title: Evaluation of fotonovela to increase human papillomavirus vaccine knowledge, attitudes, and intentions in a low-income Hispanic community.
abstract: BACKGROUND
  It has nearly been a decade since the introduction of the vaccine against human papillomavirus (HPV), yet vaccination rates in the United States have remained suboptimal, particularly among Hispanics. Culturally and linguistically relevant health education tools targeting Hispanics are needed to increase the current rate of HPV vaccination. This article evaluates a theory-informed, evidence-guided fotonovela (photographic short story) intervention to improve HPV vaccination knowledge, attitudes, and intention among young adults.
  
  
  METHODS
  Young adults (N = 41, aged 18-26 years) in a low-income primary care clinic in Southern California were administered pre- and post-intervention surveys to measure changes in perceived susceptibility to HPV, perceived benefit of vaccination in committed relationship, intention to vaccinate, intention to encourage social networks to vaccinate, and attitude towards vaccination. Post-intervention survey also examined attitudes towards fotonovela. Relationships between attitudes towards fotonovela and demographic characteristics were assessed with Fisher's exact test. Self-reported gains in knowledge were categorized and tabulated. Changes in perceptions and intentions were analyzed with the marginal homogeneity test.
  
  
  RESULTS
  The majority of participants were female (78.0%), Latino/Hispanic (92.7%), single (70.7%), and had at least a college education (61.0%). The mean age was 21.9 years (SD 0.4). The fotonovela was viewed as entertaining (95.1%), educational (97.6%), and easy to read (100 %). Following the intervention, Hispanic participants improved in all five variables of interest measured in the survey, including perceived susceptibility (+10.5%, p = 0.03), benefit of vaccination (+7.8%, p = 0.25), intent to vaccinate (+18.4%, p = 0.06), intent to encourage others to vaccinate (+10.5%, p = 0.14) and attitude towards vaccination (+13.1%, p = 0.05). Improvements in perceived susceptibility and attitude towards vaccination reached statistical significance (p < 0.05). The most frequent gains in knowledge were the risk of HPV infection despite condom use (N = 16) and relationship status (N = 8), three-dose vaccine administration schedule (N = 13), and burden of HPV infection among males (N = 9).
  
  
  CONCLUSIONS
  Results are promising because they demonstrate that health messages delivered through a narrative format can promote positive changes in knowledge, attitudes, and intentions. The fotonovela may be a powerful vehicle for HPV education, particularly among Hispanics.
authors.affiliation: School of Medicine, University of California, Irvine, Irvine, CA, USA. apchan@uci.edu.
authors.forename: Alvin
authors.initials: A
authors.lastname: Chan
authors.affiliation: Center for Healthy Communities, School of Medicine, University of California, Riverside, Riverside, CA, USA. brandon.brown@medsch.ucr.edu.
authors.forename: Brandon
authors.initials: B
authors.lastname: Brown
authors.affiliation: Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, Irvine, CA, USA. esepulve@uci.edu.
authors.forename: Enedina
authors.initials: E
authors.lastname: Sepulveda
authors.affiliation: Clayton MD Total Health Center, San Diego, CA, USA. lorechelle@gmail.com.
authors.forename: Lorena
authors.initials: L
authors.lastname: Teran-Clayton
mesh_terms: D000293:Adolescent; D000328:Adult; D001296:Audiovisual Aids; D002140:California; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D027383:Papillomaviridae / Q000276:immunology / Q000472:pathogenicity; D030361:Papillomavirus Infections / Q000150:complications / Q000208:ethnology / Q000276:immunology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011203:Poverty; D012111:Residence Characteristics; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000208:ethnology / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D014611:Vaccination
chemical_list: D053918:Papillomavirus Vaccines