A randomized, controlled, pragmatic trial of an iPad-based, tailored messaging intervention to increase human papillomavirus vaccination among Latinos

Abstract

Human papillomavirus (HPV) causes a number of cancers that disproportionally affect Latinos yet there is a paucity of research on interventions to increase HPV vaccination among this population. We sought to evaluate the efficacy of a web-based, individually customizable intervention, called CHICOs (Combatting HPV Infection and Cancers, tailored intervention) for its impact on HPV vaccine utilization. We conducted a three-armed, randomized, controlled trial in the waiting rooms of five family medicine practices from June 2014-February 2016 where CHICOS was compared to an iPad-based version of the Vaccine Information Sheet from the Centers for Disease Control and Prevention (untailored intervention), and usual care. Pair-wise comparisons between study arms of 6 different measures of HPV vaccine uptake were assessed, with analyses stratified by adolescents versus young adults. Of the 1,294 participants enrolled in the study, 1,013 individuals could be assessed for vaccination. Across study arms, 265 adolescents, but only 18 young adults, received an HPV vaccine dose during the study period. In both intention-to-treat and per-protocol analyses there were essentially no differences between the CHICOS and untailored arms in any vaccination measure, or between the untailored or CHICOS arms and usual care. Our study suggests that a tailored educational intervention may not be effective for increasing HPV vaccine uptake among Latino adolescents or young adults. However, the higher than expected baseline levels of positive vaccination attitudes of study participants could have diminished the statistical power of the study.Trial Registration Number: ClinicalTrials.gov (NCT02145156).

Can mHealth interventions contribute to increased HPV vaccination uptake? A systematic review

“…All but one of the nineteen studies included were conducted in the USA ( Aragones et al, 2015 , Bar-Shain et al, 2015 , Cassidy et al, 2014 , Dempsey et al, 2019 , Dixon et al, 2019 , Henrikson et al, 2018 , Keeshin and Feinberg, 2017 , Kempe et al, 2016 , Kharbanda et al, 2011bb , Lee et al, 2016 , Matheson et al, 2014 , Morris et al, 2015 , Patel et al, 2014 , Rand et al, 2015 , Richman et al, 2019 , Richman et al, 2016 , Szilagyi et al, 2013 ). One study was conducted in Australia ( Tull et al, 2019 ).…”

“…One study was conducted in Australia ( Tull et al, 2019 ). Eleven of the included studies were randomized control trials ( Dempsey et al, 2019 , Dixon et al, 2019 , Henrikson et al, 2018 , Kempe et al, 2016 , Patel et al, 2014 , Rand et al, 2015 , Rand et al, 2017 , Richman et al, 2016 , Richman et al, 2019 , Szilagyi et al, 2013 , Tull et al, 2019 ). The other nine studies were variations of non-randomized pre-post designs with control groups ( Aragones et al, 2015 , Bar-Shain et al, 2015 , Cassidy et al, 2014 , Keeshin and Feinberg, 2017 , Kharbanda et al, 2011aa , Lee et al, 2016 , Matheson et al, 2014 , Morris et al, 2015 )…”

“…The interventions most frequently targeted parents ( Aragones et al, 2015 , Bar-Shain et al, 2015 , Cassidy et al, 2014 , Dempsey et al, 2019 , Dixon et al, 2019 , Henrikson et al, 2018 , Kempe et al, 2016 , Kharbanda et al, 2011bb , Morris et al, 2015 , Rand et al, 2015 , Rand et al, 2017 , Richman et al, 2016 , Richman et al, 2019 ). Five interventions focused on adolescents (defined by the articles as 11–22 years old) or young adults (defined by articles as 18–26 years old) ( Keeshin and Feinberg, 2017 , Kempe et al, 2016 , Patel et al, 2014 , Richman et al, 2016 ; Szilagyi et al, 2013 ).…”

“…Parents who received the intervention were 22.5 times more likely to complete the three-dose series compared with the historical control group.  Dempsey et al ( Dempsey et al, 2019 ) Colorado, USA Three armed randomized control trial Potential concerns due to bias randomization process, deviations from intended interventions and selection of the reported results 1294 (tailored intervention = 430, untailored = 425, usual care = 439) Mean age 22 years (young adults), 12 years (adolescents); 100% female (young adults), 51% male (adolescents); 85% Hispanic (young adults) and 93% Hispanic (adolescents) Assessed the effect of a tailored educational digital intervention (CHICOs) Vaccination intent and receipt of vaccination. There were no differences between study arms in vaccination intention at baseline or post-intervention for either parents or young adults.…”

There’s Much Yet to be Done: Diverse Perspectives on HPV Vaccination

“…Eight articles in this special issue focus on pre-interventional and interventional research to improve vaccine initiation and series completion, including a review of technology-based interventions (e.g., text messaging and electronic health record reminders) designed to improve vaccination rates. 25 Three papers involve evaluations of a patient navigator program, 26 a quality improvement intervention, 27 and a tablet-based tailored messaging intervention, 28 respectively, in terms of their effects on vaccine initiation and series completion. An additional article reports on the acceptability to caregivers of the patient navigator program.…”