Evaluating a County-Sponsored Social Marketing Campaign to Increase Mothers' Initiation of HPV Vaccine for Their Preteen Daughters in a Primarily Rural Area

Abstract

Routine vaccination against human papillomavirus (HPV), the main cause of cervical cancer, is recommended for 11-12 year old girls, yet vaccine uptake is low. This study evaluates a social marketing campaign initiated by 13 North Carolina counties to raise awareness among parents and reduce barriers to accessing the vaccine in a primarily rural area. The 3-month campaign targeted mothers of girls ages 11-12 and healthcare practices serving pre-teen girls in four counties. Principles of social marketing were: product (recommended vaccine against HPV), price (cost, perception of safety and efficacy, and access), promotion (posters, brochures, website, news releases, doctor's recommendation), and place (doctors' offices, retail outlets). We analyzed (1) website traffic, hotline calls, and media placement; (2) cross-sectional surveys of mothers and providers; and (3) HPV immunization rates in intervention versus non-intervention counties. Of respondent mothers (n=225), 82% heard or saw campaign messages or materials. Of respondent providers (n=35), 94% used campaign brochures regularly or occasionally in conversations with parents. HPV vaccination rates within six months of campaign launch were 2% higher for 9-13 year old girls in two of the four intervention counties compared to 96 non-intervention counties. This evaluation supports campaign use in other primarily rural and underserved areas.

Provider communication about HPV vaccination: A systematic review

“…100,109 Additional intervention research is urgently needed to evaluate approaches for supporting effective provider communication and to prospectively evaluate the impact of those interventions on HPV vaccine uptake. Message testing to understand the impact of providers' communication content on parents' HPV vaccine decision making and satisfaction could be especially useful.…”

“…109 A second study evaluated a social marketing campaign that included public service announcements and the provision of clinic-based educational materials to parents of adolescents; most providers who participated reported that the campaign made them more likely to discuss and recommend HPV vaccination. 100 …”

“…38,71,77,99 Channel Relatively few studies assessed modes of clinical communication about HPV vaccination beyond provider dialog, but those that did focused primarily on written materials. Written brochures and fact sheets, such as the CDC's Vaccine Information Sheet, 12,87,[100][101][102][103] and posters 87,100 were commonly used in traditional primary care settings to support provider communication about HPV vaccination. In studies examining preferred materials, both parents and providers favored brief written materials, 12,16,87,94,100,101,103 with parents additionally expressing interest in websites.…”

“…Written brochures and fact sheets, such as the CDC's Vaccine Information Sheet, 12,87,[100][101][102][103] and posters 87,100 were commonly used in traditional primary care settings to support provider communication about HPV vaccination. In studies examining preferred materials, both parents and providers favored brief written materials, 12,16,87,94,100,101,103 with parents additionally expressing interest in websites. 87,103 Parents and providers across several studies voiced the need for educational materials that were tailored to parents' cultural background, language preference, and literacy level.…”

Interventions to Improve Adolescent Vaccination

“…75 Its concepts include components of several health behavior theories, social psychology, marketing science, and communication research. The application of social marketing to adolescent vaccination was explored by Cates and colleagues 76,77 in two studies. In the first, social marketing principles were used to design educational materials about HPV vaccination targeted to mothers of 11-12-year-olds and distributed across four counties in North Carolina.…”