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Women perceiving 1-2-3 Pap intervention as personally relevant and effective follow the HPV vaccination regimen

Women perceiving 1-2-3 Pap intervention as personally relevant and effective follow the HPV vaccination regimen. 141 st APHA Annual Meeting ∙ November 2013

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Women perceiving 1-2-3 Pap intervention as personally relevant and effective follow the HPV vaccination regimen

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  1. Women perceiving 1-2-3 Pap intervention as personally relevant and effective follow the HPV vaccination regimen 141st APHA Annual Meeting ∙ November 2013 Elisia L. Cohen, Robin C. Vanderpool, Katharine Head, Tom Collins, Wallace Bates, Grace Jones, Nebraska Jones, Pamela Stamper, Richard Crosby* • This presentation is supported by Cooperative Agreement Number 1U48DP001932-01 from the Centers for Disease Control and Prevention (CDC). The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the CDC.

  2. Presenter Disclosures Richard A. Crosby Drs. Crosby and Cohen have received support from the Merck Investigator Initiated Sponsored Program. (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

  3. UK Rural Cancer Prevention Center

  4. UK Rural Cancer Prevention Center The Rural Cancer Prevention Center (RCPC) is a plannedcollaboration of community members, public health professionals, and researchers designed to reduce health disparities associated with cervical, breast, and colorectal cancer among residents of the Kentucky River Health District in Appalachian Kentucky.

  5. HPV Vaccination Rates for 2010 (Time of Intervention) • Two available HPV vaccines: Gardasil and Cervarix • Adolescents ages 13-171 • ≥1 dose 48.7% nationally, 40.1% in Kentucky • ≥3 doses 32% nationally, 27.3% in Kentucky • Adult women ages 19-26 • ≥ 1 dose 20.7% nationally2 1Dorell, C., Stokley, S., Yankey, D., & Markowitz, L. (2011). National and State Vaccination Coverage Among Adolescents Aged 13 Through 17 Years- United States, 2010. Morbidity and Mortality Weekly Report, 60(33), 1117-1123. 2CDC. (2012). Adult Vaccination Coverage-United States, 2010. Morbidity and Mortality Weekly Report, 61(4), 66-72.

  6. Message Development and Testing 87 in-depth interviews with college students aged 18-26 who were HPV vaccine early adopters and non-adopters 5 small-group focus group discussions drew participants who had resided within our Appalachian Kentucky catchment areas within the past year; these young adult women were eligible if they reported having one dose of the HPV vaccine, were 18-26, and from clinical, community college, and university settings. “engaged elicitation” approach to message testing

  7. Message Development and Testing • Findings: Problem of non-adopters • Don’t know a lot about HPV/HPV vaccine • Suspicious of drug companies • Suspicious of vaccine novelty • Vaccine pain fears/worry • Privacy concerns (for both vaccine and Pap) • Belief that they’d have to “start over” if they missed 1 dose • Findings: Problem of adherence • Not knowing benefits of all 3 doses • Lack of vaccine/HPV knowledge • Myths about “starting over”/not being able to get the next dose after missed dosage • Obstacles: significant others (why do you need an STD vaccine?), transportation, time, $ • Promising message development areas: • Positive value in “staying on top of” reproductive health • Disparity frame for EKY risk: “important statistics” • 18 years old+: the vaccine/pap is no one’s business but their own… “I gotta look out for myself” • Survivor knowledge: “New opportunity” for my generation

  8. 1-2-3 Pap Intervention In order to promote doses 2 and 3, community advisory board members suggested a visual- and audio-based educational program with local “actors” to increase the salience of the health messages. Based on message testing with young adult women from eastern Kentucky, the RCPC partnered with the UK Department of Communication to develop a 12 minute DVD.

  9. 1-2-3 Pap The Rural Cancer Prevention Center (RCPC) initiated a two-stage HPV vaccine promotion program for young women residing in rural Appalachia. Stage 1 = social marketing and diffusion study Stage 2 = DVD-based intervention (randomized control trial)

  10. 1-2-3 Pap DVD The DVD features 3 young women from eastern Kentucky, 2 local female healthcare providers (a nurse practitioner and a physician), and a female television reporter from the regional news station. The primary messages of the DVD include efforts to increase self-efficacy for follow-up vaccination through modeling (& scripts), understanding the value of the HPV vaccine, emphasize the importance of all 3 doses, and understanding the importance of Pap testing. After receiving dose 1, women are randomized to watch the DVD or receive standard of care and subsequently followed to monitor uptake of doses 2 and 3.

  11. Ultimate Goal = HPV Vaccination!

  12. Table 1. 1-2-3 Pap Segment Outline

  13. Study Enrollment • From July 2010 until December 2011, 344 young women, ages 18-26, received dose 1 of the HPV vaccine as a result of outreach and social marketing efforts in the KY River District. • Of these women 155 completed pre- and post-test surveys, and women’s completion of the HPV vaccine schedule was evaluated

  14. Preliminary Findings

  15. Evaluation of the DVD’s perceived message effectiveness was evaluated with an additive scale demonstrating high reliability (.94). • Video kept attention • Video was believable • Liked the video • Identified with women* • Video was credible • Relevant to my own life* • Gave me info or ideas • Skills I can use • Info that fits needs • Made for women like me* • Convince other women

  16. Principle Component Analysis Revealed a Single Solution Component Matrixa Video Kept Attention .829 Video was believable .867 Liked the video .847 Identified with women .671 Video was credible .845 Relevant to my own life .744 Gave me info or ideas .865 Skills I can use .879 Info that fits needs .849 Made for women like me .846 Convince other women .725 Extraction Method: Principal Component Analysis. a. 1 components extracted. b. * = components of a personal relevance

  17. Perceived Message Effectiveness was Correlated with Intentions to Receive 3 Doses of HPV Vaccination Women who perceived the video as more effective (and personally relevant) are significantly more likely to intend to complete the HPV vaccine series (receive dose 3) (p <.05).

  18. Findings • Women who perceived the video as effective were also significantly more likely to complete the vaccination series (p <.05) . • This finding is consistent with data previously reported by Vanderpool et al (2013), the DVD intervention may have created a significantly (P = .003) greater return rate for series completion (43.3%) compared to the rate observed for women randomized to the control condition (31.9%) (Relative difference 35.7%). Women aassigned to the intervention were 2.44 times more likely than women in the usual care group to complete the series.

  19. Future research • The 1-2-3 Pap intervention demonstrates that a locally-tailored, high-fidelity video intervention can be effectively developed and culturally-tailored to improve HPV vaccine series completion. • We are now testing the dissemination and implementation of this video in other populations (e.g., KY statewide, WV, and NC)

  20. Questions? Thank you! Rick.crosby@uky.edu

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