The Effectiveness of mHealth Interventions Targeting Parents and Youth in Human Papillomavirus Vaccination: Systematic Review (Preprint)

Abstract

BACKGROUND The global prevalence of human papillomavirus (HPV) and its associated cancers continue to be a significant concern. In the U.S., routine HPV vaccination at age 11 or 12 years has been recommended. However, despite HPV being the most common sexually transmitted infection and the proven effect of the vaccine, the vaccination rate among youth in the United States remains below the nationally recommended levels. mHealth interventions have demonstrated promise in improving health. Examining and synthesizing the current evidence about the impact of mHealth interventions on vaccination coverage in youth and intervention characteristics could guide future mHealth interventions aimed at mitigating the vaccination gap and disease burden. OBJECTIVE This study aimed to conduct a systematic review to assess the effectiveness of mHealth interventions on parental intent to vaccinate youth against HPV and youth’s vaccine uptake. METHODS We searched empirical papers through databases including Google Scholar, PubMed, CINAHL, PsycINFO, and Cochrane Library. The inclusion criteria were: (1) published between 2011 and December 2022; (2) using mHealth aimed to improve HPV vaccination rate; (3) targeted parents of unvaccinated youth or youth; (4) measured HPV-related knowledge, its vaccination intention or vaccine uptake. Three researchers screened and appraised the quality of the eligible papers using the Melnyk Levels of Evidence and the Cochrane Grading of Recommendations Assessment, Development, and Evaluation methodology. Disagreements in search results and result interpretation were discussed until reaching a consensus. RESULTS Seventeen studies that met the inclusion criteria were included in the final review. Most studies (n=14) were conducted in the United States, used randomized controlled trial design (n=12), and adopted behavioral change theories or a culture-centric approach (n=10). mHealth interventions used in the studies included text message reminders, motivational short message services, computer or tablet-tailored interventions, smartphone apps, web-based tailored interventions, social media (Facebook) campaigns, digital videos, and digital storytelling interventions. About 88% of the mHealth intervention demonstrated positive effects on knowledge, intention, and behaviors related to the HPV vaccination. Two studies reported limited or no impact of the intervention on vaccine uptake or vaccine series completion. Factors facilitating promising vaccine uptake were interventions developed based on behavioral change theories and culturally tailored information. CONCLUSIONS This systematic review identified the impact of mHealth interventions among unvaccinated youth and their parents, which showed improvement in HPV-related knowledge, vaccination intention, and/or vaccine initiation. The interventions incorporated theories and culture-centric approaches revealed the most promising results. Despite the positive outcomes of the interventions, future studies are needed to investigate factors associated with the effect of the intervention (e.g., text messaging and social media intervention). More research is also needed for a better understanding of the intervention elements that boost the responses of age and ethnic-specific populations.