Cancer Salient Messaging for Human Papillomavirus (HPV) Vaccine Uptake: A Randomized Controlled Trial Open Access

Abstract

Introduction: Routine vaccination with the HPV vaccine is recommended for adolescents aged 11-12 years old, but uptake is suboptimal. Parents and providers are often uncomfortable discussing sexual practices of their adolescents, which have contributed to the delay or refusal of the HPV vaccine for the target age group. We created a cervical cancer salient message to promote HPV vaccination, by emphasizing disease salience and disease threat, while promoting self-efficacy. This trial tested the effects of a cervical cancer salient message on vaccine confidence and intent to vaccinate when compared to an infection salient message from the CDC and non-vaccine control.

Methods: A 3-arm randomized trial was conducted. Parents of adolescent girls (aged 9-17) were eligible for the study. Participants' vaccine confidence and intent to vaccinate were measured at baseline, and post intervention message. Surveys were administered online through Amazon Mechanical Turk.

Results: 14,165 people were screened, 1,084 participants were eligible for the follow-up survey with 653 people were counted in our final sample, yielding a 60.2% response rate. Parents who received the cervical cancer message or the CDC message were no more likely to report intent to vaccinate against HPV, and no more confident in vaccines than participants who received the non-vaccine control message.

Conclusions: Neither message had an overall effect on intent to vaccinate, highlighting the need for more research in this field to identify successful messaging strategies for HPV. Exploratory analyses suggest that among parents with ‘Low' vaccine confidence at baseline, the cervical cancer framed message may be more effective in changing intention than the CDC message or the non-vaccine related control. This finding suggests future work should target groups with ‘Low' or ‘Medium' vaccine confidence at baseline as they may be more amenable to change, and more receptive to disease salient messaging.

Table of Contents

Table of Contents Chapter I: Background ................................................................. 1 Chapter II: Manuscript ................................................................. 7 Abstract .................................................................................... 7 Introduction ............................................................................... 8 Methods .................................................................................... 9 Study Population ........................................................................ 10 Messages and Randomization Process............................................. 10 Outcome Measures ..................................................................... 11 Survey Instrument ..................................................................... 11 Sample Size .............................................................................. 12 Statistical Analysis ..................................................................... 13 Preliminary Results ..................................................................... 14 Discussion ................................................................................. 16 Strengths and Limitations ............................................................. 18 Conclusion ................................................................................. 18 References.................................................................................. 19 Tables......................................................................................... 25 Figures/Figure Legends ................................................................. 29 Chapter III: Summary, Public Health Implications, Future Directions..... 32

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	human papillomavirus message testing vaccine hesitancy adolescents disease salience HPV vaccine immunization
Committee Chair / Thesis Advisor	Omer, Saad B, Emory University
Committee Members	Bednarczyk, Robert A, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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