Middle School Students Design Text Messages to Raise Awareness of HPV Vaccine

Theoretical Background and research questions/hypothesis:  Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States, yet HPV vaccine uptake is far below expectations. HPV vaccine is routinely recommended for a 3 dose series for adolescents ages 11-12, before sexual debut. However, vaccination coverage among females ages 13-17 in 2011 was only 30% for 3 doses of HPV, and only 1% for males ages 13-17. Text message HPV immunization reminders to parents have shown effective, but use with a rural adolescent population with limited access to care is unknown. The objective was to examine young adolescents’ preferences for text messages about HPV vaccination in a rural setting.

Methods:  We collaborated with two middle schools in a rural western North Carolina county to recruit students to design text messages to raise awareness of the HPV vaccine among their peers. We used theoretical concepts from mass communication research, the Health Belief Model and message design studies. Through seven focus groups and two in-class surveys, we assessed students’ knowledge of HPV and HPV vaccine, their use of texting and preferences for text messages and message sources. We also interviewed four parents and four school personnel.

Results:  The average age of the 17 boys, 26 girls was 13, and all were white. More than 70% used text messaging with a cell phone. Awareness and knowledge of HPV and HPV vaccine increased from initial to final survey. Themes from focus groups included: misconceptions about HPV and HPV vaccination, comfort in texting on a cell phone, preferred language for text messaging; and preferred sources of text messages. Students were split on whether they preferred text spelled out (e.g., “you”) (54%) or in shorthand (e.g., “U”) (46%). They were also split on preferred greeting, with 44% choosing a friendly “Hey! What’s up?”44% a more serious, “You need to know this,” and 11% a neutral, “Hi there.” The text message with the best composite score (M=2.33, SD=.72) for likeability, trustworthiness, and making them want more information was a gain frame, “HPV is a sexually transmitted infection. But there is a vaccine you can get to prevent it!” The second best composite score (M=2.19, SD=.67) was also a gain frame, “If you get the HPV vaccine, it will help keep you healthy.” Loss frame messages with threats about not getting vaccinated were scored lower. A non-directive question, “Did you know that HPV vaccine can keep you from getting HPV one day?” scored higher (M=2.09, SD=.47) than a directive message: “You need to get the HPV vaccine to keep from getting HPV one day” (M=1.84, SD=.55). A social norm frame, “Many boys and girls have already gotten the HPV vaccine,” ranked in the middle (M=1.98, SD=.73). For preferred source of text message, 68% indicated their doctor.

Conclusions:  Middle school students prefer text messages about HPV vaccination with gain frames.

Implications for research and/or practice:  Texting adolescents on their cell phones, possibly in conjunction with texting parents, could be effective in raising awareness about susceptibility to HPV infection and the benefits of HPV vaccine.