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

摘要 据估计，目前有8000万美国人感染了人乳头瘤病毒(HPV)。人乳头瘤病毒是很强的 与女性和男性的癌症有关。高发病率、高死亡率和高经济负担 可归因于HPV相关癌症。鉴于美国HPV感染率较高，大力预防 需要作出努力，包括及时和有效地为男孩和女孩接种HPV疫苗。在新冠肺炎之前， 青年疫苗接种率次佳，13-17岁青年接种了疫苗的比例约为50%，相比之下 80%的国家目标。在大流行期间，疫苗接种率大幅下降。游戏的证据- 以健康为基础的干预措施有望促进知识的获取和保留，并促进 青少年接种疫苗行为调查。由于医疗保健提供者经常发现推广HPV教育和 临床环境下的疫苗接种，一种以游戏为基础的教育干预措施，以促进在 临床环境中的青年提供了一种创新和可扩展的方法来解决儿童 医疗保健。在社会认知理论的指导下，我们提出：(1)考察社会认知理论的可行性和可接受性 新的HPV预防干预，HPV侦探视频游戏，专为青少年及其父母设计；(2) 探讨疫苗接种意向和接种率在干预前后的变化以及理论上的变化 设定干预调解人；以及(3)评估实施更广泛干预的可能性。使用 序贯混合方法，2组(干预与常规护理)，纵向设计，亲子二人组 (32个/每个学习条件)将被招募。干预中的亲子二人组将扮演HPV Detective(平板电脑 格式)在医疗服务提供者就诊之前在诊所。对照二人组将接受标准诊所 治疗。11-14岁的青少年需要接种两剂疫苗，间隔6-12个月，以获得最大限度的保护；因此， 每周三条提醒消息将在注册后6个月内发送给两种情况下的参与者。数据将 在T0(基线)、T1(比赛后立即进行干预)和T2(7-MOS后)收集 注册)。在入学后7个月，将对8名家长进行半结构化面试- 干预组中的青年二人组，代表着儿童性别、年龄和游戏完成率的差异 征求家长/青少年对影响他们参与干预的因素的反馈 临床访问；将与3名医疗保健提供者(1名管理人员，2名提供者)进行面谈，以检查 影响干预实施的相关因素。这项研究解决了重大的公共卫生问题 通过及时为青年接种HPV相关癌症疫苗，与美国国立卫生研究院的使命保持一致。如果调查结果是 有希望的是，我们将进行更大规模的随机对照试验，以检查干预的有效性和有效性 可能会影响与癌症相关的发病率和死亡率，并降低与 人乳头瘤病毒相关疾病。这些发现还将扩展预防科学，涉及到使用 创新的计算机技术，以降低HPV相关癌症的发病率。

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.