Targeted health communication is effective. Modifying content for different cultures – beyond language translation – can help to enhance understanding and improve health outcomes.
These days, digital educational interventions play a huge role in helping to educate community members outside the boundaries of traditional clinical care.
These online tools can also help to improve compliance in preventative medicine.
In our first Health Communication Research Review, we highlighted a study that suggested when health messages are rewritten and translated to be more culturally appropriate for a Hispanic audience, they are well received.
The researchers adapted an online HPV education tool, ‘Teen VaxScene’, for the Latino community – using community engagement.
The group hope to improve education and immunisation rates in this community by making the tool more relevant.
Invasive cervical cancer remains high in Hispanic women compared to other ethnic groups in the US. (The disease is high even after a higher rate of HPV vaccination in Hispanic women compared to other populations since the 2006 HPV vaccine licensure.)
The community members were involved in the development process.
Involving the community members in the development process of the online tool helped to make it highly relevant to the target audience.
And, although a community-based approach has been proven to enhance the effectiveness of vaccines, few studies have included community members in the development of a web-based vaccine-related intervention.
Using social and cultural information collected from surveys of parents of Hispanic adolescent women and young Hispanic adults over 12 months, the researchers could tailor information on the site that is acceptable and relatable to their characteristics, preferences and values.
Three themes emerged to allow changes to the design, technical and content in the existing site.
The researchers also changed the name to from Teen VaxScene “CHICOS: Combatting HPV Infection and CancerS”.
How the researchers addressed cultural barriers through content
Religious values and cultural issues associated with sexual abstinence, particularly among fathers of daughters (“she doesn’t need it”), were a strong cultural barrier for acceptance of HPV vaccination.
From the focus groups, the researchers found, “many parents believed that teens might see the vaccine as clearance for sexual promiscuity.”
In general, it is not a cultural norm for the Hispanic community to seek preventative medicine, especially if they are healthy.
Families turn to home remedies for the treatment of disease.
However, recommendations from the Centers for Disease Control and Prevention (CDC) are that 11 to 12-year-olds should get two doses of HPV vaccine to protect against cancers caused by HPV.
Disease-specific information was added to the intervention to explain that receiving the vaccine in adolescents, who are not yet sexually active, is the most effective form of prevention.
After speaking to community members, researchers identified key content gaps
The researchers found that the participants from the Hispanic community needed more information about HPV transmission, cause, risks and symptoms.
Researchers noted comments from community members, such as, “I heard this virus is carried by large mosquitoes, right?” or “What I have read is the boy is the only transmitter of the virus.”
These and other comments made researchers change the introductory information about the HPV vaccine to include details for how the HPV vaccine works with the immune system and detection and prevention of HPV.
Although very few study participants were men, male-oriented information was added to the intervention to clarify male risks.
This added information included the types and frequencies of cancers, how HPV is detected in women compared to men, and whether there are differences in side-effects between women and men from vaccination.
The researchers also changed the look and feel of the existing website to make it more user-friendly
To make the educational intervention easier to use for the target audience, the researchers streamlined the content for easy reading, with optional viewing for graphical representation of HPV.
Graphics were also used on the site to illustrate how the vaccine works with the immune system with labels for different body parts.
The overall look and feel of the website changed from appearing less clinical to incorporating brighter colours and a more family oriented logo.
The format was also changed to allow users to click on navigational arrows and pop-up menus to select content.
This work was done in preparation for a randomised trial to assess the impact of this modified intervention on HPV vaccination attitudes and uptake among Latino young adults and parents of adolescents.
“If effective, our intervention could be a resource for reducing HPV vaccination concerns, improving immunisation rates, and educating Latinos about HPV and the HPV vaccine outside of the time boundaries of the traditional clinical encounter,” the researchers wrote in their article.
It will be interesting to see the results of the follow-up RCT and whether the newly modified “CHICOS: Combatting HPV Infection and CancerS” site can influence HPV vaccination attitudes and uptake among Hispanic parents of adolescents and young adults.
- Maertens JA. Jimenez-Zambrano AM. Albright K. et al. Using community engagement to develop a web-based intervention for Latinos about the HPV vaccine Journal of Health Communication 2017;1-9
- Meites E, Kempe A, Markowitz LE. Use of a 2-Dose Schedule for Human Papillomavirus Vaccination — Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2016;65:1405–1408