Two Web-Based and Theory-Based Interventions With and Without Brief Motivational Interviewing in the Promotion of Human Papillomavirus Vaccination Among Chinese Men Who Have Sex With Men: Randomized Controlled Trial

Abstract

Background Human papillomavirus (HPV) vaccination is effective in the prevention of vaccine-type genital warts and cancers among men who have sex with men (MSM). Objective The primary objective of this randomized controlled trial (RCT) is to evaluate the efficacies of 2 web- and theory–based interventions with and without brief motivational interviewing (MI) over the phone to increase the completion of HPV vaccination among unvaccinated participants within a 24-month follow-up period compared with the control group. Methods A 3-arm parallel-group RCT was conducted between July 2017 and December 2019. Five telephone surveys were conducted at baseline and at 3, 6, 9, and 24 months by blinded interviewers. Participants were Hong Kong Chinese–speaking MSM aged between 18 and 45 years with regular internet access who were recruited from outreaching at venues, web-based recruitment, and peer referral. Those who had ever received HPV vaccination were excluded. A total of 624 participants were randomized into either the online tutorial (OT) only group (n=208), the OT plus MI group (OT-MI; n=208), or the control group (n=208). In total, 459 (459/624, 73.6%) completed the follow-up evaluation at 24 months. Participants in the OT group received a fully automated OT developed based on the health belief model. On top of the same OT, the OT-MI group received brief MI over the phone. Reminders were sent to the participants of the OT and OT-MI groups after 1, 2, 4, 6, and 8 months. Participants in the control group received web-based health communication messages unrelated to HPV or HPV vaccination. The research team validated the self-reported HPV vaccination uptake. Intention-to-treat analysis was used for outcome analyses. Logistic regression models and multivariable linear regression models were used to test the between-group differences in primary and secondary outcomes. Baron and Kenny’s methods were used to test the mediation hypothesis. Results The participants in the OT-MI group reported a significantly higher validated completion of HPV vaccination at 24 months than the control group (36/208, 17.3% vs 15/208, 7.2%; P=.006). However, the difference in HPV vaccination completion between the OT and the control groups (24/208, 11.5% vs 15/208, 7.2%; P=.17), or between OT-MI and OT groups (P=.13), was not statistically significant. The association between randomization status (OT-MI group vs control group) and HPV vaccination completion became statistically nonsignificant after controlling for changes in the perceived susceptibility to HPV (24 months vs baseline), whereas perceived susceptibility remained strongly associated with HPV vaccination uptake in the model (P<.001). Changes in perceived susceptibility fully mediated the intervention effect. Conclusions Theory-based OT with brief MI over the phone was effective in increasing HPV vaccination completion among Chinese MSM. Perceived susceptibility is an active theoretical component that causes behavioral changes. Trial Registration ClinicalTrials.gov NCT03286907; https://clinicaltrials.gov/ct2/show/NCT03286907

Effectiveness of a Community-Based Organization—Private Clinic Service Model in Promoting Human Papillomavirus Vaccination among Chinese Men Who Have Sex with Men

“…(1) Watching an online video promoting HPV vaccination for MSM: The online video developed by our team in a previous RCT was modified for this study [31]. The modifications included: (i) cost of HPV vaccination was updated based on the recent market rate, and (ii) information of collaborative clinics (e.g., location and contacts) were added.…”

“…To validate HPV vaccination uptake, the participants were requested to send the project staff an image of their receipt without personal identification after they received each dose of HPV vaccines. The same approach to validate HPV vaccination uptake was used in a previous study [31]. Vaccinated participants were asked about the location and cost of HPV vaccination uptake, whether they experienced side-effects after vaccination, and the severity of those side-effects.…”

“…Five scales assessed perceptions based on the HBM, including a three-item Perceived Susceptibility Scale, four-item Perceived Severity Scale, four-item Perceived Benefit Scale, five-item Perceived Barrier Scale, two-item Cue to Action Scale, and two-item Perceived Self-Efficacy Scale. These scales were modified from those used in a previous study among MSM in Hong Kong [31].…”

“…A randomized controlled trial (RCT) was conducted between 2017 and 2019 among MSM in Hong Kong to evaluate online intervention promoting HPV vaccination [31]. The results showed that watching a 5-min online video based on the Health Belief Model [32] and receiving brief motivational interviewing (MI) through telephone was effective in improving HPV vaccination uptake over a 24-month study period [31].…”

Data_Sheet_2.PDF

“…Given the limited vaccine production and high cost, a gender-neutral HPV vaccination strategy, which is highly effective in eradicating oncogenic infection with HPV (17), has been proposed in debates (18). For similar reasons, MSM have not yet been included in HPV vaccination programs in mainland China, except for Hongkong, China (19). In 2019, the Chinese Food and Drug Administration approved the first Chinese 2-valent HPV vaccine (Cecolin R , Innovax, Xiamen, China).…”