JMIR Publications

ABSTRACT

Background:

Despite the availability of school-based vaccination programs against human papillomavirus (HPV), disparities in vaccine coverage persist. Barriers to HPV vaccine acceptance and uptake include parental attitudes, knowledge, beliefs, and system-level barriers. Three interventions were developed to address these barriers: an in-person presentation by school nurses, an email reminder with an interactive information and decision-support tool, and a telephone reminder using Motivational Interviewing techniques.

Objective:

To report on the development and formative evaluation of interventions to improve HPV vaccine acceptance and uptake among Grade 4 students’ parents in Quebec, Canada.

Methods:

A formative evaluation of the interventions was carried out in the summer of 2019 to assess the interventions' relevance, content, and format and to identify any unmet needs. We conducted three focus group discussions with parents of Grade 3 students and nurses. Interviews were recorded, transcribed and analyzed for thematic content using N'Vivo software. We conducted a training session for nurses on motivational interview techniques and evaluated the effect on nurses' knowledge and skills using a pre-and post-questionnaire. Descriptive quantitative analyses were carried out on data from questionnaires relating to MI training. Comparisons were made using the proportions of the results. Finally, we developed a patient decision aid using an iterative, user-centred design process. The iterative refinement process involved feedback from parents, nurses, and experts to ensure the tool's relevance and effectiveness. The evaluation protocol and data collection tools were approved by the CHU de Québec Research Ethics Committee (MP-20-2019-4655, May 16, 2019).

Results:

Following feedback from the focus groups discussion, several changes were made to the first intervention. Experts and school nurses recruited for the project gave feedback on this presentation. They appreciated the visual and simplified information in it. The results of the motivational interviewing training for school nurses demonstrated an increase in skills and knowledge of nurses in using this technique. Several changes were made between the first draft of the online decision-aid tool and the final version. More information on cancer rates, transmission, progression and screening was added. Information on vaccine safety, ingredients and side effects has also been added. Information was organized to be presented in layers so that users have the ability to click to receive more detail if more detail is desired. As for the sliders, the two choices were made more nuanced in the final version to better represent how parents conceptualize the decision.

Conclusions:

We developed and pilot-tested three interventions using an iterative process. The interventions were perceived as potentially effective to increase parents’ knowledge and positive attitudes towards HPV vaccination and, ultimately, vaccine acceptance. Future research will focus on assessing the effectiveness of these interventions on a larger scale. Clinical Trial: NA