Does Supplementing Generic Recommendations with Tailored Messaging Improve Parental Acceptance of HPV Vaccination? a Randomized-Controlled Trial

Introduction: Parental vaccine hesitancy is one reason for low uptake of human papillomavirus (HPV) vaccination in the U.S. Although medical organizations advise health care providers to use a “bundled”, announcement-style approach to recommend age-appropriate vaccination, message tailoring literature suggests that the most effective recommendation to encourage HPV vaccination may not be the same for all parents. The use of videos in primary care has become more common, and studies suggest that delivery of vaccine information through videos may increase intention to vaccinate. Our objective was to evaluate the effectiveness of brief videos tailored to vaccine-hesitant mothers' concerns about HPV vaccine.

Methods: In September 2018 we conducted a web-based randomized-controlled trial (RCT) among mothers who did not plan to vaccinate their 11- to 14-year-old child against HPV within the next 12 months. Participants were recruited from a survey panel in 27 U.S. states with HPV vaccination coverage below the national average. We randomized participants to one of three arms: 1. a general “bundled” information video only; 2. a general video plus a video addressing their top HPV vaccine concern; or 3. a general video plus ≥1 videos addressing all of their HPV vaccine concerns. Each video was less than 50 seconds in length. The outcome was intention to vaccinate in the next 12 months (1=extremely unlikely to vaccinate; 10=extremely likely to vaccinate). We used ANOVA to evaluate the overall effect of the intervention, with Tukey HSD for post-hoc pair-wise comparisons.

Results: Overall, 762 mothers (76% non-Hispanic White; 8% non-Hispanic Black; 8% Hispanic) completed the intervention. The mean intent to vaccinate post-intervention was 3.5 (95%CI 3.2-3.8) among mothers who received the general information video only, 3.9 (95%CI 3.5-4.2) among mothers who receive the general+primary concern video, and 4.2 (95%CI 3.8-4.5) among those who received the general+videos for all concerns. ANOVA indicated a significant intervention effect for at least one intervention (F=4.2, p=.016). Post-hoc analyses indicated that mothers who received tailored videos addressing all of their concerns had significantly higher intent to vaccinate post-intervention than those who received the information-only video (p=.012). There was no significant difference between the top concern group and the group receiving the information-only video (p=.24).

Conclusions: In this RCT of HPV vaccine-hesitant mothers, receiving video messaging tailored to their concerns increased intention to vaccinate within the next 12 months compared to a general vaccination message. Further research is needed to understand the impact of tailored messaging on vaccination behavior in the primary care setting.