Table 4.
HPV vaccination comparative message persuasiveness trials.
| Author, year and journal | Intervention (I) and control (C) | Outcome (O) and assessment (A) | Population | Setting | Time frame | Results RR (95%CI) or M ± SD unless otherwise noteda |
|---|---|---|---|---|---|---|
| Cox, 2010 Health Psychol41 |
Randomized, controlled trial I: 4 groups all given 1-page fact sheet about HPV infection and vaccine of varying presentations of HPV risk statistics. Some were also asked rhetorical questions to gain commitment to cancer prevention and thus, HPV vaccination: I1: Graphic risk presentation I2: Graphic risk presentation + rhetorical questions 13. Non-graphic risk presentation 14. Non-graphic risk presentation + rhetorical questions C: 2 groups both given 1-page fact sheet about HPV infection and vaccine plus: C1: Rhetorical questions C2: No additional information |
O: HPV vaccination intention for daughters A: Additive score of 3 survey items (1 = definitely would not get vaccinated, 5 = definitely would get vaccinated) assessed immediately post-intervention |
471 mothers of children ages 11–16 White non-Hispanic (58.4%), Black (21%), Hispanic (20%) No high school diploma (4.9%), high school diploma (50.5%), Some college (22.2%), College graduate or more (16.3%) Trade school (5.8%) |
Online participants from a US commercial sample vendor | Post-licensure. Date not specified | Graphic (I1 + I2): M= 12.96 Non-graphic (I3 + I4): M = 11.89 Control (C1 + C2): M= 11.88 P = 0.004 Rhetorical questions (I2 + I4 + C1): M = 12.60 No rhetorical questions (I1 + I3 +C2): M= 11.9 P = 0.033 |
| Notes: N per cohort not reported. No standard deviations for means reported. Outcomes for each treatment group not reported separately. Authors report a significant interaction between rhetorical question and risk presentation format (P = 0.035) such that in the all intervention conditions (in which participants were given statistical risk information either graphic or non-graphic), there was minimal effect of the rhetorical question; whereas, in the control conditions (without statistical risk information), there was a strongly positive effect of the rhetorical questions | ||||||
| DiClemente, 2011 Int J STD AIDS42 |
Randomized trial I: 3 groups all viewed HPV vaccine slide presentation of varying focus: I1: Cervical cancer prevention for women I2: Genital warts prevention for men I3: Head and neck cancer protection for men C: No control condition |
O: “Because the HPV vaccine is now available for use in men, how likely would you get the HPV vaccine within the next year?” A: Single item (1 = very unlikely to 6 = very likely) assessed pre- and immediately post-intervention |
150 male college students ages 18–24 Black (53.3%), White (19.3%), Asian or Pacific Islander (21.3%), other (6.1%) |
2 universities in Southern US | 10/09–12/09 post-licensure | Comparison of post-test scores for the 3 groups P = 0.56 (scores not specified) Pre-intervention (I1 + I2 + I3): 3.19 ± 1.33 Post-intervention (I1 + I2 + I3): 3.91 ± 1.34 P = 0.0001 |
| Notes: N per cohort not reported. Results also reported as comparison pre- to post-intervention | ||||||
| Dunlop, 2010 Commun Monogr43 |
Randomized, controlled trial I: 3 groups all listened to radio advertisement of varying format and some given 5-min discussion time afterwards: I1: Narrative ad (woman describes her cervical cancer treatment) + discussion I2: Informational ad (facts about HPV and cervical cancer) + discussion I3:Narrative ad only (no discussion) C: Informational ad only (no discussion) |
O: HPV vaccination intention A: Average score of 3 items, (1 =disagree strongly to 7 = agree strongly) assessed immediately post-intervention |
69 female college students ages 18–26 (in friendship dyads) | Australian University | Post-licensure Date not specified | No significant main effects of message format and discussion condition I1: 4.83 ±0.93 I2: 5.62± 1.16 I3: 5.8 ±0.73 C: 5.02± 1.31 |
| Notes: Authors report a significant interaction between message format and discussion time (P < 0.05) such that in the narrative condition, there was a negative effect of discussion time; whereas in the informational condition, there was no significant effect of discussion time | ||||||
| Fahy, 2010 Irish J Med Sci44 |
Randomized trial I: 2 groups both given 1-page fact sheet about HPV infection and vaccine of varying message frame: I1: Gain I2: Loss C: No control condition |
O: HPV vaccination intention for daughters A: Average score of 3 items, (1 =very unlikely or strongly disagree to 7 = very likely or strongly agree) assessed immediately post-intervention |
72 mothers of girls ages 8–16 | North County Kildare, Ireland | Post-licensure Date not specified. | I1:5.9 ±1.3 I2:5.62±1.4 P = 0.397 |
| Gainforth, 2012 J Health Psychol45 |
Randomized trial I: 4 groups presented with an online message of varying gain/loss and risk frames: I1: Gain, high-risk I2: Gain, low-risk I3: Loss, high-risk I4: Loss, low-risk C:No control condition |
O: HPV vaccination intention A: 3 items, each a 7 point scale (scale response categories not specified) assessed immediately post-intervention |
286 female college students with average age 22 White (80%) |
Canadian university | Post-licensure Date not specified. | Main effects: High-risk (I1 + I3): 20.00 ± 11.23 Low risk message (I2 +I4): 22.27±11.37 P = 0.04–0.05* (text and table report different P values) Gain (I1 + I2): 21.40 ± 11.59 Loss (I3 + I4): 20.81 ± 11.03 P = 0.81 |
| Notes: N per cohort not reported. How the HPV vaccination intention measure was scored was not specified. Authors also reported outcomes (not significant) for interactions among gain/loss, risk framing and history of Pap smear (not shown here) | ||||||
| Gainforth, 2012 Public Health Nursing46 |
Randomized trial I: 6 groups presented with an online message based on the Ontario government’s about HPV vaccine for parents of varying gain, loss or mixed frame: I1: Gain for parents of girls I2: Loss for parents of girls I3: Mixed for parents of girls I4: Gain for parents of boys I5: Loss for parents of boys I6: Mixed for parents of boys C:No control condition |
O: HPV vaccination intention for child within the next 3 years A: Single survey item (1 = strongly disagree to 7 = strongly agree) assessed immediately post-intervention |
367 parents of children in grades 5–7 ages 10–12 | Child-centered community and sporting events in Ontario, Canada | 10/09–3/10 post-licensure for girls (but pre-licensure for boys until 2/10) | No significant main effect of message frame on intention (scores and significance level not specified) N per cohort not reported |
| Notes: Authors also reported results for outcome of HPV vaccination attitudes (not shown here). No significant 3-way interaction among parent’s gender, child’s gender and message frame (P = 0.17–0.19) | ||||||
| Gerend, 2007 Health Psychol48 |
Randomized trial I: 2 groups both given 2-page fact sheet about HPV vaccine of varying message frame: I1: Gain I2: Loss C: No control condition |
O: HPV vaccination intention A: Average score of 5 items, (1 = very unlikely to 6 = very likely) assessed immediately post-intervention |
121 female college students White (85%), Black (10%), other(5%) Hispanic (12%) |
Florida State University | Pre- licensure Date not specified. | No significant main effect of message frame on intention (scores and significance level not specified) |
| Notes: N per cohort not reported. Authors report a significant interaction between message frame and number of lifetime partners (P = 0.035) as well as message frame and frequency of condom use (P = 0.002) in a regression model that included message frame, number of partners and condom use, and these two interaction terms. Authors also report a significant interaction between message frame and avoidance motivation (P = 0.043) in a regression model that included message frame, avoidance motivation, approach motivation and the interaction terms message frame × avoidance motivation and message frame × approach motivation | ||||||
| Gerend, 2008 Ann Behav Med49 |
Randomized trial I: 4 groups all given 2-page fact sheet of varying message frame and hypothetical number of HPV doses needed: I1: Gain, 6-shot series I2: Loss, 6-shot series I3: Gain, single shot I4: Loss, single shot C: No control condition |
O: HPV vaccination intention A: Average score of 5 items, (1 =very unlikely to 6 = very likely) assessed immediately post-intervention |
243 female college students White (76%), Black (13%), Asian/Pacific Islander (2%), other (8%) Hispanic (8%) |
University in Southern US | 11/2005 pre-licensure | I1:3.96 ± 1.54 I2:3.74 ± 1.72 P = 0.45 I3: 3.60 ± 1.55 I4: 4.65 ± 1.32 P < 0.001 |
| Notes: N per cohort not reported | ||||||
| Gerend, 2009 J Exp Soc Psychol50 |
Randomized trial I: 4 groups all given 2-page fact sheet about HPV infection and vaccine of varying message frame and color- threat priming: I1: Gain, red text box I2: Loss, red text box I3: Gain, gray text box I4: Loss, gray text box C: No control condition |
O: HPV vaccination intention A: Average score of 5 items (1 = very unlikely to 6 = very likely) assessed immediately post-intervention |
126 male college students | Florida State University | 01/2007–03/2007 pre-licensure for men | I1:3.62 ±0.259 I2: 4.41 ±0.237 P < 0.05 I3: 3.86±0.251 I4: 3.67 ±0.250 P > 0.5 |
| Notes: N per cohort not reported. Authors report a significant interaction between frame and color observed (P < 0.05) in regression model that included existence of a current sexual partner, message frame, color and the interaction term | ||||||
| Gerend, 2009 Sex Transm Dis47 |
Randomized trial I: 2 groups both given 2-page fact sheet about HPV infection and vaccine with varying additional content about: I1: Consequences for men I2: Consequences for men+women C: No control condition |
O: HPV vaccination intention A: Average score of 5 items, (1 = very unlikely to 6 = very likely) assessed immediately post-intervention |
356 heterosexual male college students White (84%), Black (4%), other/not reported (12%) Hispanic (14%) |
Florida State University | Pre-licensure for men (date not specified) | I1: 3.93 ± 1.40 I2: 3.78± 1.52 P > 0.15 |
| Notes: N per cohort not reported | ||||||
| Hopfer, 2012 Prev Sci51 |
Randomized, controlled trial I: 3 groups shown brief video about HPV vaccine in a narrative format delivered by varying source types: I1: peers I2: medical experts I3: peers and medical experts C: 3 groups shown varying video content: C1: HPV informational video without narrative C2: Campus website with information about HPV and the vaccine C3: No-message control |
O: Receipt of first HPV vaccine dose A: Single survey item (yes/no) assessed 2 months post-intervention |
404 female college students ages 18–26 White (72%), Black (10%), Asian-American (11%), Hispanic (5%), other (1%) |
Pennsylvania State University | 2008, Post-licensure | I1:17.8% vaccinated I2: 6.0% vaccinated I3: 21.8% vaccinated C: 11.8% vaccinated I1 vs. control (C1 + C2 + C3): 1.61 (0.80,3.28) 12 vs. control (C1 +C2 + C3): 0.48 (0.13,1.69) 13 vs. control (C1 +C2 + C3): 2.07 (1.05, 4.10) |
| Notes: N per cohort not reported. Authors also reported outcomes for HPV vaccination intention (not shown here) | ||||||
| Juraskova, 2011 Womens Health Issues52 |
Randomized trial I: 2 groups both given fact sheet about HPV disease and vaccine with framing paragraphs of varying focus: I1. Cervical cancer prevention I2. Cervical cancer + genital warts prevention C: No control condition |
O: Receipt of first HPV vaccine dose A: Single survey item (yes/no) assessed 2 months post-intervention |
75 female first-year college students age <27 | University of Sydney for course credit | 6/2007–8/2007 post-licensure | I1:33.3% vaccinated I2: 41.7% vaccinated (P = 0.61) 0.2 (−0.44, 0.56) |
| Notes: Authors presented vaccination outcomes as proportion immunized. Reviewers calculated P value and RR (95%CI). Authors also reported results for outcome of HPV vaccination intention and attitudes (not shown here) | ||||||
| Krieger, 2013 Health Commun53 |
Randomized trial I: 2 groups both given 1-page HPV vaccine fact sheet of varying focus: I1: Genital warts prevention I2: Cervical cancer prevention C: No control condition |
O: Intention to talk to doctor (daughters) or encourage daughter to talk to doctor (mothers) about HPV vaccination A: Average score of 3 items, (5-point Likert-type scale, higher score indicating higher intention) assessed immediately post-intervention |
188 female college students and 115 corresponding mothers Students: White (76%), Black (12%), Asian (8%), other (5%) Mothers: White (85%), Black (9%), Asian (5%), other (1%) |
US Midwestern university | Post-licensure. Date not specified | No significant direct effect of message focus on daughters’ or mothers’ intentions |
| Notes: No means or standard deviations provided. Authors also reported that self-efficacy and response efficacy sequentially mediated the positive indirect influence of the genital warts prevention message on HPV vaccination intention | ||||||
| Leader, 2009 J Womens Health54 |
Randomized trial I:3 groups all viewed online paragraph about HPV disease and vaccine with framing paragraphs of varying focus: I1. Cervical cancer prevention I2. Cervical cancer + sexually transmitted illness (STI) prevention I3. Cervical cancer + sexually transmitted illness (STI) prevention + suggestion that HPV vaccination may lead to sexual promiscuity C: No control condition |
O: HPV vaccination intention at little or no cost (women: for self and parents: for daughters) A:1 item, (1 = very unlikely to 5 = very likely) assessed immediately post-intervention |
635 adults White non-Hispanic (75%), Black non-Hispanic (11.4%), Hispanic (9.0%) More than high school graduation (55.7%) Income of > 50,000 (43.6%) |
Online participants from a US commercial sample vendor | June 2006 pre-licensure | Parents with daughters ages 9–17 only (n = 70): I1: 3.77 ± 1.45 I2: 3.21 ± 1.47 I3: 3.40 ± 1.23 P = 0.360 |
| Notes: Authors also reported separate analyses for HPV vaccination intention with out-of-pocket cost and for parents with daughters ages 0–8 and 18–26 and for women of any age (not shown here) | ||||||
| Lechuga, 2011 Ann Behav Med55 |
Randomized trial I: 2 groups, both given gain and loss-framed brochures about HPV virus and the vaccine in varying order: I1: Gain before loss I2:Loss before gain C:No control condition |
O: HPV vaccination intention A: Average score of 5 items, (1 =definitely no to 7 = definitely yes) assessed pre-intervention, after reading 1 brochure, and after reading 2 brochures |
150 mothers of daughters ages 9–17 White non-Hispanic (33.3%), Black (33.3%), Hispanic (33.3%) High school or less (59.3%), Some college (23.3%), College graduate (9.3%), Technical school (6.0%) |
4 Women, Infants and Children (WIC) supplemental nutrition clinics in Wisconsin | Post-licensure (date not specified) | No results reported for comparison of the two message framing orders (I1 vs. I2) overall ethnicities Pre-intervention: 5.13 ± 1.63 Post-intervention, after reading loss-framed message only: 6.51 ± 1.13 P < 0.05 Pre-intervention: 5.13 ± 1.63 Post-intervention, after reading gain-framed message only: 6.22 ± 1.28 P < 0.01 |
| Notes: Authors also reported separate analyses by racial/ethnic group (not shown here). Authors also reported marginally significant (P = 0.06) interaction between framing order and ethnic group such that both gain-and loss-framed messaged messages were equally effective in non-Hispanic white mothers; whereas, the loss-framed message was more effective in non-Hispanic African-American and Hispanic mothers | ||||||
| Nan, 2012 Health Commun56 |
Randomized trial I: 2 groups, both viewed online informational pamphlet about HPV infection and a section about HPV vaccine with varying message frame: I1: Gain I2: Loss C: No control condition |
O: HPV vaccination intention at no cost A: Average score of 3 items (1 = extremely unlikely to 7 = extremely likely) assessed immediately post-intervention |
229 male and female college students ages 18–26 White (61.1%), Black (11.4%), Asian (15.7%), other (7.4%) Hispanic (4.4%) |
University for course credit | Post-licensure (date not specified) | No main effect of message framing on intention P = 0.65 |
| Notes: N per cohort not reported. Author also reported separate analyses for HPV vaccination intention with out-of-pocket cost (not shown here). Authors also reported a significant interaction between message framing and motivation (P < 0.05) such that the loss-framed message was more effective for avoidance-oriented participants; whereas, both frames were equally effective for approach-oriented participants | ||||||
| Nan, 2012 Hum Commun Res57 |
Randomized trial I: 2 groups, both viewed online informational pamphlet about HPV infection and a section about HPV vaccine with varying message frame: I1: Gain I2: Loss C: No control condition |
O: HPV vaccination intention at no cost A: Average score of 3 items (1 =extremely unlikely to 7 = extremely likely) assessed immediately post-intervention |
282 male and female college students ages 18–26 White (65.8%), Black (9.9%), Asian (12.8%), Hispanic (5.5%), other (6%) |
Northeast university for course credit | Post-licensure (date not specified) | No significant main effect of message framing on intentions 0.05 ≤ P< 0.1 |
| Notes: N per cohort not reported. Author also reported separate analyses for HPV vaccination intention with out-of-pocket cost (not shown here). Author also reported a significant interaction between message framing and time orientation (P < 0.05) such that the loss-framed message was more effective for present-minded participants; whereas, both frames were equally persuasive for future-minded participants | ||||||
| Nan and Madden, 2012 Health Commun58 |
Randomized trial I: 2 groups, both viewed online blog with varying levels of support for HPV vaccine: I1: Positive blog (vaccine is “effective and safe”) I2: Negative blog (vaccine is “not effective and potentially dangerous”) C: No blog |
O: HPV vaccination intention at no cost A: Average score of 3 items (1 =extremely unlikely to 7 = extremely likely) assessed immediately post-intervention |
176 male and female college students White (63.9%), Black (10.9%), Asian (16.7%), Hispanic (4.4%), other (4.1%) |
Northeast university for course credit | Post-licensure Date not specified. | I1:4.872 ± 0.0205 (standard error) I2: 3.97 ±0.242 (standard error) P < 0.05 I1:4.872 ± 0.0205 (standard error) C: 4.781 ±0.214 (standard error) P < 0.05 I2 vs. C P ≥ 0.05 |
| Notes: N per cohort not reported. Author also reported separate analyses for HPV vaccination intention with out-of-pocket cost (not shown here) |
a
RR (95%CI) = relative risk (95% confidence intervals) where RR > 1 indicates higher and RR < 1 indicates lower HPV vaccine acceptance. M ± SD = mean ± standard deviation.