An Educational Intervention to Improve HPV Vaccination: A Cluster Randomized Trial

Abstract

Background: Human Papillomavirus (HPV) infection can lead to serious health issues and remains the most common sexually transmitted infection. Despite availability of effective vaccines, HPV vaccination rates are suboptimal. Methods: In a cluster randomized trial, an intervention targeting parents of adolescents (11-17 years) eligible for a dose of HPV vaccine was tested in pediatric clinics part of an urban health system. Parents watched a digital video outlining the risks and benefits of vaccine using a tablet in the exam room. The primary outcome was change in HPV vaccine status two weeks after the clinic visit. An intention to treat analysis for the primary outcome utilized generalized estimating equations to accommodate the potential cluster effect of clinics. Results: A total of 1596 eligible adolescents were observed during the 7-month trial. One-third of adolescents visited an intervention clinic. Adolescents who attended an intervention clinic were more likely to be younger (11-12 years) than those who attended a control clinic (72.4% versus 49.8%; p<0.001). No differences in race or gender were observed. The proportion of adolescents with an observed change in vaccine status was higher for those attending an intervention clinic (64.8%) versus control clinic (50.1%; OR=1.82; 95% CI=1.47-2.25; p<0.001). Adolescents whose parents watched the video had a three times greater odds of receiving a dose of the HPV vaccine (78.0%; OR=3.07; 95% CI=1.47-6.42; p=0.003). Conclusions: Educational interventions delivered within a clinical setting hold promise to improve vaccination behaviors.