Stories to Prevent (StoP) HPV Cancers: A communication intervention to increase HPV cancer prevention in primary care

Despite the availability of recommended human papillomavirus (HPV) cancer prevention services that can prevent over 37,300 HPV 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 cancer prevention decisions. Pre-visit education to parents could complement provider communication. There is a critical need to identify better communication strategies to increase uptake of the recommended HPV cancer prevention service, including the use of narrative messaging and existing digital technologies in clinics and at home (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 initiation rates of HPV cancer prevention in primary care. 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 prevention or control (placebo video). Our overall objectives are to understand (1) how narrative communication is received in the context of HPV cancer prevention decision-making, including the psychological mechanisms (cognitive and emotional) narratives use to inform parents’ informed decisions, 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 recommended HPV cancer prevention service 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 cancer prevention initiation 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 cancer prevention. Our primary outcome is initiation of the recommended HPV prevention service 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, 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 initiate HPV cancer prevention for their children. This study is innovative in (1) maximizing the use of available clinic and mobile technologies to deliver messaging responsive to parents’ information preferences and (2) in developing a greater understanding of the use of narratives in the context of cancer prevention. We expect a significant impact on HPV cancer prevention as we address parents’ communication needs with an intervention that fits the existing technology ecosystem and workflow of primary care clinics.

Grant Number: 5R21CA290500-02
NIH Institute/Center: NIH
Principal Investigator: William Calo