Utilizing mHealth technology to increase HPV knowledge and HPV vaccine uptake in adolescents: A qualitative study

This study sought to identify communication preferences for tailoring mHealth interventions on HPV and what information in messaging should be included to increase HPV education, vaccination and schedule adherence among youth. A convenient sample of 210 students answered an online survey. Participants were 18 – 25 years old (88%), female (85.6%), Caucasian (60%), never been diagnosed with HPV (92.9%) and completed all 3 doses (61.6%). Our respondents were initially hesitant to use SMS text messages and mobile apps for HPV primarily due to privacy, memory and data cost concerns but thought the personalization options would increase message saliency and information trustworthiness if sent by a healthcare provider. Healthcare providers should use the information to tailor HPV and sexual health interventions

Differences in Current Hookah and Cigarette Smoking Status Attitudes and Beliefs at a Florida University: A Discriminant Analysis

Rising college hookah use, in the absence of cigarettes, suggests attitudinal differences among both forms of tobacco consumption. This study examines which smoking attitudes/beliefs are most distinguishing across current non-smokers, cigarette smokers, hookah smokers, and dual (cigarette and hookah-only) smokers at a Florida university. Self- administered questionnaire data from 373 university students were categorized into four groups based on self-reported 30-day smoking status. Discriminant analysis was used to examine maximal differences between groups across perceived peer acceptability of cigarette smoking, peer acceptability of hookah smoking, hookah smoking harmfulness, and attitude toward peer hookah smoking. Descriptive analyses indicated an overall awareness of hookah smoking harmfulness across all four groups. Discriminant analysis findings indicated peer acceptability of cigarette smoking (r = .75) contributed the most to attitude/belief differences across all four groups. Pairwise group comparisons showed a significant attitudinal mean difference in peer acceptability to cigarettes for cigarette smokers vs hookah smokers (T=3.9, p=.001). Study findings underscore the need for campus-based anti-smoking social norm approaches targeting positive hookah smoking peer use attitudes. Programming efforts are recommended to implement the use of self-reported perceived peer acceptability to cigarette smoking as a potential risk indicator for students at-risk for cigarette or dual use

How Health Care Providers Can Use Digital Health Technologies to Inform Human Papillomavirus (HPV) Decision Making and Promote the HPV Vaccine Uptake Among Adolescents and Young Adults

High-risk stains of human papillomavirus (HPV) is linked to causing cancer, is highly prevalent, and has increased incidence among adolescents and young adults. However, vaccination rates are low. Health care provider recommendation is the biggest influencer toward vaccine uptake. Since more health care providers are using digital health technologies in their medical practices, this study investigated the feasibility of technology to increase informed decision making. A convenience sample of 210 students completed an online survey. Participants were 18–25 years of age (88%), female (85%), Caucasian (60%), and never been diagnosed with HPV (92.9%). Overwhelmingly, participants owned a smartphone (98.9%) and used mobile apps for health/health tracking (65.5%). However, only 29.3% indicated that they received text messages from their health care provider. Digital health technology can be a cost-effective way for increasing HPV knowledge, removing barriers, and increasing vaccine uptake. Health care providers should explore using various platforms to empower their health care decision making

Designing and Testing an Inventory for Measuring Social Media Competency of Certified Health Education Specialists

Objective: The aim of this study was to design, develop, and test the Social Media Competency Inventory (SMCI) for CHES and MCHES. Methods: The SMCI was designed in three sequential phases: (1) Conceptualization and Domain Specifications, (2) Item Development, and (3) Inventory Testing and Finalization. Phase 1 consisted of a literature review, concept operationalization, and expert reviews. Phase 2 involved an expert panel (n=4) review, think-aloud sessions with a small representative sample of CHES/MCHES (n=10), a pilot test (n=36), and classical test theory analyses to develop the initial version of the SMCI. Phase 3 included a field test of the SMCI with a random sample of CHES and MCHES (n=353), factor and Rasch analyses, and development of SMCI administration and interpretation guidelines. Results: Six constructs adapted from the unified theory of acceptance and use of technology and the integrated behavioral model were identified for assessing social media competency: (1) Social Media Self-Efficacy, (2) Social Media Experience, (3) Effort Expectancy, (4) Performance Expectancy, (5) Facilitating Conditions, and (6) Social Influence. The initial item pool included 148 items. After the pilot test, 16 items were removed or revised because of low item discrimination (r.90), or based on feedback received from pilot participants. During the psychometric analysis of the field test data, 52 items were removed due to low discrimination, evidence of content redundancy, low R-squared value, or poor item infit or outfit. Psychometric analyses of the data revealed acceptable reliability evidence for the following scales: Social Media Self-Efficacy (alpha=.98, item reliability=.98, item separation=6.76), Social Media Experience (alpha=.98, item reliability=.98, item separation=6.24), Effort Expectancy(alpha =.74, item reliability=.95, item separation=4.15), Performance Expectancy (alpha =.81, item reliability=.99, item separation=10.09), Facilitating Conditions (alpha =.66, item reliability=.99, item separation=16.04), and Social Influence (alpha =.66, item reliability=.93, item separation=3.77). There was some evidence of local dependence among the scales, with several observed residual correlations above |.20|. Conclusions: Through the multistage instrument-development process, sufficient reliability and validity evidence was collected in support of the purpose and intended use of the SMCI. The SMCI can be used to assess the readiness of health education specialists to effectively use social media for health promotion research and practice. Future research should explore associations across constructs within the SMCI and evaluate the ability of SMCI scores to predict social media use and performance among CHES and MCHES

mHealth Video Gaming For Human Papillomavirus Vaccination Among College Men-Qualitative Inquiry For Development

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Persistent infection with HPV can cause various cancers; however, HPV vaccination can prevent infections associated with high risk, cancerous strains of the virus. As it relates to HPV, college age men have been identified as one of the catch-up vaccination groups. Among college age men, gaming is an extremely popular extracurricular activity. Further, video games have emerged as a popular public health intervention tool. Therefore, this study aims to collect qualitative data on how to develop, implement and evaluate the effectiveness of a gaming intervention to increase HPV risk perceptions, improve self-efficacy and increase intention to receive the HPV vaccine among male college students (18–26 years old). Methods: Four focus group sessions ranging from eight to ten individuals were conducted among male college students from one large research-intensive university in the South. Using grounded theory, data from focus group interviews were coded using NVivo software to identify emergent themes. Results: Participants emphasized that although customization was not viewed as important by college aged males, the ability to tailor in game experiences or experience different things each time they played (creative freedom) was more important. They encouraged that the digital game be created on a mobile platform, incorporate health messages, and be informative to reach their population. Furthermore, they suggested innovative way to disseminate the game, which included having health department/health care providers prescribe the game to patients as an end of clinical interaction strategy. Conclusions: College age men, are natural avid gamers, enjoy game play, and can engage in learning online or offline. While platform preference varies among gamer type, college age men in our study emphasized that mobile based gaming is the most advantageous way to increase knowledge/awareness and encourage positive in game behavior which can impact out of game behaviors such as vaccination. Because of the level of access and natural disposition of mHealth technology seen as an “extension of the self”, games for health developers should consider the mobile platform as the ideal for the target demographic

“Someone You Love” Documentary: Using Narratives in Entertainment Media to increase HPV vaccination in Georgia

Background: Although HPV is the most common sexually transmitted disease in the United States, vaccination rates are still lagging among adolescents and young adults. Entertainment-education is a popular strategy for incorporating educational messages into entertainment media. With popular shows on television now integrating health messages into their narrative, there are more opportunities to influence knowledge, attitude and health behaviors. Objective: To (a) determine the effectiveness of the HPV narrative included in the “Someone You love” documentary on HPV risk perception, vaccine self-efficacy and behavioral intention for HPV vaccine uptake on college students and (b) assess the immediate impact of the documentary on HPV vaccine initiation. Methods: A dependent samples t-test was conducted to determine if differences in the scale scores for each variable existed between pre and post viewing. Scale items were measured on a 7-point Likert scale and summed for analyses. Results: Students (n=126) participated in four screenings. Participants were mostly female (76.5%), freshman (40%), Caucasian (48.3%), heterosexual (81.5%) and sexually active (74.3%). The results showed a positive and significant effect from pre- and post-test scores on Risk Perception 7.150, t (119) = 14.502, p Discussion: While the documentary shares light on the impact of HPV transmission and its deadly impact, no formal research study has been done to measure its overall impact on behavior change. After watching the documentary in our study, gains pre to posttest scores indicate that overall students in our study felt more at risk for HPV, were confident in their ability to seek out and receive the vaccine and they had a greater intention to start the HPV vaccination series. Conclusion: With more young adults streaming television on services like Netflix and watching documentary series, public health should explore using messaging in media as a tailoring strategy to improve health outcomes

Customization of Avatars In a HPV Digital Gaming Intervention for College-Age Males: An Experimental Study

Background: Digital games are increasingly popular among college age men and present themselves as an ideal platform to deliver HPV interventions. Customizing avatars in role playing games encourage intrinsic motivation in the learning process because of self-representation. Proteus Effect research suggests that the representations people make are an adaption of their actual/ ideal self and dictate how one conforms to the expectations and identity cues of their avatar. Objective/Purpose: This study evaluated the effectiveness of a digital gaming intervention aimed at increasing HPV risk perceptions, self- efficacy and behavioral intention to receive the HPV vaccine among college age men (18 - 26). Methods: This randomized control trial employed a 2 X 2 fully-crossed between subjects and tested the effects of avatar characters (assigned/customized) and perception of self (ideal/actual) on HPV risk perception, HPV vaccine self-efficacy and behavioral intent to receive the HPV vaccine. Participants were randomly assigned to one of four conditions. Results: A Factorial ANOVA with repeated measures and a between subjects’ factor (split plot) was used to test for the differences between the means of the outcome variables. Despite having no main or interaction effect our analysis did report a significant main effect of using a pre-post design with the experiment as a stimulus. Discussion/Conclusion: For experimental data, customizing an avatar to look like one’s actual self increases risk perception for the HPV virus and self – efficacy for the HPV vaccine whereas customizing an avatar to look like one’s ideal self increases one’s intent to receive the HPV vaccine

HPV Vaccine Communication Competency Scale for Medical Trainees: Interdisciplinary Development Study

BackgroundHuman papillomavirus (HPV) infection is the most common sexually transmitted infection in the United States. High-risk HPV strains are associated with cancer of the cervix, oropharynx, anus, rectum, penis, vagina, and vulva. To combat increasing HPV-related cancers, the 9-valent HPV vaccine Gardasil was developed. Recommendation of the HPV vaccine by a health care provider has been cited as the number one factor affecting vaccine uptake among adolescents and young adults. Physician assistants, nurse practitioners, and pharmacists have been enlisted to bridge the gap. ObjectiveThe specific aim of this research study was to develop a reliable and valid HPV vaccine communication scale that can be used to measure the competency of primary care providers when recommending the need for vaccination to parents and patients. MethodsUsing a descriptive study, we collected data via a literature review, focus groups, and an expert panel to inform the scale domains and blueprint design. Pretesting (cognitive interviews) was used to inform item revision decisions. An item analysis was also conducted for the responses provided in the cognitive interviews. Item statistics (means and SDs), interitem correlations, and reliability were examined. Data were analyzed using SPSS (IBM Corp) software. ResultsA valid and reliable 42-item HPV vaccine communication competency scale was developed. The scale included 6 domains of interest. Scale items were moderately to strongly correlated with one another, and Cronbach α indicated good internal consistency with each scale. Scale items included were related to provider introduction or rapport (α=.796), patient respect or empathy (α=.737), provider interview or intake (α=.9), patient counseling or education (α=.935), provider communication closure (α=.896), and provider knowledge (α=.824). ConclusionsPharmacists, nurse practitioners, and physician assistants should be trained to be competent in HPV vaccine communication and recommendation due to their expanded roles. Interdisciplinary collaboration is important to account for the trainee’s individual differences and ensure the best health care outcomes for patients. A standardized HPV communication scale can be used to ensure effective and consistent recommendation by health care providers, thus affecting immunization rates

Designing and Testing an Inventory for Measuring Social Media Competency of Certified Health Education Specialists

BACKGROUND: Social media can promote healthy behaviors by facilitating engagement and collaboration among health professionals and the public. Thus, social media is quickly becoming a vital tool for health promotion. While guidelines and trainings exist for public health professionals, there are currently no standardized measures to assess individual social media competency among Certified Health Education Specialists (CHES) and Master Certified Health Education Specialists (MCHES). OBJECTIVE: The aim of this study was to design, develop, and test the Social Media Competency Inventory (SMCI) for CHES and MCHES. METHODS: The SMCI was designed in three sequential phases: (1) Conceptualization and Domain Specifications, (2) Item Development, and (3) Inventory Testing and Finalization. Phase 1 consisted of a literature review, concept operationalization, and expert reviews. Phase 2 involved an expert panel (n=4) review, think-aloud sessions with a small representative sample of CHES/MCHES (n=10), a pilot test (n=36), and classical test theory analyses to develop the initial version of the SMCI. Phase 3 included a field test of the SMCI with a random sample of CHES and MCHES (n=353), factor and Rasch analyses, and development of SMCI administration and interpretation guidelines. RESULTS: Six constructs adapted from the unified theory of acceptance and use of technology and the integrated behavioral model were identified for assessing social media competency: (1) Social Media Self-Efficacy, (2) Social Media Experience, (3) Effort Expectancy, (4) Performance Expectancy, (5) Facilitating Conditions, and (6) Social Influence. The initial item pool included 148 items. After the pilot test, 16 items were removed or revised because of low item discrimination (r<.30), high interitem correlations (Ρ>.90), or based on feedback received from pilot participants. During the psychometric analysis of the field test data, 52 items were removed due to low discrimination, evidence of content redundancy, low R-squared value, or poor item infit or outfit. Psychometric analyses of the data revealed acceptable reliability evidence for the following scales: Social Media Self-Efficacy (alpha=.98, item reliability=.98, item separation=6.76), Social Media Experience (alpha=.98, item reliability=.98, item separation=6.24), Effort Expectancy(alpha =.74, item reliability=.95, item separation=4.15), Performance Expectancy (alpha =.81, item reliability=.99, item separation=10.09), Facilitating Conditions (alpha =.66, item reliability=.99, item separation=16.04), and Social Influence (alpha =.66, item reliability=.93, item separation=3.77). There was some evidence of local dependence among the scales, with several observed residual correlations above |.20|. CONCLUSIONS: Through the multistage instrument-development process, sufficient reliability and validity evidence was collected in support of the purpose and intended use of the SMCI. The SMCI can be used to assess the readiness of health education specialists to effectively use social media for health promotion research and practice. Future research should explore associations across constructs within the SMCI and evaluate the ability of SMCI scores to predict social media use and performance among CHES and MCHES