An IMB Model-based Study On Influencing Factors And Intervention On HPV Vaccination Among College Girls

ObjectivesWhile the HPV vaccines have been approved by the US FDA since 2006,in recent years an increasing number of women are living with cervical cancer globally.Among them,Chinese women have a higher cervical cancer incidence and mortality rate than the global average,with mortality rates being almost twice the global average.However,the current approach of HPV vaccination in China is not satisfactory given the high disease burden of cervical cancer.The current study is a randomized controlled trial designed to identify the barriers and facilitators of HPV vaccination among Chinese female students.This study will also test a health intervention measure via a popular form of new media in order to improve the HPV vaccine uptake under the framework of Information-Motivation-Behavioral skill Model(IMB).MethodsThis investigation was a multicenter,school-based,prospective,randomized,parallel group,waitlist controlled trial involving a 7-day education intervention with a further 3-month follow-up.From February 27,2020 to March 30,2020,we enrolled 3867 female college students older than 18 years.The enrolled participants were randomly divided into two groups,and the ratio of Art and Science majored in within group was about 1:1.The intervention groups were offered a 7-day online education,and participants in both groups filled out 4 questionnaires at the baseline,7 days,1 month and 3 months after the intervention.The primary outcome was the difference in willingness and practice of HPV vaccination between the intervention and control groups.Secondary outcomes were the comparison of HPV related information,motivation,and behavioral skill towards HPV vaccination between these two groups.SPSS 23.0 was used for statistical analysis.The chi-square test was used to analyze the sociological characteristics of participants,the cognitive status of health and sexual behavior,the differences in willingness and practice of HPV vaccination.The t test was used to compare the difference in continuous variables such as HPV related knowledge scores between groups.Logistic regression analysis was used to analyze the influencing factors of the HPV vaccination willingness among college girls.Generalized estimating equations was used to compare the outcome measurements of two groups at different time points.ResultsAmong the 3867 participants,102 had been vaccinated against HPV before the study,and the vaccination rate was 2.64%.The multivariate logistic regression analysis of 3765 unvaccinated participants showed that:previous sexual experience,relatives or friends with cancer,heard of HPV,actively searched for or consulted HPV vaccine and perceived susceptibility,perceived severity,perceived obstacles,social norms and self-efficacy were the predicting factors of HPV vaccination willingness(P<0.05).A total of 3484 participants were followed up,and there was no statistical difference in the rate of loss of follow-up between the two groups during the intervention and follow-up period.At different follow-up time points,HPV-related knowledge,motivation and behavioral skills towards HPV vaccination,and HPV vaccination intention in the intervention group were higher than those in the control group.HPV-related knowledge between the two groups was statistically different,while the motivation,behavioral skills towards HPV vaccination,and HPV vaccination intention only showed statistical differences immediately after the intervention.The difference between the groups reached a peak immediately after the intervention,and then gradually narrowed the gap over time.And there was no statistical difference in HPV vaccination rate between these two groups.Conclusions(1)HPV-related awareness deficits in college girls,willingness of HPV vaccination was high,while the HPV vaccination rate was low.(2)Willingness to get HPV vaccine was associated with sexual experience,family or friends with cancer,having heard of HPV,having actively searched for or consulted on HPV vaccine issues,perceived susceptibility,perceived severity,perceived barriers,subjective norms and self-efficacy.(3)Online intervention based on IMB model can improve the HPV related knowledge,motivation and behavioral skills towards HPV vaccination,and willingness of HPV vaccination among college girls in the short term,but the effect gradually decreases over time,which proves that this intervention has good educational effect,but it needs to be repeated many times to consolidate and maintain the intervention effect.