HPV Vaccination Uptake Among Adolescents

In this podcast, Anne Teitelman, PhD, discusses her team's study that investigated whether human papillomavirus (HPV) vaccination rates among adolescents could potentially be impacted by Vaccipack, a new mobile app that she and her team designed.

Additional resource:

• Teitelman AM, Gregory EF, Jayasinghe J, et al. Vaccipack, a mobile app to promote human papillomavirus vaccine uptake among adolescents aged 11 to 14 years: development and usability study. JMIR Nursing. 2020(3)1:e19503. doi:10.2196/19503
• Penn nursing's mobile app targets HPV vaccination gap. News release. Penn LDI. January 2021. Accessed January 21, 2021. https://ldi.upenn.edu/news/penn-nursings-mobile-app-targets-hpv-vaccination-gap

Anne Teitelman, PhD, is an associate professor of nursing and global women's health at the University of Pennsylvania in Philadelphia, Pennsylvania. 

TRANSCRIPT:

Leigh Precopio:  Hello everyone, and welcome to another installment of Podcasts360, your go‑to resource for medical news and clinical updates. I'm your moderator, Leigh Precopio with Consultant360 Specialty Network.

Just 49% of adolescents in the United States have completed the human papillomavirus, or HPV vaccine series, despite knowing that more than 90% of HPV‑related cancers could be prevented by widespread vaccination, according to the Centers for Disease Control and Prevention. As a result, healthcare providers are left to devise creative solutions to promote HPV vaccination and increase vaccination rates.

With us today is Dr. Anne Teitelman, who is an associate professor of nursing and global women's health at the University of Pennsylvania. Dr. Teitelman and her colleagues are the creators of Vaccipack, a mobile app designed to increase HPV vaccination uptake among adolescents.

Following the development of this mHealth technology, Dr. Teitelman and her team conducted a study that evaluated the acceptability and usability of the Vaccipack app. Thank you so much for joining me today. To begin, could you discuss the motivation behind conducting this study?

Dr Anne Teitelman:  I'm also a family nurse practitioner. We were very excited when the HPV vaccine first became available, HPV meaning human papillomavirus. Because it works so effectively at preventing cervical cancer and had a really good safety profile.

When it first became available, it was only available for adolescent girls and young women. I conducted an initial study with that group, because the uptake at that point was extremely low.

I was working in a clinic with young adult women. We began to study why these women weren't taking the vaccine and led to the development of another app that we have, which is called "Now I Know," for young adult women 18 to 26, to promote the HPV vaccine. Later, the vaccine was approved for boys and men as well as girls and young women, up from ages 9 through 26, both genders.

It also became increasingly clear that earlier vaccination was more effective than waiting until the 20s, the late teens or the early 20s. We now focused on the younger age group, the 11 to 14 year-old group, which is what's considered the primary vaccine recipients, or the primary series of getting the HPV vaccine for both boys and girls.

And so we started to look around for health promotion messages. One thing that happens with the HPV vaccine is that it requires two doses for this age group 11 to 14, and three doses for the older age group 15 to 26. While a person might get a vaccine, the second vaccine is often lost. We're concerned both with the initial uptake and then the completion of the vaccine.

Mobile apps are very good at reminding people when they're out of clinic, about a particular topic to augment the education they receive when they are at their clinic visit. We decided to work on developing an app to focus on this 11 to 14 year-old population to promote the vaccine uptake.

Leigh Precopio:  You and your team developed Vaccipack, a mobile app designed to increase HPV vaccination rates through the use of health behavior theory and parental beliefs. How is this app different from other available mHealth technologies for increasing vaccination rates?

Anne Teitelman:  So one of the ways that it's different is that a lot of apps out there do not try to target what we call modifiable determinants of health behavior, which are ways people view a behavior, such as taking the HPV vaccine. These are considered points at which we can educate individuals, and potentially influence their behavioral choices.

So we leveraged health behavior theory in order to identify these potentially modifiable determinants of health behaviors. That's one thing, and a lot of apps don't do that.

The other is that we also did a broad‑sweep evaluation of what apps are available in this group, in this area of vaccine promotion. We found that most of the vaccine apps that are out there are for infants and young children. There were no vaccine promotion apps for adolescents.

And partly that's because the number of adolescent vaccines has increased a great deal in the last several years. It's a new area that hasn't had much focus as the childhood vaccines.

There are a couple of apps that are out there that are for general adolescent health wellness. They include some information about vaccines, but it's not the focus of the app. Even those apps have not been evaluated for any impact or effectiveness at this point. We saw a huge gap that we wanted to fill with the creation of Vaccipack.

Leigh Precopio:  Your study notes that while parents and caregivers are the primary health decision‑makers for their adolescents, the app also helped to promote responsibility among adolescents for their health. What was the importance of including adolescents in your study, as well as parents?

Anne Teitelman:  Developmentally, adolescents in this age range 11 to 14 years of age are just beginning to take more responsibility for their own health care. We want to encourage that. We want to involve the teens, to the extent that they felt ready and interested to participate in the process of learning about vaccines.

As they get older, they will need their vaccine records for things like sports participation and entry into college. Now in the age of COVID, having a readily accessible vaccine record may take on even greater importance, because accessing this record may allow them entree into certain programs, services, schools, etc.

One thing I wanted to mention is that the name Vaccipack came from the adolescents who were part of our advisory board. They thought of Vaccipack as a way to carry their vaccine information in their backpack, and so they like this idea of Vaccipack.

That is the idea that it's readily accessible. Wherever they go, this information about their vaccines that we wanted them to have available to them and begin to learn more about vaccines, as they were ready to do so.

Leigh Precopio:  What are the key takeaway messages for physicians from the study? How can these key takeaways be implemented in clinical practice?

Anne Teitelman:  I mentioned that the HPV vaccine is one of several vaccines that adolescents now get. One recommendation is to make sure to include the HPV vaccine in the package of vaccines.

One thing that sometimes happens is that the HPV vaccine is singled out as separate by providers. I believe it is not mandated by many schools. Those laws are variable across the country, state by state. I can't make a general statement about what's required by schools.

In many locations, the HPV vaccine is not required where some of the other adolescent vaccines are, and so a physician might say or provider might say, "You need these vaccines for school. You could also get this other one, the HPV vaccine."

The recommendation would be to say, "There are this group of adolescent vaccines that we recommend that you take at this point," and not say, "You could wait on this one or you don't really need this one," or whatever.

That's one point of clinical relevance and that approach is recommended by the Centers for Disease Control and Prevention, and other professional groups of pediatricians and family practice providers.

The other is to make a strong recommendation for getting the HPV vaccine. It goes along with the first point I made about promoting HPV vaccine as part of a package but also saying, "I highly recommend this vaccine," coming from the provider.

If there were one determinant that I have seen in the literature as being most important for increasing the uptake of the HPV vaccine, it is the strong provider recommendation that is so important, that parents want to hear that.

Those are the main two points. The other I could put in a plug for Vaccipack and say that, it's a great way for parents and teens to keep track of adolescent vaccines. If providers knew about Vaccipack, maybe they could recommend that to their adolescents. It's just one tool, and there are perhaps other tools, but that is one tool that they could use.

Leigh Precopio:  What knowledge gaps still exist concerning mHealth technologies, such as the Vaccipack app?

Anne Teitelman:  While we know that Vaccipack is acceptable and that parents and teens thought it likely that they would use it, we still don't know if they used it, would it improve vaccine uptake and vaccine completion. We still have more work ahead of us to do in that area.

There have been a few studies that have shown that text messaging or reminder calls from providers' offices are effective at helping to improve vaccine uptake. That's encouraging, but more research needs to be done in this area around mobile applications that offer, not only vaccine reminder, but a way to keep track of the vaccine on their own.

What I mean by that is, it's a patient‑facing mobile application, which means the parent, the adolescent, is the target of the mobile app, and they are in control of it and they have the information readily available to them, and the education is meant for them.

A mobile app provides a greater depth of information than say, a text messaging program that a provider might offer. We still don't know the impact of these added features in terms of outcome.

You know I think our awareness of vaccine hesitancy has increased in recent months with COVID‑19 and the advent of the new COVID vaccines that are becoming available. It's important for us, as providers, to promptly message the importance of not only the HPV vaccine, but the COVID vaccine and other vaccines which are often life‑saving and have very good safety profiles.

Some of the lessons we have here in Vaccipack could translate to other types of vaccines such as COVID. I would say, we should use all the information we can to try to promote these new vaccines.

Leigh Precopio:  Thank you for joining me today, and answering all my questions.