User Engagement on a Novel Educational Health Intervention Aimed at Increasing HPV Vaccine Uptake in Hong Kong: A Qualitative Study

"...promising results which may hint at potentially increased vaccination uptake upon programme implementation in Hong Kong..."

Human papillomavirus (HPV) vaccine uptake rates are suboptimal in Hong Kong due to a combination of factors including low awareness, misinformation, distrust, inaccessibility, social attitudes, and more. Health education is a potentially effective solution to encourage vaccine acceptance and combat hesitancy. This study collects user feedback on the educational resources developed for a multi-disciplinary school-based HPV health-promotion programme (MDL-SHPVP) aimed at raising HPV knowledge levels and increasing vaccine uptake among girls aged 14-17 years (grades 8-11) in Hong Kong.

Twenty-six participants, including eight mother-daughter dyads, four teachers, three social workers, two school principals, and one school nurse, took part in the study. To cater to the diverse audience, ten educational videos, three animations, a digital game, and one booklet were developed for the programme and distributed to the participants for viewing. Semi-structured interviews were then conducted from January to March 2021 to collect feedback on the acceptability and effectiveness of the resources.

Prior to the study, most participants had little to no knowledge about HPV and HPV vaccination. Some had heard about them vaguely from television advertisements but only possessed superficial knowledge. The educational materials were well received and found to be effective in raising HPV knowledge levels, generating confidence in vaccine safety and effectiveness, and boosting vaccination intention. One participant expressed that they now felt confident in explaining the topic to others, which was an encouraging indicator of the resources' ability to not only fulfil learning needs but also to generate conversations about health amongst the community. In terms of feedback on particular resources, some examples include:

• The booklet on HPV was the most popular resource, as it was considered to be the most comprehensive and convenient source of information. The participants often preferred the booklet over the videos, as they felt it already contained information mentioned in the videos, could be viewed at their own pace, and was not as time-consuming as the videos.
• The animations were found to be engaging and appropriate for adolescents, while the healthcare provider (HCP) interview video was more popular with the parents. The involvement of HCPs was especially compelling, as the participants considered them to be authoritative sources of health information, and they trusted their knowledge on HPV vaccination.

Despite overall satisfaction with the resources, some doubts about the vaccination remained among participants. The most common concerned the 10-year protection duration of existing vaccines. Also, although progress was made regarding participants' perception of the necessity of early vaccination, one parent said they did not feel the urgency to get their daughter vaccinated and felt it would be better to wait. Challenges in intervention delivery, particularly in the context of the COVID-19 pandemic, were also identified. As school suspensions have been frequent and classes are often shifted online, some participants suggested that the programme could be delivered through online communication tools. While teachers believed that the convenience of online meetings may lead to increased participation among parents, there was no guarantee of students' attendance, and overall interactivity may be reduced.

Besides the videos and booklet, the participants were asked to comment on the feasibility of small-group discussions including parents, students, and healthcare workers at schools. Although most believed that interactions between the participants could encourage greater exchange and retention of information, there were frequent concerns regarding parent availability and students' willingness to participate actively.

The MDL-SHPVP team has implemented the recommendations provided during this study to further improve the materials (e.g., by adding subtitles to the videos to make them easier to understand). Future studies may explore educational interventions that aim to increase not only HPV vaccination intention but also a sense of urgency so as to encourage timely vaccination for adolescents at the ideal age. Study findings may provide direction for the development of similar health education interventions in other contexts.