Evaluating the preliminary effectiveness of a video-based intervention for HPV vaccination promotion among college students aged 18–26: study protocol for a pilot randomised controlled trial

Abstract

Introduction

Human papillomavirus (HPV) affects nearly 85% of sexually active adults during their lifetime and is responsible for HPV-related cancers in both males and females. Although the HPV vaccine can prevent up to 90% of these cancers, vaccination rates remain low, particularly among college students. Recently, video has emerged as a powerful intervention for shaping public opinion and behaviour toward health-related topics; however, most interventions have primarily focused on adolescents, their parents and females. The primary objective of this study is to develop a video-based intervention, informed by input from a diverse group of stakeholders and evaluate its preliminary effectiveness in promoting HPV vaccination intention, attitudes toward vaccination, subjective norms, perceived behavioural control (PBC) and uptake of the first HPV vaccine dose among college students through a randomised controlled trial (RCT).

Methods and analysis

The study is guided by the Theory of Planned Behaviour. A Student Advisory Board of eight college students was established to provide insights and guidance across all phases, including the co-development of HPV and HPV vaccine-related videos with faculty mentors. A pilot RCT will then be conducted in which participants in the intervention group view the stakeholder-created videos, while those in the control group watch four Centers for Disease Control and Prevention (CDC)-based videos of comparable length and content. The effectiveness of the videos will be compared by measuring participants’ intentions, attitudes, subjective norms and PBC regarding the HPV vaccine between the intervention and control groups at baseline, immediately after the intervention and 2 months after implementing the intervention. The uptake of the first dose of the HPV vaccine will be assessed at the 2-month time point. Moderators, including message fatigue and processing fluency, participants’ satisfaction and intervention dose as well as confounding variables such as provider recommendation and encouragement will also be measured. A research team member responsible for data management and analysis will be blinded to the study condition/group allocation, while another team member will send reminder texts.

Ethics and dissemination

Ethical approval from the Michigan State University’s Biomedical and Health Institutional Review Board has been obtained (Study ID: STUDY00010264). The results will be disseminated to the broader public through public forums, social media and seminars organised by the college health centre, community resource centre and local health departments. Additionally, the findings will be shared with healthcare professionals through professional training and meetings, and with researchers via conferences and publications.

Protocol version

14 March 2025 submitted. Revised manuscript—V.1 27 September 2025.

Trial registration number

NCT06397378.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• This study is guided by the theory of planned behaviour.

• This study focuses on diverse young adults, including female, male and international students.

• This study uses a student advisory board to develop interventions specifically designed for their peers.

• While the study focuses on college students, the findings may not be fully generalisable to other populations.

Introduction

Background and rationale

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection in the USA, affecting nearly 85% of sexually active adults during their lifetime.¹ It is linked to approximately 40 000 new cancer cases annually among both males (eg, oropharyngeal, anal) and females (eg, cervical, vaginal) in the USA.² HPV-related cancers contribute to over 7000 deaths each year and impose a substantial economic burden of US$774 million.³ Nearly half of the 14 million new HPV infections each year occur in individuals aged 15–24, highlighting the critical need for effective prevention strategies in younger populations.⁴

Vaccination is a key strategy for preventing HPV-associated cancers, with the potential to prevent more than 90% of these cancers.⁵ The Centers for Disease Control and Prevention (CDC) recommends HPV vaccination for individuals aged 9–26, and studies have demonstrated the effectiveness of HPV vaccines in reducing infection rates in the USA.^{6 7} Despite these recommendations, HPV vaccination coverage remains low among US college students, a demographic with higher HPV prevalence and lower vaccination rates compared with other age groups.⁸ A 2022 nationwide survey revealed that only 53% of college students—41% of men and 57% of women—were up to date with the recommended HPV vaccination, a rate lower than the 62.9% coverage for adolescents aged 13–17 years in 2021.^{9 10}

Barriers to HPV vaccination among college students include lack of awareness and proper knowledge, concerns regarding its safety, inconvenience and concerns about side effects.¹¹,¹⁵ Most existing interventions have primarily targeted adolescents and predominantly female college students, leaving the male population under-represented.¹²¹⁶,¹⁸ This gender disparity highlights a significant gap in efforts to promote HPV vaccination comprehensively. Additionally, many studies have focused primarily on the health outcomes associated with HPV, such as the prevention of cervical cancer, rather than exploring factors like vaccine access, social attitudes and cultural beliefs that directly influence vaccine uptake. Expanding research to include male college students and adopting a more comprehensive focus on diverse health outcomes—such as students’ intentions, attitudes, subjective norms and perceived behavioural controls regarding the HPV vaccine—could enhance the effectiveness of interventions and promote broader vaccine coverage across all populations.

In today’s digital era, social media has become a vital part of youth culture, offering unique opportunities to promote both physical and mental health through education and social support.¹⁹ However, creating content that is not only impactful but also safe for diverse young adults aged 18–26 presents significant challenges. The lack of professional oversight on social media videos has exacerbated the spread of vaccine misinformation and disinformation, posing a threat to public health efforts.²⁰,²² For example, researchers analysed 172 videos about HPV vaccines and found that most had a negative tone, expressing disapproval of the vaccine.²³ Furthermore, these negative videos garnered more likes from viewers compared with positive or neutral content, highlighting the preference for and influence of negative messaging in this context.²³ However, in any large controversy, media videos can play a pivotal role in amplifying both objections to and acceptance of the issue at hand. For young adults, it may be particularly impactful, as they often turn to online videos for information and perspectives.²⁴ The internet has become a primary source for health-related content, with 59% of US adults—equivalent to 8 in 10 internet users—reporting that they have searched online for health information.²⁵ This highlights the significant influence online videos can have on shaping public opinion and behaviours, especially regarding health topics. For instance, in a randomised controlled trial (RCT), young adults exposed to YouTube videos had a significantly higher COVID-19 vaccination rate compared with the control group.²⁶ Moreover, college students have expressed a preference for educational videos featuring healthcare providers and peers, shared on platforms like YouTube and Instagram, but few video-based interventions have been developed for this purpose.¹¹

The Theory of Planned Behaviour (TPB) is a well-established framework recognised for its effectiveness in predicting human behaviour within specific contexts.^{27 28} Researchers have widely applied TPB to examine individuals’ intentions and behaviours related to vaccinations, including those for influenza, HPV and COVID-19.²⁹,³³ For instance, a study comparing the Health Belief Model (HBM) and the TPB in predicting HPV vaccine uptake among young adult women found that TPB consistently outperformed the HBM.³⁴ The study reported that TPB constructs—attitudes, subjective norms and perceived behavioural control (PBC)—were all positively associated with vaccination intentions, which in turn were positively associated with actual HPV vaccine uptake.

The goal of this protocol is to establish a diverse Student Advisory Board (SAB) to co-develop and pilot test the preliminary effectiveness of a video intervention targeting the college student population. Guided by the TPB, which includes attitudes toward the behaviour, PBC, subjective norms and behavioural intentions, this research aims to collaboratively create a culturally and developmentally appropriate video intervention with the SAB. The study will also examine the mechanisms driving changes in outcomes, such as vaccination intention and the uptake of the first dose of the HPV vaccine, among college students.

The study hypothesises that college students who receive the stakeholder-informed, video-based intervention will report significantly greater HPV vaccination intention, more positive attitudes toward HPV vaccination, stronger subjective norms, higher perceived behavioural control and a higher rate of first-dose uptake at 2 months post-intervention compared with students who receive videos with CDC fact information.

Theoretical framework

We applied the TPB to examine the relationships between attitudes toward the behaviour, PBC, subjective norms and behavioural intentions related to HPV vaccination and vaccine uptake among college students in the USA. Within this framework, attitudes refer to how individuals evaluate a behaviour, whether they view it positively or negatively. PBC relates to an individual’s belief in their capability to carry out a specific action, which can be shaped by their understanding of the situation. For example, research has shown that many young adults do not recognise themselves as being at risk for HPV.¹³ This misconception is likely due to a lack of awareness about the high prevalence of HPV and the fact that it can affect individuals regardless of their current symptoms or health practices.^{13 35} Subjective norms reflect the perceived social pressures to engage in a behaviour, particularly the approval or disapproval of key individuals in one’s life.²⁷ According to the TPB, these factors—attitudes, PBC and subjective norms—can shape an individual’s intention to perform a behaviour, which may ultimately lead to the behaviour itself.^{27 28} Furthermore, increasing young adults’ awareness of the widespread nature of HPV could enhance their perceived control and motivate them to adopt preventive actions like vaccination.

Methods

Study design

This study was approved by the host university’s Biomedical and Health Institutional Review Board (Study ID: STUDY00010264). We proposed a two-phase, mixed-methods research project to co-develop a culturally and developmentally appropriate video-based intervention on HPV infection and the HPV vaccine. In Phase 1, an SAB consisting of eight college students from diverse backgrounds (eg, sex, age, discipline) collaborated with the research team to co-create four short videos focused on HPV and the HPV vaccine. Once the videos were finalised, the SAB continued participating in Phase 2 activities, which aim to assess the feasibility, acceptability and preliminary effectiveness of the intervention through a pilot RCT among college students aged 18–26. This report is made using the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) reporting guideline.³⁶ The study included two phases, as described below.

Phase 1: aim

The aim of Phase 1 was to develop a developmentally and culturally congruent video-based intervention for college students aged 18–26 in collaboration with the SAB.

Study setting

The SAB met monthly with faculty researchers at the host university for approximately 2 hours, depending on the goals and activities planned for each meeting. All discussions were digitally recorded, transcribed verbatim and organised using qualitative data management software for thematic analysis.

Study sample/recruitment

Eight college students aged 18–26 were recruited from the university where the research team was based to form the SAB. To ensure diversity, we collaborated with various university student organisations, including Sandbox Street Teams, a student-run creative group that partners with non-profit organisations through interdisciplinary projects; focal point, a student-produced newscast; the student union; and the Office for International Students and Scholars. Using purposive sampling, we invited students who reflected our target population in terms of age, sex, race/ethnicity and academic discipline. Partnering with these organisations provided access to a broad and diverse student population, enabling the inclusion of individuals from varied cultural and academic backgrounds. As stakeholders, SAB members contributed unique perspectives, represented the needs of under-represented groups and provided meaningful feedback throughout the project.

The SAB played an active role in co-developing a tailored video intervention to promote HPV vaccination intention and behaviour among their peers. Two student assistants with expertise in filming and video editing were also involved to enhance the quality of the videos. Each SAB member received a certificate of completion and a US$200 Amazon e-gift card in recognition of their time and contributions. The number of students selected was guided by prior research and literature to balance diversity with feasibility. Eight members allowed for meaningful perspectives and discussions while keeping the group small enough to support efficient scheduling, active participation and manageable data collection.

Participant timeline

The first phase of the study was completed in May 2025, with SAB members developing four videos. They will continue contributing to data collection, interpretation and dissemination activities through May 2026.

Number of videos

The choice of the number of brief videos to be included in the intervention is based on the empirical evidence that four short videos have been found to be optimal for changing attitudes and increasing behavioural intentions.³⁷

Data collection, management and analysis

Discussions during the meetings were digitally recorded, transcribed verbatim and managed using NVivo V.12 qualitative data analysis software.³⁸ Once the recordings were transcribed, they were erased from the recorder. Transcripts will be de-identified and stored in a secure OneDrive folder dedicated to the project. One of the investigators co-facilitated the meetings with the board chair, and another investigator will take notes and observe interactions among board members. These discussion guidelines were developed by the research team and included: (1) actively engaging students in the research process to ensure that HPV vaccine messaging was relevant and acceptable; (2) promoting healthy behaviours among peers to support HPV vaccination and cancer prevention; (3) contributing to projects that raised awareness and encouraged vaccine uptake on campus; and (4) building skills as future researchers and health advocates. In collaboration with the SAB, we have developed a video-based intervention consisting of four brief videos.

Phase 2: aim

We plan to conduct a pilot RCT to examine the feasibility (participation rate, retention, intervention fidelity), acceptability (satisfaction) and preliminary effectiveness of a video-based intervention to promote HPV vaccination among college students aged 18–26. Our goal is to determine whether stakeholder-created videos are more engaging and effective than less participatory formats.

Study setting

The second phase, a pilot RCT study, will be conducted online using Qualtrics survey links.

Study sample

College students are eligible if s/he (1) is ≥18 years old and self-identifies as a student currently attending a mid-west public university, (2) has not received HPV vaccine, (3) agrees to receive text message reminders and provides evidence (eg, vaccine record) for the 2-month follow-up assessment. Exclusion criteria include individuals who are unable to understand English, are under 18 or over 26 years of age, or have already received the HPV vaccine.

Sample size and recruitment

The sample size was increased from 80 to 123 college students to improve statistical power and enhance generalisability. Building on our prior successful experience, we collaborated with the University Registrar’s Office (RO) to recruit the target sample. The RO distributed a recruitment flyer to all undergraduate students at the host university in the beginning of September 2025, which included the study purpose, a Qualtrics survey link, three screening questions and the pre-intervention survey. Within 2 days, over 900 students accessed the Qualtrics link; of these, 123 eligible college students passed the screening questions and completed the pre-intervention survey.

Accordingly, the study was not powered to detect between-group differences in mediators or outcomes. The sample size afforded (at a 90% confidence level) a precision of ±7.4% for estimates of participation rate, retention and intervention involvement/fidelity of 80%.

Intervention

The intervention will consist of four short videos co-developed by the SAB and faculty mentors. For the comparison arm, factual information on HPV and the HPV vaccine will be adapted from the CDC website. The content corresponding to each of the student co-developed videos will be converted into four videos of comparable length and format, with voiceover narration to ensure consistency in delivery.³⁹ The average length of the intervention videos is 1 min and 39 s, and the CDC-based videos for the control group will be designed to match this criterion.

Procedure

College students who access the Qualtrics survey link provided on the recruitment flyer were able to review the study purpose, IRB information, benefits of participation and data security and management procedures, and will provide their consent. After giving consent, participants who met the inclusion criteria completed the pre-intervention survey (T0). 2 months after completing the pre-intervention survey, participants will be randomly assigned to four groups, including three intervention groups and one control group (figure 1. Participants in the three intervention groups will watch the intervention videos in a randomised order to minimise potential bias from the sequence in which the videos are viewed and to reduce the risk of contamination. Participants assigned to the control group will watch the converted four videos, matching the number of viewings of the intervention videos to ensure equivalent exposure across groups and control for potential dosage effects. The post-intervention survey will be embedded in the last video, allowing participants to complete the survey immediately after finishing the final video. The videos and post-intervention survey will be distributed automatically through Outlook email. Based on the SAB’s recommendation, we plan to distribute one video daily allowing participants to complete all four videos within 1 week and ensuring consistent engagement throughout the intervention period. The pilot RCT is scheduled to take place in November 2025.

Figure 1. Phase 2 trial schema. CDC, the Centers for Disease Control and Prevention; HPV, human papillomavirus; SAB, Student Advisory Board.

In Qualtrics, the ‘Timing’ setting will be used to ensure participants watched each video in its entirety (average length: 1 min and 39 s). Following each video, participants will complete a short survey of five questions. Each survey includes one attention-check question specific to that video to assess attentiveness and maintain data quality, while the remaining four questions focus on the participants’ enjoyment of and engagement with the video.

Pre-intervention and post-intervention surveys will be used to measure multiple factors relevant to HPV vaccination, including socio-demographic characteristics, HPV knowledge, attitudes toward receiving the HPV vaccine, subjective norms regarding vaccination, perceived behavioural control over vaccination and vaccination intent. The survey measures will be drawn from empirical evidence and theoretical constructs associated with behavioural intentions and behaviour change. All survey questions will be adapted from prior research and have demonstrated reliability and validity.⁴⁰,⁴⁴ Table 1 provides examples of the measures that will be used to collect data at different time points. The SAB will review all study materials, including the assessment tools and modifications will be made based on the board’s input (measured outcomes are listed in table 1). 2 months after completion of the intervention, a follow-up Qualtrics survey (T2), using the same questions as the pre-intervention and post-intervention surveys plus two additional questions on self-reported vaccine uptake and satisfaction with the video intervention, will be sent to participants.

Table 1. Measurements.

	Scoring	Time
Outcome variables
Vaccination intention
Intention to vaccinate	3 items; Likert scale from 1 ‘strongly unlikely’ to 5 ‘strongly likely’	0	1	2
Vaccine uptake
Vaccine uptake (first dose)	Self-report (one yes/no item)			2
HPV attitudes
Attitudes toward HPV vaccination, with a lower score indicating more positive attitudes	5 items; Likert scale from 1 ‘strongly disagree’ to 5 ‘strongly agree’	0	1	2
Perceived behavioural control
Amount of control participants believe to have over engaging in vaccination behaviour	5 items; Likert scale from 1 ‘strongly disagree’ to 5 ‘strongly agree’	0	1	2
Subjective norms
Willingness to comply with reference groups that are important to them	4 items; Likert scale from 1 ‘strongly disagree’ to 5 ‘strongly agree’	0	1	2
Other variables
Socio-demographic and health43,46
Age, sex, family and self-cancer history, insurance, etc	~16 items; tested in our prior work	0
Moderator
Message fatigue39	5 items; Likert scale from 1 ‘strongly disagree’ to 5 ‘strongly agree’		1
Processing fluency	5 items; Likert scale from 1 ‘strongly disagree’ to 5 ‘strongly agree’		1
Confounding variables
Provider suggestion, education from other sources, others’ encouragement	3 items and open-ended question; tested in our prior work	0	1	2
Intervention dose
Intervention dose will be assessed by tracking video exposure			1	2
Satisfaction
Student’s satisfaction	Are you satisfied with this project? (1) very dissatisfied to (5) very satisfied Will you recommend the intervention to others? (1) definitely not to (5) definitely yes			2

HPV, human papillomavirus.

Five questions related to message fatigue will be asked to gather participants’ input because there are four videos, and we aim to assess how repeated exposure to similar health messages may influence engagement, attention and the effectiveness of message delivery.³⁷ Research has shown that repeated health communications can lead to message fatigue, which may reduce information processing, recall and behaviour change, so understanding participants’ perceptions will help optimise the intervention design. One sample question regarding message fatigue is ‘Messages about the HPV vaccine are tedious’.

The interventions (four intervention videos vs comparison CDC videos) and T0-T2 assessments will be administered online via Qualtrics. A resource kit including available resources to obtain vaccines will be provided to all participants after T2 assessment. We will also provide the video-based intervention to the students in the comparison arm after T2 assessment should they be interested. Each participant will receive appropriate compensation in graduated amounts for participating in surveys at each assessment period: T0 (US$10), T1 (US$15) and T2 (US$20).

Allocation

To minimise imbalances regarding college students’ sex, stratified block randomisation will be used. Two strata will be defined according to students’ self-identified sex. The RAND function in Excel will be used by the research team to generate a random numbers table (0=comparison group receiving videos based on control group; 1=intervention group). Participants were assigned randomly to either study condition.

Blinding

To increase the robustness of the study design and results, the team member who handles data and analysis will be blinded to the assignment of participants in the respective study arms. Each participant will be assigned a unique ID linked to respective random group assignments. One person on the research team will be unblinded and send out the reminder email to encourage participants to complete the survey and follow the study procedures as assigned. The reminder text is a message sent to participants to encourage them to complete the survey without revealing any additional information about the intervention or comparison condition, thus preserving the overall integrity of the study.

The Principal Investigator (PI) will closely monitor the procedures to ensure high treatment fidelity. In this study, fidelity for the video intervention is defined as the extent to which the intervention is delivered and received as intended in the study protocol. Fidelity will be maintained by ensuring that all participants in the intervention arm receive the same video content in the randomised sequence, delivered consistently through the designated platform. Specifically, one of the four videos will be distributed to participants in the video group daily via Qualtrics, following the planned schedule. Fidelity will also be monitored by tracking whether participants access and view the videos as intended, with reminders sent as needed to promote adherence. Participant exposure will be monitored through Qualtrics settings to confirm that videos are accessed and viewed as intended. By adhering closely to these procedures, the study will ensure that the intervention is implemented uniformly across participants, thereby enhancing both the validity and reliability of the findings.

Measures

Feasibility will be assessed by enrolment rate (proportion of eligible individuals agreeing to participate), retention (proportion retained through immediate post-intervention), intervention fidelity (% of participants watching all stories). Acceptability will be assessed via two Likert-type satisfaction questions. Based on our prior research (Chen et al, 2023), we will use the following benchmarks to determine study feasibility as ≥80% enrolment rate, ≥80% retention rate, ≥80% intervention fidelity and acceptability by a mean satisfaction score ≥4.0. Preliminary effectiveness will be determined by the % of participants completing the first HPV vaccine dose within 2 months of completing the intervention (T2).

Data management

All survey data will be collected and managed using Qualtrics, a secure web-based platform. All data management and analysis will be performed on secure data servers that are backed up daily. Each participant will be assigned a unique ID code to allow for linking of longitudinal surveys in the database. A key linking participant ID to personally identifying information will be kept on a separate password-protected and encrypted computer system and only accessible to the investigative team.

Data analysis

SAS V.9.4 (reference) will be used for the quantitative analyses described below. Descriptive statistics will be run to characterise the enrolled sample (mean and SD for continuous and number and frequency for categorical variables) and test for baseline differences between groups on key model variables using t-tests for continuous variables and χ² tests for categorical variables.

Feasibility and acceptability of the video-based intervention

Each intervention feasibility and acceptability metric (proportion enrolled, proportion retained through follow-up, proportion who watch all videos and complete T0-T2 assessments, satisfied with intervention) and its corresponding 95% CI will be computed for the entire sample and then examined for any differences by sex and ethnicity (using χ² analyses). The results will then be evaluated with respect to the a priori benchmark values described above.

All analyses examining preliminary effectiveness will be conducted as intent-to-treat. For vaccination intention, a repeated measures analysis of variance specifying sex and ethnicity as classification factors and the co-variates listed in table 1 will be conducted. A survival analysis will assess the uptake of the first dose of the HPV vaccine for both groups by 2 months post-intervention. Statistical significance is set at p<0.05 but we will also report effect size estimates or ORs to ascertain clinically meaningful results which may not be statistically significant. Although the study is not powered to conduct a mediational analysis, we plan to examine changes in potential mediators over time in order to compute effect size estimates which will be used to calculate sample size and power in a future larger trial. An exploratory analysis will examine the effect of intervention dose on vaccine uptake.

Missing data

To minimise missing data, we will employ effective strategies shown in our prior work: (1) bilingual/bicultural staff, (2) acknowledgement through compensations and (3) text message reminders regarding participation in survey data collection. Retention will be further enhanced by careful attention to participant burden and frequent recognition of their time and effort. Prior to conducting the main analyses, we will investigate whether there are differences in missing data between intervention groups.

Patient and public involvement

The study aims to develop and evaluate the effectiveness of a video-based intervention, co-created by college students and faculty mentors, to promote HPV vaccination intention and the uptake of the first dose of the HPV vaccine among their peers. We will involve eight college students who will provide valuable insights in designing and developing four videos as part of the intervention. These students, in collaboration with faculty from the College of Communication Arts and Sciences, will assist in refining the wording and clarity of the questionnaires and revising the videos based on feedback from the surveyed students. Additionally, we will recruit college students who have not received any doses of the HPV vaccine and invite them to watch the developed videos. Their feedback will be used to further revise the videos and enhance their effectiveness.

Depending on the type of study, completing the survey has no foreseeable risks or research-related injury. The study’s results will be disseminated to the broader public through multiple channels, including public forums, social media and seminars organised by the college health centre, community resource centres and local health departments. These dissemination efforts will not only increase awareness of the intervention but also provide practical guidance for its implementation in real-world settings. By sharing findings with key stakeholders and community partners, the study can inform strategies for scaling up the intervention to reach larger and more diverse populations. Additionally, feedback from these dissemination activities can support ongoing evaluation, adaptation and refinement of the intervention to ensure effectiveness and sustainability across different contexts.

Discussion

Promoting HPV vaccination intention and uptake should be a public health priority, as the HPV vaccine can prevent up to 90% of HPV-related cancers. Additionally, college students have a vital opportunity to catch up on HPV vaccination, as it is recommended for individuals up to age 26. This study has several strengths. First, current interventions aimed at increasing HPV vaccination rates primarily focus on adolescents as recipients.¹⁶ However, our study will focus on college students, including male and international students, who may hold misconceptions and have limited opportunities to receive the vaccine. By addressing these gaps, our study aims to influence attitudes toward the HPV vaccine by increasing awareness of the vaccine’s benefits and correcting misinformation. Prior research studies have reported that positive attitudes toward receiving the HPV vaccine among college students were a statistically significant predictor of behavioural intention to receive the HPV vaccine series in the next 12 months.^{30 45 46} Second, confirming the effectiveness of a video-based intervention can yield theoretical, clinical and societal contributions. The intervention is cost-effective, timely and scalable compared with treating cervical HPV-related conditions. The short videos can be delivered early in a convenient format, allowing participants to receive key information and act promptly. By promoting early HPV vaccination, the intervention has the potential to prevent HPV-related cancers, while producing and distributing the videos requires relatively low resources compared with the high costs of treating HPV-related cancers, including procedures, hospitalisation and follow-up care. It will enhance knowledge and positively shape participants’ PBC by showing how and where they can access the vaccine. Furthermore, the intervention may influence subjective norms by incorporating peer perspectives and trusted voices, potentially increasing perceived social approval of HPV vaccination. Ultimately, by targeting key constructs of the TPB, this intervention has the potential to improve both the intention to receive the HPV vaccine and the actual vaccination rates among college students—a population often overlooked in current HPV prevention efforts.

Additionally, healthcare providers may hesitate to strongly recommend the HPV vaccine due to discomfort discussing sexual health, fears of negative perceptions or lack of knowledge. If our intervention proves effective, it could serve as a model for developing evidence-based communication tools and training modules for providers. This would help them feel more confident and consistent in their vaccine recommendations, ultimately contributing to shifting clinical norms around discussing and promoting the HPV vaccine.

Our intervention will also be co-developed by an SAB, whose first-hand insights will help ensure the content is relevant and persuasive. This will further support TPB constructs by making the content more relatable, thereby increasing positive attitudes, shaping peer norms and reducing perceived barriers. SAB members will also benefit by gaining knowledge and becoming advocates, helping to extend the intervention’s impact. Future research should explore broader implementation and longer follow-up periods to assess sustained changes in intention and behaviour.

While the study focuses on college students, the findings may not fully generalise to other populations, as students differ in age, education, socioeconomic status and health behaviours. Additionally, the study setting, resources and campus culture may not reflect other communities. Future research should examine the intervention with more diverse populations to assess its effectiveness across different contexts.

Ethics and dissemination

Ethical approval from the Michigan State university’s Biomedical and Health Institutional Review Board has been obtained (Study ID: STUDY00010264). Written agreements were obtained from SAB members outlining their advisory role, expectations and voluntary nature of participation. E-consent will be obtained via Qualtrics survey from college students who agree to participate in the RCT study. All participants will be provided with a detailed explanation of the study objectives, the voluntary nature of their participation, their right to withdraw and the risks and benefits of the study. The consent form clearly states that participation in this research is voluntary. Each participant may choose not to participate, and they may stop at any time after the study has begun. If they decide to withdraw, there will be no consequences, no loss of benefits they would normally receive, and they will not be criticised in any way. The research team does not anticipate any risks associated with the study activities. If they agree to participate but later change their mind, they are free to withdraw at any time. If they have questions or concerns about their role and rights in the study, would like to obtain information, offer input or would like to register a report about this study, they may contact, anonymously if they wish, the host University’s Human Research Protection Programme by phone or by fax. The video-based intervention is designed to cause no physical or psychological harm to participants. However, if any unanticipated issues arise or if a participant experiences discomfort or distress during the SAB meeting, video creation or while completing the questionnaire, they may choose to withdraw from the study at any time. Additionally, participants have the option to skip any questions they do not wish to answer.

This pilot RCT is registered under ClinicalTrials.gov (registration number: NCT06397378). The study protocol follows the SPIRIT guidelines. Study findings will be: (1) shared with participating patients; (2) reported to funding bodies, affiliated institutions and the hospital; (3) presented at local, national and international conferences; and (4) disseminated through peer-reviewed publications.