Utilizing mHealth Technology to Increase HPV Knowledge and HPV Vaccine Uptake in Adolescents: A Qualitative Study

"Although there were many pros and cons associated with using mHealth technology for HPV, adolescents and young adults speak technology."

Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) in the United States (US), and is responsible for 99% of all cervical cancer cases worldwide. Although a vaccine is available to reduce the risk of HPV infection, immunisation coverage rates remain low worldwide - in part due to shortcomings in healthcare provider recommendations and reminders. In that context, this study sought to identify communication preferences for tailoring mHealth interventions, such as those using short messaging service (SMS), on HPV and what information in messaging should be included to increase HPV education, vaccination, and schedule adherence among youth.

The study was conducted among both male and female students at a large public university in Florida, US. Although the intended population for most HPV interventions is adolescents, college students were selected as the study participants because of (a) increased usage of new media technologies such as smart phones, the internet, social networking sites, and digital games, and (b) because of their identity (18-26 year olds) as the "catchup group" for HPV vaccination. A convenience sample of 210 students answered an online survey. Participants were mostly female (85.6%), Caucasian (60%), never been diagnosed with HPV (92.9%), and completed all 3 HPV vaccine doses (61.6%).

Select findings:

• Among all participants, 30% (n=51) indicated they would be receptive to receiving text messages on the HPV virus. A few of the emerging themes that stood out included increased awareness/knowledge, personalisation or tailoring of messages and the "extension of self" concept (phone as part of the self because of the power or control that can be forced upon it). Other themes also included using the text messages as appointment/vaccine reminders and as a simple source of information because of the ability to receive fast and easy-to-read updates. Seventy percent (n=121) indicated they did not want to receive text messages on the HPV virus, indicating they were concerned about the trust and reliability of the information and being spammed constantly based upon the timing and frequency of the messages. They preferred to receive HPV information from their doctor or from other communication channels such as a website or health magazine, or they would rather do their own research on the topic.
• When asked about receiving text messages relevant to the HPV vaccine, 24% of respondents (n=41) indicated they would be open to receiving the messages. Similar themes in support of using text messages for communicating about the HPV virus emerged for communicating about the vaccine. Among the 76% (n=131) who were against receiving information on the HPV vaccine over text SMS message, one theme to emerge was fear that receiving HPV vaccine messages on their phone which would communicate the wrong message to their friends and peers about their sexual health.
• Suggestions for messaging included that it should address: the effectiveness of the vaccine (n=78; 46%), their risk of acquiring HPV (n=69; 40%), and the safety of the vaccine (n=67; 37%). Other suggestions highlighted the importance for the intervention to be entertaining and personalised to the population of focus. Respondents were increasingly in favour of using personal testimonies from those with HPV, indicated the importance of using infographics/visual imagery, suggested that more focus should be on men, and communicated that they would like information about statistics/infection rates as a way to measure their own susceptibility to the disease.
• With regard to message framing, the students encouraged that the intervention not only focus on HPV but, rather, explore all STI information so that recipients could get a comprehensive overview of information related to their sexual health. They also thought messages should include information relevant to vaccine initiation and completion, and that recipients should have the ability to opt out. They valued getting the information from a credible source such as a reputable governmental health organisation or healthcare provider.
• The 35% (n=59) of respondents who were open to a mobile application indicated that an app would be more convenient for students, viewing it as a highly customisable communication channel by which to provide resourceful and relevant source of information. Sixty-five percent (n= 110) of the sample who were hesitant about the idea of using a mobile app to educate, inform, and motivate one to receive the HPV vaccine said they primarily used their apps for other functions (social media), did not use health apps overall, and, if they did, they preferred health apps like those used for physical activity and fitness tacking. Some said that if the app had the words "HPV" or an HPV icon, it could potentially be an embarrassing situation if the phone were lost or placed in the wrong hands.
• While the discussion or HPV can be a serious topic, respondents indicated they wanted an app to be not only informative but entertaining/interesting to use as well. They suggested that the app be free, updated frequently, incorporate great design to increase appeal for intended users, and feature a user-friendly interface. They thought that the app should be interactive in nature, and allow for a variety of features such as forums/chat rooms, embedded games, rewards/badges/incentives, push notification, and resources such as links to websites. Respondents also emphasised having the app log in features incorporate privacy safeguards such as anonymity. Lastly, they encouraged creative advertising and endorsement to increase credibility and usability.

"Taking all of this into consideration, healthcare providers should explore customizing their already existing technology practices (mobile apps and SMS text messages) to offer an alternative way to communicate with and connect with their young patients concerning the HPV vaccine. The information provided in this study can guide the creation of new mHealth strategies aimed at increasing HPV vaccine rates, diminish the uncomfortableness adolescents experience when discussing their sexual health with their healthcare provider and empower adolescents in their informed decision making skills regarding their health."