Conversational Agents to Improve HPV Vaccine Acceptance in Primary Care

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Universal Human Papillomavirus (HPV) vaccination would significantly decrease cervical, vaginal, vulvar, anal, and oral cancers, and reduce racial disparities in these cancers. However, HPV vaccination rates for U.S. adolescents of all races, ethnicities, and income levels remain far below national targets. Increasing anti-vaccine information, limited clinician time to engage with hesitant parents, and backlogs of preventive care incurred during the COVID pandemic contributed to deficits of HPV vaccination that may years to resolve. Embodied Conversational Agents (ECAs) are animated computer agents that simulate face-to-face conversation between a patient and a caregiver, using both verbal and nonverbal conversational behavior, to provide a natural and intuitive computer interface that is accessible to patients of all levels of health and computer literacy. We have successfully developed and evaluated this interface in several clinical trials to motivate health behavior change for a wide range of populations, including a pilot evaluation of an ECA that promotes HPV vaccination for the families of patients with cervical pre-cancer and cancer. In this project we will adapt this technology to produce English and Spanish smartphone ECAs for HPV vaccination (ECA-HPV) to provide vaccine recommendations and motivational interviewing to parents/guardians and vaccine-eligible adolescents and facilitate communication with clinic staff. HPV vaccine promotion over time can lead to acceptance among parents who initially decline, and the ECA can provide continual interactions both prior to and following clinic visits. We will evaluate ECA-HPV in a randomized controlled trial for HPV-vaccine eligible adolescents aged 9-12 to evaluate ECA-HPV, comparing usual care (UC) (n=175) versus usual care plus four design variants of the ECA-HPV (UC+ECA) (n= 175 x 4 = 700). All intervention participants will get the ECA-HPV for the parent; the design variants include inclusion vs exclusion of ECA-HPV for the adolescent and inclusion vs exclusion of clinic notification of information from the system in a 2x2 factorial design to differentiate the impact of the adolescent- facing and clinic notification features of the intervention. The research team is nationally recognized as leaders in HPV vaccination, health literacy, and innovative technologies to improve health. This study will advance our research on the development of easy-to-use technologies to empower patients. This scalable approach has a significant potential to reduce vaccine hesitancy and increase adolescent vaccination. If successful, our team will promote the ECA-HPV through national networks for broad implementation and work to adapt ECA-HPV to include other childhood, adolescent, maternal, and adult immunizations.