To create a website that provides culturally tailored information about human papillomavirus (HPV) for Latinos and to assess if the website affects HPV vaccine decisions and actions among Latino adolescents and young adults compared with an untailored website and usual care.
|Randomized controlled trial
|308 Latino young adults and 498 Latino parents of adolescents
- Tailored educational website intervention for Latinos about HPV vaccination
- Untailored website intervention about HPV vaccination
- Usual care
Primary: HPV vaccine use
Secondary: vaccination decision quality, vaccination timing
|15-month follow-up for primary outcome
The research team conducted a three-group randomized controlled trial to test the effect of a culturally tailored website, called CHICOs, on HPV vaccination among Latinos. One group viewed CHICOs, one group viewed an untailored website, and one group received usual care. CHICOs, which stands for Combatting HPV Infection and Cancer, is a modified version of Youth VaxScene, a website designed to improve adolescent vaccine uptake. The team tailored the content and appearance of CHICOs for Latinos based on feedback from focus groups and a yearlong iterative feedback process with a community advisory board composed of Latino young adults and parents of Latino adolescents.
The research team based the untailored website on the Centers for Disease Control and Prevention’s Vaccine Information Statement (VIS) for HPV. Usual care refers to providers’ usual practice regarding HPV vaccine education for patients. Interviews before the study indicated that usual care consisted of providing a paper version of the VIS for HPV, discussing the vaccine, or not discussing the vaccine.
The study outcomes were HPV vaccine use, vaccination decision quality, and vaccination timing.
The study included 308 Latino young adults ages 18 to 26 and 498 Latino parents of adolescents ages 11 to 17. Participants lived in central Colorado. All young adults in the study were female, and 49% of the adolescents were female. The study took place in family healthcare clinics that primarily serve Latino patients with low incomes.
Participants in the CHICOs and untailored groups responded to questions about their HPV vaccination intentions before and after viewing the websites. These participants also completed a four-question survey on HPV vaccination decision making after viewing the websites. Participants in the usual-care group took the postintervention survey after completing doctor visits.
After 15 months, the research team collected data on participant vaccination status using health records and a statewide vaccination registry. Participants also completed a follow-up survey on HPV decision making.
HPV vaccine utilization. The study found no difference in HPV vaccination among the three groups. Among all adolescents in the study, 42–45% received at least one needed dose of the vaccine during the study. Among the young adults in the study, only 3–6% received at least one dose of the vaccine during the study. Subgroup analyses were limited due to the low vaccination rates for young adults.
Both CHICOs and the untailored intervention increased participants’ intentions to get the HPV vaccine (p<0.0001); the increase was about the same in the two groups.
HPV vaccination decision quality. Parents and young adults in the CHICOs and untailored groups understood the benefits and risks of the vaccine better than parents and young adults in the usual-care group immediately after the intervention (p=0.001) and at the 15-month follow-up (p=0.006). In addition, at the 15-month follow-up, more parents and young adults in the CHICOs group said they knew the benefits and risks of getting the vaccine than did parents and young adults in the untailored or usual-care groups (p=0.002).
Vaccination timing. The study did not find statistically significant differences in vaccination timing.
The research team was unable to link a high proportion of study participant names with electronic health records or the state vaccination database because of name discrepancies and other problems in initial enrollment. The team used imputation to account for the missing data, which led to high uncertainty in the study analyses. Reviewing the websites with the research team present may have made participants more likely to give the websites high ratings or masked any usability issues. In addition, no males chose to enroll in the young adult group.
Conclusions and Relevance
Among Latino young adults and adolescents, the CHICOs website did not increase HPV vaccination series completion compared with the untailored intervention or usual care. Both CHICOs and the untailored intervention did increase the intent to get the HPV vaccine among young adults and parents of adolescents.
Future Research Needs
Future studies could continue to examine how to increase HPV vaccination rates among Latino youths.