Human Papillomavirus Vaccine Communication Materials for Young People in English-speaking Countries: A Content Analysis

"In order to improve communication about the HPV vaccine, interventions should be developed with, and tailored by, the target populations with lower uptake. This is important to ensure messages are framed in a way that is most likely to address vaccine hesitancy and enable positive decision-making."

Improving the communication of evidence-based vaccine messages and responding to misinformation circulating in social media and anti-vaccination activities have been proposed as strategies to address vaccine hesitancy and improve vaccine confidence. Because an effective communication strategy may change how young people and their parents think and feel about the human papillomavirus (HPV) vaccine, leading to higher and more equitable uptake, researchers leading the EDUCATE study undertook a content analysis of HPV vaccine communication materials in majority English-speaking countries.

The EDUCATE study, described in more detail at Related Summaries, below, is an effort to co-produce an educational package about the HPV vaccine with young people for delivery in schools. This co-production reflects a greater emphasis on the experience of the HPV vaccination process from the perspectives of young people. The goal is to reduce inequalities in uptake of the vaccine by addressing young people's information needs and increasing their autonomy in decision-making and consent procedures.

For the content analysis, between March and April 2020, the researchers searched online for relevant communication materials. Content analysis was used to describe how the following key issues were covered: (i) side effects, (ii) safety, (iii) practicalities related to receiving the HPV vaccine, and (iv) gender-specific information. Forty-four separate communication materials were retrieved, predominantly videos, webpages, and leaflets. Notably, no communication materials were retrieved for English-speaking countries in the Caribbean, where HPV vaccination programmes have been introduced in recent years.

Fifteen (34.1%) of the 44 communication materials were also available in languages other than English. To cite a few examples: One international website provided 11 different communication materials (posters, video, leaflets) translated into French, Hindi, Malay, Spanish, and Chinese. A video was provided in Te Reo, spoken by the Māori people, for the New Zealand HPV vaccination programme. For the Scottish HPV vaccination programme, an information leaflet was provided in Polish, Arabic, and simplified Chinese.

The analysis showed that there was a focus on mild side effects of the vaccine (43.2%), with less frequent reference being made to moderate or serious side effects (22.7%). Reassurance concerning the safety profile of vaccine was communicated by referencing the widespread use of the HPV vaccine (31.8%). Information regarding formal criteria for entry into the vaccination programme emphasised country-specific eligibility criteria (59.1%), the setting in which vaccination was offered (38.6%), and the number of doses required (38.6%). Content intended to improve young people's experiences of receiving the HPV vaccine was less often provided (22.7%). Gender-specific content usually related to specific HPV-related diseases (52.3%) and/or the availability of cervical cancer screening programmes (52.3%).

In reflecting on the findings, the researchers note, for example, that:

• While information specifically informing young women about relevance of HPV vaccination to prevent cervical cancer was frequently provided, the content of sex-specific communication needs to be considered as the vaccine programme becomes normalised for both genders.
• Men who have sex with men (MSM) are at heightened risk of developing HPV-related disease, and, in some countries, the national HPV vaccination programme has been extended to MSM for older ages. However, this information was rarely provided in HPV vaccine communication materials for young people. Per the researchers, this was a missed opportunity to reinforce communication to school-aged young men about the availability of the HPV vaccine.
• Care must be taken when communicating potentially "negative" information, such as issues with safety and side effects, as studies show contradictory impacts. For example, some studies have shown that providing "myth busting" content to address specific concerns about vaccinations may reinforce negative perceptions and reduce uptake.
• Lower knowledge and uptake of HPV vaccine has been shown among young people from minority ethnic groups. Some of the communication materials included in this review appeared to address these issues and were illustrated with young people belonging to different minority ethnic groups or were available in languages in addition to English. The effectiveness of this approach in increasing the relevance, and uptake, of the HPV vaccine to families belonging to minority ethnic groups will be considered as part of the EDUCATE study.

In conclusion: "Information materials, be these paper-based or digital, need to be tailored to target populations if uptake is to be improved....As part of an effective vaccination communication strategy, population-specific communication materials (e.g. leaflets, videos and social media campaigns) may also be required to address barriers to vaccination..." In short: "More needs to be done however to tailor communication materials to address the specific information needs, improve health literacy and address vaccine hesitancy among populations identified as having a lower uptake of HPV vaccination programmes."