A Self-Persuasion App to Boost Adolescent HPV Vaccination Among Low-Income Families

A pilot study conducted at a safety net hospital has armed researchers with a new educational tool: a digital app to persuade parents to vaccinate their adolescent against the human papilloma virus (HPV). The study, conducted at the Southern Methodist University, Dallas, Texas, found that the self-persuasion app, developed for both English and Spanish speakers, was feasible and changed parents’ decisions.

HPV infects a quarter of the US population, including teens, and according to the CDC, the virus can cause cervical, vaginal, and vulvar cancers in females; penile cancer in males; and anal cancer, back of the throat cancer, and genital warts in both genders. Existing public health efforts rely heavily on education messages and physician recommendations to persuade parents to vaccinate their adolescent children. Two shots of the vaccine, 6 to 12 months apart, is the recommendation for children in the 11-to-14-year age group; a third dose may be required if the first 2 doses are administered less than 5 months apart. For the 14-to-26-year age group, 3 shots over a 6-month period are recommended.

For their study, the authors enrolled 45 parents—a majority were mothers—who took their pre-teen and teenage children to safety net pediatric clinics. Parents were educated on the importance of HPV vaccination in the clinic’s waiting room via a customized application on an iPad. The software is designed for individuals to scroll through audio prompts that help them understand the importance of vaccination. A majority of the participants were Hispanic and had a high school education or less. However, since the app has a dual language option and is voice-based, illiteracy and language were not barriers for the study.

The parents rated the self-persuasion tasks as being easy to complete and helpful. Of the 33 parents with unvaccinated adolescents, 27 (nearly 82%) reported that the app had persuaded them to vaccinate their children.

“This approach is based on the premise that completing the vaccination series is less likely unless parents internalize the beliefs for themselves, as in ‘I see the value, I see the importance, and because I want to help my child,’” explained Austin S. Baldwin, PhD, the primary investigator of the study, in a press release.

While the parents were motivated to initiate the process, sustenance is the issue. Previous research by the group found that autonomous motivation was strongly correlated with parents’ intentions to vaccinate. “So they may get the first dose because the doctor says it's important,” Baldwin said. “But the second and third doses require they come back in a couple months and again in six months. It requires the parent to feel it’s important to their child, and that’s perhaps what’s going to push or motivate them to complete the series.”

These studies are part of a National Cancer Institute—funded research grant to develop patient education software for the HPV vaccine that is easily used by low-income parents who may struggle to read and write, and speak only Spanish.