Theoretical Background and research questions/hypothesis: The long term trend of rising incidence in cancers associated with human papillomavirus (HPV) in the US is alarming. Nationally, HPV4 vaccine completion among boys was only 1% following two years of a permissive vaccine recommendation for males by CDC’s Advisory Committee on Immunization Practices (ACIP). Health care providers play an influential role in parents’ decisions to vaccinate their sons against HPV yet evidence suggests providers are not yet fully promoting the vaccine at the recommended ages of 11-12.We sought to determine if a 12-week social marketing campaign aimed at providers and parents could improve HPV vaccine uptake among preteen boys in a 13-county North Carolina region. We evaluated change in HPV vaccination rates among pre-teen boys, identified common communication practices among providers, parents and preteen boys, and elicited key concerns about vaccination.
Methods: The ‘Protect Him’ campaign involved distribution of posters and brochures (English and Spanish) to all county health departments (n=13) plus 194 consented providers, 2 radio PSAs, and a website. All materials were developed expressly for the campaign, aimed at parents with pre-teen sons, primarily available in health settings, and underwent formative evaluation. Print materials were based on the Health Belief Model, emotional relevance, and positive gain frames that highlight prevention of HPV disease. PSAs were staged where the first ad introduced the vaccine and the second encouraged vaccination. We evaluated our campaign using (1) regression analyses of pretest-posttest provider and parent surveys, and (2) event (survival) analysis with NC immunization registry data. A Cox proportional hazards model was fit using registry data to examine whether vaccination rates in 9-13 year old boys increased during the intervention period in the 13 intervention counties compared to a cluster of control counties (n=14) with similar demographics in another part of the state.
Results: The Cox model provided evidence of an intervention effect (β=0.29, HR=1.34, p=.0024), indicating that during the intervention the probability of vaccination increased by 34% in the intervention counties relative to the control counties. Of 140 providers who completed a follow-up questionnaire, most said they felt comfortable strongly recommending the vaccine for 11-12 year old boys (76%), that vaccine benefits outweigh risks (70%), and that other adolescent vaccines make it easier to introduce the vaccine (69%). Intervention materials helped initiate conversations with parents and boys (69%), focus the discussion (55%), and discuss prevention of disease (48%). Perceived provider concerns around HPV vaccination included failure of insurance companies to reimburse vaccine costs to patients, and the need for practices to pay vaccine costs up front. Parents cited lack of perceived sexual activity, son too young, lack of knowledge about HPV vaccine and lack of provider recommendation as top reasons for not vaccinating (n=278).
Conclusions: Social marketing techniques can encourage health care providers to vaccinate preteen boys against HPV.
Implications for research and/or practice: Dissemination strategies to stimulate communication about HPV vaccine among healthcare providers, parents and preteen boys can be used to reduce HPV infection in males.