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Persuasive messaging for human papillomavirus vaccination by adolescent providers in a five-country multi-site study
  1. Janvier Rwamwejo1,
  2. Silvina Ramos2,
  3. Karen Morgan3,
  4. Karin Richter4,
  5. Chan Joo Kim5,
  6. Mercè Peris6 and
  7. Jennifer S Smith1,7
  1. 1 Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
  2. 2 Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
  3. 3 Perdana University Royal College of Surgeons in Ireland School of Medicine, Selangor, Malaysia
  4. 4 Department of Medical Virology, University of Pretoria, National Health Laboratory Service Pretoria, Pretoria, South Africa
  5. 5 Department of Obstetrics and Gynecology, The Catholic University of Korea, College of Medicine, St Paul’s Hospital, Seoul, South Korea
  6. 6 Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Institut Catala d’Oncologia, Barcelona, Spain
  7. 7 Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
  1. Correspondence to Jennifer S Smith, Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA; jennifers{at}


Objective Strong persuasive messaging by providers is a key predictor for patient acceptance of prophylactic human papillomavirus vaccination. We aimed to determine optimal messaging to promote human papillomavirus adolescent vaccination across different geographical sites.

Methods Adolescent providers (n = 151) from Argentina, Malaysia, South Africa, South Korea, and Spain were surveyed on messages, family decision makers, and sources of communication to best motivate parents to vaccinate their adolescent daughters overall, and against human papillomavirus. Multivariate logistic regression assessed the likelihood of recommending messages specifically targeted at cervical cancer with providers’ characteristics: gender, medical specialization, and previous administration of human papillomavirus vaccination.

Results Mothers were considered the most important human papillomavirus vaccination decision makers for their daughters (range 93%–100%). Television was cited as the best source of information on human papillomavirus vaccination in surveyed countries (range 56.5%–87.1%), except Spain where one-on-one discussions were most common (73.3%). Prevention messages were considered the most likely to motivate parents to vaccinate their daughters overall, and against human papillomavirus, in all five countries (range 30.8%–55.9%). Optimal messages emphasized cervical cancer prevention, and included strong provider recommendation to vaccinate, vaccine safety and efficacy, timely vaccination, and national policy for human papillomavirus vaccination. Pediatricians and obstetricians/gynecologists were more likely to cite that the best prevention messages should focus on cervical cancer (OR: 4.2, 95% CI: 1.17 to 15.02 vs other medical specialists).

Conclusions Provider communication messages that would motivate parents to vaccinate against human papillomavirus were based on strong recommendation emphasizing prevention of cervical cancer. To frame convincing messages to increase vaccination uptake, adolescent providers should receive updated training on human papillomavirus and associated cancers, while clearly addressing human papillomavirus vaccination safety and efficacy.

  • cervical cancer
  • human papillomavirus
  • vaccination
  • messaging
  • multi-site study

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  • Funding This study was an ancillary study to the GlaxoSmithKline Biologicals SA funded parent study (ID: 117339) which aimed to compare two versus three dose HPV vaccination. GSK was not involved in the conduct and analysis of this ancillary study. GSK was provided the opportunity to review this manuscript for accuracy, but the authors are solely responsible for final content and interpretation. Janvier Rwamwejo was supported by the University of North Carolina’s Graduate School Doctoral Merit Assistantship for study in Epidemiology during the completion of this work.

  • Patient consent Not required.

  • Ethics approval Study collaborators from each country received Institutional Review Board (IRB) approval from their respective institutions prior to data collection. UNC study staff received IRB approval for analysis of de-identified secondary data.

  • Provenance and peer review Not commissioned, externally peer reviewed.