Development of an efficient strategy to improve HPV immunization coverage in Japan.
BACKGROUND
In Japan, new HPV immunizations have dropped dramatically after repeated adverse media reports and a June 2013 temporary suspension of the government's recommendation for the vaccine. The aim of the present study was to develop an efficient strategy to improve HPV immunization coverage across Japan.


METHODS
We conducted an internet survey in Japan of mothers of 12-16 year-old girls who were unvaccinated as of May, 2015. The goal was to gather behavioral information from the mothers to develop a strategy for improving Japanese HPV immunization coverage.


RESULTS
Valid survey answers were obtained from 2060 mothers. The survey found that a hypothetical restart of a governmental recommendation for the vaccine would induce 4.1 % of all the mothers surveyed to be more likely to encourage vaccination of their daughters, without any other preconditions. This initial result would be followed by a moderate spread of vaccinations to these daughters' close friends and acquaintances, hypothetically resulting in a total vaccination rate of 21.0 % of the targeted age-eligible girls. As a second critical step for improving vaccinations, an educational information sheet integrating the concepts of behavioral economics for changing behaviors was found to be significantly effective for persuading mothers with poorer decision-making facilities, who would otherwise prefer to wait to first see the vaccination of other girls of the same age as their daughter.


CONCLUSIONS
Following what we foresee as the inevitable restart of the Japanese government's recommendation for receiving the HPV vaccine, we expect to first see vaccinations occurring in a very small group of girls, the daughters of the most willing mothers, which will be roughly 4 % of those eligible for government paid vaccinations. This will be followed by the spread of vaccinations outward through these girls' circle of friends and acquaintances, and, finally, to the daughters of the most skeptical mothers, those who would await the return of new vaccine safety results from a large group of similarly-aged girls. As a critical step in improving HPV vaccine coverage in Japan, an educational information sheet that integrates the concepts of behavioral economics for changing behaviors can be employed to persuade mothers with poor decision-making facilities.
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
Asami
A
Yagi
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan. ZVF03563@nifty.ne.jp.|The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan. ZVF03563@nifty.ne.jp.
Yutaka
Y
Ueda
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.|The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.
Tomomi
T
Egawa-Takata
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.|The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.
Yusuke
Y
Tanaka
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.|The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.
Akiko
A
Morimoto
The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.|Department of Obstetrics and Gynecology, Osaka Medical College Graduate School of Medical Sciences, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
Yoshito
Y
Terai
The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.|Department of Obstetrics and Gynecology, Osaka Medical College Graduate School of Medical Sciences, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
Masahide
M
Ohmichi
The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.|Department of Obstetrics and Gynecology, Osaka City University Graduate School and Faculty of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
Tomoyuki
T
Ichimura
The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.|Department of Obstetrics and Gynecology, Osaka City University Graduate School and Faculty of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
Toshiyuki
T
Sumi
The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.|Department of Obstetrics and Gynecology, Kansai Medical University Graduate School of Medicine, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan.
Hiromi
H
Murata
The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.|Department of Obstetrics and Gynecology, Kansai Medical University Graduate School of Medicine, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan.
Hidetaka
H
Okada
The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.|Department of Obstetrics and Gynecology, Kinki University Graduate School of Medical Sciences, 377-2 Ono-Higashi, Sayama, Osaka, 589-8511, Japan.
Hidekatsu
H
Nakai
The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.|Department of Obstetrics and Gynecology, Kinki University Graduate School of Medical Sciences, 377-2 Ono-Higashi, Sayama, Osaka, 589-8511, Japan.
Masaki
M
Mandai
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.|The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.
Kiyoshi
K
Yoshino
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.|The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.
Tadashi
T
Kimura
The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.|Saito Women's Clinic, 1-6-1 Miyahara, Yodogawa-ku, Osaka, 532-0003, Japan.
Junko
J
Saito
Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
Risa
R
Kudoh
Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
Masayuki
M
Sekine
The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.|Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
Takayuki
T
Enomoto
Institute for Academic Initiatives, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
Kei
K
Hirai
The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.
Yorihiko
Y
Horikoshi
The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.
Tetsu
T
Takagi
The Obstetrical Gynecological Society of Osaka, 4-4-3 Kawaramachi, Chuo-ku, Osaka, 541-0048, Japan.
Kentaro
K
Shimura
Adverse events; Behavioural economics; Decision-making facility; Governmental recommendation; HPV vaccination rate; Internet survey; Stepped strategy
Lancet. 2015 Jun 27;385(9987):2571
26122153
Psychol Sci. 2011 Dec;22(12):1494-9
22075239
Pediatrics. 2013 Apr;131(4):645-51
23509163
N Engl J Med. 2015 Jun 11;372(24):2281-3
26061834
Arch Gynecol Obstet. 2012 Jun;285(6):1719-24
22246478
Am J Obstet Gynecol. 2015 Mar;212(3):405-6
25434842
Vaccine. 2006 Aug 31;24 Suppl 3:S3/11-25
16949997
Lancet. 2013 Aug 31;382(9894):768
23993189
J Obstet Gynaecol Res. 2015 Dec;41(12 ):1965-71
26420072