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Vacteens: A Mobile Web App to Improve HPV Vaccine Uptake

Vacteens: A Mobile Web App to Improve HPV Vaccine Uptake

Dr. W. Gill Woodall from Klein Buendel (KB) and the University of New Mexico and Jeanny Reither from KB presented findings from the Vacteens Project at the Eurogin International Multidisciplinary HPV Congress in Lisbon, Portugal, December 2-5, 2018. Eurogin is one of the most important conferences on Human Papillomavirus (HPV) infection and related cancers. It aims to raise the public health profile of HPV, increase the need for responsible health services, and examine the cost-effectiveness of risk-based screening to pave the way for the development of new strategies for the prevention of HPV-induced cancers.

The uptake of the HPV vaccine in the United States remains significantly below the Healthy People 2020 goal of 80% series completion, and this is particularly so for the young adolescent age range, when the immunogenic response to the vaccine is stronger. While a number of factors may account for this less than desirable vaccine uptake, parental concerns and misinformation about the efficacy and safety of HPV vaccine remain barriers to reaching public health vaccination goals. Physician and clinic-based interventions have shown some limited positive effect on vaccine uptake. However, parental barriers to HPV vaccination may ideally be addressed by digital interventions (in this case, smartphone applications) that are tailored to their concerns. Specifically, research indicates there is a great deal of: (1) confusion and uncertainty about HPV vaccine, and (2) concomitant misinformation about HPV vaccine, who it is meant for, and the conditions under which it is maximally effective.

With funding from the Patient Centered Outcomes Research Institute (PCORI) and the National Cancer Institute, Dr. Woodall’s team systematically developed a set of mobile web app tools to prompt the informed adoption of HPV vaccination. They used Diffusion of Innovations Theory and related research on Informed Decision Making to guide the iterative development of mobile apps for parents of young female and male adolescents.

Ms. Reither presented a poster that reported the results of developmental research and early trial findings from two smartphone web app projects — one focused on parents and adolescent girls (ages 11-14) and the other on parents and adolescent boys in the same age range. The objective of these investigations is to develop and evaluate a mobile web app to encourage HPV vaccination in New Mexico, an ethnically-diverse state. Current ongoing randomized controlled efficacy trials with parents and their adolescent children in New Mexico clinics provide data to determine the impact of these mobile web apps on informed decision making and uptake for the HPV vaccine.

Dr. Woodall participated in a panel session entitled “Uses of New Technologies in HPV Vaccine Behavioral Science Research.” He gave a presentation on the design, development, and testing of the innovative Vacteens web app. New technologies and social networking sites like this can be used to understand sources of information and misinformation about HPV vaccination, engage parents and youth, and encourage HPV vaccination.

The progress and initial results of these ongoing research efforts will have implications for reaching HPV vaccine uptake goals set by Healthy People 2020 in the United States. Mobile web-based interventions show promise for reaching HPV vaccine uptake goals. A mobile web app can make decision-making tools widely available on popular mobile platforms such as tablet computers and smartphones, as well as personal computers.

This research was funded by grants from PCORI and the National Cancer Institute (CA210125; Dr. W. Gill Woodall, Principal Investigator). Collaborators included Dr. Alberta Kong, Dr. Randall Starling, Dr. Lance Chilton, and Dr. Tamar Ginossar from the University of New Mexico; Dr. Greg Zimet from Indiana University; and Dr. David Buller and Jeanny Reither from KB. 


Dr. W. Gill Woodall and Jeanny Reither from Klein Buendel
INSIGHTS ON HPV VACCINATION FROM MOTHERS’ COMMENTS ON FACEBOOK POSTS IN A RANDOMIZED TRIAL

INSIGHTS ON HPV VACCINATION FROM MOTHERS’ COMMENTS ON FACEBOOK POSTS IN A RANDOMIZED TRIAL

HPV vaccine uptake among adolescent girls in the United States remains below the national goal of 80%. Parent decisions to vaccinate daughters can be impeded by confusion, uncertainty, and misinformation about the Human Papilloma Virus (HPV) vaccine. Dr. David Buller from Klein Buendel (KB) presented an analysis of mothers’ beliefs about vaccinating their adolescent daughters for HPV at the Eurogin International Multidisciplinary HPV Congress in Lisbon, Portugal, December 2-5, 2018.

Mothers with adolescent daughters from 34 states (n=880) were recruited to participate in a randomized controlled trial evaluating a social media campaign on adolescent health. The mothers’ beliefs were expressed in comments to posts on HPV vaccination in a social media campaign on adolescent health. Participants were recruited through Qualtrics survey panels or local efforts at the Tennessee study site. Eligibility criteria were: having a daughter aged 14-17, living in one of 34 states without a complete ban on indoor tanning for minors, using a Facebook account 1+ times a week, being able to read English, consenting to participate, completing the baseline survey, and willing to join the Facebook group. The campaign, implemented through Facebook private groups, included posts on HPV vaccination, as one of seven general health topics. The experimental manipulation varied posts on indoor tanning versus prescription drug abuse prevention. Posts on HPV vaccination and reactions and comments from mothers were extracted.

Mothers had a mean age of 43.1 years; 6.5% were Hispanic and 86.6% white; and 63.1% reported that their daughter had been vaccinated for HPV (17.8% receiving two shots and 31.5% three shots). HPV vaccination posts received on average 1.3 reactions and 3.3 comments from mothers. Comments often formed a dialogue among mothers. More than half of the comments (52.8%) were favorable, indicating that the daughter had been vaccinated and HPV vaccination reduced mothers’ anxiety, HPV infection rates, and related disease risk. However, 45.3% were unfavorable, citing safety concerns, lack of efficacy, unknown long-term consequences, inappropriate age for the vaccine, apprehension by other mothers, fears of vaccine tampering, lack of physician support, and sexual activity issues (for example, plans to wait until daughter becomes sexually active or using vaccine to guard against unprotected sex). Some commented, mostly favorably, on the need to vaccinate boys.

Facebook comments indicated both support for and resistance to HPV vaccination by mothers in the United States. Reasons for not vaccinating girls were similar to barriers expressed in other research and reflected negative media coverage of HPV vaccination. Effective strategies are needed in social media to counter misinformation on and resistance to HPV vaccines.

This research was funded by a grant from the National Cancer Institute (CA192652; Dr. David Buller, Principal Investigator). Collaborators include Dr.Barbara Walkosz and Julia Berteletti from KB; Dr. Sherry Pagoto and Jessica Oleski from the University of Connecticut, and Dr. Katie Baker from East Tennessee State University.

Eurogin is one of the most important conferences in the world on HPV infection and related cancers. The international gathering examines public health, health services, screening, and prevention of HPV-induced cancers.

COLLABORATOR SPOTLIGHT:
DR. GREGORY ZIMET

COLLABORATOR SPOTLIGHT:
DR. GREGORY ZIMET

Dr. Gregory Zimet is a Clinical Psychologist and Professor in the Department of Pediatrics at the Indiana University School of Medicine. Since he arrived there in 1993, he has guided an extensive, multi-faceted research program focused on attitudes about, and acceptance of, vaccines for the prevention of sexually-transmitted infections, including the human papillomavirus (HPV) vaccine.

Currently, Dr. Zimet serves as a KB collaborating scientist with Dr. Gill Woodall and Dr. David Buller on a research project entitled “Web App Technology for Boys and Parents: Improving HPV Vaccine Uptake.” Other collaborating investigators include Dr. Alberta Kong and Dr. Randall Starling from the University of New Mexico. The four-year HPV project, funded by a grant from the National Cancer Institute (CA210125; G. Woodall, PI), is designed to produce a mobile web app to accurately inform parents and adolescent boys about the HPV vaccination and address unique concerns about its safety and effectiveness for boys. The mobile web app is being developed for personal computers, smartphones, and tablet computers.

Dr. Zimet’s research also has involved randomized clinical trials designed to evaluate the effects of brief health communication messages on hepatitis B virus and HPV vaccine uptake, and on acceptance of HIV testing. Through his involvement over the past five years in the Adolescent Medicine Trials Network for HIV/AIDS Interventions, Dr. Zimet has expanded his research focus to examine factors related to recruitment of adolescents into biomedical HIV prevention clinical trials. Biomedical trials that may involve the recruitment of adolescents are related to pre-exposure prophylaxis, HIV vaccine, and microbicides. Some of his recent publications address HPV vaccination, microbicide acceptability among adolescents, and attitudes about HIV and herpes simplex virus type 2 testing.

Dr. Zimet has served as a research mentor to five physician fellows, over 20 pre- and post-doctoral fellows in psychology, social work, health behavior, and nursing, and several junior faculty in the Department of Pediatrics and the School of Nursing at Indiana University.