Communicating with Families About HPV Vaccines

Personalized Communication

Parents’ reasons for not having their adolescent vaccinated against HPV are often complex and multifactorial [71,72]. Personalized approaches are needed to account for each parent’s unique informational needs, beliefs, and prior experiences [65]. Unfortunately, given the short amount of time allotted for clinical visits, it is often difficult to provide adequate information to parents during these encounters [73–75]. Indeed, concern about prolonged HPV vaccine discussions has been identified as an important barrier for providers that cause some to forgo recommending the vaccine [36,75].

One potential solution to this issue is to leverage technology in the form of web-based interventions that use software to tailor materials to each individual’s unique informational needs. Feasibility for this idea comes from the knowledge that many parents already use the web to research health issues related to their children [76], and that doctors’ offices are increasingly using patient portals and other web-based resources to help parents prepare for upcoming visits, especially those focused on health maintenance [77,78]. Tailored messaging interventions have been shown across populations and health issues to generally result in superior adherence with health behaviors when compared to untailored controls [79–82]. Several researchers have thus begun exploring whether such a personalized communication strategy may be similarly effective for adolescent HPV vaccination [50,83–85]. As an example, Maertens and colleagues used community-based participatory research techniques to develop a web-based tailored messaging intervention for Latinos regarding HPV vaccination [86]. A subsequent randomized controlled trial of the intervention in over 1200 parents of adolescents and young adults demonstrated that the intervention improved participants’ intentions to vaccinate compared to usual care [87], and among adolescents, higher HPV vaccine series initiation levels (unpublished data). Although additional work is needed to understand the feasibility of implementing such an intervention more broadly, additional support for the usefulness of a tailored messaging approach comes from a study of female university students that demonstrated higher HPV vaccination intentions after exposure to tailored information compared to untailored information. However, the impact on actual HPV vaccine utilization was not measured in the study [84]. Contrasting results were found in a different study of university students where researchers failed to find an impact of message tailoring on HPV vaccination utilization. However, this study was limited by a low response rate (~50%) to the follow up survey where vaccination status was assessed, and also by overall low levels of HPV vaccine initiation among the entire study sample (8%) [85]. Given the low number of studies in this area, and some conflicting data, additional research is needed to better understand the impact of personalized communication on HPV vaccination levels. However, results from these studies suggest that a modest benefit may be achieved with this approach, especially if coupled with other, evidence-based, clinic-level interventions to promote vaccination (eg, vaccine reminders, extended office hours), as is suggested by the Task Force on Community Preventive Services [48].

Focusing Communication on Cancer Prevention

HPV vaccines are unique in that they are only 1 of 2 vaccines for cancer prevention (the other being hepatitis B). Provider and parent surveys suggest that while most providers do mention cancer prevention when discussing HPV vaccines [40,88,89], this may be more commonly done with female patients than males [22]. Focusing on cancer prevention rather than sexual transmissibility is a communication technique suggested by the Centers for Disease Control and Prevention (CDC) as many parents cite this aspect of the vaccine as one of the most compelling reasons for vaccinating [45,90]. CDC’s “You are the Key” program [91] uses cancer prevention as a central theme in their physician and patient communication materials, based on significant prior market research on the acceptability and impact of such messages among parents and providers. In 2016 Malo and colleagues tested the potential impact of brief messages related to HPV vaccination, including cancer prevention messages, among a national sample of 776 medical providers and 1504 parents of adolescents [92]. In addition to their potential to motivate parents to vaccination, associations between parental endorsement of each message and their adolescent’s vaccination status were also examined. The cancer prevention messages were among those most highly endorsed by both parents and providers as being motivating for parents to get their adolescent vaccinated. More importantly, among parents these endorsements were associated with a significantly higher likelihood of the adolescent having been vaccinated against HPV. Interestingly, one of the briefest messages in the study, “I [the physician] strongly believe in the importance of this cancer preventing vaccine for [child’s name],” was perceived as the most persuasive message by parents.