Pilot Testing of a Game-Based Intervention to Promote HPV Vaccination in Families with Unvaccinated Children

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ABSTRACT An estimated 80 million Americans are currently infected with human papilloma virus (HPV). HPV is strongly associated with cancers for females and males. High morbidity, mortality, and economic burden are attributable to HPV-associated cancers. Given the high infection rate of HPV in the US, vigorous prevention efforts are needed—including timely and effective HPV vaccination for boys and girls. Before COVID-19, the youth vaccination rate was suboptimal with about 50% youth 13-17 years having been vaccinated in contrast to the national goal of 80%. Vaccination rates dropped dramatically during the pandemic. Evidence for game- based health interventions is promising to facilitate knowledge acquisition and retention, and to promote vaccination behaviors in youth. As healthcare providers often find it challenging to promote HPV education and vaccination in clinical settings, an educational gamed-based intervention to promote HPV vaccination among youth in clinical settings offers an innovative and scalable approach to address this disparity in children’s healthcare. Guided by Social Cognitive Theory, we propose to (1) examine the feasibility and acceptability of a new HPV preventive intervention, the HPV Detective video game, designed for youth and their parents; (2) explore pre-post, intervention-related change in vaccine intent and uptake as well as change in theoretically posited intervention mediators; and (3) assess the potential for broader intervention implementation. Using a sequential mixed-methods, 2-group (intervention vs usual care), longitudinal design, 64 parent-youth dyads (32/per study condition) will be recruited. Parent-youth dyads in the intervention will play HPV Detective (tablet format) at the clinic prior to the healthcare provider visits. The control dyads will receive standard clinic treatment. Youth ages 11-14 need to receive two doses, 6-12 months apart, for maximum protection; thus, three weekly reminder messages will be sent 6-mos post enrollment to participants in both conditions. Data will be collected at T0 (baseline), T1 (immediately post game for intervention only) and at T2 (7-mos post enrollment). At 7-mo post enrollment, semi-structured interviews will be conducted with a subset of 8 parent- youth dyads in the intervention group, representing differences in child sex, age, and game completion, to solicit parent/youth feedback about factors that influenced their engagement in the intervention during the clinical visit; interviews with 3 healthcare providers (1 administer, 2 providers) will be conducted to examine factors related to intervention implementation. This study addresses the significant public health problem of HPV-associated cancers through timely youth vaccination, aligning with the mission of NIH. If the findings are promising, we will conduct a larger-scale RCT to examine the efficacy and effectiveness of the intervention that is likely to impact cancer-related morbidity and mortality, and reduce economic and social costs related to HPV-associated diseases. The findings will also extend prevention science with respect to the use of innovative computer technology to reduce incidence of HPV-associated cancers.