Does a Customized Website Affect HPV Vaccine Use among Latino Adolescents and Young Adults? [Internet]

Excerpt

Background: Human papillomavirus (HPV) causes a number of cancers and other diseases, several of which disproportionally affect Latinos. Unfortunately, Latinos also have poor uptake of HPV vaccines, which prevent HPV-associated diseases. There is a paucity of research on interventions to increase HPV vaccination among Latinos, which our work sought to address.

Objectives: The objectives of the project were to (1) use community input to create a web-based educational intervention for Latino young adults (aged 18-26) and parents of Latino adolescents (aged 9-17) that provided individually and culturally tailored information about HPV for Latinos; (2) compare the impact of the intervention vs an untailored web-based educational intervention based on the HPV Vaccine Information Sheet from the Centers for Disease Control and Prevention, vs usual care (individualized physician discussion of the vaccine and/or receipt of a paper version of the on HPV Vaccine Information Sheet) on vaccine use among young adults and adolescents.

Methods: In phase I, community input representing end-users of our intervention created the intervention for Latinos. In phase II, we evaluated this new intervention, called CHICOS (Combatting HPV Infection and Cancers), in a 3-armed, randomized controlled trial conducted in the waiting rooms of 5 family medicine practices serving mainly Latinos. We assessed the relative efficacy of CHICOS vs an untailored intervention, both of which were delivered via iPad, vs usual care for their impact on HPV vaccine uptake among adolescent and young adult Latinos. Eligible participants were English- or Spanish-speaking young adult patients (aged 18-26 years) or parents of Latino adolescents (aged 9-17 years) who reported not yet completing the 3-dose HPV vaccine series (ie, 0, 1, or 2 doses). Data on the primary outcomes—6 different measures of HPV vaccine uptake—came from the clinics' medical records and the statewide immunization registry. The primary analyses were 2-way comparisons between arms (ie, tailored vs untailored, tailored vs control, untailored vs control), stratified by adolescent vs young adult vaccination. We used multiple imputation to account for missing data and analyzed data using an intent-to-treat (ITT) approach. Secondary outcomes included changes in vaccination intention from before to after viewing the iPad materials (tailored and untailored arms only), time between study enrollment and HPV vaccine doses received (all arms), and patterns of utilization of the tailored and untailored websites.

Results: Significant Latino community input through a series of 6 focus group and quarterly meetings with a community advisory board in phase I was used to create CHICOS. Phase II enrolled 1294 parents and young adults. In the ITT analyses, nearly all vaccination outcomes assessed in 2-way comparisons demonstrated no statistically significant differences between groups. The 1 exception was completion of the series among adolescents who entered the study with at least 1 dose. In this analysis, the tailored group performed significantly better than the untailored group (odds ratio [OR], 2.0; 95% CI, 1.1-3.8) but there were no statistically significant differences in completing the 3-dose series among this subgroup when the tailored intervention was compared against usual care (OR, 1.6; 95% CI, 0.8-3.2). Few young adults received HPV doses. Individuals in the untailored arm took a statistically nonsignificant longer time to receive vaccine doses than those in the untailored or usual care arms. The untailored and tailored interventions significantly improved vaccination intention from baseline to postintervention; the amount of change was the same in the 2 groups.

Conclusions: Neither the tailored intervention nor the untailored intervention improved HPV vaccination outcomes in adolescents and young adults. In young adults, the rate of HPV vaccination was uniformly low across the 3 study arms, resulting in high rates of missing data.