An Increase in HPV-Related Knowledge and Vaccination Intent Among Parental and Non-parental Caregivers of Adolescent Girls, Age 9–17 Years, in Appalachian Pennsylvania

Abstract

A theory and community-based educational intervention was designed to increase HPV-related knowledge and intent to vaccinate adolescent girls, against human papillomavirus (HPV) in Appalachia, a region with high cervical cancer incidence and mortality. An HPV educational session was conducted with immediate pre-/post-test questionnaires and 1-month follow-up telephone interview. McNemar tests and paired t tests evaluated change in individual knowledge variables and change in overall knowledge and intent to vaccinate against HPV, respectively. Of 117 attendees, 38 (32.5%) were parents of vaccine-eligible daughters and 79 (67.5%) non-parental caregivers. HPV-related knowledge increased for all participants (p < 0.0001) and among parents (p < 0.0001). Intent to vaccinate daughters within 1 month increased among parents (p = 0.002). Of nine (23.7%) parents who completed the follow-up interview, 100% reported the intervention as helpful and 44.4% reported that they started vaccination. Our education intervention was associated with increased HPV-related knowledge and intent to vaccinate girls in Appalachia against HPV.

Educational interventions to increase HPV vaccination acceptance: A systematic review

“…Spleen et al tested the effectiveness of a 1-h slide presentation about HPV infection to parents of girls in Appalachian Pennsylvania. This study found increases in scores for intention to accept the HPV vaccine after the presentation of less than 1 point on a 4 point-scale ( P = 0.002) although it should be noted that 31% of the sampled parents had daughters who had already started the HPV vaccination series at the time of the intervention [29]. A study by Kepkaet al [32] tested the effectiveness of a Spanish-language radio advertisement (referred to as radionovela in the study) to educate Latino parents about HPV vaccination.…”

“…Of these, five were conducted in the United States [26–29] and other two were from India [30] and China [31]. Less than half the studies were randomized, controlled trials [27,28,32] with most designed as quasi-experimental comparisons of parental intentions to vaccinate pre- versus post-intervention [26,29–31]. All but two of the studies [26,27] exclusively surveyed parents of girls and none of the studies involved any follow-up assessment beyond the period immediately following the intervention.…”

“…All but two of the studies [26,27] exclusively surveyed parents of girls and none of the studies involved any follow-up assessment beyond the period immediately following the intervention. All of the studies used the primary outcome of self-reported indicators of HPV vaccine acceptability rather than actual vaccination behavior (i.e., child’s HPV vaccination status post-intervention), although in the study by Spleen et al, the authors did assess self-reported HPV vaccination receipt one month post-intervention among nine, non-randomly-selected participants [29]. It would not have been possible to assess actual vaccination receipt in four of the studies since they were conducted prior to HPV vaccine licensure in the study country [26,27,30,31].…”

“…Despite the fact that cervical cancer mortality disproportionately affects socioeconomically disadvantaged populations [60], only thirteen (39%) of the studies in this review included populations outside the university setting. Of these, only six tested an intervention that did not require participants to be literate [29,32–35,37]. Only one study tested a culturally-tailored intervention in a population at risk for under-immunization (specifically Hispanic Americans), and this study was likely under-powered [32].…”

What are the factors that contribute to parental vaccine-hesitancy and what can we do about it?

“…Spleen and colleagues conducted an educational session to increase HPV vaccine knowledge and vaccination intent for parents and caregivers of HPV vaccine-eligible girls in Appalachia. 53 Intention to vaccinate within 1 mo increased significantly among parents post intervention (P D 0.002). Kepka et al evaluated the effectiveness of a culturally-tailored Spanish HPV vaccine awareness program broadcasted as a "radionovella" through a randomized trial.…”