusted vaccination messengers in 30 schools spread across nine counties in Western New York that had low COVID vaccination rates as well as in the City of Rochester, which has high rates of social vulnerability and low flu vaccination rates. The team will then track flu and HPV vaccination rates in those 30 schools and compare them to vaccination rates in 30 schools in the same counties that didn’t receive any intervention.

The study will run in phases. Over the next year, the research team will consult with school leadership, staff, students, and parents, as well as local health department leadership and immunization workers, to learn how best to implement the program at each school. The first year of training, likely starting in 2026, will focus on improving flu vaccination rates across all ages, while the second year will focus on improving HPV vaccination among middle and high school students.

“This is really different from things we’ve done before,” said Rand. “I have been involved in school-based immunization clinics in the past, which were effective but are hard to set up and sustain. In this case, we’re not vaccinating in schools; we’re focusing on educating the community, which we hope will have a longer-lasting impact than a single vaccination.”

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The project is supported by a Special Interest Project Supplement to the UR CTSI’s CDC Prevention Research Center grant, which is led by Steven Barnett, PhD, and funds the UR CTSI’s National Center for Deaf Health Research.

Susanne Pritchard Pallo | 1/28/2025