Health Information Source Characteristics Matter: Adapting the Dissemination of an HPV Vaccine Intervention to Reach Latina and Vietnamese Women

"An important step in addressing cancer health disparities involves more effectively reaching these minority populations and more fully appreciating the sources to which Latina and Vietnamese turn for trusted health information."

Media trends show an expanding range of communication channels, especially social media and online sources, that may be used to access health information. To inform the adaptation of an evidence-based cancer control programme (EBCCP) called HPV Vaccine Decision Narratives, this study elicited preferences and characteristics associated minority underserved women's interest in various health information sources, specifically for human papillomavirus (HPV) vaccination. Latina and Vietnamese women in the United States (US), who are the focus of the study, are disproportionately burdened with cervical cancer associated with HPV and yet underutilise the HPV vaccine.

In late summer 2016, the researchers recruited a purposive sample of 24 Latina women, 24 Vietnamese-American women, and 2 staff members from Planned Parenthood of Orange and San Bernardino Counties (PPOSBC) health centres in California, US. They conducted semi-structured interviews with them, guided by the Channel Complementarity Theory (CCT).

Of the vaccinated participants (aged 18-24), a majority (72%) had completed the HPV vaccine series (three shots); Latina women completed the series to a lesser extent (50%) than did Vietnamese women (94%).

Overall, the women described using a range of online sources to seek health information, such as the internet, social media platforms, email, and mobile or cell phone texting. (See image above for frequency distribution of top communication preference (general health information) by ethnicity.) They also reported turning to in-person medical providers or family members for health questions and concerns. Vietnamese women valued in-person visits with medical doctors to a greater degree than other sources for health information, whereas Latina women described a wide range of preferences for health information sources.

Specific characteristics that motivate women's online use of health information included immediacy and access, convenience, and credibility. When receiving HPV vaccine information in particular, important considerations include: protecting privacy, avoiding information overload (i.e., message fatigue), engaging in interpersonal communication, and receiving health information from trusted sources (e.g., Planned Parenthood, school, doctors, or mothers). Particularly for sexual health, text message notifications were described as problematic due to fear of disclosure to others, particularly parents.

According to the researchers, these results have implications for adapting the dissemination of the video-based HPV vaccine EBCCP referenced above. Latina or Vietnamese women did not prefer any one particular source, which would have suggested the need for a singular delivery modality for intervention dissemination. CCT recognises individuals' joint use of many sources, including interpersonal medical, family, and friend networks, as a complement to online networks, rather than displacing one source for another. Thus, "[s]earching for and receiving health information from diverse sources appears to be the new norm..."

Given that many women expressed their preference to receive HPV vaccine recommendations from in-person medical consultations - and the fact they actually rely on a range of sources due to factors such as accessibility and immediacy of online content - the researchers suggest that health communication strategies in the digital age incorporate credibility cues that permit access to medical expertise online.

Specific to the EBCCP, the findings of this study might support "an integrated marketing communication approach to reach women across many platforms in a coordinated and integrated way, ideally with the same trusted message....Such an approach not only repeats the same messages through multiple sources but also emphasizes creating a unified and seamless message for the audience - in this case, minority women....Using multiple sources reinforces messaging that can robustly affect behavior change..."

An alternative or complementary dissemination strategy might include having women self-select their channel preference when visiting Planned Parenthood health centres. People tend to be more receptive and satisfied when they have input regarding how they receive health information. Tailoring education by patient preference has been used as a communication strategy to deliver health promotion materials and change behaviours. Relatedly, including material that is audio based (e.g., videos) might make educational material more accessible to immigrant populations with low literacy skills.

In conclusion, this study "advances the prevention literature by elevating the role of platform delivery considerations and emphasizing preferences to effectively reach Latina and Vietnamese women, who are disproportionately burdened by HPV cancers and are less aware of HPV vaccine prevention."