Conversational Agents to Improve HPV Vaccine Acceptance in Primary Care

普遍接种人乳头瘤病毒(HPV)将显著减少宫颈、阴道、外阴、肛门、 和口腔癌，并减少这些癌症的种族差异。然而，美国的HPV疫苗接种率。 所有种族、民族和收入水平的青少年仍然远远低于国家目标。加强抗疫苗接种 信息，临床医生与犹豫不决的父母接触的时间有限，以及产生的预防护理积压 在COVID大流行期间，导致HPV疫苗接种不足，这可能需要数年时间才能解决。体现 对话代理(ECA)是模拟面对面对话的动画计算机代理 患者和照顾者，使用语言和非语言的对话行为，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地开发和评估了这种接口，以促进健康行为的改变 针对广泛人群，包括对非洲经委会的试点评价，该评价旨在促进为 子宫颈癌前病变和癌患者家属。在这个项目中，我们将采用这项技术来生产 用于HPV疫苗接种的英语和西班牙语智能手机ECA(ECA-HPV)提供疫苗建议 和对父母/监护人和符合疫苗条件的青少年进行激励性访谈，并促进 与诊所工作人员沟通。随着时间的推移，HPV疫苗的推广可以使父母接受 最初拒绝，非洲经委会可以在就诊之前和之后提供持续的互动。我们会 对9-12岁符合HPV疫苗资格的青少年进行随机对照试验评估ECA-HPV ECA-HPV，比较常规护理(UC)(n=175)和常规护理加上ECA-HPV的四个设计变体 (UC+ECA)(n=175 x 4=700)。所有干预参与者都将获得父母的ECA-HPV；设计 变种包括纳入与排除青少年Eca-HPV和纳入与排除临床 采用2x2析因设计从系统通知信息，以区分青少年的影响- 干预的面对面和临床告知特点。这个研究小组是全国公认的领军人物 在人乳头状瘤病毒疫苗接种、健康素养和改善健康的创新技术方面。这项研究将推动我们的 研究开发易于使用的技术来增强患者的能力。这种可伸缩的方法具有 在减少疫苗接种迟疑和增加青少年接种疫苗方面具有重大潜力。如果成功，我们的团队 将通过广泛实施的国家网络促进非洲经委会-HPV，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.