A Randomized Study to Determine the Effect of a Culturally Focused Video Intervention on Improving HPV Vaccine Intentions in a Christian Population in the United States

"These results suggest that culturally focused educational interventions are effective at influencing vaccine intentions and attitudes, even when those are based on religious or cultural feelings."



A myriad of factors influence vaccine hesitancy. This group of researchers previously identified factors that impact parental intent to vaccinate their children against human papillomavirus (HPV), which is a sexually transmitted infection. They found that parents who feel that religious adherence supports values (e.g., about sexual purity) provides protection against HPV have lower intent to vaccinate. They also previously found that talking to those who have experienced vaccine-preventable diseases improves vaccine attitudes. In that context, the present study sought to determine if a culturally relevant story from a cervical cancer survivor would be sufficient to improve intent to vaccinate against HPV in a Christian population. It also tested the effectiveness of this story on altering specific beliefs that hinder HPV vaccine acceptance and the effectiveness of vaccine education on HPV acceptance.



The researchers created three intervention videos, for distribution electronically. In a parallel trial format, each participant received only one intervention.

• The first video ("Control") contains information on an adenovirus but nothing about HPV or vaccines in general.
• The second video ("Religious") is a story told by a devout Christian cervical cancer survivor who discusses her experiences and advocates for getting vaccinated. The subject emphasises her faith and spiritual experiences along with her experience with cancer. The purpose of this video was to destigmatise HPV infection and vaccination in this community. This approach fits within a social identity theory framework.
• The third video ("Informational") is an educational intervention that contains scientific facts about human papillomaviruses, the diseases they cause, how they are transmitted, and how vaccination protects against them. No attempt is made to debunk wrong information; it merely presents facts about HPV and present the benefits of vaccination.

The survey that accompanied the video viewing was administered nationwide (United States) through the survey company Qualtrics. Subjects were included if they self-identified as Christian and had at least one child under the age of 11. The survey was open from April 29 2022 to June 15 2022. It was completed by 1,241 parents, including 612 HPV-vaccine-hesitant individuals. Responses were measured before and after participants watched one of the above three randomly selected videos.



Half of the participants viewed HPV as a major cause of cancer. The majority of the sample (70%) viewed vaccines favourably. Most of the participants (73%) indicated they were likely to vaccinate their children against HPV.



The religious-focused and educational interventions significantly (p < 0.0001, p = 0.0015) improved intentions towards HPV vaccination; the control video had no significant effect (p = 0.79). Although the videos had a significant effect on intent to vaccinate, the effect scores were low. This is likely due to the fact that a majority of the survey population was already committed to vaccination or strongly anti-vaccination, so the videos did not have a large effect on these groups. However, among those deemed HPV vaccine hesitant, the religious video had a highly significant effect, and the information video showed a moderately significant change. The control video was not significant (p = 0.71).



To test the hypothesis that the religious video would decrease the feeling that family values protect against HPV and therefore vaccination is unnecessary, the researchers asked the participants to what extent they agreed with the statement, "I do not need to vaccinate my children against HPV because HPV is sexually transmitted, therefore my family's values will protect my children from contracting HPV". After watching the religious video, there was a significant change towards disagreement with this statement (p = 0.023, effect size 0.07), while those who watched the control or informational videos did not have a significant change in their response to this question. When the HPV-vaccine-hesitant population was considered alone, the response to the video was even more evident. Those who watched the religious video had a significant decrease in their agreement with this statement (p = 0.014, effect size 0.33). Neither those who watched the control video (p = 0.27) or the informational video (p = 0.19) showed a significant change in the response to this item.



As an additional mechanism for measuring the utility of the intervention videos, one question in the survey asked, "Please indicate how much you agree with the following statement: After watching the video, I am more likely to vaccinate my children against HPV". Those who watched the religious or informational interventions reported significantly higher scores than those who watched the control videos (p < 0.001 for each, effect size 0.14, 0.17 respectively).



In short: "The culturally-focused intervention had the power to influence a specific idea that is decreasing vaccination rates in this community: the idea that they are safe from HPV infection because of their values....Identifying the ideas or attitudes inhibiting vaccine acceptance, then making positive, culturally-relevant interventions that address them, is likely to be an effective strategy in improving vaccine attitudes. Considering that vaccine hesitant populations are often congregated in specific groups..., an approach directed towards those groups is likely to be more effective than broad messaging."



The researchers conclude that educational interventions, whether informational or in the form of personal stories, can be effective at improving intent to vaccinate against HPV. Furthermore, a culturally-focused personal story can change specific attitudes that are detrimental to intent to vaccinate. However, highly specific interventions are likely to be necessary for optimal improvement in vaccine hesitancy.