Online Media Scans: Applying Systematic Review Techniques to Assess Statewide Human Papillomavirus Vaccination Activities

"Evidence about potential HPV vaccination disparities affecting specific populations should be confirmed in future studies and used to inform the design and implementation of HPV vaccine research and education campaigns to ensure that resources are reaching those at greatest risk of missing out on HPV vaccination."

Uptake of human papillomavirus (HPV) vaccine in the United States (US) is low, particularly in the state of Minnesota, where specific populations may have lower HPV vaccination rates than the general population. For example, the Rochester Epidemiology Project in Minnesota found that Somali-American adolescent girls were less likely to complete the HPV series than their white, non-Hispanic peers. To address disparities in HPV vaccine access, the researchers of the present study used an online media scan to describe the nature and scope of ongoing activities to increase HPV vaccination in Minnesota; this method may be applied to other jurisdictions to gain insight about various public health issues.

Conducted between January and July 2018, the media scan included: (i) structured internet searches of HPV vaccine health education/promotion activities ongoing in Minnesota since 2013, and (ii) searches in research databases of the published literature on HPV vaccination in Minnesota from 2013 to 2018. Searches resulted in 880 online and 142 research article matches, with 40 and 36 meeting selection criteria.

Most activities were statewide (52% health education/promotion and 35% research), followed by activities located in entirely urban areas (15% health education/promotion and 41% research). Only 6% of health education/promotion activities and 2% of research activities carried out in entirely rural areas. This finding is of consequence because rural location has been associated with provider HPV vaccine recommendation practices and parental HPV vaccine hesitancy, as well as lower HPV vaccine uptake.

Health education/promotion activities more often focused on health providers (80% of all education/promotion activities), and a high proportion of health education/promotion activities involved parents (53%). The researchers describe this as "a positive result, given the strong role of the parent-health provider interaction in HPV vaccination decision-making."

Some research has been conducted on HPV vaccination among lesbian, gay, bisexual, transgender, and queer or questioning youth (11%), including studies on improving HPV vaccination outreach to gay and bisexual men using social media. However, few HPV-vaccine health education/promotion activities focus specifically on the LGBTQ community (5%). "Existing and new HPV vaccine health education/promotion efforts should consider whether they are meeting the needs of LGBTQ adolescents."

Most HPV-vaccine health education/promotion activities (78%) and research activities (64%) identified in the search aimed to increase HPV vaccine awareness and education among all eligible youth rather than on those of specific races or ethnicities. For the 40 HPV vaccine health education/promotion activities, there were some efforts that the researchers characterise as "innovative" in their efforts to reach specific populations. For example, partnerships between Somali community leaders and county departments of health were formed in a quest to improve HPV vaccination rates, and medical training incorporated simulations that included scenarios with Somali patients. Partnerships have been established across state borders to train health providers and share resources in promoting HPV vaccination among the American Indian population. However, the only activities that mention outreach to African Americans are statewide reports with demographic breakdowns by race, which may not address gaps in differential uptake of the HPV vaccine. According to the researchers, given that African Americans have the lowest child immunisation rate in Minnesota by race after American Indians, it is advisable that strategies be developed to increase HVP uptake among them.

The researchers also identified "few activities focused exclusively on catch-up vaccination. Organizations and researchers may wish to consider developing and implementing activities targeting older youth who have missed HPV vaccination to ensure high coverage overall."

In conclusion, the application of systematic review techniques in this online media scan provides "insight into potential gaps in public health activities", thus indicating a methodology that can be applied to other activities in the health and social sciences.