Informing Content and Feature Design of a Parent-Focused Human Papillomavirus Vaccination Digital Behavior Change Intervention: Synchronous Text-Based Focus Group Study

Abstract

Background Human papillomavirus (HPV) is a common and preventable sexually transmitted infection; however, vaccination rates in the United States among the target age group, which is 11-12 years, are lower than national goals. Interventions that address the barriers to and facilitators of vaccination are important for improving HPV vaccination rates. Web-based, text-based focus groups are becoming a promising method that may be well suited for conducting formative research to inform the design of digital behavior change intervention (DBCI) content and features that address HPV vaccination decision-making. Objective This study aims to explore parental HPV vaccination decision-making processes using a web-based, text-based focus group protocol to inform content and feature recommendations for an HPV prevention DBCI. Methods We conducted 4 web-based, text-based synchronous focus groups via Skype with the parents of patients aged 11-13 years within a large urban US pediatric clinic network. Results The 22 parents were mostly female, White, non-Hispanic college graduates, and they mostly had private health insurance for their children. Approximately half (14/25, 56%) of the parents' 11-13 year old children had initiated HPV vaccination. Most parents had experience using Skype (19/22, 86%). Approximately half (8/17, 47%) of parents expressed no preference for the focus group format, whereas 47% (8/17) requested a text-only chat format and 6% (1/17) requested an audiovisual format. The three main themes from the qualitative data were barriers to HPV vaccination, facilitators of HPV vaccination, and suggestions for improving the HPV vaccination clinic experience. A total of 11 intervention content and feature recommendations emerged from the themes, including addressing HPV knowledge barriers using trusted sources, designing for a family audience, focusing on the framing of messages, reporting reputable HPV research in a comprehensible format, and expanding the clinic visit experience. Conclusions Synchronous text-based focus groups are feasible for conducting formative research on HPV vaccination decision-making. Among well-educated and well-resourced parents, there are barriers such as misinformation and facilitators such as pediatrician recommendations that influence HPV vaccination decision-making. Parents want to conduct their own HPV research as well as receive relevant HPV vaccination advice from their child’s pediatrician. In addition, parents want an enhanced clinic visit experience that lets them access and connect to tailored information before and after clinic visits. The results gathered provide guidance for content and features that may inform a more responsive DBCI to address HPV vaccination decision-making among parents.

AVPCancerFree : Impact of a digital behavior change intervention on parental HPV vaccine –related perceptions and behaviors

“…HPVcancerFree app (HPVCF) was designed for use by English = speaking parents of HPV vaccine-eligible patients 11–17 years of age at TCP clinics. 29–31 It is compatible with iOS and Android systems on mobile devices. HPVCF was designed to provide parent educational content to reduce barriers and increase willingness to initiate HPV vaccination among 11–17-year-old children, enable parents to record talking points regarding the HPV vaccine for discussion with the HCP at a future appointment, and to provide a reminder system for HPV vaccine dose appointments to promote completion of the series.…”

Parents’ Experience With a Mobile Health Intervention to Influence Human Papillomavirus Vaccination Decision Making: Mixed Methods Study (Preprint)

“…HPVCF was created using user-centered design principles and Intervention Mapping, an evidence-and theory-based systematic framework for developing behavior change interventions [38]. The design steps included (1) literature review and online synchronous text-based focus groups with parents from the pediatric clinic network to assess HPV attitudes, barriers, beliefs, and needs related to a digital behavior change solution [39]: (2) matrices describing target behaviors, psychosocial determinants of behavior, and change objectives; (3) delineation of theoretical methods and practical applications; (4) prototype build; (5) heuristic evaluation and in-house alpha testing; and (6) iterative user testing to assess app content, function, delivery channel, usability, value, desirability, and adoptability for both design and content. HPVCF contains 4 self-tailored components: (1) HPV A-Z, a compendium of 9 content domains providing facts about HPV and the HPV vaccine; (2) Bust-a-Myth, 7 educational modules, including peer and health care provider testimonials addressing the most salient HPV vaccination barriers; (3) Notes 4 Doc, a medium to facilitate communication with health care providers about the HPV vaccine; and (4) Get the Vax, a feature to schedule HPV vaccination appointments and receive tailored reminders (Figure 1).…”

Effect of an HPV Vaccination Multi-Level, Multi-Component Program on HPV Vaccination Initiation and Completion in a Pediatric Clinic Network

“…The AVP comprises six evidence-based strategies that target clinic systems, providers, and parents (Figure 1). AVP development was guided by the Intervention Mapping systematic approach [37], informed by behavioral theory (i.e., Social Cognitive Theory [38], Theory of Reasoned Action [39], Health Belief Model) [40], and guided by formative work with clinic leadership, providers (pediatricians and medical assistants) and parents [41], to increase provider delivery of consistent, bundled (when possible), presumptive and unqualified HPV vaccination recommendations [42].…”

“…of Reasoned Action [39], Health Belief Model) [40], and guided by formative work with clinic leadership, providers (pediatricians and medical assistants) and parents [41], to increase provider delivery of consistent, bundled (when possible), presumptive and unqualified HPV vaccination recommendations [42]. We previously demonstrated that the AVP effectively increased HPV vaccination initiation in a 51-clinic pediatric network in Houston, Texas [43].…”