Table 1.

Application of Health Belief Model and Theory of Reasoned Action to Educational Intervention Content

HBM/ TRA Constructs	Translating Constructs to the Intervention	Parent Brochure Content	Student Curriculum Content
HBM Constructs
Perceived susceptibility	Parents and adolescents must feel at risk for tetanus, diphtheria, pertussis, meningococcal, influenza and human papillomavirus	Information about how tetanus, diphtheria, pertussis, meningitis, influenza, and human papillomavirus are spread -It is spread through cuts, scratches or wounds (tetanus) -It is spread through coughing, sneezing (influenza, diphtheria and pertussis) -It is spread through coughing, kissing, sneezing or sharing items that touch a person’s mouth (meningococcal disease) -It is spread through sexual contact (human papillomavirus) -Infected adolescents can spread pertussis to infants	Information about how tetanus, diphtheria, pertussis, meningitis, influenza, and human papillomavirus are spread -Visual aids depicting the spread of disease -Interactive activity that models the spread of disease through the exchange of bodily fluids
Perceived severity	Parents and students must feel that the consequences of tetanus, diphtheria, pertussis, meningococcal, influenza and human papillomavirus are serious	Information about the seriousness of tetanus, diphtheria, pertussis, meningitis, influenza, and human papillomavirus -Influenza is a major cause of missed school days -10 to 15% of people with meningococcal disease die -HPV causes cervical cancer, which is the second leading cause of cancer deaths among women worldwide	Information about the seriousness of tetanus, diphtheria, pertussis, meningitis, influenza, and human papillomavirus
Perceived benefits	Parents and adolescents must believe that Tdap, MCV4, flu and HPV vaccination will be beneficial in terms of preventing disease	Information about how adolescent vaccines can help prevent adolescents from getting these diseases -Vaccines are the best way to prevent these diseases -Vaccines may be required before starting college or a new job -HPV vaccine is one of the few ways to prevent a type of cancer Information about how vaccination can help prevent adolescents from spreading disease to others -Teen vaccines not only protect them, but also their friends, family and community	Information about how the vaccines can help prevent adolescents from getting tetanus, diphtheria, pertussis, meningitis, influenza, and human papillomavirus Information about how to prevent spreading diseases to others -Visual images of the proper way to cover one’s cough or sneeze
Perceived barriers	Parents and adolescents must believe that they can overcome barriers that would prevent them from being vaccinated	Information dispelling myths about vaccines Visual images of parents accompanying teens, who are receiving vaccines	Information about vaccines safety -Vaccines are tested on tens of thousands of volunteers to ensure they are safe and effective -Potential mild side-effects from vaccination (mild fever, sore arm) Information about how vaccines work -Age appropriate video explains how vaccines are created
Cues to action	Parents’ and adolescents’ decision to obtain the vaccines will be influenced by various factors	The brochure serves as a cue to action -Visual cues of teens being vaccinated with parental support -Slogans including: “vaccines aren’t just for babies” and “Get your teen vaccinated”	Visual images of teens receiving vaccines
Self efficacy	Parents and adolescents must feel confident in their ability to get vaccinated	Motivational testimony from parents and a nurse practitioner on the importance of vaccination -“I had cervical cancer, so I got my daughter the vaccine for HPV. I don’t want her to go through what I went through” (Monique, Mother)	Visual images of teens receiving vaccines Information about where to get vaccinated
TRA Constructs
Social norms	Injunctive norms: Parents and adolescents must feel that their peers would approve of vaccination Descriptive norms: Parent and adolescents must believe that their peers receive vaccination	Pictures of multiethnic parents and adolescents receiving vaccines Motivational testimony from parents and a nurse practitioner	Students ask questions and answer to demonstrate their understanding of adolescent vaccines