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Doctor Recommendations and Parents' HPV Vaccination Intentions in Kenya: A Randomized Survey

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Author

Affiliation

Carnegie Mellon University (Horn, Chapman); Busara Center for Behavioral Economics (Chouhan)

Date
Summary

"...visual communication of a doctor's support for the HPV vaccine can strengthen intentions and safety perceptions but may not be enough to persuade the vaccine hesitant to vaccinate."

In Kenya, cervical cancer is the leading cause of cancer deaths for women. The human papillomavirus (HPV) vaccine prevents cervical as well as anal, oral, penile, and vulvovaginal cancers. In 2019, the Kenyan government included the HPV vaccine in the national immunisation package, but vaccination rates have fallen well below the target. Doctor recommendations have been found to be a strong predictor of HPV vaccination uptake and trust in the United States. A possible approach to obtain the benefits of a doctor's recommendation without the logistical and systemic demands of an in-person visit in low-resource countries is through public health communication. This study investigates how doctors' endorsement of the HPV vaccine communicated through a low-cost intervention - that is, a public health poster - affects parents' decisions to vaccinate their daughters in Kenya.

In January and February 2021, 600 parents of daughters eligible for the HPV vaccine (8-11 years old) but not yet vaccinated in two predominantly urban counties in Kenya - Nairobi and Nakuru - were recruited and completed a randomised survey. Participants saw a poster from a national governmental campaign about HPV vaccination and either nothing further (control group) or an additional poster containing an HPV vaccine recommendation from a female doctor (FDR) or male doctor (MDR). Primary outcomes are intentions to vaccinate and perceived safety of the HPV vaccine.

Both recommendation arms increased the likelihood that participants reported the highest levels of vaccine intentions (FDR: 33.7% p = 0.01; MDR: 30.5%, p = 0.05, compared to control (22.4%)) and safety perceptions (FDR: 24.2%. p = 0.09; MDR: 28.0%, p = 0.01, compared to control (17.1%)), but there was no statistically significant increase in the likelihood to report above-moderate vaccine intentions (FDR: 72.6%, p = 0.76; MDR: 72.5%, p = 0.77, compared to control (71.4%)) or safety perceptions (FDR: 68.9%, p = 0.91; MDR: 75.0%, p = 0.17, compared to control (68.6%)). There was no differential treatment effect by the recommending doctor's gender.

Notably, 10% of the sample report being unlikely to obtain the HPV vaccine for their daughters, and 29% of the sample do not consider the vaccine to be very or extremely safe. These numbers suggest the need for an assessment of the predictors of HPV vaccine hesitancy in Sub-Saharan Africa to inform future interventions.

In terms of further research directions, the researchers note that these results speak only to the efficacy of a doctor's recommendation within a printed or online poster. Future research could compare the effect of doctor's recommendations when communicated in various media and identify the differential effect of each medium on vaccination uptake.

In conclusion, this study has found that "given the low-cost of this intervention, incorporating a doctor's recommendation into existing public health campaigns may be justified. However, the messaging should be evaluated against other potential message framings within the campaign's target population."

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Source

Preventive Medicine Reports, Volume 25, February 2022, 101659. https://doi.org/10.1016/j.pmedr.2021.101659. Image caption: Swahili text on FDR poster with English translations: "Nilichukua kiapo cha kulinda watu dhidi ya ugonjwa na kifo. Ndio maana napeana Chanjo ya HPV kwa Wagonjwa wangu." ("I took an oath to protect people against sickness and death. That is why I give the HPV vaccine to my patients"); "Chanjo ya HPV inalinda dhidi ya saratani ya mlango wa kizazi." ("The HPV vaccine protects against cervical cancer."); "Ni salama na inatolewa bure kwa wasichana wote wa miaka 10 katika vituo vya afya vya umma kote nchini." ("It is safe and offered free of charge to all 10 year old girls in public health facilities nationwide.")