Developing a self-persuasion intervention promoting adolescent HPV vaccination

描述（由申请人提供）：人乳头瘤病毒（HPV）相关癌症，包括宫颈、阴道、肛门和口咽，是美国医疗保健系统的重大负担，可以通过青少年HPV疫苗预防。尽管临床指南建议青少年女性和男性接种HPV疫苗，但美国青少年的HPV疫苗覆盖率并不理想（2010年，女性：1剂49%，3剂32%；男性：1剂2%）。在安全网医疗保健机构中，传统上得不到充分服务的患者（无保险、低收入、种族和少数民族）的发病率最低。许多青少年的父母对疫苗的态度是矛盾的，并推迟做出决定或与提供者讨论。自我说服——为健康行为提出自己的理由——对于尚未决定或没有动力做出疫苗决定的父母可能特别有效。通过三个阶段，我们将确定一个最佳的和可行的自我说服干预策略，以促进青少年HPV疫苗接种在安全网诊所。在第一阶段，我们将通过以下方式了解支持疫苗争论的内容和范围：对患者父母（n=50）进行认知访谈，以及在诊所访问期间父母-提供者HPV疫苗讨论的录音（n=50）。在第二阶段，我们将(a)利用第一阶段的研究结果开发四种自我说服干预条件，这些条件因认知加工水平（父母口头化vs.倾听争论）和争论主题的选择（父母选择vs.指定主题）而异。(b)通过一项受控的概念证明研究（n = 160）确定哪种干预条件是最佳的，该研究定量检查了基本的自我说服机制(认知加工，选择)并定性地探索干预任务的经验。在第三阶段，我们将在安全网诊所进行一项试点研究（n = 90）

DESCRIPTION (provided by applicant): Human papillomavirus (HPV) related cancers, including cervical, vaginal, anal, and oropharyngeal are a significant burden on the US healthcare system that can be prevented through adolescent HPV vaccination. Despite the fact that clinical guidelines recommend vaccination for adolescent females and males, HPV vaccine coverage among US adolescents is suboptimal (in 2010, females: 49% for 1 dose and 32% for all 3 doses; males: 2% for 1 dose). Rates are lowest among traditionally underserved patients (uninsured, low income, racial and ethnic minorities) seen in safety-net healthcare settings. Many parents of adolescents are ambivalent about the vaccine and delay making a decision or talking with a provider about it. Self-persuasion -generating one's own arguments for a health behavior - may be particularly effective for parents who are undecided or not motivated to make a vaccine decision. Through three stages, we will identify an optimal and feasible self-persuasion intervention strategy to promote adolescent HPV vaccination in safety-net clinics. In Stage 1, we will learn about the content and scope of pro-vaccine arguments through: cognitive interviews conducted with parents (n=50) of patients and audio recordings of parent-provider HPV vaccine discussions (n=50) during clinic visits. In Stage 2, we will (a) use findings from Stage 1 to develop four self-persuasion intervention conditions that vary by cognitive processing level (parents verbalize vs. listen to arguments) and choice of argument topics (parents choose vs. are assigned topics) and (b) identify which intervention condition is optimal through a controlled proof of concept study (n = 160) that quantitatively examines basic self-persuasion mechanisms (cognitive processing, choice) and qualitatively explores experiences with intervention tasks. In Stage 3, we will conduct a pilot study (n = 90) in the safety-net clinics to assess feasibility of the optimal intervention condition identified in Stage 2. We will also assess its impact on parent-provider discussions. The research will result in a feasible and acceptable self-persuasion intervention that can impact public health through prevention of HPV-related cancers. Our interdisciplinary team will be positioned to conduct a future efficacy trial of the sef-persuasion HPV vaccine intervention for underserved, undecided parents of adolescents and develop clinic-based self-persuasion approaches for other cancer prevention behaviors.