Nurses in ideal position to deliver messages that increase HPV vaccine acceptability

Nurses should be aware of a stigma surrounding human papillomavirus (HPV) vaccination and factor that into communications with patients, Cheryl S. Lee, MS, RN, ACNP-BC, MD Anderson Cancer Center, Houston, Texas, said in presenting a systematic review of how messages about the HPV vaccine are framed during the Oncology Nursing Society 36th Annual Congress.

Most cervical cancer is caused by HPV, which is also associated with many other malignancies. While HPV-related cancers are largely preventable, especially with the recent launch of HPV vaccines, uptake remains low. The biggest barriers: knowledge, costs, personal beliefs, and attitudes.

Message framing is one way to address negative beliefs and attitudes and nurses are in a prime position to communicate with patients regarding the vaccine. In addition, they should know how to frame their recommendation for maximum effectiveness, she said..

To assess message framing as a communication strategy to increase HPV vaccine acceptability in males and females, Lee conducted a systematic literature review for studies in English on framing and the HPV vaccine in Cochrane, Medline-PubMed, SCOPUS, CINAHL Plus, PsycInfo, PsycARTICLES, and Psychology and Behavioral Sciences Collection-EBSCO. Additional limits were: clinical trial, randomized controlled trial, review, and meta-analysis. No date limits were set.

A total of 43 papers were reviewed; of these, eight published between 2007 and 2011 were relevant and were analyzed using the Critical Appraisal Skills Programme tool. All eight studies were cross-sectional and the majority had moderate to large sample sizes. Four studies attempted randomized selection but true representativeness was questionable. All used different measures with questionable validity and inconsistent terminology (eg, “acceptability,” “intention,” and “interest”). Six studies reported use of a conceptual framework.

Results found acceptability of the HPV vaccine was higher when framed as preventing cancer rather than preventing sexually transmitted infection, Lee noted. Acceptability was also higher when the message was framed positively, instead of negatively.

This limited literature suggests health care provider recommendation would be more successful in increasing acceptance of the HPV vaccine when results are framed in terms of preventing cancer, along with an acknowledgement of safety and efficacy. Mediators of acceptability, including perceived susceptibility and severity based on conceptual frameworks such as the Health Behavior Model, may also help frame recommendations.

The way in which the HPV vaccine is presented is integral to acceptance and subsequent uptake, she concluded, adding that more studies are needed on communication strategies to increase acceptability.
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