Approximately 80 million people in the United States – or about one in four – are infected with human
papillomavirus (HPV). HPV can cause cancer and there are vaccines that protect against cancer-related strains.
Evidence supporting vaccine efficacy and safety is robust, and vaccine availability is widespread; however
coverage rates continue to fall short of the national goal of 80% (48.6% in 2017). Understanding the barriers to
vaccine acceptance, particularly related to parent resistance and their informational needs, is key to
strengthening vaccine uptake among adolescents. Communicating evidence to parents and engaging them
through narrative strategies may address some of the barriers during the decision-making process. Parents use
social media as an important parenting tool and useful source for health information. In 2015, 75% of all parents
used social media, and of these 1 in 4 used Twitter – equating to millions of parent users. We know that using
social media data for surveillance has had early impact in public health. However, what is not known is the
effectiveness of using large-scale social media data to inform a targeted social media intervention to support
HPV vaccine uptake. This study will advance the growing field by evaluating the efficacy of an innovative
narrative-focused intervention designed to communicate evidence and information about the HPV vaccine for
parents who use social media as a health information source. The approach is informed by narrative engagement
theory that posits narratives strengthen knowledge and promote engagement through storytelling by tapping into
feelings of empathy, identification, and transportation. We will evaluate the efficacy of our Twitter-based pilot
intervention in a randomized controlled trial that will enroll 600 parents/caregivers of children ages 9-14, whose
child(ren) has not started the vaccine series. Our central hypothesis is that exposure to narrative-focused
exemplar messages will lead to greater intention to vaccinate, and subsequently increased rates of vaccination
in the intervention group compared to parents in the comparison group, who receive non-narrative HPV vaccine
information (i.e., existing HPV vaccine information developed for Twitter). We will use a Twitter-based
Community Advisory Board, virtual focus groups, and existing Twitter messages developed by the HPV
Roundtable to inform narrative-focused message development. The proposed study will address three specific
aims: 1) Develop narrative-focused scientific exemplars for HPV vaccine communication utilizing existing online
messages and community engagement on Twitter; 2) Quantify differences in engagement, intention to vaccinate,
and self-reported vaccination between parents exposed to the narrative-focused scientific exemplars and parents
exposed to non-narrative scientific messages; 3) Collect and analyze longitudinal participant metadata to
measure Twitter activity during the study period. This study will impact the field of cancer prevention generally
and HPV vaccination specifically by establishing the efficacy of narrative-focused health messaging campaign
on social media, using a Twitter-based parent-engagement strategy.
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