The impact of a comic book intervention on increasing East African-American adolescents’ HPV vaccine-related knowledge, attitudes and intentions to receive vaccine

Abstract

Background: HPV vaccine uptake is low among East African-American (EAA) adolescents in the U.S. To improve HPV vaccine uptake in EAA communities, we developed a theory-based, community-informed comic book for adolescents as a part of an intervention targeting mothers and adolescents. We evaluated the impact on participating adolescents’ HPV and HPV vaccine knowledge, attitudes and vaccination intentions. Methods: The culture-specific comic book intervention was delivered to unvaccinated EAA adolescents who participated in ethno-linguistic-specific dinners with their mothers in Washington (8 dinners in Somali, 2 in Amharic) between 2017-2018. English-speaking adolescents aged 14-17 were assigned to complete a self-administered survey either before or after reading the comic book. Surveys were identical and assessed knowledge, barriers, communication with parents, and intention. Responses between adolescents completing the pre- vs post-test were compared with chi-squared tests. We used generalized estimating equation (GEE) models to estimate relative risks (RRs) and 95% confidence intervals (CIs) to measure the magnitude of the impact of the intervention on each construct. We also stratified the GEE models by gender to enumerate gender-specific intervention effects and tested for the presence of interaction between the participants’ gender and the assigned survey group (e.g., pre- or post-intervention). Results: Among 136 (Pre-test=64, Post-test=72) participants, 90% were Somali and 54% female. Adolescents assigned to the post-test were more likely to correctly answer questions on HPV/HPV-vaccine knowledge than those assigned to the pre-test (correct responses ranged from 27%-67% on the pre-test vs. 66%-90% post-test). The differences were statistically significant (p<.001) for 10 of 11 questions. Overall, the adolescents in the post-intervention survey group were 1.87 (95% CI: 1.54-2.27) times and 1.74 (95% CI: 1.46-2.07) times more likely than adolescents in the pre-intervention group to correctly answer questions related to HPV and HPV vaccine knowledge, respectively. Significant pre/post differences were also observed for comfort talking with a parent (58% vs. 90% somewhat/very comfortable, RR: 1.55 [95% CI: 1.24-1.94]), willingness (38% vs. 83% probably/definitely willing, RR: 2.16 [95% CI: 1.55-3.01]) and intention to get vaccinated (34% vs. 86% very/somewhat likely, RR: 2.39 [95% CI: 1.69-3.37]). The impact of the comic book tended to be stronger in male versus female adolescents for all constructs (RR between the pre- and post-test groups ranged from 1.40-3.20 for males vs. 1.30-2.00 for females). Conclusion: The comic book improved the EAA adolescents’ HPV and HPV vaccine knowledge, attitudes and intentions to receive vaccine. This intervention could be adapted for other EAA and ethnic-minority communities.