Development of a Tailored Mobile Phone–Based Intervention to Facilitate Parent-Child Communication and Build Human Papillomavirus Vaccine Confidence: Formative Qualitative Study

Jennifer Erves, Consuelo H. Wilkins, Amanda F. Dempsey, Jessica L. Jones, Chris Thompson, Kathryn Edwards, Megan Davis, Lindsay S. Mayberry, Douglas Landsittal, Pamela C. Hull

Research output: Contribution to journalArticlepeer-review


Background: Human papillomavirus (HPV) vaccine hesitancy is on the rise, and provider communication is a first-line strategy to address parental concerns. The use of the presumptive approach and motivational interviewing by providers may not be enough to influence parental decision-making owing to the providers’ limited time, self-efficacy, and skills to implement these strategies. Interventions to enhance provider communication and build parental HPV vaccine confidence have been undertested. Delivering tailored patient education to parents via mobile phones before they visit the health care provider may address time constraints during clinic visits and positively affect vaccine uptake. Objective: This study aimed to describe the development and evaluate the acceptability of a mobile phone–based, family-focused intervention guided by theory to address concerns of HPV vaccine–hesitant parents before the clinic visit, as well as explore intervention use to facilitate parent-child communication. Methods: The health belief model and theory of reasoned action guided intervention content development. A multilevel stakeholder engagement process was used to iteratively develop the HPVVaxFacts intervention, including a community advisory board review, a review by an advisory panel comprising HPV vaccine–hesitant parents, a health communications expert review, semistructured qualitative interviews with HPV vaccine–hesitant parents (n=31) and providers (n=15), and a content expert review. Inductive thematic analysis was used to identify themes in the interview data. Results: The qualitative interviews yielded 4 themes: overall views toward mobile device use for health information, acceptability of HPVVaxFacts, facilitators of HPVVaxFacts use, and barriers to HPVVaxFacts use. In parent interviews after reviewing HPVVaxFacts prototypes, almost all parents (29/31, 94%) stated they intended to have their child vaccinated. Most of the parents stated that they liked the added adolescents’ corner to engage in optional parent-child communication (ie, choice to share and discuss information with their child; 27/31, 87%) and shared decision-making in some cases (8/31, 26%). After incorporating all input, the final intervention consisted of a 10-item survey to identify the top 3 concerns of parents, followed by tailored education that was mapped to each of the following concerns: evidential messages, images or graphics to enhance comprehension and address low literacy, links to credible websites, a provider video, suggested questions to ask their child’s physician, and an optional adolescents’ corner to educate the patient and support parent-child communication. Conclusions: The multilevel stakeholder-engaged process used to iteratively develop this novel intervention for HPV vaccine–hesitant families can be used as a model to develop future mobile health interventions. This intervention is currently being pilot-tested in preparation for a randomized controlled trial aiming to increase HPV vaccination among adolescent children of vaccine-hesitant parents in a clinic setting. Future research can adapt HPVVaxFacts for other vaccines and use in other settings (eg, health departments and pharmacies).

Original languageEnglish
Article numbere43041
JournalJMIR Formative Research
StatePublished - 2023

Bibliographical note

Funding Information:
AFD is currently an employee of Merck; her involvement in this study occurred before this, when she was a faculty member at the University of Colorado. JE is an education consultant for Merck; she became a consultant after this study was completed. KE receives grant funding from the National Institutes of Health (NIH) and is a consultant to Bionet. KE is also a member of the IBM Data Safety and Monitoring Board for Sanofi, X-4 Pharma, Seqirus, Moderna, Pfizer, Merck, and Roche. PCH has received funding from the Merck Foundation for research (unrelated to human papillomavirus vaccination) focused on patient navigation for patients with cancer.

Funding Information:
The authors would like to thank the parents and pediatric providers for their valuable insights into the needs of parents who are undecided about human papillomavirus vaccination and strategies to increase acceptance. The authors also thank the parental advisory panel and community advisory board guiding this study. This work was supported by the National Cancer Institute of the National Institutes of Health (1K01CA237748, U54CA163072, U54CA163066, and U54CA163069). This work was also supported by the National Center for Advancing Translational Science of the National Institutes of Health (UL1 RR024975 and UL1 TR000445). The funders were not involved in any aspects of this research study.

Publisher Copyright:
© Jennifer Erves, Consuelo H Wilkins, Amanda F Dempsey, Jessica L Jones, Chris Thompson, Kathryn Edwards, Megan Davis, Lindsay S Mayberry, Douglas Landsittal, Pamela C Hull.


  • adolescents
  • hesitancy
  • HPV
  • human papillomavirus
  • mHealth
  • mobile health
  • parent-child communication
  • patient education
  • theory
  • vaccine

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Informatics


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