Part 2: Formative Research and the Development of Effective Communication Pieces

Background: Persistent infection with specific types of human papillomavirus (HPV) leads to precancer and cancer in men and women. A study that covered 100% of the U.S. population during 2004–2008 estimated that about 33,300 HPV-associated cancers occur each year. About 21,300 HPV-associated cancers occur each year among females, and about 12,100 occur each year among males. Cervical cancer is the most common HPV-associated cancer among women, and oropharyngeal cancers are the most common among men. The 3-dose series of HPV vaccine is routinely recommended for both boys and girls at 11 or 12 years to prevent infection with the types of HPV that cause most cancers. 

Program background: Recent data collected by U.S. Centers for Disease Control and Prevention (CDC) indicate that the HPV vaccination rate for females is stagnating. In an effort to increase health communication around the disease and the vaccine, CDC conducted formative qualitative and quantitative research with parents, physicians, and non-physician healthcare providers to explore the barriers to, and facilitators of, HPV vaccination.

Evaluation Methods and Results: Qualitative formative research methods included online message-testing with moms of preteens and teens. Qualitative formative research methods included in-depth interviews with physicians, in-depth interviews with non-physician healthcare providers (RNs, LPNs, and MAs), and focus groups with moms of preteens. Online message tested provided data on the best messages to use with parents making decisions about HPV vaccination. Additionally, responses to open-ended questions revealed that parents reported the desire for information about vaccine safety and efficacy.  Parents also wanted to hear that credible medical associations support HPV vaccination, specifically for the prevention of cancer.  In depth interviews demonstrated that a large number of physicians and non-physician clinicians lacked knowledge of the range of indications for HPV vaccine beyond cervical cancer and therefore could not provide compelling reasons for vaccination.  Physicians and other clinicians reported a desire for information on how to address parent concerns about HPV vaccine.

Conclusions: Communication messages for parents need to focus on the “HPV is Cancer Prevention” message and the importance of vaccination during the preteen years.  Physicians and other clinicians require specific materials that provide them with statements that can be used to offer a strong recommendation for HPV vaccination when patients are 11 or 12 years old. Physicians providing HPV vaccine, especially pediatricians, do not routinely see the results of not vaccinating and therefore may benefit from peer-to-peer education from physician who routine treat HPV-related cancers. The cancer prevention message was echoed throughout all of the materials created for the campaign including print and digital products.

Implications for research and/or practice: Because provider recommendation is the strongest predictor of vaccine receipt, physician and non-physician clinicians require education and training in providing strong recommendation to parents for vaccinating patients at age 11 or 12 years. Reaching parents with specific HPV vaccination messaging on websites they are already visiting could increase acceptance of the vaccine once a strong recommendation is given. The creation of new marketing pieces that focused on the cancer prevention message was also key to educating clinicians and parents about the importance of the vaccine.