title: Developing a Tablet-Based Self-Persuasion Intervention Promoting Adolescent HPV Vaccination: Protocol for a Three-Stage Mixed-Methods Study.
abstract: BACKGROUND
  Human papillomavirus (HPV)-related cancers are a significant burden on the US health care system that can be prevented through adolescent HPV vaccination. Despite guidelines recommending vaccination, coverage among US adolescents is suboptimal particularly among underserved patients (uninsured, low income, racial, and ethnic minorities) seen in safety-net health care settings. Many parents are ambivalent about the vaccine and delay making a decision or talking with a provider about it. Self-persuasion-generating one's own arguments for a health behavior-may be particularly effective for parents who are undecided or not motivated to make a vaccine decision.
  
  
  OBJECTIVE
  Through a 3-stage mixed-methods protocol, we will identify an optimal and feasible self-persuasion intervention strategy to promote adolescent HPV vaccination in safety-net clinics.
  
  
  METHODS
  In Stage 1, we will define content for a tablet-based self-persuasion app by characterizing (1) parents' self-generated arguments through cognitive interviews conducted with parents (n=50) of patients and (2) parent-provider HPV vaccine discussions through audio recordings of clinic visits (n=50). In Stage 2, we will compare the effects of the four self-persuasion intervention conditions that vary by cognitive processing level (parents verbalize vs listen to arguments) and choice of argument topics (parents choose vs are assigned topics) on parental vaccine intentions in a 2 × 2 factorial design randomized controlled trial (n=160). This proof-of-concept trial design will identify which intervention condition is optimal by quantitatively examining basic self-persuasion mechanisms (cognitive processing and choice) and qualitatively exploring parent experiences with intervention tasks. In Stage 3, we will conduct a pilot trial (n=90) in the safety-net clinics to assess feasibility of the optimal intervention condition identified in Stage 2. We will also assess its impact on parent-provider discussions.
  
  
  RESULTS
  This paper describes the study protocol and activities to date. Currently, we have developed the initial prototype of the tablet app for English- and Spanish-speaking populations, and completed Stage 1 data collection.
  
  
  CONCLUSIONS
  Our systematic collaboration between basic and applied behavioral scientists accelerates translation of promising basic psychological research into innovative interventions suitable for underserved, safety-net populations. At project's end, we plan to have a feasible and acceptable self-persuasion intervention that can affect key cancer disparities in the United States through prevention of HPV-related cancers.
  
  
  BACKGROUND
  ClinicalTrials.gov http://clinicaltrials.gov/ct2/show/NCT02537756 and http://clinicaltrials.gov/ct2/show/NCT02535845 (Archived by WebCite at http://www.webcitation.org/6e5XcOGXz and http://www.webcitation.org/6e5XfHoic, respectively).
authors.affiliation: Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States. jasmin.tiro@utsouthwestern.edu.
authors.forename: Jasmin A
authors.identifier: http://orcid.org/0000-0001-8300-0441
authors.initials: JA
authors.lastname: Tiro
authors.forename: Simon Craddock
authors.identifier: http://orcid.org/0000-0001-6345-1237
authors.initials: SC
authors.lastname: Lee
authors.forename: Emily G
authors.identifier: http://orcid.org/0000-0002-4730-7400
authors.initials: EG
authors.lastname: Marks
authors.forename: Donna
authors.identifier: http://orcid.org/0000-0001-6779-2629
authors.initials: D
authors.lastname: Persaud
authors.forename: Celette Sugg
authors.identifier: http://orcid.org/0000-0002-2535-4476
authors.initials: CS
authors.lastname: Skinner
authors.forename: Richard L
authors.identifier: http://orcid.org/0000-0001-7392-9927
authors.initials: RL
authors.lastname: Street
authors.forename: Deborah J
authors.identifier: http://orcid.org/0000-0003-2120-4937
authors.initials: DJ
authors.lastname: Wiebe
authors.forename: David
authors.identifier: http://orcid.org/0000-0003-4251-2189
authors.initials: D
authors.lastname: Farrell
authors.forename: Wendy Pechero
authors.identifier: http://orcid.org/0000-0003-3253-2688
authors.initials: WP
authors.lastname: Bishop
authors.forename: Sobha
authors.identifier: http://orcid.org/0000-0003-4821-2822
authors.initials: S
authors.lastname: Fuller
authors.forename: Austin S
authors.identifier: http://orcid.org/0000-0001-8602-6903
authors.initials: AS
authors.lastname: Baldwin
keywords: HPV vaccination; adolescents; intervention development; self-persuasion
references.citation: Gynecol Oncol. 2014 Mar;132 Suppl 1:S13-20
references.pmid: 24491412
references.citation: Am J Public Health. 2002 Nov;92 (11):1728-32
references.pmid: 12406794
references.citation: Prev Sci. 2004 Mar;5(1):41-5
references.pmid: 15058911
references.citation: Health Serv Res. 2007 Aug;42(4):1758-72
references.pmid: 17286625
references.citation: Sex Transm Dis. 2010 Apr;37(4):234-9
references.pmid: 19940807
references.citation: Psychol Health. 2006;21(2):247-72
references.pmid: 21985120
references.citation: Cancer Nurs. 2002 Feb;25(1):1-7
references.pmid: 11838715
references.citation: Ann Behav Med. 2009 Jun;37(3):315-24
references.pmid: 19373517
references.citation: Pediatrics. 2013 Jun;131(6):1114-24
references.pmid: 23650297
references.citation: J Gen Intern Med. 1990 Jan-Feb;5(1):29-33
references.pmid: 2299426
references.citation: J Low Genit Tract Dis. 2012 Jan;16(1):16-23
references.pmid: 21964205
references.citation: J Womens Health (Larchmt). 2007 Oct;16(8):1224-33
references.pmid: 17937576
references.citation: J Behav Med. 1985 Mar;8(1):37-59
references.pmid: 3981627
references.citation: Health Educ Res. 2007 Oct;22(5):691-702
references.pmid: 17138613
references.citation: Cancer Epidemiol Biomarkers Prev. 2011 Jul;20(7):1463-72
references.pmid: 21602307
references.citation: Vaccine. 2015 Mar 30;33(14):1748-55
references.pmid: 25659278
references.citation: J Sch Nurs. 2011 Dec;27(6):434-46
references.pmid: 21750234
references.citation: Br J Educ Psychol. 2006 Sep;76(Pt 3):663-75
references.pmid: 16953968
references.citation: Health Psychol. 2013 Dec;32(12):1209-17
references.pmid: 23025303
references.citation: Soc Sci Med. 2007 Aug;65(3):586-98
references.pmid: 17462801
references.citation: Med Care. 2006 Nov;44(11 Suppl 3):S21-30
references.pmid: 17060830
references.citation: Sex Transm Infect. 2010 Jun;86(3):241-6
references.pmid: 19951936
references.citation: Arch Pediatr Adolesc Med. 2011 Jun;165(6):547-53
references.pmid: 21646588
references.citation: Ann Behav Med. 1999 Fall;21(4):276-83
references.pmid: 10721433
references.citation: J Cancer Educ. 2013 Jun;28(2):352-6
references.pmid: 23564430
references.citation: Health Commun. 2001;13(1):61-73
references.pmid: 11370924
references.citation: J Adolesc Health. 2009 Nov;45(5):528-31
references.pmid: 19837361
references.citation: CA Cancer J Clin. 2007 Jan-Feb;57(1):7-28
references.pmid: 17237032
references.citation: MMWR Morb Mortal Wkly Rep. 2015 Mar 27;64(11):300-4
references.pmid: 25811679
references.citation: Arch Pediatr Adolesc Med. 2006 Feb;160(2):157-63
references.pmid: 16461871
references.citation: Pediatrics. 2006 Nov;118(5):e1287-92
references.pmid: 17079529
references.citation: Perspect Sex Reprod Health. 2012 Mar;44(1):39-47
references.pmid: 22405151
references.citation: Obstet Gynecol. 2008 May;111(5):1103-10
references.pmid: 18448742
references.citation: Pediatrics. 2012 Jun;129(6):e1437-45
references.pmid: 22566415
references.citation: Cancer. 2006 Sep 15;107(6):1313-20
references.pmid: 16909424
references.citation: Hum Vaccin. 2011 Apr;7(4):419-25
references.pmid: 21389777
references.citation: J Health Psychol. 2013 Jul;18(7):926-38
references.pmid: 22992585
references.citation: Health Educ Behav. 2007 Jun;34(3):471-85
references.pmid: 17000622
references.citation: Med Care. 1991 Nov;29(11):1146-52
references.pmid: 1943273
references.citation: Sex Transm Dis. 2009 Jan;36(1):58-62
references.pmid: 18830138
references.citation: Ann Behav Med. 2012 Oct;44(2):171-80
references.pmid: 22547155
references.citation: Vaccine. 2012 Jun 29;30(31):4588-95
references.pmid: 22579865
references.citation: Med Care. 1998 May;36(5):728-39
references.pmid: 9596063
references.citation: Health Psychol. 2012 Jan;31(1):31-4
references.pmid: 22229933
references.citation: Prev Med. 2009 May;48(5):420-5
references.pmid: 19133288
references.citation: Obstet Gynecol. 2006 Sep;108(3 Pt 1):699-705
references.pmid: 16946235
references.citation: Cancer Epidemiol Biomarkers Prev. 2010 Sep;19(9):2187-98
references.pmid: 20826829
references.citation: Am Psychol. 2000 Jan;55(1):68-78
references.pmid: 11392867
references.citation: MMWR Morb Mortal Wkly Rep. 2014 Jul 25;63(29):620-4
references.pmid: 25055185
references.citation: Vaccine. 2014 Apr 7;32(17):1901-20
references.pmid: 24530401
references.citation: J Consult Clin Psychol. 2008 Apr;76(2):329-40
references.pmid: 18377128
references.citation: JAMA Pediatr. 2014 Jan;168(1):76-82
references.pmid: 24276343
references.citation: Health Psychol. 2013 Apr;32(4):361-9
references.pmid: 22059622
references.citation: Pediatrics. 2015 Nov;136(5):850-9
references.pmid: 26482674
references.citation: BMC Pediatr. 2011 Aug 30;11:74
references.pmid: 21878128
references.citation: Psychol Bull. 2006 Mar;132(2):249-68
references.pmid: 16536643
references.citation: N Engl J Med. 2012 Feb 2;366(5):391-3
references.pmid: 22296072
references.citation: Health Commun. 2006;20(2):123-9
references.pmid: 16965249
references.citation: Cancer Epidemiol Biomarkers Prev. 2007 Feb;16(2):288-94
references.pmid: 17267388
references.citation: J Pers Soc Psychol. 1968 Jan;8(1):31-4
references.pmid: 5638019
references.citation: Vaccine. 2012 Mar 16;30(13):2368-75
references.pmid: 22108490
references.citation: J Health Commun. 2011 Oct;16(9):988-1005
references.pmid: 21728780
references.citation: J Womens Health (Larchmt). 2009 Oct;18(10):1679-86
references.pmid: 19785564
references.citation: J Consult Clin Psychol. 2003 Oct;71(5):843-61
references.pmid: 14516234
references.citation: Pediatrics. 2002 Nov;110(5):e58
references.pmid: 12415064
references.citation: MMWR Morb Mortal Wkly Rep. 2011 Dec 23;60(50):1705-8
references.pmid: 22189893
references.citation: Health Educ Res. 2008 Jun;23(3):467-76
references.pmid: 18218615