Michigan Improving Human Papillomavirus Vaccination

PSE Change Real-World Example – Step 5: Promote
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PSE Change Example

Problem: At the time of this initiative, 47.2% of girls and 28.6% of boys ages 13-17 received the recommended doses of HPV vaccine in Michigan1. An objective of the Cancer Plan for Michigan 2016-2020 (Cancer Plan) was to increase to 80% the proportion of children ages 13-17 who received the recommended doses. A dedicated workgroup of the Michigan Cancer Consortium (MCC) reviewed dating indicating that nationally, Hispanic women had the highest cervical cancer rates2 and focused on increasing HPV  vaccinations in that population. 

1Reagan-Steiner, S., Yankey, D., Jeyarajah, J., Elam-Evans, L.D., Curtis, C. R., MacNeil, J., … Singleton, J. A. (2016). National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2015. MMWR Morbidity and Mortality Weekly Report (65)33, 850–858. http://dx.doi.org/10.15585/mmwr.mm6533a4 

2National Program of Cancer Registries SEER*Stat Database: U.S. Cancer Statistics Incidence Analytic file 1998–2017. (2020). United States Department of Health and Human Services, Centers for Disease Control and Prevention. Released June 2020, based on the 2019 submission. 

PSE Change Solution: The workgroup held focus groups for the Latinx/a/o community, with translators available. Based on emergent themes, the workgroup developed a multimedia campaign with Spanish-language HPV public service announcements and an educational brochure. The information was disseminated using radio and newspaper advertisements. Messaging was culturally relevant.  

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Problem 

Human papillomavirus (HPV) causes almost all cases of cervical cancer, along with other cancers of the genitals, mouth and throat (Centers for Disease Control and Prevention [CDC], 2020; CDC 2018). The CDC recommends HPV vaccination at age 11 or 12 (CDC 2019). In 2015, the national averages of girls and boys ages 13-17 receiving the recommended three1 doses of HPV vaccine were 41.9% and 28.1%, respectively (Reagan-Steiner et al., 2016). In Michigan, 47.2% of girls and 28.6% of boys ages 13-17 received the recommended three doses (Reagan-Steiner et al., 2016). 

1CDC currently recommends two doses for children receiving the HPV vaccine before their 15th birthday. 

PSE Solution 

An objective of the Cancer Plan for Michigan 2016-2020 (Cancer Plan) was to increase to 80% the proportion of boys and girls ages 13-17 who receive at least three doses of the HPV vaccine (Michigan Cancer Consortium, 2015). The Michigan Cancer Consortium (MCC) chose this objective as one of its 2016-2017 priorities and assembled the MCC HPV Vaccine Priority Workgroup (HPV Workgroup). Based on a review of existing data (Step 3 – Assess), including data showing that nationally, Hispanic women have the highest cervical cancer rates (National Program of Cancer Registries SEER*Stat Database, 2020), workgroup members decided to focus on increasing HPV vaccinations in Michigan’s Latino population. A short-term outcome of this initiative was the development of a targeted education campaign to promote vaccine uptake. 

Actions/Results 

To ascertain knowledge among men and women about HPV and cervical cancer, and to assess participants’ reactions to three HPV vaccine advertisements, the HPV Workgroup conducted one focus group for Latino men (n=6) and another for Latina women (n=17) in the fall of 2016. Participants between the ages of 30 and 50 years old were recruited by the local health department. Translators were available to assist in both groups. Topics addressed included general cancer knowledge, HPV and cervical cancer specific knowledge, and a review of three advertisements about HPV vaccination. Recorded notes were analyzed for themes and consensus across the two groups. Focus group findings showed that: 

  • Most women were the primary health care decision makers for their families. 

  • More women reported using more sources of health information compared to men. These included physicians, online resources, friends and family. 

  • More women expressed interest in obtaining accurate information about vaccine dosing and age recommendations. 

  • Most women were unaware that the HPV vaccine could also benefit boys.

  • Most men were unaware of HPV and its effects on males. Both women and men expressed a need for Spanish-language HPV materials. 

Addressing the need for accessible information on HPV and the HPV vaccine, the HPV Workgroup developed a multimedia campaign with translated HPV public service announcements and an educational brochure. The information was disseminated using radio and newspaper advertisements. 

Success Factors and Key Questions Addressed 

How did you frame your message for each audience? 

Based on the findings from the focus groups, workgroup members determined that addressing parents and caregivers, using plain language in messaging, and making information relevant to the Latino community were important aspects of a communication campaign. 

What cultural and/or community norms were incorporated to strengthen the message and make it more acceptable to your intended audience(s)? 

Focus group feedback informed culturally-relevant messaging, resulting in the development of a multi-media campaign that featured Spanish-language HPV public service announcements and an educational brochure. Provider resources also were developed. 

Which media platform(s) were best suited to promoting your message and why? 

Along with distributing the educational brochure, radio advertisements were played on Spanish-language stations in three cities – Grand Rapids, Kalamazoo and Big Rapids. Print advertisements were placed in a widely circulated Spanish-language newspaper. Additional Spanish-language HPV resources were developed and added to the Michigan Cancer Consortium’s website for the first time. 

The radio ad aired in Hispanic media markets 100 times over 4 weeks. On Pandora there were 732,339 impressions, with a click-through rate of 0.28% (benchmark = 0.24%). On cross-screen digital, there were 2,853,349 impressions with a click-through rate of 0.78% (benchmark = 0.53%). There also were 10,000 impressions for print ads that were placed in a bilingual magazine. 

Next Steps 

The HPV Workgroup developed a project work plan for 2018-2019 that used the CDC’s Assessment, Feedback, Incentives, and eXchange (AFIX) model to assess the offering and administration of the HPV vaccine — according to current CDC recommendations — by providers to 9-to-26-year-olds in five regions of Michigan (Step 7 – Evaluate). 

Related Resources 

Read more about the Michigan Cancer Consortium’s HPV vaccination initiative in the Michigan Journal of Public Health

REFERENCES 

Centers for Disease Control and Prevention. (2020). Basic Information about HPV and Cancer, Retrieved from https://www.cdc.gov/cancer/hpv/basic_info/index.htm 

Centers for Disease Control and Prevention. (2019). Human Papillomavirus (HPV). Genital HPV Infection – Fact Sheet. Retrieved from https://www.cdc.gov/std/hpv/stdfact-hpv.htm 

Centers for Disease Control and Prevention. (2018). Cancers Associated with Human Papillomavirus by State, 2010- 2014. U.S. Cancer Statistics Data Briefs, No. 2. Retrieved from https://www.cdc.gov/cancer/uscs/about/data-briefs/no2-hpv-assoc-cancers-by-state-2010-2014.htm 

Michigan Cancer Consortium. (2015). Cancer Plan for Michigan 2016-2020. 

National Program of Cancer Registries SEER*Stat Database: U.S. Cancer Statistics Incidence Analytic file 1998–2017. (2020). United States Department of Health and Human Services, Centers for Disease Control and Prevention. Released June 2020, based on the 2019 submission. 

Reagan-Steiner, S., Yankey, D., Jeyarajah, J., Elam-Evans, L.D., Curtis, C. R., MacNeil, J., … Singleton, J. A. (2016). National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2015. MMWR Morbidity and Mortality Weekly Report (65)33, 850–858. http://dx.doi.org/10.15585/mmwr.mm6533a4 

Resources to Support Similar Evidence-Based Initiatives 

What Works for Health 

Community-based interventions for human papillomavirus (HPV) vaccination 

Evidence-Based Cancer Control Programs  

DOSE HPV: Development of Systems and Education for HPV Vaccination 

HPV Vaccine Decision Narratives: Encouraging Informed HPV Vaccine Decision-making 

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