Internal and External Validity of Social Media and Mobile Technology-Driven HPV Vaccination Interventions: Systematic Review Using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework

Abstract

Social media human papillomavirus (HPV) vaccination interventions show promise for increasing HPV vaccination rates. An important consideration for the implementation of effective interventions into real-world practice is the translation potential, or external validity, of the intervention. To this end, we conducted a systematic literature review to describe the current body of evidence regarding the external validity of social media HPV vaccination-related interventions. Constructs related to external validity were based on the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework. Seventeen articles published between 2006 and 2020 met the inclusion criteria. Three researchers independently coded each article using a validated RE-AIM framework. Discrepant codes were discussed with a fourth reviewer to gain consensus. Of these 17 studies, 3 were pilot efficacy studies, 10 were randomized controlled trials (RCTs) to evaluate effectiveness, 1 was a population-based study, and 3 did not explicitly state which type of study was conducted. Reflecting this distribution of study types, across all studies the mean level of reporting RE-AIM dimensions varied with reach recording 90.8%, effectiveness (72.1%), adoption (40.3%), implementation (45.6%), and maintenance (26.5%). This review suggests that while the current HPV vaccination social media-driven interventions provide sufficient information on internal validity (reach and effectiveness), few have aimed to gather data on external validity needed to translate the interventions into real world implementation. Our data suggest that implementation research is needed to move HPV vaccination-related interventions into practice. Included in this review are recommendations for enhancing the design and reporting of these HPV vaccination social media-related interventions.

Vacteens.org: A Mobile Web app to Improve HPV Vaccine Uptake

“…The results of this investigation suggest that mobile web app technology, systematically developed for ease and convenience of use on mobile and other computing devices and guided by DOI and IDM theories of health behavior, that communicates about parents' concerns, lack of information, and misinformation parents hold regarding the HPV vaccination, can substantially improve HPV vaccine uptake. A recent review of social media and mobile technology interventions to improve HPV vaccine uptake ( 28 ) indicates that text message, e-mail, phone contact and social media groups can improve HPV vaccine uptake. This investigation adds mobile web applications to the list of digital techniques for vaccine uptake improvement.…”

Adaptation and Dissemination of a National Cancer Institute HPV Vaccine Evidence-Based Cancer Control Program to the Social Media Messaging Environment

“…This observational study generated some of the first evidence to our knowledge, on which intervention dissemination strategies can increase user engagement and reach for educational HPV vaccine messages in a real-time, in vivo , competitive social media message environment. Although more difficult to measure, learning how promotional and narrative or dialogue-based vaccine messages perform in the competitive social media message environment lends greater external validity ( 21 ) and advances science about which strategies increase reach and engagement under conditions of message competition. This study generated evidence for how select social media platforms function to propagate vaccine messages.…”

“…Twelve strategies were used to adapt the NCI EBCCP HPV vaccine intervention to the social media setting. The selection of adaptation strategies was informed by the vaccine social media literature (47)(48)(49)(50), implementation and dissemination of science frameworks, such as RE-AIM (19,21) and push-pull (5,20), and empirically grounded experience by two co-authors who are social media micro-influencers. The 12 strategies are listed in Table 1.…”

“…Yet, limited guidance exists on how to implement and adapt evidence-based HPV vaccine interventions on social media ( 18 , 19 ). Drawing on an implementation and dissemination scientific framework, the push-pull capacity model ( 5 , 20 ), and RE-AIM ( 19 , 21 ), our observational study aimed to understand how the social affordances of social media can be harnessed to effectively disseminate an evidence-based HPV vaccine intervention.…”

“…The RE-AIM implementation framework ( 19 , 21 ) that also guided our study proposes that the success of adapting an intervention is best evaluated by five dimensions: reach, effectiveness, adoption, implementation, and maintenance. In our study, we sought to evaluate the first of the five dimensions, to examine the reach of broadcasting the HPV vaccine narratives across three platforms: Instagram, TikTok, and Twitter.…”