Michelle Cohen, MPH, CHES Health Educator Shan Baker, MS, WHNP-BC Women’s Clinic Supervisor

1. Using the Health Belief Model to Promote the HPV Vaccine to Students: A Collaborative Campus Effort Michelle Cohen, MPH, CHES Health Educator Shan Baker, MS, WHNP-BC Women’s Clinic Supervisor

2. Objectives • Identify collaborative partners on-campus • Describe formative research tasks involved with campaign • Explain development of marketing campaign and implementation of campaign

3. Getting to know Georgia Tech • 19,000 students • Predominately male (70%) • Urban setting (heart of Atlanta) • Students receive technologically-based education • Consistently ranked in U.S. News & World Report's top ten public universities in U.S. • 31.7% GT women report receiving the HPV vaccine (NCHA, 2009)

4. General HPV information • Human Papillomavirus (HPV) • Can lead to genital warts and cervical cancer • Most common sexually transmitted infection (STI) • 50% of sexually active men and women will get HPV (CDC, 2008) • HPV vaccine(Gardasil) • FDA approved for women aged 9-26 in June 2006 • Protects against types 6, 11, 16, 18 (which cause 90% of genital warts and 70% of cervical cancers) • Available at low cost from Health Services

5. Healthy Campus 2010 Objective 25-5 calls for a reduction of the proportion of persons with human papillomavirus (HPV) infection Standards of Practice for Health Promotion in Higher Education Standard 2 (collaborative practice) Standard 4 (theory-based practice) Guiding principles

6. Synopsis • Charged with creating a HPV vaccine campaign on-campus • Developed overarching goal of campaign • Created a plan (tasks and timeline) • Recruit members to create a committee • Conduct formative research • Create a marketing plan • Launch campaign • Conduct summative evaluation

7. Goal of campaign • To increase awareness of the availability of the HPV vaccine on-campus

8. HPV Vaccine Marketing Committee • Stamps Health Services • Health Educator • APRN from Women’s Clinic • RN from Immunization Clinic • Housing-Hall Director • Women’s Resource Center-Program Coordinator • Auxiliary Services-Marketing Coordinator • GT Communications and Marketing

9. GT Communications and Marketing • The Institute's full-service, in-house marketing and communications resource • Purpose: To promote GT’s brand identity and provide professional communications and marketing support • Resources include: • Client Manager • Student Communications Officer • Director of Market Research • Writer/Editor • Graphic Designer

10. Formative research tasks • Review of peer-reviewed literature • Review of national campaigns • Review of other campus campaigns • Conducting focus groups

11. Review of the literature • HPV vaccine acceptability literature suggests use of the Health Belief Model (HBM) (Brewer & Fazekas, 2007 and Levy, 2008) • HBM developed by group of social psychologists in the 1950’s (Glanz, Rimer, &Lewis, 2002)

12. Health Belief Model Six constructs (campaign focuses on four) Perceived susceptibility (HPV is most common STI) Perceived benefits (vaccine protects against genital warts and cervical cancer) Perceived barriers (cost, availability) Cues to action (recommendation from healthcare provider, parent, reputable health organization, or friend)

13. Review of the literature • Sexually active and those diagnosed with STIs/ abnormal Pap are more likely to become vaccinated-susceptibility (Crosby, et al., 2007; Gerend & Shepherd, 2007) • Vaccine acceptability increased if: • Vaccine prevents both cervical cancer AND genital warts-benefit(Jones & Cook, 2008 and Hoover, Carfioli, & Moench, 2000) • Vaccination is low cost-barrier(Boehner, Howe, Bernstein, & Rosenthal, 2003) • Universal vaccination/endorsement by professional organizations-cues to action (Boehner, Howe, Bernstein, & Rosenthal, 2003 and Zimet, 2005)

14. Review of literature • Importance of education • Educate about HPV (Levy, 2008; Jones & Cook, 2008; and Brewer & Fazekas, 2007) • Educate about the benefits of the vaccine (Jones & Cook, 2008 and Hoover, Carfioli, & Moench, 2000)

15. National campaigns • Merck • Gardasil commercial • Website: www.gardasil.com • Print materials • Partnership to End Cervical Cancer: www.nocervicalcancer.org • American College Health Association

19. Campus campaigns • Print media • Website • Information sessions for students at Health Services • Educating clinical staff

20. Focus groups • Three focus groups conducted with students (conducted by GT Communications and Marketing) • Two in housing • One at the Women’s Resource Center

21. Focus group findings • Limited knowledge of HPV • Frequency • What it causes • Limited knowledge of HPV vaccine • Who should get it • What it protects against • Issues regarding sexual health not discussed often • Merck’s Gardasil campaign source of information

22. Create marketing plan • Conduct focus group with key stakeholders • Identify target population • Identify outcomes/key messages • Develop evaluation plan • Develop marketing strategies • Implement campaign

23. Stakeholder focus group • One focus group conducted with major stakeholders • HPV Vaccine Marketing Committee • Stamps Health Services key staff • Colleges Against Cancer: student group

24. Target population • Male students • Parents • Female students

25. Outcomes/key messages Students will be able to: • Identify HPV as the most common STI (susceptibility) • Recognize what the HPV vaccine is effective against (benefit) • Recall hearing of the HPV vaccine • Discuss the vaccine with friends/partners (cues to action) • Identify where the HPV vaccine is available (barrier)

26. Evaluation plan • Create research protocol • Administer survey to assess knowledge of HPV vaccine before and after campaign implementation • Survey female patients* seen in Primary Care Clinic at Stamps Health Services (n=111) • Surveys administered by Medical Records and Nursing staff *Women’s Clinic patients not surveyed as they are most likely more educated about HPV vaccine

27. Evaluation plan (cont.) • Create survey instrument based on campaign outcomes • Consult with Communications and Marketing • Pilot with students • Submit research protocol and instrument to IRB • Administer pre-survey for three weeks (Time 1) • Implement campaign for one month • Administer post-survey for three weeks (Time 2) • Analyze data and create report • Share findings

28. Strategies • Buzz bags • Tablings (SHS, Vagina Monologues, Student Center) • Webpage: www.preventHPV.gatech.edu • Facebook fansite

31. Promotional materials • Print materials* • Flyers • Posters • Postcards • Plasma screen promotions *Posted in Stamps Health Services, residence halls, Campus Recreation Center, and Student Center (including Food Court)

35. Promotional materials • Promotional items • Buttons, magnets • Safer sex kits • Body sprays • Tampons

36. Survey results

37. Survey results (cont.)

38. Limitations • Formative research • Limited research on effective HPV vaccine campaigns • Limited focus groups • Campaign • Limited message testing • Length of implementation • Models not Georgia Tech students

39. Limitations (cont.) • Evaluation • Nature of the sample • Only knowledge measured (not attitudes or behaviors) • Limited information about number of women on-campus vaccinated

40. Next steps • Additional data analysis • Sharing findings • Developing additional phases of the campaign

41. References • Boehner, C., Howe, S.R., Bernstein, D.I., & Rosenthal, S. (2003). Viral sexually transmitted disease vaccine acceptability among college students. Sexually Transmitted Diseases, 30 (10), 774-778. • Brewer, N. & Fazekas, K.I. (2007). Predictors of HPV vaccine acceptability: a theory-informed, systematic review. Preventive Medicine, 45, 107-114. • Centers for Disease Control and Prevention. (2008). Human papillomavirus (HPV) infection Retrieved July 16, 2008 from http://www.cdc.gov/std/hpv • Crosby, R. et al. (2007). Correlates of intent to be vaccinated against human papillomavirus: an exploratory study of college-aged women. Sexual Health, 4, 71-73. • Gerend, M. & Shephard, J.E. (2007). Using message framing to promote acceptance of the humanpapillomavirus vaccine. Health Psychology, 26 (6), 745-752. • Glanz, K., Rimer, B,K., & Lewis, F.M. (Eds.) (2002). Health Behavior and Health Education. San Francisco: John Wiley and Sons, Inc. • Hoover, D.R., Carfioli, B., & Moench, E.A. (2000). Attitudes of adolescent/young adult women toward human papillomavirus vaccination and clinical trails. Health Care for Women International, 21, 375-391. • Jones, M. & Cook, R. (2008). Intent to receive an HPV vaccine among university men and women and implications for vaccine administration. Journal of American College Health, 57(1), 23-31. • Levy, E. (2008, March). HPV vaccine acceptability among college students. Presented at the National Immunization Conference, Atlanta, GA. • Zimet, G.D. (2005). Improving adolescent health: focus on HPV vaccine acceptance. Journal of Adolescent Health, 37, S17-S23.

42. Special thanks! • HPV Vaccine Marketing Committee • Stamps Health Services staff • GT Communications and Marketing

43. Discussion questions Who have you partnered with to do similar campaigns? What other theories have been used to develop similar campaigns? How have you evaluated the effectiveness of educational campaigns?

44. Michelle Cohen, MPH, CHES Health Educator michelle.cohen@health.gatech.edu Shan Baker, MS, WHNP-BC Women’s Clinic Supervisor shan.baker@health.gatech.edu