HPV vaccine parental decision-making: The role of interpersonal and mass communication

Phokeng M. Dailey, M.A.

School of Communication

The Ohio State University

Human papillomavirus

Questions

1. What role does mass communication play in informing individuals about the HPV vaccine?

2. How are language and vaccine framing in interpersonal communication linked to HPV vaccine parental decision making?

3. What are the communication goals of parents when discussing HPV vaccination with their child and child’s health care provider (HCP)?

4. How do those communication goals inform parent-child & parent-HCP communication about the vaccine?

MYTHS vs THE FACTS

FACT:

Two HPV vaccines

1. Cervarix, for females 10 to 25

2. Gardasil for males & females 9 to 26

Myth 1: for girls only

Source: CDC, 2012

FACT:

Several types of cancer associated with HPV

Cervical

Anal

Penile

Oropharyngeal

Myth 2: vaccine only protects against cervical cancer so boys don’t need it

Source: CDC, 2012

FACT: Vaccines target HPV types that most commonly cause cervical

cancer Do NOT protect against all HPV types so they will not prevent

all cases of cervical cancer

Myth 3: hasn’t been proven to prevent HPV-related cervical cancer

Source: CDC, 2012

FACT:

Even people with one life-time sexual partner can get HPV

Myth 4: only people who have multiple sexual partners can get HPV

Source: CDC, 2012

FACT:

not associated with increased sexual activity related outcomes rates

Myth 5: leads to sexual promiscuity

Source: Bednarczyk, et al., 2012

FACT:

both vaccines are made with a very small part (protein outer coat) of the human papillomavirus

(HPV) that cannot cause infection.

Myth 6: vaccine gives you the virus so it can cause cancer

Source: CDC, 2012

Myth 7: serious side effects associated with the vaccine

Source: CDC, 2012

Mild to Moderate

local reaction (pain; redness; itching; swelling at injection site)

fever

nausea

dizziness

vomiting

syncope (fainting)

FACT:

Leading source of health information: MASS MEDIA

Public health information often presented in numbers & statistics Confusing; audience disinterested

Anti-vaccine campaigns often use of narratives anecdotes, quotations, vignettes, personal stories can lead to cancer-relevant belief and behavior change more effective than statistical evidence on some patient

outcomesSources: Green, 2006; Serpell & Mazoret al., 2007

Health Information

Top reasons parents cite for not vaccinating child (female)

Not needed or necessary 23.2%

Not sexually active 19.5%

Safety concern/side effects 19.3%

Lack of knowledge 15.2%

Not recommended by provider 9.6%

Source: NIS-Teen, 2011

VACCINE DECISION-MAKING: OMISSION BIAS the tendency for people to favor acts of omission over acts

of commission may lead to bias against vaccines

decision not to vaccinate is reversible, whereas deciding to vaccinate is not

Could account for why parents who express an intention to vaccinate or adopt certain avoidance or delay strategies

Sources: Petrovic, Roberts, Ramsay, & Charlett, 2003; Serpell & Green, 2006

VACCINE DECISION-MAKING: MULTIPLE GOALS IN COMMUNICATION

communication is purposeful and involves much more than interactions of behaviors or exchanges of information

Communication is typically strategic and individuals use communication to perform actions

Assumptions:

1. People enact multiple goals concurrently in communicative situations

2. People may enter a communicative exchange with competing goals

3. Individuals subjectively interpret the goals of others in conversations

Sources: Caughlin, 2010; Krieger et al, 2011

Challenges• Lack of awareness• Vaccine safety and impact on future

fertility• Health literacy

Knowledge

• Acronym use• Optional

Language

• Cultural and/or religious beliefsCulture

• Informed consent Ethical Issues

Themes

• Implications for sexual activity• Confusion: HPV & HIV• Optional therefore unnecessary

Language, Culture & Decision-

making

• Uncertainty: Vaccine efficacy• Uncertainty: Side-effects

Parent-HCP vaccine

communication

• Avoidance• Framing: Health promotion behavior

Parent-Child vaccine

communication

Language & Culture

• “It’s for the bad girls”

• “I don’t want her to think she’s protected and—I’m giving her the idea that it’s easy for her to do this—sex for a young girl.”

Sexual Activity

• “Maybe the doctor was saying we can protect from HPV with medicine. Maybe it’s different—maybe it’s same thing, HPV and HIV. It’s still something we can prevent with good behavior.”

• “I will tell her other ways you can get this. I’ll tell her you can get this from needles.”

HPV & HIV

• “From what I heard it’s like a seasonal vaccine. And every time you give it…he’ll get used to it…So the more you give the more the child gets immune to it and it won’t help anything.”

• “I’m not doing the vaccine for a thing that…to be honest it’s like the flu…And my daughter doesn’t have to get it [HPV]. She can make good decisions for health and not get it.”

OPTIONAL =

UNNECESSARY

Parent-HCP Communication

• “If I make an appointment…and the doctor says this is what your daughter is needing—this is something that is good for her then yes, this is something I would consider. If he says this is something that is for health then of course I‘m going to consider this. But I’m not sure yet if it works.”

Uncertainty: vaccine efficacy

• “I’m not a medical person—I’m not. Some have effect and benefit and some don’t. That’s what I believe. It could be the HPV [vaccine] has a benefit but it could also have a lot of problems.”

• “My cousin was given this HPV. He’s—now he’s not talking. He goes to school but is not normal in the healthy way. I see a lot of people—they complain about this vaccine.”

Uncertainty: side effects

Parent-Child Communication• “I don’t wanna tell about that one. She’s too young for that.

When they older—yah I will tell her”

• “No, I won’t tell my daughter. First of all she’s a kid. Second, she will now get the idea that my mom was giving me the immunization for the—something in terms of sexual outcome. I don’t want her to get the idea that’s what I was doing.”

Avoidance

• “I’m going to tell her this is like other immunizations that will help with preventing disease. I don’t have to talk about the other stuff. It’s not necessary when she’s so young. If it’s safe—in my idea I want to focus on good health.”

• “I’m going to tell him this is for health.—this shot is something that will prevent you from getting any infection from your wife if she is sick. But only for when you’re married.”

Framing: Health

promotion NOT STI prevention

ConclusionATTITUDE TOWARD VACCINES:

Generally hold favorable views about vaccines - do not necessarily extend to HPV vaccine

OMISSION

likely to choose omission if they believe vaccination uptake promotes sexual activity, but not as likely if they think vaccination promotes health.

COMMUNICATION GOALS:

communication preference (i.e. we don’t talk about sex) may determine how parents frame HPV vaccine discussions with their children – vaccine promotes health

CULTURAL VALUES

informs HPV vaccine decision-making and how parents talk to their children about the vaccine – sexual activity within marriage / avoid ance

Implications for practice Target female parents

Detailed discussion about efficacy and side-effects

Contextualize threat of exposure to HPV (an STI) marriage or when an individual desires pregnancy

Frame the vaccine as a health promotion behavior versus STI prevention behavior

 

THANK YOU

References

Bednarczyk, R. A., Davis, R., Ault, K., Orenstein, W., & Omer, S. B. (2012). Sexual activity-related outcomes after human papillomavirus vaccination of 11- to 12-year-olds. PEDIATRICS, 130, 798–805. doi:10.1542/peds.2012-1516

Caughlin, J. P. (2010). A multiple goals theory of personal relationships: Conceptual integration and program overview. Journal of Social and Personal Relationships, 27(6), 824–848.

Centers for Disease Control and Prevention. (2012, August 9). Sexually Transmitted Diseases (STDs): Genital HPV infection - Fact sheet. Retrieved September 17, 2012, from http://www.cdc.gov/std/HPV/HPV-Factsheet-Aug-2012.pdf

Green, M. C. (2006). Narratives and cancer communication. Journal of Communication, 56(s1), S163–S183. doi:10.1111/j.1460-2466.2006.00288.x

Krieger, J. L., Kam, J. A., Katz, M. L., & Roberto, A. J. (2011). Does mother know best? An actor-partner model of college-age women’s human papillomavirus vaccination behavior. Human Communication Research, 37(1), 107–124.

Mazor, K. M., Baril, J., Dugan, E., Spencer, F., Burgwinkle, P., & Gurwitz, J. H. (2007). Patient education about anticoagulant medication: is narrative evidence or statistical evidence more effective? Patient Education and Counseling, 69(1-3), 145–157. doi:10.1016/j.pec.2007.08.010

National Immunization Survey—Teen (2011). Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, National Center for Health Statistics. Available at www.cdc.gov/nchs/nis/data_files_teen.htm. Accessed December 14, 2011

Petrovic, M., Roberts, R. J., Ramsay, M., & Charlett, A. (2003). Parents’ attitude towards the second dose of measles, mumps and rubella vaccine: a case-control study. Communicable disease and public health / PHLS, 6(4), 325–329.

Serpell, L., & Green, J. (2006). Parental decision-making in childhood vaccination. Vaccine, 24(19), 4041–4046.