Por Nuestros Hijos An educational program to increase HPV vaccination

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1 Por Nuestros Hijos An educational program to increase HPV vaccination Maria E Fernandez, PhD Professor of Health Promotion and Behavioral Sciences Director, Center for Health Promotion and Prevention Research

2 Cervical Cancer and Hispanic Women Hispanic women have among the highest rates of cervical cancer incidence and mortality in the U.S. Rates are 64% higher among Hispanics than non-hispanic whites in the US. Low rates of screening contribute to cervical cancer-related health disparities. American Cancer Society. Cancer Facts & Figures for Hispancis/Latinos Atlanta: American Cancer Society, 2012.

3 The HPV vaccine can protect against cervical cancer.

4 HPV Vaccine Coverage HPV vaccination rates in Texas and among Hispanics fall short of the Healthy People 2020 goal of 80% yrs Girls, 2014 Texas Hispanic 1 dose 51% 66% 3 doses 34% 47% 13-17yrs Boys, 2014 Texas Hispanic 1 dose 37% 54% 3 doses 18% 28%

5 Por Nuestros Hijos Our team developed two educational interventions for Hispanic parents, and we conducted a group randomized trial to assess their effectiveness in increasing HPV vaccination among Hispanic adolescent girls. Tailored Interactive Multimedia Intervention Print Fotonovella

6 Intervention Development We used Intervention Mapping (IM) to develop the two educational interventions. IM provides health promotion program planners with a systematic framework for developing theory- and evidence-based interventions. IM informs intervention planning, implementation, and evaluation.

7 Tailored Interactive Multimedia Intervention Delivered by Lay Health Workers Delivers messages through video, graphics, and animations Follows story of a mother learning about the HPV vaccine, talking to her doctor, and deciding to have her daughter vaccinated

8 Tailored Interactive Multimedia Intervention Tailored on language, knowledge, perceived risk of infection, perceived vaccine efficacy, and vaccination barriers Automatic tailoring based on user responses Do you think your daughter is at risk for HPV in the future? Self-tailoring based on user choosing information Please choose all of the concerns you have about the HPV vaccine. Example of self-tailoring

9 Print Fotonovella Delivered by Lay Health Workers Follows story of mother deciding to vaccinate daughter Story-telling format helps convey health information to individuals with low-literacy skills Employs theory and evidencebased methods such as social modeling and vicarious learning

10 Group Randomized Trial 30 clinics randomized to (1)standard care; (2) LHW-delivered fotonovella; (3)LHW-delivered ipad-based TIMI We conducted a group randomized trial and delivered interventions to parents of Hispanic adolescent girls in clinic waiting rooms. We recruited 1004 participants. Clinic eligibility criteria: 1)participate in Vaccine for Children s (VFC) program; 2) serve predominantly Hispanic communities Parent eligibility criteria: 1) self-identify as Hispanic; 2) have an unvaccinated daughter years of age We assessed vaccine initiation 6 months after baseline.

11 1 st Follow-up Baseline Group Randomized Trial 29 Clinics Eligible participants n= control clinics n= fotonovella clinics n=426 9 TIMI clinics n=260 n=267 (84%) --- Vaccinated = 24% n=351 (83%) --- Vaccinated = 34% n=198 (76%) --- Vaccinated = 32% Validated overall = 75% Validated overall = 85% Validated overall = 72%

12 Por Nuestros Hijas Results Parents receiving the TIMI and parents receiving the fotonella were significantly more likely to vaccinate their daughters at follow- up compared to parents in the control group. No significant difference in HPV initiation between the two interventions. Pre Protocol Intent-to-Treat Subjects Comparison OR (95% CI) p-value % vaccinated OR (95% CI) p-value Fotonovela vs. Control 1.65 ( ) % 24% 1.67 ( ) TIMI vs. Control 1.79 ( ) % 24% 1.63 ( ) 0.01 TIMI vs. Fotonovela 1.08 ( ) % 34% 0.98 ( ) 0.88

13 Next Steps Does the program work for parents of boys? Is the vaccine safe for David? We have tailored the interventions for parents of boys, and we will conduct a study to test their effectiveness in increasing HPV vaccination among Hispanic boys ages 11-17yrs. The HPV vaccine is as safe as the other vaccines that children David s age receive. The most common side effect is a little bit of pain on the arm at the injection site.

14 Next Steps Does adding a parental text message reminder increase HPV vaccination? We are currently conducing a sequential multiple assignment randomized trial (SMART) to test the effects of text messaging on HPV vaccination initiation. Text messages are based on a communication study examining the effects of agency assignment. HPV can infect your daughter and seriously harm her health. You can protect your daughter by having her vaccinated against HPV.

15 Next Steps How can we increase reach and effectiveness? Dissemination and Implementation of PNH across Texas Partnering with clinics, CHW organizations, and DSHS Breast and Cervical Cancer Services

16 Our Team and Contact Information For more information: Maria E. Fernández, PhD, PI Sally Vernon, PhD, Co-Investigator Lara Savas, PhD, Co-Investigator Paula Cuccaro, PhD, Co-Investigator Serena Rodriguez, MA, MPH, Project Co-Director Natalie Fernández- Espada, MS, Project Co-Director Jennifer Villamar, Research Assistant I Diana Lopez, Graduate Assistant Adriana Henriquez, Senior Data Collector