Effect of a cervical cancer survivor story on willingness and behavioral change for Human Papillomavirus Vaccination: Randomized Controlled Trial (Preprint)

Abstract

Providing adequate information to parents who have children eligible for human papillomavirus (HPV) vaccination is essential to overcoming vaccine hesitancy in Japan, where the government recommendation has been suspended. However, prior trials assessing the effect of brief educational tools showed only limited effects on increasing the willingness of parents to vaccinate their daughters.

The aim of this trial was to assess the effect of a cervical cancer survivor story on the willingness of parents to get HPV vaccination for their daughters.

In this double-blinded, randomized controlled trial implemented online, we enrolled 2175 participants aged 30–59 years in March 2020 via a webpage and provided them with a questionnaire related to the following aspects: awareness regarding HPV infection and HPV vaccination, and willingness for HPV vaccination. Participants were randomly assigned (1:1) to see a short film of cervical cancer survivor story or nothing, stratified by sex (male vs. female) and willingness to HPV vaccination prior to randomization (Yes vs. No). The primary endpoint was the rate of parents who agreed to HPV vaccination for their daughters. The secondary endpoint was the rate of parents who agreed to HPV vaccination for their daughters and the HPV vaccination rate at 3 months.

Among 2175 participants, 1266 (58.2%) were men and 909 (41.8%) were women. A total of 191 (8.8%) participants were willing to consider HPV vaccination prior to randomization. Only 339 (15.6%) participants were aware of the benefits of HPV vaccination. In contrast, 562 (25.8%) patients were aware of the adverse events of HPV vaccination. Although only 476 (21.9%) of the respondents displayed a willingness to vaccinate their daughters for HPV, there were 7.5% more respondents in the intervention group with this willingness immediately after watching the short movie (odds ratio [OR] 1.55, 95% CI 1.27-1.91). In a sub-analysis, the willingness to vaccinate daughters for HPV was 10.9% higher in males in the intervention group (OR 1.75, 95% CI 1.36-2.25); however, such a difference was not observed among females (OR 1.25, 95% CI 0.86-1.81). Male participants were more likely to have willingness for HPV vaccination compared to female participants. In the follow-up survey at 3 months, 1807 (83.1%) participants responded. Of these, 149 (8.2%) responded that they had had their daughters receive vaccination during the 3 months, even though we could not see the effect of the intervention; 77 (7.9%) in the intervention group and 72 (8.7%) in the control group.

A cervical cancer survivor story increases immediate willingness to consider HPV vaccination, but the effect does not last for 3 months. Furthermore, this narrative approach to parents did not increase vaccination rates in children eligible for HPV vaccination.

UMIN Clinical Trials Registry UMIN000039273; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000043714.