Perspectives of Young Chinese Singaporean Women on Seeking and Processing Information to Decide about Vaccinating against Human Papillomavirus

Singapore-based studies have found low uptake of human papillomavirus (HPV) vaccination related to lack of awareness about HPV and the vaccine. However, establishing that a lack of awareness exists only tells us whether information is present or absent; also needed is an understanding of information behaviour, which describes active information seeking and unintentional or passive acquiring of information. Thus, this study examined the means by which young Singaporean women seek and process information about HPV vaccination in their decision to become vaccinated.

The study was guided by the Elaboration Likelihood Model (ELM), which provides a framework to study the dual process of persuasion - that is, individuals' perceptions and reactions to information presented in a message. ELM postulates that information processing can be through the central (i.e., logic-based) or peripheral (i.e., heuristic-based) route. The central route involves substantial cognitive effort in examining the reasoning and evidence presented in a message, whereas the latter route relies on peripheral cues such as source credibility, source likability, and attractiveness.

From January to March 2016, 26 in-depth interviews were conducted among young Chinese women (aged 21-26 years) who had had at least one shot of any of the two approved HPV vaccines in Singapore. Data were analywed using thematic analysis.

With regard to information acquisition, passive acquisition of information highlighted the role of friends and family in providing information related to HPV vaccines. Active acquisition of information highlighted the role of credible sources, such as medical pamphlets and government websites, in providing information related to HPV vaccines. Whether engaging in active or passive information-seeking behaviour, all participants relied on the peripheral route to process, regardless of the strength and accuracy of the HPV vaccine-related information. For example, information acquired from online forums were processed based on surface characteristics, such as number of hits of the website.

Similarly, vaccination decisions revealed that women relied on heuristic cues in their decision to get vaccinated. A sense of support was an important factor that propelled all participants toward decision making. Support came from validation from their peers, trust in government regulations, and comfort with (likability of) medical providers. For example, participants noted feeling a sense of belonging and receiving confirmation from their peers that the HPV vaccination was a beneficial and positive experience. Peer-to-peer information sharing and imitating actions is a reflection of peripheral route processing based on heuristic cues. There was a lack of scrutiny of the information provided.

Reflecting on the findings, the researchers surmise that "perception of the risk of HPV infection is low, thus leading to only the heuristic information processing strategy being employed. Furthermore, when prior information and attitude about a topic is lacking (i.e., HPV vaccination in this case), heuristic processing is extremely useful....Thus, findings of the study revealed the importance of social and interpersonal networks in actualizing preventive health behavior. The study highlights the importance of relational influences and heuristic cues in information search behaviors, in evaluations of information, and in decision-making processes."

Implications for health education and promotion efforts, particularly related to message delivery and design, include:

• When targeting health information behaviour, social and personal networks should be taken into account; providing health messages through peers can be an effective way of increasing HPV vaccination uptake.
• It may be necessary to rethink health communication efforts that craft fact-based messages that require central processing such as the logic behind getting vaccinated, the medical benefits of the vaccine, and the facts about HPV. Instead, information such as source credibility, authority, sense of belonging, and acceptance of behaviour can be utilised in heuristic-based messages.

In short, the findings suggest that "information was sought and processed but not necessarily based on perceived need for knowledge, awareness, or information; it was rather based very much on social influence and what was easily accessible in their day-to-day lives." In conclusion, it is advised that intervention efforts - which should be culturally specific - focus on strengthening social support among personal networks to increase the uptake of the HPV vaccine.