Abstract B87: Development of a tablet-based application to elicit self-persuasion about HPV vaccination among undecided parents
Authors: Tiro Jasmin A. , Lee Simon Craddock , Farrell David , Marks Emily G. , Baldwin Austin S. , Denman Deanna C. 
Published: May 2016

Abstract
Introduction: The human papillomavirus (HPV) vaccine is highly efficacious and universally recommended, yet US adolescent vaccination rates remain suboptimal. Vaccination rates are lowest among racial/ethnic minorities and other medically underserved (uninsured, and low-income) populations. Many parents are ambivalent or hesitant about the HPV vaccine and delay making a decision. Self-persuasion – the process of generating one's own arguments for changing behavior – has been an effective approach to influence motivation and behavior. But, self-persuasion's effectiveness for HPV vaccination among safety-net populations is unknown. Also, evidence is unclear about the optimal method to elicit self-persuasion. We describe development of a tablet-based application with two different elicitation methods (verbalizing own arguments versus listening to peer-generated narratives) to encourage HPV vaccination among parents of adolescents attending safety-net clinics.
Methods: We recruited participants from six clinics in Dallas, TX, the 9th largest US county— a diverse population of low-literacy Spanish- and English-speaking parents. In the first phase of the project, we developed application functions, interface, and language-specific (English and Spanish) scripts. Culturally-matched graphics and narrators were selected for an educational video and self-persuasion elicitation question prompts. In the second phase, we conducted cognitive interviews where parents used the tablet application and then were queried about the experience (e.g., feedback on comprehension of instructions and educational video as well as the time spent on each task). The goal of the interview was to identify prompts that were perceived as helpful and elicited detailed responses.
Results: We dropped prompts that did not elicit new or relevant arguments and modified the language of other prompts to improve parents' understanding (e.g. the item addressing anticipated regret was reworded as it was eliciting parental concerns about potential vaccine side effects rather than perceived future regret for not vaccinating). Parents reported they enjoyed using the application, found the self-persuasion prompts helpful in vaccine decision-making, and confirmed that tablet use did not raise concerns about the HPV vaccine. We used the audio-recorded responses of 45 parents to generate peer narratives with the vernacular of the target population. The final version of the application will be used in a randomized factorial design trial to examine basic psychological processes underlying why self-persuasion is effective.
Conclusion: It is feasible for safety-net parents to use a tablet application and verbalize their self-generated arguments for HPV vaccination. Tablet-based interventions may be ideal to deliver educational messages in busy clinic settings because it is self-administered and addresses literacy limitations of safety-net parents.
Citation Format: Jasmin A. Tiro, Simon Craddock Lee, David Farrell, Emily G. Marks, Austin S. Baldwin, Deanna C. Denman. Development of a tablet-based application to elicit self-persuasion about HPV vaccination among undecided parents. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B87.