1. Amari Pearson-Fields, PhD, MPH1 and Tasha B. Moses, MPA2
#HPVFreeDC: Combining Peer Education and Social Media to Increase HPV Vaccination Rates Pilot
Amari Pearson-Fields, PhD, MPH1 and Tasha B. Moses, MPA2
1District of Columbia Department of Health, Community Health Administration, Cancer and Chronic Disease Bureau, 2Strategic Management Solutions, LLC
Human papillomavirus (HPV) has been linked to the development of anogenital cancers. According to the Centers for Disease Control and Prevention (CDC), 96% of cervical cancers, 51% of vulvar, 64% of vaginal, 36% of penile, 93% of anal and 63% of oropharyngeal cancers are linked to HPV. These cancers are almost entirely preventable by administration of the HPV vaccine. The District of Columbia (DC) was an early adopter of policies mandating HPV vaccination for school attendance. NIS-Teen data for 2015 reported 76.5% of girls and 73.0% of boys received the 1st dose; 58.8% and
40.9% of girls and boys respectively received the 3rd dose. Although HPV vaccination rates in DC are higher than the national average, the rates lag behind other vaccines, suggesting that missed opportunities for HPV vaccination exist. DC is testing an intervention to increase demand for the HPV vaccine and dose completion among youth ages using a peer-to-peer education, outreach and social media approach. The HPV Ambassadors Program intervention pilot will complement parental and provider targeted interventions occurring in DC.
Background & Challenge
Methods
A STI-focused HPV curriculum was adapted to apply a cancer prevention frame. The curriculum includes five modules on topics to include HPV and Cancer, the HPV Vaccine, Vaccine Safety Concerns and Community Outreach and utilizes activities such as role-play exercises, to reinforce concepts. Pre- and post-test evaluations are used to gauge knowledge acquisition.
During Phase One of the project, two pilot trainings have were held a total of 12 youth recruited to provide peer-to-peer education within their sphere of influence. Additionally, four VFC health centers, representing more than 30 clinics, were recruited to distribute #HPVFreeDC bandages and educational materials encouraging social media posts using #HPVFreeDC. Tracking was established to monitor hashtag utilization.
Phase One Results
Initial evaluation results from the pilot showed a 30% increase in knowledge acquisition as a result of the training. After the training, participants stated they felt prepared and excited to hit the field and provide outreach to their friends, families and more importantly, their peers. Further, participants who had not received the vaccine prior to the training expressed eagerness in being vaccinated.
Goals & Objectives
The HPV Ambassador Program is a project of the DC Comprehensive Cancer Control Program (CCCP) and the DC Cancer Action Partnership (CAP) that seeks to 1.) Accelerate HPV vaccination uptake and compliance among youth ages in DC and 2.) Empower youth to discuss and convey the importance of getting vaccinated against HPV as a means of preventing cancer with members of their peer group.
Project Overview
The CCCP and the CAP sought to implement a pilot intervention to increase demand for the HPV vaccine among youth ages in the District using a peer-to-peer and social media approach. The program encompasses three components:
A Peer-to-Peer Training Curriculum to train and empower youth ages to educate and discuss HPV, the vaccine and the importance of getting the vaccine to prevent cancer with members of their peer group. The curriculum is comprised of five modules on HPV, Correlation between HPV & Cancer, HPV Vaccines, Vaccine Safety Concerns and Community Outreach.
Trained HPV Ambassadors serve as the program’s “boots on the ground”. The HPV Ambassadors will perform outreach to and engage their peers in a variety of settings.
The #HPVFreeDC Social Media Campaign expands the program’s reach within those receiving peer led education. Bandages with the logo #HPVFreeDC and HPV information cards with and instructions on how to promote the hashtag are provided to Vaccines for Children (VFC) providers.
This program, coupled with provider education, will create a synergistic impact leading increased rates of HPV dose completion and reduced vaccination missed opportunities.
Lessons Learned
Key lessons learned throughout the pilot phase include:
Collaborate with the Immunization registry to target schools with low compliance and school-based health centers.
Obtain buy-in from school staff and administrators and work with them to plan trainings and activities to coincide with school schedules;
Identify a champion to support program promotion.
Recruit youth that have already been trained in as peer ambassadors. The knowledge base and experience of these youth truncates timeframe for implementation.
Next Steps
Phase Two of the pilot project will be used to address and build on lessons-learned during Phase One. Phase Two evaluation will measure program success in increasing HPV dose completion and reducing missed opportunities. Post-test and 6-month follow-up data on vaccine uptake will be collected from youth trained as HPV Ambassadors. Additionally, data from 2016 school-based HPV vaccination coverage and completion rates is being reviewed to establish a baseline from which to set goals for 2017 and beyond. Schools with low coverage and completion rates will be prioritized. DOH-managed school based health centers at high schools with low compliance will be leveraged to increase vaccination. Data from the immunization registry will be used to monitor vaccine increase for priority schools. VFC provider “booster” trainings and provider vaccine usage feedback and assessment will be used to improve clinical performance.
Acknowledgements
We gratefully acknowledge the curriculum developers Romico Davis, Nicole Offer, Chidozie Onyima, Danyell S. Wilson, PhD.
This project was supported by the Preventive Health and Health Services Block Grant (1NB01OT ), funded by the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or the Department of Health and Human Services.