The Effect of a Web-Based Cervical Cancer Survivor’s Story on Parents' Behavior and Willingness to Consider Human Papillomavirus Vaccination for Daughters: Randomized Controlled Trial

Abstract

Background Providing adequate information to parents who have children eligible for human papillomavirus (HPV) vaccination is essential to overcoming vaccine hesitancy in Japan, where the government recommendation has been suspended. However, prior trials assessing the effect of brief educational tools have shown only limited effects on increasing the willingness of parents to vaccinate their daughters. Objective The aim of this trial is to assess the effect of a cervical cancer survivor’s story on the willingness of parents to get HPV vaccination for their daughters. Methods In this double-blinded, randomized controlled trial (RCT) implemented online, we enrolled 2175 participants aged 30-59 years in March 2020 via a webpage and provided them with a questionnaire related to the following aspects: awareness regarding HPV infection and HPV vaccination, and willingness for HPV vaccination. Participants were randomly assigned (1:1) to see a short film on a cervical cancer survivor or nothing, stratified by sex (male vs female) and willingness for HPV vaccination prior to randomization (yes vs no). The primary endpoint was the rate of parents who agreed for HPV vaccination for their daughters. The secondary endpoint was the rate of parents who agreed for HPV vaccination for their daughters and the HPV vaccination rate at 3 months. The risk ratio (RR) was used to assess the interventional effect. Results Of 2175 participants, 1266 (58.2%) were men and 909 (41.8%) were women. A total of 191 (8.8%) participants were willing to consider HPV vaccination prior to randomization. Only 339 (15.6%) participants were aware of the benefits of HPV vaccination. In contrast, 562 (25.8%) participants were aware of the adverse events of HPV vaccination. Although only 476 (21.9%) of the respondents displayed a willingness to vaccinate their daughters for HPV, there were 7.5% more respondents in the intervention group with this willingness immediately after watching the short film (RR 1.41, 95% CI 1.20-1.66). In a subanalysis, the willingness in males to vaccinate daughters was significantly higher in the intervention group (RR 1.50, 95% CI 1.25-1.81); however, such a difference was not observed among females (RR 1.21, 95% CI 0.88-1.66). In the follow-up survey at 3 months, 1807 (83.1%) participants responded. Of these, 149 (8.2%) responded that they had had their daughters receive vaccination during the 3 months, even though we could not see the effect of the intervention: 77 (7.9%) in the intervention group and 72 (8.7%) in the control group. Conclusions A cervical cancer survivor’s story increases immediate willingness to consider HPV vaccination, but the effect does not last for 3 months. Furthermore, this narrative approach to parents does not increase vaccination rates in children eligible for HPV vaccination. Trial Registration UMIN Clinical Trials Registry UMIN000039273; https://tinyurl.com/bdzjp4yf

Actions speak louder than words; pediatricians, gynecologists, nurses, and other mothers’ perspectives on the human papillomavirus vaccine: an Istanbul multicenter study

“…In Group 2 of our study, 5/120 (4.2%) of the mothers received a vaccination. This rate exceeded the vaccination rate of just 11 (1.2%) out of 909 Japanese mothers in the survey study conducted by Suzuki Y et al It has been reported that one of the main barriers to HPV vaccination in Japan is vaccine hesitancy (8). Social media was the first source in Group 2.…”

Systematic review and meta-analysis comparing educational and reminder digital interventions for promoting HPV vaccination uptake

“…A total of 281,280 unique participants were drawn from the 34 included studies 27 , 32 , 34 – 65 . Twenty-five studies were conducted on parents and/or adolescents (73.5%), while the remaining studies were conducted on healthcare providers.…”

“…Their effectiveness in improving vaccination uptake has been well-documented 14 – 17 , 22 , 25 , 26 . These methods have been rigorously tested through Randomized Clinical Trials (RCTs) 34 – 43 , and although the results are promising, the implementation of guidelines for health promotion practice presents challenges. Specifically, these challenges arise from the lack of a direct meta-analytic comparison of these five key interventions, complicating the clear assessment of their individual effectiveness.…”

Willingness and hesitancy towards the governmental free human papillomavirus vaccination among parents of eligible adolescent girls in Shenzhen, Southern China

“…However, the lasting impact of health education interventions remains uncertain. For instance, a randomised controlled trail in Japan demonstrated that while a cervical cancer survivor’s story initially increased parents’ willingness to consider HPV vaccination, this effect did not persist and failed to increase vaccination rates among children [ 30 ]. Echoing these findings, a recent systematic review by Escoffery et al emphasised the need to broaden HPV vaccination promotion strategies beyond just educational efforts [ 31 ].…”