Conversational Agents to Improve HPV Vaccine Acceptance in Primary Care

普遍的人乳头瘤病毒（HPV）疫苗接种将显着减少宫颈，阴道，外阴，肛门， 和口腔癌，并减少这些癌症的种族差异。HPV疫苗接种率在美国 所有种族、族裔和收入水平的青少年仍然远远低于国家目标。增加抗疫苗 信息，临床医生与犹豫不决的父母接触的时间有限，以及预防性护理的积压 在COVID大流行期间导致HPV疫苗接种不足，可能需要数年才能解决。体现 会话代理（ECA）是动画计算机代理，模拟面对面的对话， 患者和护理者使用语言和非语言的会话行为，以提供自然和 直观的计算机界面，可供所有健康水平和计算机素养的患者使用。我们有 在几项临床试验中成功开发并评估了该界面，以促进健康行为改变 包括对ECA进行试点评估，该ECA促进HPV疫苗接种， 宫颈癌前病变和宫颈癌患者家属。在这个项目中，我们将采用这种技术来生产 英语和西班牙语智能手机ECAs用于HPV疫苗接种（ECA-HPV），以提供疫苗建议 对父母/监护人和符合接种条件的青少年进行动机性访谈， 与诊所工作人员沟通。随着时间的推移，HPV疫苗的推广可能会导致父母的接受， 在最初的情况下，ECA可以在诊所访问之前和之后提供持续的互动。我们将 在一项针对9-12岁符合HPV疫苗接种条件的青少年的随机对照试验中评估ECA-HPV， ECA-HPV，比较常规治疗（UC）（n=175）与常规治疗加ECA-HPV的4种设计变体 (UC+ECA）（n= 175 x 4 = 700）。所有干预参与者将获得父母的ECA-HPV;设计 变量包括青少年ECA-HPV的纳入与排除，以及诊所ECA-HPV的纳入与排除。 在2x2析因设计中通知来自系统的信息，以区分青少年的影响- 干预的面向和诊所通知特征。该研究团队是全国公认的领导者 HPV疫苗接种、健康知识普及和创新技术以改善健康。这项研究将促进我们的 研究开发易于使用的技术，以增强患者的能力。这种可扩展的方法具有 减少疫苗犹豫和增加青少年疫苗接种的巨大潜力。如果成功，我们的团队 将通过国家网络推广ECA-HPV，以广泛实施，并努力使ECA-HPV适应 包括其他儿童、青少年、产妇和成人免疫接种。

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.