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Prevention Science

, Volume 13, Issue 2, pp 173–182 | Cite as

Effects of a Narrative HPV Vaccination Intervention Aimed at Reaching College Women: A Randomized Controlled Trial

  • Suellen Hopfer
Article

Abstract

This longitudinal study reports on the development and evaluation of a narrative intervention aimed at increasing human papillomavirus (HPV) vaccination among college women. The prevention of HPV is a public health priority due to its pervasiveness and relationship to cervical cancer, the second leading cause of cancer deaths among women worldwide. Pilot work utilizing culture-centric narrative theory guided development of the intervention content. Exemplification theory led to hypotheses comparing communication sources of the narrative messages (peer only, medical expert only, or a combination of the two source types) in a four-arm randomized controlled trial (N = 404; 18–26 year olds). The combined peer-expert narrative intervention nearly doubled vaccination compared to controls (22% vs. 12%). The pragmatic goal of increasing HPV vaccination and the theoretical predictions about message source were supported. As predicted, the inclusion of peer and medical expert sources plays a critical role in promoting HPV vaccination among college women. Furthermore, the intervention increased HPV vaccination by increasing vaccine self-efficacy and intent. Theoretical and practical implications for designing effective HPV vaccine messages are discussed.

Keywords

HPV vaccination Culture-centric narrative communication theory Communication source College women 

Notes

Acknowledgements

This research was supported by a Cooperative Agreement Number R36 CD0000704 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the author and do not necessarily represent the official views of the CDC. The author gratefully acknowledges Michael Hecht for his review of the manuscript and mentorship throughout the design and implementation of the overall project as a dissertation, Michelle Miller-Day, Greg Zimet, Heather Brandt, and Allison Friedman for their feedback in developing the HPV vaccine messages, Peg Spear and Linda LaSalle for their support of the project and collaboration with UHS, and all the women who participated in the study.

References

  1. Adams, M., Jasani, B., & Fiander, A. (2009). Prophylactic HPV vaccination for women over 18 years of age. Vaccine, 27, 3391–3394. doi: 10.1016/j.vaccine.2009.01.067.PubMedCrossRefGoogle Scholar
  2. Bandura, A. (2002a). Social cognitive theory in cultural context. Applied Psychology: An International Review, 51, 269–290. doi: 10.1111/1464-0597.00092.CrossRefGoogle Scholar
  3. Bandura, A. (2002b). Social cognitive theory of mass communication. In J. Bryant & D. Zillmann (Eds.), Media effects: Advances in theory and research (pp. 121–153). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
  4. Brewer, N. T., & Fazekas, K. I. (2007). Predictors of HPV vaccine acceptability: A theory-informed, systematic review. Preventive Medicine, 45, 107–114. doi: 10.1016/j.ypmed.2007.05.013.PubMedCrossRefGoogle Scholar
  5. Carmine, E. G. & McIver, J. P. (1981). Analyzing models with unobserved variables. In G. W. Bohrnstedt & E. F. Borgatta (Eds.). Social measurement: Current issues, Beverly Hills, CA: Sage.Google Scholar
  6. CDC. (2009). United States cancer statistics: 1999–2005 incidence and mortality web-based report, from http://www.cdc.gov/cancer/cervical/statistics/race.htm.
  7. CDC. (2010). Recommended adult immunization schedule: United States, 2010 Morbidity and Mortality Weekly Report (Vol. 60).Google Scholar
  8. Conroy, K., Rosenthal, S. L., Zimet, G. D., Jin, Y., Bernstein, D. I., & Glynn, S. (2009). Human papillomavirus vaccine uptake, predictors of vaccination, and self-reported barriers to vaccination. Journal of Women's Health, 18, 1679–1686. doi: 10.1089/jwh.2008.1329.PubMedCrossRefGoogle Scholar
  9. Cook, C., Heath, F., & Thompson, R. L. (2000). A meta-analysis of response rates in web- or internet-based surveys. Educational and Psychological Measurement, 60, 821–836. doi: 10.1177/00131640021970934.CrossRefGoogle Scholar
  10. Daley, E. M., Vamos, C. A., Buhi, E. R., Kolar, S. K., McDermott, R. J., Hernandez, N., et al. (2010). Influences on human papillomavirus vaccination status among female college students. Journal of Women's Health, 19, 1885–1891. doi: 10.1089/jwh.2009.1861.PubMedCrossRefGoogle Scholar
  11. Daley, M. F., Crane, L. A., Markowitz, L. E., Black, S. R., Beaty, B. L., & Barrow, J. (2010). Human papillomavirus vaccination practices: A survey of US physicians 18 months after licensure. Pediatrics, 126, 425–433.PubMedCrossRefGoogle Scholar
  12. Dempsey, A., Cohn, L., Vanessa, D., & Mack, R. (2011). Worsening disparities in HPV vaccine utilization among 19–26 year old women. Vaccine, 29, 528–534. doi: 10.1016/j.vaccine/2010.10.051.PubMedCrossRefGoogle Scholar
  13. Downs, J. S., Murray, P. J., Bruine de Bruin, W., Penrose, J., Palmgren, C., & Fischhoff, B. (2004). Interactive video behavioral intervention to reduce adolescent females’ STD risk: A randomized controlled trial. Social Science & Medicine, 59, 1561–1572.CrossRefGoogle Scholar
  14. Downs, J. S., Bruine de Bruin, W., & Fischhoff, B. (2008). Parent’s vaccination comprehension and decisions. Vaccine, 26, 1595–1607. doi: 10.1016/j.vaccine.2008.01.011.PubMedCrossRefGoogle Scholar
  15. Dunne, E. F., Unger, E. R., Sternberg, M., McQuillan, G., Swan, D. C., Patel, S. S., et al. (2007). Prevalence of HPV infection among females in the United States. Journal of the American Medical Association, 297, 813–819. doi: 10.1001/jama.297.8.813.PubMedCrossRefGoogle Scholar
  16. Fan, D. P. (2002). Impact of persuasive information on secular trends in health-related behavior. In R. Hornik (Ed.), Public health communication (pp. 251–264). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
  17. Fisher, W. R. (1987). Human communication as narration: Toward a philosphy of reason, value, and action. Columbia: University of South Carolina Press.Google Scholar
  18. Gellin, B. G., Maibach, E. W., & Marcuse, E. K. (2000). Do parents understand immunizations? A national telephone survey. Pediatrics, 106, 1097–1102.PubMedCrossRefGoogle Scholar
  19. Graham, J. W. (2009). Missing data analysis: Making it work in the real world. Annual Review of Psychology, 60, 549–576. doi: 10.1146/annurev.psych.58/10405.085530.PubMedCrossRefGoogle Scholar
  20. Guttman, N., Gesser-Edelsburg, A., & Israelashvili, M. (2008). The paradox of realism and authenticity in entertainment-education: A study of adolescents’ views about anti-drug abuse dramas. Health Communication, 23, 128–141. doi: 10.1080/1041023080196870.PubMedCrossRefGoogle Scholar
  21. Hecht, M. L., & Krieger, J. K. (2006). The principle of cultural grounding in school-based substance use prevention: The drug resistance strategies project. Journal of Language and Social Psychology, 25, 301–319. doi: 10.1177/0261927x06289476.CrossRefGoogle Scholar
  22. Hecht, M. L., & Miller-Day, M. (2009). Drug resistance strategies project: Using narrative theory to enhance adolescents’ communication competence. In K. Cissna & L. Frey (Eds.), Handbook of applied communication: Exemplary programs. New York: Routledge.Google Scholar
  23. Hecht, M. L., Marsiglia, F. F., Elek, E., Wagstaff, D. A., Kulis, S., & Dustman, P. (2003). Culturally-grounded substance use prevention: An evaluation of the Keepin’ it R.E.A.L. curriculum. Prevention Science, 4, 23–248.CrossRefGoogle Scholar
  24. Hopfer, S., & Clippard, J. R. (2010). College women’s HPV vaccine decision narratives. Qualitative Health Research, 21, 262–277. doi: 10.1177/1049732310383868.PubMedCrossRefGoogle Scholar
  25. Hu, L., & Bentler, P. (1999). Cut off criteria for fit indices in covariate structure analysis: Conventional analysis versus new alternatives. Structural equation modeling, 6, 1–55.Google Scholar
  26. Jackson, S., & Jacobs, S. (1983). Generalizing about messages: Suggestions for design and analysis of experiments. Human Communication Research, 9, 169–191. doi: 10.1111/j.1468-2958.1983.tb00691.x.CrossRefGoogle Scholar
  27. Jain, N., Euler, G. L., Shefer, A., Lu, P., Yankey, D., & Markowitz, L. (2009). Human papillomavirus (HPV) awareness and vaccination initiation among women in the United States, National Immunization Survey-Adult 2007. Preventive Medicine, 48, 426–431. doi: 10.1016/j.ypmed.2008.11.010.PubMedCrossRefGoogle Scholar
  28. Kahn, J. A., Rosenthal, S. L., Hamann, T., & Berstein, D. I. (2003). Attitudes about human papillomavirus vaccine in young women. International Journal of STD & AIDS, 14, 300–306. doi: 10.1258/095646203321605486.CrossRefGoogle Scholar
  29. Kahn, J. A., Rosenthal, S. L., Jin, Y., Huang, B., Namakydoust, A., & Zimet, G. (2008). Rates of human papillomavirus vaccination, attitudes about vaccination, and human papillomavirus prevalence in young women. Obsetrics & Gynecology, 111, 1103–1110. doi: 10.1097/AOG.0b013e31817051fa.CrossRefGoogle Scholar
  30. Kreuter, M. W., Holmes, K., Alcaraz, K., Kalesan, B., Rath, S., Richert, M., et al. (2010). Comparing narrative and informational videos to increase mammography in low-income African-American women. Patient Education and Counseling, 81, S6–14. doi: 10.1016/j.pec.2010.09.008.PubMedCrossRefGoogle Scholar
  31. Larkey, L. K., & Gonzalez, J. (2007). Storytelling for promoting colorectal cancer prevention and early detection among Latinos. Patient Education and Counseling, 67, 272–278. doi: 10.1016/j.pec.2007.04.003.PubMedCrossRefGoogle Scholar
  32. Larkey, L. K., & Hecht, M. L. (2010). A model of effects of narrative as culture-centric health promotion. Journal of Health Communication, 15, 114–135. doi: 10.1080/10810730903528017.PubMedCrossRefGoogle Scholar
  33. Licht, A. S., Murphy, J. M., Hyland, A. J., Fix, B. V., Hawk, L. W., & Mahoney, M. C. (2010). Is use of the human papillomavirus vaccine among female college students related to human papillimavirus knowlegde and risk perceptions? Sexually Transmitted Infections, 86, 74–78. doi: 10.1136/sti.2009.037705.PubMedCrossRefGoogle Scholar
  34. MacKinnon, D. P., Fritz, M. S., Williams, C. L., & Lockwood, C. M. (2007a). Distribution of the product confidence limits for the indirect effect: Program PRODCLIN. Behavior Research Methods, 39, 384–389. doi: 10.3758/BF03193007.CrossRefGoogle Scholar
  35. MacKinnon, D. P., Lockwood, C. M., Brown, C. H., & Hoffman, J. M. (2007b). The intermediate endpoint effect in logistic and probit regression. Clinical Trials, 4, 499–513.CrossRefGoogle Scholar
  36. Markowitz, L. E., Dunne, E. F., Saraiya, M., Lawson, H. W., Chesson, H., & Unger, E. R. (2007). Quadrivalent human papillomavirus vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP) 56 (pp. 1–24). Atlanta, GA: Center for Disease Control (CDC) Department of Health and Human Services (DHHS): MMWR Recommendation Report.Google Scholar
  37. Munoz, N., Castellsague, X., Berrington de Gonzalez, A., & Gissmann, L. (2006). Chapter 1: HPV in the etiology of human cancer. Vaccine, 24, S3/1–S3/10. doi: 10.1016/j.vaccine.2006.05.115.CrossRefGoogle Scholar
  38. Muthen, L. K., & Muthen, B. O. (2007). Mplus user’s guide (5th ed.). Los Angeles, CA: Authors.Google Scholar
  39. Myint-U, A., Bull, S., Greenwood, G. L., Patterson, J., Rietmeijer, C. A., Vrungos, S., et al. (2010). Safe in the City: Developing an effective video-based intervention for STD clinic waiting rooms. Health Promotion Practice, 11, 408–417. doi: 10.1177/1524839908318830.PubMedCrossRefGoogle Scholar
  40. Parkin, D. M. (2006). The global burden of infection-associated cancers in the year 2002. International Journal of Cancer, 118, 3030–3044.CrossRefGoogle Scholar
  41. Poland, G. A., Jacobson, R. M., & Ovsyannikova, I. G. (2009). Trends affecting the future of vaccine development and delivery: The role of demographics, regulatory science, the anti-vaccine movement, and vaccinomics. Vaccine, 27, 3240–3244. doi: 10.1016/j.vaccine.2009.01.069.PubMedCrossRefGoogle Scholar
  42. Rees, N. (2010). HHS says doctors and minorities mistrust vaccines. VaccineNewsDaily.com, from http://vaccinenewsdaily.com/news/212825-hhs-says-doctors-and-minorities-mistrust-vaccines.
  43. Sales, M. J., Milhausen, R. R., Wingwood, G. M., DiClimente, R. J., Salazar, L. F., & Crosby, R. A. (2008). Validation of a parent-adolescent communication scale for use in STD/HIV prevention interventions. Health Education & Behavior, 35, 332–345. doi: 10.1177/1090198106293524.CrossRefGoogle Scholar
  44. Snyder, L., & Hamilton, M. A. (2002). A meta-analysis of U.S. health campaign effects on behavior: Emphasize enforcement, exposure, and new information and beware the secular trend. In R. C. Hornik (Ed.), Public health communication: Evidence for behavior change (pp. 357–382). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
  45. Soper, D. (2006). Reducing the health burden of HPV infection through vaccination. Infectious Diseases in Obstetrics and Gynecology, 1, 5. doi: 10.1155/IDOG/2006/83084.Google Scholar
  46. Stupiansky, N. W., Rosenthal, S. L., Wiehe, S. E., & Zimet, G. D. (2010). Human papillomavirus vaccine acceptability among a national sample of adult women in the U.S.A. Sexual Health, 7, 304–309.PubMedCrossRefGoogle Scholar
  47. Wang, A. (2008). Consensus and disagreement between online peer and expert recommendations. International Journal of Internet Marketing and Advertising, 4, 328–349. doi: 10.1504/JIMA.2008.019152.CrossRefGoogle Scholar
  48. Zillmann, D. (1999). Exemplification theory: Judging the whole by the some of its parts. Media Psychology, 1, 69–94. doi: 10.1207/s1532785xmep0101_5.CrossRefGoogle Scholar
  49. Zillmann, D. (2002). Exemplification theory of media influence. In J. Bryant & D. Zillmann (Eds.), Media effects: Advances in theory and research (pp. 19–41). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
  50. Zillmann, D. (2006). Exemplification effects in the promotion of safety and health. Journal of Communication, 56, 221–237. doi: 10.1111/j.1460-2466.2006.00291.x.CrossRefGoogle Scholar
  51. Zillmann, D., & Brosius, H. B. (2000). Exemplification in communication: The influence of case reports on the perception of issues. Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
  52. Zimet, G. D., Weiss, T. W., Rosenthal, S. L., Good, M. B., & Vichnin, M. D. (2010). Reasons for non-vaccination against HPV and future vaccination intentions among 19–26 year-old women. BMC Women’s Health, 10, 27–37. doi: 10.1186/1472-6874-10-27.PubMedGoogle Scholar

Copyright information

© Society for Prevention Research 2011

Authors and Affiliations

  1. 1.The Pennsylvania State UniversityThe Methodology CenterState CollegeUSA

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