Stories to Prevent (StoP) HPV Cancers: A communication intervention to increase HPV vaccination among diverse populations

Abstract
Despite the availability of the human papillomavirus (HPV) vaccine that can prevent over 37,300 HPV-related
cancers in the US every year, only 62.6% of girls and boys were up-to-date in 2022. Low-quality provider
recommendations and time constraints during clinic visits limit parents’ opportunities to discuss and make HPV
vaccination decisions. Pre-visit education to parents could complement provider communication to promote
HPV vaccination. There is a critical need to identify better communication strategies to increase HPV vaccine
uptake, including the use of narrative messaging and existing digital technologies in clinics and at home
(electronic health records, patient portal, mobile devices). We propose the Stories to Prevent (StoP) HPV
Cancers Study, a randomized controlled trial (RCT), to evaluate the association of a narrative communication
intervention delivered through digital and mobile technology before clinic visits on HPV vaccine initiation rates.
Parents of children ages 9-12 will be randomized (1:1) to a brief video intervention showcasing local cancer
survivors narrating their experiences with an HPV-associated cancer and recommending the HPV vaccine or
control (placebo video). Our overall objectives are to understand (1) how narrative communication is received
in the context of HPV vaccine decision-making, including the psychological mechanisms (cognitive and
emotional) narratives use to influence vaccination decision-making by parents, and (2) how digital technologies
can support the delivery of this intervention. This project builds on our feasibility study with parents of
adolescents, where we found that 52% of the sample said that their decision to get the HPV vaccine was
influenced by a narrative video intervention that we delivered through the patient portal before clinic visits. Aim
1 is to evaluate the association of our narrative communication intervention on HPV vaccination rates among
9- to 12-year-olds. We will recruit cancer survivors to film their narratives and produce our intervention videos
(n=6). RCT participants will be the parents (n=200) of children ages 9-12 who have not yet initiated HPV
vaccination. Our primary outcome is HPV vaccine initiation (≥1 dose) among children ages 9-12 at the time of
the wellness visit. Aim 2 is to explore the effect of narratives on theory-based mediators of HPV vaccination,
including parents’ cognitive (e.g., risk perception) and emotional (e.g., hope, anticipated regret) reactions. Our
expected outcome is to demonstrate the efficacy of a highly scalable intervention to educate, engage, and
encourage parents to get the HPV vaccine. This study is innovative in (1) maximizing the use of available clinic
and mobile technologies to deliver cancer prevention messaging responsive to parents’ vaccine information
preferences (before clinic visit) and (2) in developing a greater understanding of the use of narratives in the
context of HPV vaccination. We expect a significant impact on HPV vaccine uptake as we address parents’
communication needs with an intervention that fits the existing technology ecosystem and workflow of primary
care clinics. Our long-term goal is to help reduce HPV-associated cancers in the US.

Grant Number: 1R21CA290500-01A1
NIH Institute/Center: NIH
Principal Investigator: William Calo