Journal of Community Health

, Volume 42, Issue 1, pp 169–178 | Cite as

Using Social Marketing Theory as a Framework for Understanding and Increasing HPV Vaccine Series Completion Among Hispanic Adolescents: A Qualitative Study

  • Angelica M. Roncancio
  • Kristy K. Ward
  • Chakema C. Carmack
  • Becky T. Muñoz
  • Miguel A. Cano
  • Felicity Cribbs
Original Paper


HPV vaccine series completion rates among adolescent Hispanic females and males (~39 and 21 %, respectively) are far below the Healthy People 80 % coverage goal. Completion of the 3-dose vaccine series is critical to reducing the incidence of HPV-associated cancers. This formative study applies social marketing theory to assess the needs and preferences of Hispanic mothers in order to guide the development of interventions to increase HPV vaccine completion. We conducted 51 in-depth interviews with Hispanic mothers of adolescents to identify the key concepts of social marketing theory (i.e., the four P’s: product, price, place and promotion). Results suggest that a desire complete the vaccine series, vaccine reminders and preventing illnesses and protecting their children against illnesses and HPV all influence vaccination (product). The majority of Completed mothers did not experience barriers that prevented vaccine series completion and Initiated mothers perceived a lack of health insurance and the cost of the vaccine as potential barriers. Informational barriers were prevalent across both market segments (price). Clinics are important locations for deciding to complete the vaccine series (place). They are the preferred sources to obtain information about the HPV vaccine thus making them ideal locations to deliver intervention messages, followed by television, the child’s school and brochures (promotion). Increasing HPV vaccine coverage among Hispanic adolescents will reduce the rates of HPV-associated cancers and the cervical cancer health disparity among Hispanic women. This research can inform the development of an intervention to increase HPV vaccine series completion in this population.


HPV Social marketing theory Hispanic women Intervention development Vaccine completion 



Research for this publication was supported by NIH/NCI Grant K01CA181437.

Compliance with Ethical Standards

Conflict of Interest

The authors report no conflicts of interest.


  1. 1.
    Markowitz, L. E., Dunne, E. F., Saraiya, M., Chesson, H. W., Curtis, C. R., Gee, J., et al.; Centers for Disease Control and Prevention (CDC). (2014). Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 63(RR-05), 1–30. Retrieved from
  2. 2.
    Administration, F. and D. (2014). Highlights of prescribing information. Gardasil 9 (human papillomavirus 9-valent vaccine, recombinant). Silver Spring, MD.Google Scholar
  3. 3.
    Saraiya, M. (2015). Population-based HPV genotype attribution in HPV-associated cancers. Presented at Anal Intraepithelial Neoplasia Society Conference, March 13–15. Atlanta.Google Scholar
  4. 4.
    Chaturvedi, A. K., Engels, E. A., Pfeiffer, R. M., Hernandez, B. Y., Xiao, W., Kim, E., et al. (2011). Human papillomavirus and rising oropharyngeal cancer incidence in the United States. Journal of Clinical Oncology, 29(32), 4294–4301. doi: 10.1200/JCO.2011.36.4596.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Jemal, A., Simard, E. P., Dorell, C., Noone, A. M., Markowitz, L. E., Kohler, B., et al. (2013). Annual report to the nation on the status of cancer, 1975–2009, featuring the burden and trends in human papillomavirus (HPV)-associated cancers and HPV vaccination coverage levels. Journal of the National Cancer Institute, 105(3), 175–201. doi: 10.1093/jnci/djs491.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Howlader, N., Noone, A. M., Krapcho, M., et al. (2011). SEER cancer statistics review, 1975–2008. Bethesda. Retrieved from
  7. 7.
    U.S. Department of Health and Human Services,, O. of D. P. and H. P. (n.d.). Healthy People 2020 [Internet]. D.C. Retrieved from
  8. 8.
    Centers for Disease Control and Prevention. (2014). National Immunization Survey, 2014. Atlanta. Retrieved from
  9. 9.
    Bryant, C. A., & Grier, S. (2005). Social marketing in public health. Annual Review of Public Health, 26(9), 319–339. doi: 10.1146/annurev.publhealth.26.021304.144610.PubMedGoogle Scholar
  10. 10.
    Glanz, K., Rimer, B. K., & Viswanath. (2008). Health behaviour and health education: theory, research and practice. doi: 10.1016/S0033-3506(49)81524-1.
  11. 11.
    Glanz, K., & Bishop, D. B. (2010). The role of behavioral science theory in development and implementation of public health interventions. Annual Review of Public Health, 31, 399–418. doi: 10.1146/annurev.publhealth.012809.103604.CrossRefPubMedGoogle Scholar
  12. 12.
    Francis, S. L., & Taylor, M. L. (2009). A social marketing theory-based diet-education program for women ages 54 to 83 Years improved dietary status. Journal of the American Dietetic Association, 109(12), 2052–2056. doi: 10.1016/j.jada.2009.09.002.CrossRefPubMedGoogle Scholar
  13. 13.
    Alaimo, K., Carlson, J. J., Pfeiffer, K. A., Eisenmann, J. C., Paek, H. J., Betz, H. H., et al. (2015). Project FIT: A school, community and social marketing intervention improves healthy eating among low-income elementary school children. Journal of Community Health, 40(4), 815–826. doi: 10.1007/s10900-015-0005-5.CrossRefPubMedGoogle Scholar
  14. 14.
    Pérez-Escamilla, R. (2012). Breastfeeding social marketing: Lessons learned from USDA’s “loving support” campaign. Breastfeeding Medicine, 7(5), 358–363. doi: 10.1089/bfm.2012.0063.CrossRefPubMedGoogle Scholar
  15. 15.
    Mack, N., Woodsong, C., McQueen, K. M., Guest, G., & Namey, E. (2005). Qualitative research methods: A data collector’s field guide. doi: 10.1108/eb020723.
  16. 16.
    Middlestadt, S. E., Bhattacharyya, K., Rosenbaum, J., Fishbein, M., & Shepherd, M. (1996). The use of theory based semistructured elicitation questionnaires: formative research for CDC’s Prevention Marketing Initiative. Public Health Reports, 111 (Suppl 1), 18–27.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Parsons, N. P., & McCormack Brown, K. R. (2004). Formative research: The bedrock of social marketing. The Health Education Monograph Series, 21(1), 1–5.Google Scholar
  18. 18.
    Hsieh, H.-F. (2005). Three Approaches to Qualitative Content Analysis. Qualitative Health Research, 15(9), 1277–1288. doi: 10.1177/1049732305276687.CrossRefPubMedGoogle Scholar
  19. 19.
    Perkins, R. B., Tipton, H., Shu, E., Marquez, C., Belizaire, M., Porter, C., et al. (2013). Attitudes toward HPV vaccination among low-income and minority parents of sons: A qualitative analysis. Clinical Pediatrics, 52(3), 231–240. doi: 10.1177/0009922812473775.CrossRefPubMedGoogle Scholar
  20. 20.
    Reiter, P. L., McRee, A. L., Pepper, J. K., Gilkey, M. B., Galbraith, K. V., & Brewer, N. T. (2013). Longitudinal predictors of human papillomavirus vaccination among a national sample of adolescent males. American Journal of Public Health, 103(8), 1419–1427. doi: 10.2105/AJPH.2012.301189.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Dorell, C. G., Stokley, S., Yankey, D., & Markowitz, L. E. (2012). Compliance with recommended dosing intervals for HPV vaccination among females, 13–17 years, National Immunization Survey-Teen, 2008–2009. Vaccine, 30(3), 503–505. doi: 10.1016/j.vaccine.2011.11.042.CrossRefPubMedGoogle Scholar
  22. 22.
    Jacobson Vann, J. C., & Szilagyi, P. (2005). Patient reminder and recall systems to improve immunization rates. Cochrane Database of Systematic Reviews, 2005(3), CD003941. doi: 10.1002/14651858.CD003941.pub2.
  23. 23.
    Kharbanda, E. O., Stockwell, M. S., Fox, H. W., Andres, R., Lara, M., & Rickert, V. I. (2011). Text message reminders to promote human papillomavirus vaccination. Vaccine, 29(14), 2537–2541. doi: 10.1016/j.vaccine.2011.01.065.CrossRefPubMedGoogle Scholar
  24. 24.
    Liddon, N. C., Hood, J. E., & Leichliter, J. S. (2012). Intent to receive HPV vaccine and reasons for not vaccinating among unvaccinated adolescent and young women: Findings from the 2006–2008 National Survey of Family Growth. Vaccine, 30(16), 2676–2682. doi: 10.1016/j.vaccine.2012.02.007.CrossRefPubMedGoogle Scholar
  25. 25.
    Brewer, N. T., & Fazekas, K. I. (2007). Predictors of HPV vaccine acceptability: A theory-informed, systematic review. Preventive Medicine, 45(2–3), 107–114. doi: 10.1016/j.ypmed.2007.05.013.CrossRefPubMedGoogle Scholar
  26. 26.
    Reiter, P. L., Gupta, K., Brewer, N. T., Gilkey, M. B., Katz, M. L., Paskett, E. D., & Smith, J. S. (2014). Provider-verified HPV vaccine coverage among a national sample of hispanic adolescent females. Cancer Epidemiology Biomarkers and Prevention, 23(5), 742–754. doi: 10.1158/1055-9965.EPI-13-0979.CrossRefGoogle Scholar
  27. 27.
    Mills, a. L., Head, K. J., & Vanderpool, R. C. (2013). HPV vaccination among young adult women: a perspective from Appalachian Kentucky. Preventing Chronic Disease, 10, E17. doi: 10.5888/pcd10.120183.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Corcoran, N. (2007). Communicating health. Strategies for health promotion. London: SAGE Publications, 5–31. doi: 10.1212/01.CON.0000443830.87636.9a.Google Scholar
  29. 29.
    Rahman, M., Laz, T. H., McGrath, C. J., & Berenson, A. B. (2015). Provider Recommendation Mediates the Relationship Between Parental Human Papillomavirus (HPV) Vaccine Awareness and HPV Vaccine Initiation and Completion Among 13- to 17-Year-Old US Adolescent Children. Clinical Pediatrics, 54(4), 371–375. doi: 10.1177/0009922814551135.CrossRefPubMedGoogle Scholar
  30. 30.
    McRee, A.-L., Reiter, P. L., & Brewer, N. T. (2012). Parents’ internet use for information about HPV vaccine. Vaccine, 30(25), 3757–3762. doi: 10.1016/j.vaccine.2011.11.113.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Health Promotion and Behavioral SciencesThe University of Texas School of Public HealthHoustonUSA
  2. 2.Department of Obstetrics and GynecologyUniversity of Florida HealthJacksonvilleUSA
  3. 3.Psychological Health and Learning SciencesUniversity of HoustonHoustonUSA
  4. 4.Department of PsychologyMount St. Mary’s UniversityEmmitsburgUSA
  5. 5.Department of EpidemiologyFlorida International UniversityMiamiUSA

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