Advertisement

Easing Human Papillomavirus Vaccine Hesitancy: A Communication Experiment With U.S. Parents

  • Parth D. Shah
    Correspondence
    Address correspondence to: Parth D. Shah, PharmD, PhD, Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Mail Stop M3-B232, Seattle WA 98109.
    Affiliations
    Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington

    Department of Health Behavior, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    Search for articles by this author
  • William A. Calo
    Affiliations
    Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania

    Penn State Cancer Institute, Penn State Hershey Medical Center, Hershey, Pennsylvania
    Search for articles by this author
  • Melissa B. Gilkey
    Affiliations
    Department of Health Behavior, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    UNC Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    Search for articles by this author
  • Marjorie A. Margolis
    Affiliations
    Department of Health Behavior, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    UNC Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    Search for articles by this author
  • Susan Alton Dailey
    Affiliations
    Department of Health Behavior, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    Search for articles by this author
  • Karen G. Todd
    Affiliations
    Public Health Leadership Program, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    SAFEchild Advocacy Center, Raleigh, North Carolina
    Search for articles by this author
  • Noel T. Brewer
    Affiliations
    Department of Health Behavior, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    UNC Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    Search for articles by this author

      Introduction

      The Announcement Approach using presumptive announcements increases human papillomavirus vaccine uptake. This study seeks to understand the impact of the final Announcement Approach steps—easing parents’ vaccine concerns and then encouraging them to get human papillomavirus vaccine for their children—on parents’ human papillomavirus vaccine hesitancy and confidence in the vaccine's benefits.

      Methods

      In 2017–2018, investigators recruited an online national sample of 1,196 U.S. parents of children aged 9–17 years who had not yet completed the human papillomavirus vaccine series. Following the steps of the Announcement Approach, participants viewed brief videos of a pediatrician announcing that a child was due for human papillomavirus vaccine (shown to all the parents). In the 2 × 2 experiment, parents saw (1) a video of the pediatrician attempting to ease a concern that the parent had raised earlier in the survey (Ease video), (2) a video of the pediatrician encouraging the parent to get their child vaccinated (Encourage video), (3) both videos, or (4) neither of the videos. Data analysis was conducted in spring 2020.

      Results

      Seeing the Ease video message led to lower human papillomavirus vaccine hesitancy than not seeing it (mean=2.71, SD=1.29 vs mean=2.97, SD=1.33; p<0.001). The beneficial impact of easing concerns on lower vaccine hesitancy was explained by higher confidence (p<0.05). By contrast, the Encourage video had no impact on human papillomavirus vaccine hesitancy or confidence.

      Conclusions

      Addressing parents’ concerns can decrease human papillomavirus vaccine hesitancy and increase confidence. On the basis of these findings, the Announcement Approach retained its emphasis on announcing that children are due for vaccination and easing parent concerns.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Elam-Evans LD
        • Yankey D
        • Singleton JA
        • et al.
        National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years - United States, 2019.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 1109-1116https://doi.org/10.15585/mmwr.mm6933a1
        • Office of Disease Prevention and Health Promotion, HHS
        Immunization and infectious diseases.
        2019 (PublishedAccessed May 26, 2020)
        • Santoli JM
        • Lindley MC
        • DeSilva MB
        • et al.
        Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration - United States, 2020.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 591-593https://doi.org/10.15585/mmwr.mm6919e2
        • WHO
        Ten threats to global health in 2019.
        WHO, Geneva, Switzerland2019 (PublishedAccessed March 16, 2021)
        • Brewer NT
        • Chapman GB
        • Rothman AJ
        • Leask J
        • Kempe A.
        Increasing vaccination: putting psychological science into action.
        Psychol Sci Public Interest. 2017; 18: 149-207https://doi.org/10.1177/1529100618760521
        • Brewer NT
        • Hall ME
        • Malo TL
        • Gilkey MB
        • Quinn B
        • Lathren C.
        Announcements versus conversations to improve HPV vaccination coverage: a randomized trial.
        Pediatrics. 2017; 139e20161764https://doi.org/10.1542/peds.2016-1764
        • Dempsey AF
        • Pyrznawoski J
        • Lockhart S
        • et al.
        Effect of a health care professional communication training intervention on adolescent human papillomavirus vaccination: a cluster randomized clinical trial.
        JAMA Pediatr. 2018; 172e180016https://doi.org/10.1001/jamapediatrics.2018.0016
        • Sturm L
        • Donahue K
        • Kasting M
        • Kulkarni A
        • Brewer NT
        • Zimet GD.
        Pediatrician-parent conversations about human papillomavirus vaccination: an analysis of audio recordings.
        J Adolesc Health. 2017; 61: 246-251https://doi.org/10.1016/j.jadohealth.2017.02.006
        • Opel DJ
        • Mangione-Smith R
        • Robinson JD
        • et al.
        The influence of provider communication behaviors on parental vaccine acceptance and visit experience.
        Am J Public Health. 2015; 105: 1998-2004https://doi.org/10.2105/AJPH.2014.302425
        • Opel DJ
        • Heritage J
        • Taylor JA
        • et al.
        The architecture of provider-parent vaccine discussions at health supervision visits.
        Pediatrics. 2013; 132: 1037-1046https://doi.org/10.1542/peds.2013-2037
      1. Training tools. HPV IQ. https://www.hpviq.org/communication-training-tools/. Accessed May 23, 2020.

        • Making effective HPV vaccine recommendations
        National Cancer Institute.
        2020 (Updated August 4,Accessed December 15, 2020)
        • Michie S
        • Fixsen D
        • Grimshaw JM
        • Eccles MP.
        Specifying and reporting complex behaviour change interventions: the need for a scientific method.
        Implement Sci. 2009; 4: 40https://doi.org/10.1186/1748-5908-4-40
        • Ipsos
        Public affairs KnowledgePanel.
        Ipsos, New York, NY2020 (PublishedAccessed December 10, 2020)
      2. Standard definitions: final dispositions of case codes and outcome rates for surveys.
        9th edition. The American Association for Public Opinion Research, 2016 (UpdatedAccessed March 9, 2021)
        • Dimitrov DM
        • Rumrill Jr., PD
        Pretest–posttest designs and measurement of change.
        Work. 2003; 20: 159-165
        • Calo WA
        • Gilkey MB
        • Malo TL
        • Robichaud M
        • Brewer NT.
        A content analysis of HPV vaccination messages available online.
        Vaccine. 2018; 36: 7525-7529https://doi.org/10.1016/j.vaccine.2018.10.053
        • Shah PD
        • Calo WA
        • Gilkey MB
        • et al.
        Questions and concerns about HPV vaccine: a communication experiment.
        Pediatrics. 2019; 143e20181872https://doi.org/10.1542/peds.2018-1872
        • Gilkey MB
        • Calo WA
        • Moss JL
        • Shah PD
        • Marciniak MW
        • Brewer NT.
        Provider communication and HPV vaccination: the impact of recommendation quality.
        Vaccine. 2016; 34: 1187-1192https://doi.org/10.1016/j.vaccine.2016.01.023
        • Gilkey MB
        • Malo TL
        • Shah PD
        • Hall ME
        • Brewer NT.
        Quality of physician communication about human papillomavirus vaccine: findings from a national survey.
        Cancer Epidemiol Biomarkers Prev. 2015; 24: 1673-1679https://doi.org/10.1158/1055-9965.EPI-15-0326
        • Reiter PL
        • Brewer NT
        • Gottlieb SL
        • McRee AL
        • Smith JS.
        Parents’ health beliefs and HPV vaccination of their adolescent daughters.
        Soc Sci Med. 2009; 69: 475-480https://doi.org/10.1016/j.socscimed.2009.05.024
        • McRee AL
        • Brewer NT
        • Reiter PL
        • Gottlieb SL
        • Smith JS.
        The Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS): scale development and associations with intentions to vaccinate.
        Sex Transm Dis. 2010; 37: 234-239https://doi.org/10.1097/OLQ.0b013e3181c37e15
        • Brewer NT
        • Gottlieb SL
        • Reiter PL
        • et al.
        Longitudinal predictors of human papillomavirus vaccine initiation among adolescent girls in a high-risk geographic area.
        Sex Transm Dis. 2011; 38: 197-204https://doi.org/10.1097/OLQ.0b013e3181f12dbf
        • McRee AL
        • Reiter PL
        • Gottlieb SL
        • Brewer NT.
        Mother–daughter communication about HPV vaccine.
        J Adolesc Health. 2011; 48: 314-317https://doi.org/10.1016/j.jadohealth.2010.07.006
        • Kornides ML
        • McRee AL
        • Gilkey MB.
        Parents who decline HPV vaccination: who later accepts and why?.
        Acad Pediatr. 2018; 18: S37-S43https://doi.org/10.1016/j.acap.2017.06.008
        • CDC
        National immunization surveys.
        National Immunization Survey – Teen: Household Interview Questionnaire. 2010;
        https://www.cdc.gov/nchs/nis/data_files_teen.htm
        Date accessed: February 22, 2018
        • Topics CHAMP
        North Carolina health and human services.
        Child Health Assessment and Monitoring Program (CHAMP), 2013 (–14) (Updated June 26, 2017. Accessed February 22, 2018)
        • Hall MG
        • Sheeran P
        • Noar SM
        • Ribisl KM
        • Boynton MH
        • Brewer NT.
        A brief measure of reactance to health warnings.
        J Behav Med. 2017; 40: 520-529https://doi.org/10.1007/s10865-016-9821-z
        • Brewer NT
        • Hall MG
        • Noar SM
        • et al.
        Effect of pictorial cigarette pack warnings on changes in smoking behavior: a randomized clinical trial.
        JAMA Intern Med. 2016; 176: 905-912https://doi.org/10.1001/jamainternmed.2016.2621
        • Gilkey MB
        • Magnus BE
        • Reiter PL
        • McRee AL
        • Dempsey AF
        • Brewer NT.
        The Vaccination Confidence Scale: a brief measure of parents’ vaccination beliefs.
        Vaccine. 2014; 32: 6259-6265https://doi.org/10.1016/j.vaccine.2014.09.007
      3. Muthén LK, Muthé BO. Mplus user's guide 7th edition, 2012, Muthén & Muthén, Los Angeles, CA https://www.statmodel.com/download/usersguide/Mplus%20user%20guide%20Ver_7_r3_web.pdf. Published September 2012. Accessed March 1, 2020.

        • MacKinnon DP
        • Lockwood CM
        • Williams J.
        Confidence limits for the indirect effect: distribution of the product and resampling methods.
        Multivariate Behav Res. 2004; 39: 99https://doi.org/10.1207/s15327906mbr3901_4
        • Dempsey AF
        • Pyrzanowski J
        • Campagna EJ
        • Lockhart S
        • O'Leary ST
        Parent report of provider HPV vaccine communication strategies used during a randomized, controlled trial of a provider communication intervention.
        Vaccine. 2019; 37: 1307-1312https://doi.org/10.1016/j.vaccine.2019.01.051
        • Jones AM
        • Omer SB
        • Bednarczyk RA
        • Halsey NA
        • Moulton LH
        • Salmon DA.
        Parents’ source of vaccine information and impact on vaccine attitudes, beliefs, and nonmedical exemptions.
        Adv Prev Med. 2012; 2012932741https://doi.org/10.1155/2012/932741
        • Teoh D.
        The power of social media for HPV vaccination–not fake news!.
        Am Soc Clin Oncol Educ Book. 2019; 39: 75-78https://doi.org/10.1200/EDBK_239363
        • Sheeran P
        • Webb TL.
        The intention–behavior gap.
        Soc Personal Psychol Compass. 2016; 10: 503-518https://doi.org/10.1111/spc3.12265
        • Jeong M
        • Zhang D
        • Morgan JC
        • et al.
        Similarities and differences in tobacco control research findings from convenience and probability samples.
        Ann Behav Med. 2019; 53: 476-485https://doi.org/10.1093/abm/kay059
        • Krumpal I.
        Determinants of social desirability bias in sensitive surveys: a literature review.
        Qual Quant. 2013; 47: 2025-2047https://doi.org/10.1007/s11135-011-9640-9
        • Malo TL
        • Hall ME
        • Brewer NT
        • Lathren CR
        • Gilkey MB.
        Why is announcement training more effective than conversation training for introducing HPV vaccination? A theory-based investigation.
        Implement Sci. 2018; 13: 57https://doi.org/10.1186/s13012-018-0743-8