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#4Corners4Health: Protocol for a Randomized Stepped-Wedge Trial

#4Corners4Health: Protocol for a Randomized Stepped-Wedge Trial

Dr. David Buller from Klein Buendel and Dr. Andrew Sussman from the University of New Mexico are leading a large multiple state research team on the design, implementation, and evaluation of #4Corners4Health. The research study aims to decrease cancer risk factors among emerging adults (ages 18-26) living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah using a targeted social media campaign. The team has published a full description of their study procedures in JMIR Research Protocols.

Many emerging adults are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among emerging adults delivered over social media is limited. Cancer prevention information and recommendations may reach emerging adults more effectively over social media than in settings such as health care, schools, and workplaces, particularly for emerging adults residing in rural areas.

Specifically, the research team will recruit a sample of 1000 emerging adults aged 18 to 26 years residing in rural counties in the Four Corners states from the Qualtrics’ research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and HPV vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and emerging adults and focus groups with emerging adults. The emerging adults will complete assessments at baseline and five additional data after randomization. Assessments will measure six cancer risk behaviors, theoretical mediators, and participants’ engagement with the social media campaign.

The trial is being led by a steering committee. Team members are working in three subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by emerging adults, and community resources available. A framework for the social media intervention with topics, format, and theoretical mediators has been created, along with protocols for social media management.

In summary, the researchers believe that social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among emerging adults. Because of the popularity of web-based information sources among emerging adults, an innovative, multiple risk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors.

This research is supported by a 5-year R01 grant from the National Cancer Institute (CA268037) to Klein Buendel. Dr. David Buller from Klein Buendel and Dr. Andrew Sussman from the University of New Mexico are the project’s Multiple Principal Investigators. The JMIR publication has 24 collaborating authors from multiple institutions.

EUROGIN HPV Panel Presentation

EUROGIN HPV Panel Presentation

Klein Buendel Senior Scientists, Dr. W. Gill Woodall and Dr. David Buller, presented two research projects in a panel discussion at the EUROGIN International Multidisciplinary HPV Congress on Feb 8-11, 2023 in Bilbao, Spain. The “Digital Interventions to Increase HPV Vaccination” panel featured four presentations and was moderated by Dr. Greg Zimet from the University of Indiana. Other Klein Buendel scientists and staff (at the time of abstract submission) contributing as co-authors included Dr. Barbara Walkosz, Ms. Marita Brooks, Ms. Lila Martinez, and Ms. Jeanny Reither. Klein Buendel employees’ names are bolded.

Presentation 1

Title: “Randomized Trials of HPV Vaccine Uptake Improvement: Web Apps for Parents and Young Adolescent Girls and Boys”

Presenter: W. Gill Woodall, PhD, Senior Scientist, Klein Buendel, Inc. Albuquerque, NM, USA

Co-authors: A. Kong, G. Zimet, D. Buller, L. Chilton, J. Reither, L. Martinez, M. Brooks

This presentation discussed the results of two randomized trials of parent-focused web apps to improve HPV vaccine uptake for young adolescents (ages 11-14).  For the first trial, the web app was tailored to parents and young adolescent girls, and in the second trial, the web app was tailored to parents and young adolescent boys. Results of both trials indicated significant web app impact on HPV vaccine uptake for adolescent girls and boys, as well as other vaccine uptake related variables.  The discussion included a consideration of web app content and tailoring to determine HPV vaccine uptake improvement.

Presentation 2

Title: “Successful technology-based rural patient HPV vaccination reminder intervention and social media assessment of strategies to reduce HPV vaccine misinformation”

Presenter: Deanna Kepka, PhD, MPH, University of Utah, Salt Lake City, UT, USA

Co-authors: K. Christini, E. McGough, B. Gibson, E. Warner, H. Brandt

This presentation described a multi-level and multi-component intervention that included healthcare team training activities and technology-based HPV vaccination reminders. Missed opportunities for HPV vaccination declined significantly from the pre-intervention to the post-intervention period. Participants who recalled receipt of an electronically delivered vaccination reminder had higher unadjusted odds of scheduling a visit compared with those who did not recall receiving a reminder. Social media-delivered misinformation related to HPV vaccination is pervasive. The presenters also discussed new strategies to evaluate and reduce the impact of HPV vaccine misinformation in rural settings.

Presentation 3

Title: “Promoting HPV vaccination to emerging adults in rural communities in a multi-risk factor cancer prevention social media intervention”

Presenter: David Buller, PhD, Senior Scientist, Klein Buendel, Inc., Denver, CO, USA

Co-authors: A. Sussman, D. Kepka, W. G. Woodall, E. Warner, B. Walkosz

This presentation described an innovative social media campaign targeting six cancer risk factors, including HPV vaccination. It is being developed for the diverse population of adults aged 18-26 in rural counties in the Mountain West region of the U.S. Emerging adults obtain health information online far more than information from health care providers and other media. A framework for social media message development was presented based on social cognitive, self-determination, and diffusion of innovation theory. Misinformation, especially on vaccination, will be combatted by instructing emerging adults in digital and media and by using an epidemiological model of monitoring and quickly responding to correct misinformation. The campaign will be tested with a sample of 1000 emerging adults in a stepped-wedge quasi-experimental design.

Presentation 4

Title: “U.S. National Digital Point of Care Communication to Improve Uptake of HPV and Other Adolescent Vaccines in Clinic Settings”

Presenter: Judy Klein, BA, BS, President, UNITY Consortium, Philadelphia, PA, USA

Co-authors: G. Zimet, V. Agadi, C. Hu, A. Jaramillo

This presentation reported on a study that involved digital targeted adolescent vaccination infographics and videos widely disseminated to clinical practices throughout the U.S. Over 11,000 clinicians whose practices received these digital interventions (exposed condition) were matched to an equal number of non-exposed comparison practices matched on multiple practice characteristics. The outcomes of interest were the number of vaccine doses (Tetanus-diphtheria-pertussis booster or Tdap, HPV, MenACWY, and MenB) administered to patients 11-18 years of age. The exposed clinics showed significant increases in administration of adolescent vaccines, including HPV vaccine, compared to the non-exposed clinics.

#4Corners4Health

#4Corners4Health

A collaborative team of highly-experienced cancer prevention and control investigators from the Four Corners Cancer Centers Collaborative (University of Arizona, University of Colorado, University of New Mexico, and University of Utah), Colorado State University, and Klein Buendel is launching a research study that focuses on decreasing cancer risk factors among emerging adults (ages 18-26) living in rural counties in the “Four Corners” states (Arizona, Colorado, New Mexico, and Utah) using a social media campaign. Cancer risks related to infrequent physical activity, unhealthy diet, nicotine product use, alcohol intake, ultraviolet radiation exposure and lack of HPV vaccination are prevalent among emerging adults and contribute to cancer later in life.

The project will test a theory-based, multi-risk factor social media approach to cancer prevention through the use of Facebook and its private group function. Social media can improve information dissemination, credibility, and relevance, be used to detect and respond to emerging trends, and engage users with user-generated content that personalizes information. It offers a superior intervention for emerging adults compared to health care, schools, and workplaces which can be challenging to implement in low-resourced rural communities and will not reach many emerging adults who have low preventive health care utilization, school enrollment, and/or employment.

#4Corners4Health Specific Aims

  • Develop a social media intervention for diverse emerging adults in rural communities via a community-engaged process that combines expert advice, user-generated content, and online instruction about behavioral cancer risks, cancer misinformation, counter marketing, digital and media literacy, and family communication.
  • Evaluate the effect of a theory-based social media intervention on moderate to vigorous physical activity (MVPA), health eating patterns, nicotine product use, alcohol intake, sunburn prevalence, and HPV vaccination with the diverse (ethnically/ socioeconomically) population of emerging adults aged 18-26 in rural counties in the Four Corner states recruited from Qualtrics’ survey panel and enrolled in a pragmatic randomized trial using a stepped-wedge design in which individual emerging adults will be randomized to one of four cohorts and receive social media feed for varying durations in separate Facebook private groups.
  • Test if improvements in merging adults cancer risk knowledge and beliefs, digital and media literacy skills, accurate cancer prevention information, and family communication mediate impact of the social media campaign.
  • Explore whether the impact of the social media campaign differs according to a) level of emerging adults engagement with campaign, b) cancer risk factors, and c) biological sex of the participants.

The investigators hypothesize that (1) emerging adults will increase MVPA and healthy eating pattern, reduce nicotine product and alcohol use, and sunburns, and increase HPV vaccine uptake from pre to post when receiving social media campaign, and (2) positive impact of the social media campaign on cancer risk factors among emerging adults will be mediated by improved cancer risk knowledge and beliefs (self-response efficacy; norms; social support; vaccine antecedents), digital and media literacy skills, misinformation, and family communication.

This research will be led by Dr. David Buller from Klein Buendel and Dr. Andrew Sussman from the University of New Mexico (Multiple Principal Investigators). It is being funded by a 5-year R01 grant from the National Cancer Institute (CA268037). Key collaborators include Dr. Kimberly Henry from Colorado State University; Dr. Cindy Blair from the University of New Mexico; Dr. Judith Gordon, Dr. Cynthia Thomson, and Dr. Jennifer Hatcher from the University of Arizona; Dr. Evelinn Borrayo and Dr. Douglas Taren from the University of Colorado; Dr. Deanna Kepka, Dr. Echo Warner, and Dr. David Wetter from the University of Utah; and Dr. Gill Woodall, Dr. Barbara Walkosz, Dr. Kayla Nuss, and Ms. Julia Berteletti from Klein Buendel.