Multimodal Counseling Interventions: Effect on Human Papilloma Virus Vaccination Acceptance

Human papillomavirus (HPV) vaccine was developed to reduce HPV-attributable cancers, external genital warts (EGW), and recurrent respiratory papillomatosis, yet adolescent HPV vaccination series completion rates are less than 40% in the United States (US). Parental HPV vaccination acceptance may be most strongly associated with attitude, habit, intention, and subjective norms, providing direction for vaccination education. This type of education can, for example, refute the assumption that HPV vaccination results in increased sexual activity. The objective of this quantitative comparative study was to evaluate whether multimodal counseling interventions increased HPV vaccination series non-completers' knowledge of HPV-attributable disease and acceptance of HPV-attributable disease prophylaxis (vaccination).

In February 2015, the researchers performed a single-blind, quantitative, 4-group, probability sampling, simple randomised, pre-test/post-test online survey with a minimum of 260 participants per study group, comprised half of young adults and half of parents, about 60:40 female to male ratio, totaling 1,109 participants overall. The first- and control-level counseling intervention received by all study groups was a 14-sentence informational brief. The second-level counseling intervention comprised the 14-sentence informational brief and a 4.34-min audiovisual Why vaccinate against HPV. The third-level counseling intervention was the 14-sentence informational brief and a public health education handout (PHEH) based on the Public Health Fact Sheet: Patient information about HPV and the HPV vaccine. The fourth-level counseling intervention comprised the 14-sentence informational brief, the audiovisual, and the PHEH.

The study found that compared to the control group, all experimental groups showed a greater increase in HPV-attributable disease and HPV vaccination knowledge, p = 0.038. The PHEH intervention, and the combined audiovisual and PHEH intervention, raised knowledge of HPV-attributable EGW, p < 0.001. (Previous investigators had found that cervical cancer prevention was a greater motivator for HPV vaccination acceptance than prevention of a sexually transmitted infection (STI). Yet, this study found that EGW, a visible manifestation of an HPV-attributable STI, was the most easily communicated HPV-attributed disease.) The combined audiovisual and PHEH intervention raised knowledge of HPV vaccination purpose, p = 0.02.

Furthermore, the combined PHEH and audiovisual achieved increased HPV vaccination acceptance for 7 items, p < 0.001 to p = 0.023. The audiovisual intervention achieved increased HPV vaccination acceptance for 6 items, p < 0.001 to p = 0.006. Parents were more likely to accept offers of HPV vaccination for a child than were childless young adults for themselves (68.2% and 52.9%). (As proportionately more parents than childless young adults were initially accepting of HPV vaccination, adults overall may be more likely to be contemplative towards HPV vaccination than childless young adults.) Particularly, parents of more sons than daughters were more likely to accept HPV vaccination. The inclusion of 39% male participants may have played into the finding that parents of sons retained the most information about HPV.

As reported here, the audiovisual choice may have not been as well received as the PHEH, reflected in greater response to the latter than the former. A combination of survey length and audiovisual choice may account for the combined audiovisual and PHEH Group 3 not standing out from the PHEH Group 2 as the most effective intervention. A separate study evaluating audiovisual presentations to determine the most effective audiovisual could improve HPV vaccination counseling. Given a potential 23% cost differential in using electronic instead of print counseling materials, increased comparative audiovisual effectiveness is described here as essential for audiovisual counseling use.