women perceiving 1-2-3 pap intervention as personally relevant and effective follow the hpv...
TRANSCRIPT
Women perceiving 1-2-3 Pap intervention as personally relevant and effective follow the HPV vaccination regimen
141st APHA Annual Meeting November 2013∙
Elisia L. Cohen, Robin C. Vanderpool, Katharine Head, Tom Collins, Wallace Bates, Grace Jones, Nebraska
Jones, Pamela Stamper, Richard Crosby*
This presentation is supported by Cooperative Agreement Number 1U48DP001932-01 from the Centers for Disease Control and Prevention (CDC). The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the CDC.
Presenter Disclosures
(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
Richard A. Crosby
Drs. Crosby and Cohen have received support from the Merck Investigator Initiated Sponsored Program.
UK Rural Cancer Prevention Center
UK Rural Cancer Prevention Center
The Rural Cancer Prevention Center (RCPC) is a planned collaboration of community members, public health professionals, and researchers designed to reduce health disparities associated with cervical, breast, and colorectal cancer among residents of the Kentucky River Health District in Appalachian Kentucky.
HPV Vaccination Rates for 2010 (Time of Intervention)
• Two available HPV vaccines: Gardasil and Cervarix
• Adolescents ages 13-171
• ≥1 dose 48.7% nationally, 40.1% in Kentucky• ≥3 doses 32% nationally, 27.3% in Kentucky
• Adult women ages 19-26• ≥ 1 dose 20.7% nationally2
1Dorell, C., Stokley, S., Yankey, D., & Markowitz, L. (2011). National and State Vaccination Coverage Among Adolescents Aged 13 Through 17 Years- United States, 2010. Morbidity and Mortality Weekly Report, 60(33), 1117-1123.2CDC. (2012). Adult Vaccination Coverage-United States, 2010. Morbidity and Mortality Weekly Report, 61(4), 66-72.
Message Development and Testing
• 87 in-depth interviews with college students aged 18-26 who were HPV vaccine early adopters and non-adopters
• 5 small-group focus group discussions drew participants who had resided within our Appalachian Kentucky catchment areas within the past year; these young adult women were eligible if they reported having one dose of the HPV vaccine, were 18-26, and from clinical, community college, and university settings.
• “engaged elicitation” approach to message testing
Message Development and Testing
• Findings: Problem of non-adopters• Don’t know a lot about HPV/HPV vaccine• Suspicious of drug companies• Suspicious of vaccine novelty• Vaccine pain fears/worry• Privacy concerns (for both vaccine and Pap)• Belief that they’d have to “start over” if they missed 1 dose
• Findings: Problem of adherence• Not knowing benefits of all 3 doses• Lack of vaccine/HPV knowledge• Myths about “starting over”/not being able to get the next dose after missed dosage• Obstacles: significant others (why do you need an STD vaccine?), transportation, time, $
• Promising message development areas:• Positive value in “staying on top of” reproductive health• Disparity frame for EKY risk: “important statistics”• 18 years old+: the vaccine/pap is no one’s business but their own… “I gotta look out for myself”• Survivor knowledge: “New opportunity” for my generation
1-2-3 Pap Intervention
In order to promote doses 2 and 3, community advisory board
members suggested a visual- and audio-based educational program with local “actors” to increase the salience of the health messages.
Based on message testing with young adult women from eastern Kentucky, the RCPC partnered with the UK Department of Communication to develop a 12 minute DVD.
1-2-3 Pap
The Rural Cancer Prevention Center (RCPC) initiated a two-stage HPV vaccine promotion program for young women residing in rural Appalachia.
Stage 1 = social marketing and diffusion studyStage 2 = DVD-based intervention (randomized control trial)
1-2-3 Pap DVDThe DVD features 3 young women from eastern Kentucky, 2 local female healthcare providers (a nurse practitioner and a physician), and a female television reporter from the regional news station.
The primary messages of the DVD include efforts to increase self-efficacy for follow-up vaccination through modeling (& scripts), understanding the value of the HPV vaccine, emphasize the importance of all 3 doses, and understanding the importance of Pap testing.
After receiving dose 1, women are randomized to watch the DVD or receive standard of care and subsequently followed to monitor uptake of doses 2 and 3.
Ultimate Goal = HPV Vaccination!
Theme Script exemplar
Opening 1-2-3 Pap is a special project designed to reduce cancer disparities among young adult women from Eastern Kentucky.
Local TV anchor and KY Cancer Control Specialist indicates “Women in Eastern KY are 40% more likely to die from cervical cancer than elsewhere in the United States.”
1 HPV is a common disease Nurse explains “many women who get cervical cancer when they are older, likely got HPV in their teens or 20s.”
2 The HPV vaccine is effective Graphics and Nurse explaining: The HPV vaccine can protect women against the types of HPV that cause 70% of cervical cancers.
3 Granddaughter/grandmother narrative about cervical cancer
Tommi, a young women from E. KY who lost her grandmother to cervical cancer, explains that the vaccine is a novel opportunity for her generation.
4 The benefits of vaccination and Pap testing overwhelm the short-term consequences of each
Nurse describes how the pain of a vaccine or the slight discomfort from a Pap test can prevent a lot of pain later, and even save women’s lives
5 1-2-3 Pap; reminder of vaccine and Pap schedule Nurse narrates over graphics and pictures of a young adult receiving a vaccine that 3 shots in addition to regular Pap testing provides fullest protection against cervical cancer.
6 Overcoming stigma associated with HPV vaccination Young adult women from EKY explain how to talk to others who may question the need for a vaccine; women can remind their partners that all three doses of the vaccine compared with regular pap-tests will help women take care of their body and reproductive health for the long term.
7 1-2-3 Pap; remember to schedule your Pap test Graphics showing schedule and Nurse suggests after women get their three doses of the HPV vaccine, “if you have not scheduled a pelvic exam and Pap tests that you should!”
8 A Pap test is private and routinely conducted by medical professionals
The segment explains a Pap test and shows the tools used by medical professionals in the process.
9 1-2-3 Pap; overcoming obstacles to vaccination Young women from EKY describe the hurdles that women may face in getting all three doses of the vaccine. These segments describe how women may keep their decision (to vaccinate/get a Pap test) private, how they can talk openly with their loved ones about how HPV can be spread through skin-to-skin contact; how the safe and effective vaccine can protect against this common virus; and how the benefits of the HPV vaccine outweigh the pain.
10 1-2-3 Pap; scheduling efficacy Young women from EKY remind the viewer that they should think through how, where and when they can follow up by scheduling their next vaccination today.
Closing RCPC information and cues to action Local TV anchor and KY Cancer Control Specialist thanks participants and reminds them to schedule their next HPV vaccines and Pap tests by calling the 1-888 (toll-free) number listed on the screen.
Table 1. 1-2-3 Pap Segment Outline
• From July 2010 until December 2011, 344 young women, ages 18-26, received dose 1 of the HPV vaccine as a result of outreach and social marketing efforts in the KY River District.
• Of these women 155 completed pre- and post-test surveys, and women’s completion of the HPV vaccine schedule was evaluated
Study Enrollment
Percent of Sample
Lived in southeastern Kentucky more than 5 years 90%
Age Mean = 21.99 (SD 2.4)
Caucasian 96%
Some college 48%
Married 30%
Children at home 39%
Ever abnormal Pap test result 47.9%
Not using birth control 49.3%
Never had a Pap test 10.8%
Sexually experienced 93.9%
Lifetime partners Mean = 4.7 (SD 7.2)
Preliminary Findings
Evaluation of the DVD’s perceived message effectiveness was evaluated with an additive scale demonstrating high reliability (.94).
• Video kept attention• Video was believable• Liked the video• Identified with women*• Video was credible• Relevant to my own life*• Gave me info or ideas• Skills I can use• Info that fits needs• Made for women like me*• Convince other women
Principle Component Analysis Revealed a Single Solution
Component Matrixa
Video Kept Attention .829Video was believable .867Liked the video .847Identified with women .671Video was credible .845Relevant to my own life .744Gave me info or ideas .865Skills I can use .879Info that fits needs .849Made for women like me .846
Convince other women .725Extraction Method: Principal Component Analysis.
a. 1 components extracted.
b. * = components of a personal relevance
Perceived Message Effectiveness was Correlated with Intentions to Receive 3 Doses of HPV VaccinationCorrelations
How likely 3rd dose
Video Kept Attention Pearson Correlation .435**
Sig. (2-tailed) 0
N 153
Video was believable Pearson Correlation .519**
Sig. (2-tailed) 0
N 154
Liked the video Pearson Correlation .374**
Sig. (2-tailed) 0
N 153
Identified with women Pearson Correlation .213**
Sig. (2-tailed) 0.008
N 153
Video was credible Pearson Correlation .569**
Sig. (2-tailed) 0
N 155
Relevant to my own life Pearson Correlation .273**
Sig. (2-tailed) 0.001
N 154
Gave me info or ideas Pearson Correlation .480**
Sig. (2-tailed) 0
N 154
Skills I can use Pearson Correlation .346**
Sig. (2-tailed) 0
N 155
Info that fits needs Pearson Correlation .352**
Sig. (2-tailed) 0
N 154
Made for women like me Pearson Correlation .339**
Sig. (2-tailed) 0
N 155
** Correlation is significant at the 0.01 level (2-tailed).
Women who perceived the video as more effective (and personally relevant) are significantly more likely to intend to complete the HPV vaccine series (receive dose 3) (p <.05).
Findings
• Women who perceived the video as effective were also significantly more likely to complete the vaccination series (p <.05) .• This finding is consistent with data previously reported by
Vanderpool et al (2013), the DVD intervention may have created a significantly (P = .003) greater return rate for series completion (43.3%) compared to the rate observed for women randomized to the control condition (31.9%) (Relative difference 35.7%). Women aassigned to the intervention were 2.44 times more likely than women in the usual care group to complete the series.
Future research
• The 1-2-3 Pap intervention demonstrates that a locally-tailored, high-fidelity video intervention can be effectively developed and culturally-tailored to improve HPV vaccine series completion.
• We are now testing the dissemination and implementation of this video in other populations (e.g., KY statewide, WV, and NC)
