JMIR Publications

ABSTRACT

Background:

Suboptimal adolescent human papillomavirus (HPV) vaccination rates have been attributed to parental perceptions of HPV vaccine. The internet has been cited as a setting where misinformation and controversy about HPV vaccination have been amplified.

Objective:

To test message effectiveness in changing parents’ attitudes and behavioral intention toward HPV vaccination.

Methods:

We conducted a message testing experiment online with six control messages and 25 experimental messages and, five from each of five salient themes about HPV vaccination (Theme 1: safety/side effects/risk/ingredient concerns and long-term or major adverse events, Theme 2: distrust of the healthcare system, Theme 3: HPV vaccine effectiveness concerns, Theme 4: connection to sexual activity, and Theme 5: misinformation about HPV/HPV vaccine). Themes were identified from prior online focus group discussions with parents, and the specific messages were developed by the study team using content from credible scientific sources. Throughout an iterative process of message development, the messages were crafted to be appropriate for presentation on a social media platform. Among 1,713 participants recruited via social media and crowdsourcing sites, 1,043 eligible parents completed a pre-test survey questionnaire. Participants were then randomly assigned to one of the 31 messages and asked to complete a post-test survey questionnaire that assessed attitudes toward the vaccine and perceived effectiveness of the viewed message. A subgroup of participants (n=189) with unvaccinated children 9-14 years old were also assessed for their behavioral intention to vaccinate their child(ren) against HPV.

Results:

Parents in the experimental group had increased positive attitudes toward HPV vaccination compared to those in the control group (t=3.03, p=.003), which was associated with increased intention to vaccinate among parents of unvaccinated 9-14 years old children (r=1.14, p=.05). On the thematic level, we identified four themes (Themes 2-5) that were relatively effective in increasing behavioral intentions by positively influencing attitudes toward the HPV vaccine (RMSEA=.014, CFI =.91, SRMR=.031). On the message-level, messages that provided scientific evidence from government-related sources (e.g., the Centers for Disease Control and Prevention) and corrected misinformation (e.g., “vaccines like the HPV vaccine are simply a way for pharmaceutical companies to make money. That isn’t true”) were effective in forming positive perceptions toward the HPV vaccination messages.

Conclusions:

Evidence-based messages directly countering misinformation and promoting HPV vaccination in social media environments can positively influence parents’ attitudes and behavioral intentions to vaccinate their child(ren) against HPV. Clinical Trial: NCT03747302