Persuasive messaging for human papillomavirus vaccination by adolescent providers in a five-country multi-site study

Int J Gynecol Cancer. 2019 Feb;29(2):250-256. doi: 10.1136/ijgc-2018-000004. Epub 2019 Jan 4.


Objective: Strong persuasive messaging by providers is a key predictor for patient acceptance of prophylactic human papillomavirus vaccination. We aimed to determine optimal messaging to promote human papillomavirus adolescent vaccination across different geographical sites.

Methods: Adolescent providers (n = 151) from Argentina, Malaysia, South Africa, South Korea, and Spain were surveyed on messages, family decision makers, and sources of communication to best motivate parents to vaccinate their adolescent daughters overall, and against human papillomavirus. Multivariate logistic regression assessed the likelihood of recommending messages specifically targeted at cervical cancer with providers' characteristics: gender, medical specialization, and previous administration of human papillomavirus vaccination.

Results: Mothers were considered the most important human papillomavirus vaccination decision makers for their daughters (range 93%-100%). Television was cited as the best source of information on human papillomavirus vaccination in surveyed countries (range 56.5%-87.1%), except Spain where one-on-one discussions were most common (73.3%). Prevention messages were considered the most likely to motivate parents to vaccinate their daughters overall, and against human papillomavirus, in all five countries (range 30.8%-55.9%). Optimal messages emphasized cervical cancer prevention, and included strong provider recommendation to vaccinate, vaccine safety and efficacy, timely vaccination, and national policy for human papillomavirus vaccination. Pediatricians and obstetricians/gynecologists were more likely to cite that the best prevention messages should focus on cervical cancer (OR: 4.2, 95% CI: 1.17 to 15.02 vs other medical specialists).

Conclusions: Provider communication messages that would motivate parents to vaccinate against human papillomavirus were based on strong recommendation emphasizing prevention of cervical cancer. To frame convincing messages to increase vaccination uptake, adolescent providers should receive updated training on human papillomavirus and associated cancers, while clearly addressing human papillomavirus vaccination safety and efficacy.

Keywords: cervical cancer; human papillomavirus; messaging; multi-site study; vaccination.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Argentina / epidemiology
  • Attitude of Health Personnel*
  • Female
  • Health Knowledge, Attitudes, Practice
  • Health Personnel / psychology*
  • Humans
  • Malaysia / epidemiology
  • Male
  • Mothers / psychology
  • Papillomaviridae / immunology
  • Papillomavirus Infections / complications*
  • Papillomavirus Infections / virology
  • Papillomavirus Vaccines / administration & dosage*
  • Patient Acceptance of Health Care*
  • Professional-Family Relations
  • Prognosis
  • Republic of Korea / epidemiology
  • South Africa / epidemiology
  • Spain / epidemiology
  • Surveys and Questionnaires
  • Uterine Cervical Neoplasms / epidemiology
  • Uterine Cervical Neoplasms / prevention & control*
  • Uterine Cervical Neoplasms / psychology
  • Vaccination / psychology*


  • Papillomavirus Vaccines