Untangling the psychosocial predictors of HPV vaccination decision-making among parents of boys

BACKGROUND Human papillomavirus is a common and preventable sexually transmitted infection but vaccination rates in the U.S. among the target age group, 11-12 years old, are lower than national goals. Interventions that address the barriers and facilitators to vaccination are important in improving HPV vaccination rates. Online text-based focus groups are becoming a promising method that may be well-suited for conducting formative research to inform the design of digital behavior change intervention content and features that address HPV vaccination decision making. OBJECTIVE This study explores parental HPV vaccination decision-making processes using an online text-based focus group protocol in order to inform content and feature recommendations for an HPV prevention digital behavior change intervention. METHODS We conducted four online text-based synchronous focus groups via Skype with parents of 11-13-year-old patients within a large urban U.S. pediatric clinic network. RESULTS The 22 parents were majority female, white non-Hispanic, had a graduate or professional degree and had private health insurance for their children. Fifty-six percent of the parents’ 11-13-year-old children had initiated HPV vaccination. Most parents had experience using Skype (82%). Parents requested a text-only chat format (47%) over an audio-visual call format (6%) for their focus group. The three main themes from the qualitative data were (1) HPV vaccination misinformation and confusion; (2) HPV beliefs and attitudes; and (3) facilitators to vaccination. Eleven intervention content and feature recommendations emerged from the themes including: address HPV knowledge barriers using trusted sources; design for a family audience; focus on the framing of messages; report reputable HPV research in a digestible format; and expand the clinic visit experience. CONCLUSIONS Synchronous text-based focus groups are feasible for conducting formative research on HPV vaccination decision making. Among well-educated and well-resourced parents, there is misinformation about HPV and knowledge barriers that influence HPV attitudes and beliefs. Parents want to conduct their own HPV research as well as receive relevant HPV vaccination advice from their child’s pediatrician. In addition, parents want an enhanced clinic visit experience which lets them access and connect to tailored information before and after clinic visits. The results gathered provide guidance for content and features that may inform a more responsive digital behavior change intervention to address HPV vaccination decision making among parents.

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Parents Experience with an mHealth Intervention to Influence HPV Vaccination Decision-Making: Mixed Methods Feasibility Study (Preprint)

10.2196/preprints.30340 ◽

2021 ◽

Author(s):

Elisabeth R.B. Becker ◽

Ross Shegog ◽

Lara S. Savas ◽

Erica L. Frost ◽

Sharon P. Coan ◽

...

Keyword(s):

Decision Making ◽

Mixed Methods ◽

Hpv Vaccine ◽

Rating Scales ◽

Controlled Trial ◽

Hpv Vaccination ◽

Future Research ◽

Mhealth Intervention ◽

Pediatric Clinic ◽

Vaccination Decision

BACKGROUND HPV-attributed cancers are preventable, yet HPV vaccination rates severely lag other adolescent vaccinations. HPVcancerFree is an mHealth intervention developed to influence parental HPV vaccination decision making by raising awareness of HPV, reducing HPV vaccination barriers and enabling HPV vaccination scheduling and reminders through a smartphone. Evaluating the feasibility and user experience of mHealth interventions are vital components in assessing their quality and success. OBJECTIVE We aimed to evaluate the feasibility of HPVcancerFree using mixed methods data collected from log files, survey measures and qualitative feedback METHODS Study data was evaluated from parents in a large U.S. pediatric clinic network using HPVcancerFree in the intervention arm of a group randomized controlled trial. Log data captured HPVcancerFree retention and use. Post intervention rating scales and items, including the uMARS survey (reflecting engagement, functionality, aesthetics and information), assessed HPVcancerFree utility, usefulness, understandability, appeal, credibility, perceived impact and overall quality. Open-ended responses assessed patient recommendations for HPVcancerFree enhancement. RESULTS The 98 parent participants were mainly female (96%), 41±5.67 years of age, college educated (56%), white, non-Hispanic (56%) and had private health insurance for their children (77%). Parents used HPVcancerFree 197 times with average visit duration approximating 3.5 minutes. The uMARS app quality score was positively skewed (4.2/5). Mean ratings were highest for information (4.46±0.53) and lowest on engagement (3.74±0.69). Forty-seven percent of parents rated HPVcancerFree as helpful in HPV vaccination decision making and 17% attributed HPV vaccine initiation to HPVcancerFree. Parents reported that HPVcancerFree increased their awareness (89%), knowledge (89%) and HPV vaccination intentions (68%). Most parents rated the four HPVcancerFree components as useful (74-94%). Parents agreed that HPVcancerFree was clear (91%), accurate (91%), and more helpful than other HPV vaccine information they had received (94%), and that they would recommend it to others (85%). Parents suggested increasing awareness about the app, incorporating a tailored reminder system and creating opportunities to engage with adolescents about HPV and sexual health as enhancements for future iterations. CONCLUSIONS HPVcancerFree is a feasible mHealth intervention to support regular pediatric clinic HPV vaccine education. HPVCF was well received by parents. Future research is indicated to determine its efficacy to persuade parents to vaccinate and best promotional strategies to motivate parents to use HPVcancerFree.

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