Reaching everyone: school nurses' experiences of including refugee and migrant students in the extended school-based HPV vaccination programme in Sweden.

Background: In Sweden, providing a free-of-charge national child vaccination programme is part of national public health work to promote health and prevent illness. Yet Sweden is no exception when it comes to systematic societal inequality. Research worldwide has shown that childhood vaccination coverage is lower among refugee and migrant children than among non-migrant children.

Aim: The aim of this study is to explore how school nurses working in one of Sweden's largest regions reflect on their strategies and experiences of including children with refugee or migrant backgrounds in the school-based extended HPV vaccination programme.

Methods: The study draws from semi-structured individual interviews with 21 school nurses. Analysis drew on Braun et al's (2011) four contextual dimensions: 1) the situated context; 2) the professional context; 3) material contexts; 4) external contexts. Thematic analysis was undertaken (Braun and Clarke, 2006; Clarke and Braun, 2013).

Results: Three themes were identified: 1) social and economic deprivation; 2) ways of communicating; 3) gratitude. According to the school nurses, mapping the families' social situation and building trusting relationships are essential. Providing written information about the vaccination in diverse languages and/or involving an interpreter are also important strategies to reach refugee and migrant parents. Despite the families' often marginalised position, the children and their parents favour the HPV vaccination, which could be interpreted as vaccine confidence.

Conclusions: Meeting the needs of children and families with refugee or migrant backgrounds requires that school nursing practice take a holistic perspective. The study contributes new insights regarding these issues.