Using Intervention Mapping to Develop and Adapt Two Educational Interventions to Increase HPV Vaccination Among Hispanic Adolescents

Abstract

Background: HPV vaccination among Hispanic adolescents falls below the national goal. Tailored interventions to increase vaccination among Hispanic populations are needed to reach national goals and to reduce HPV-related cancer disparities. Aim: We used the intervention mapping (IM) framework to develop and adapt two educational interventions, a print fotonovela and a tailored interactive multimedia intervention (TIMI), targeting Hispanic parents of adolescents to increase HPV vaccine uptake. Methods: To develop the interventions, we followed IM steps 1-6 to 1) develop a logic model of the problem and identify modifiable factors associated with vaccination by conducting literature reviews, focus groups, and in-depth interviews with Hispanic parents; 2) develop behavioral outcomes, identify determinants, and develop a matrix of change objectives; 3) develop a program theme and program components, identify theoretical methods, and operationalize methods as practical applications; 4) develop an intervention design plan; 5) develop implementation strategies; and 6) evaluate the interventions. To adapt the interventions, we followed steps 1-6 for the new target population, Hispanic parents of adolescent males. Throughout the adaptation process, we assessed the outputs from the original intervention development process to identify needed adaptations. Results: Through formative research in step 1, we identified modifiable determinants associated with parental decision-making about vaccinating their daughters. In step 2, we crossed performance objectives with these factors to produce a matrix of change objectives that served as a blueprint for program development. We then identified tailoring and targeting, framing and anticipated regret, modeling, skill building, and education and counseling as theoretical methods to address the determinants and create behavior change. We produced two program components, a print fotonovela and TIMI, with the theme “For Our Daughters.” Our implementation plan identified lay health workers as implementers. A logic model of change guided evaluation planning. We later adapted the intervention content for parents of Hispanic adolescent males and changed the theme to “For Our Children.” We identified new knowledge gaps as parents were less informed about the HPV vaccine for males. We made surface adaptations including filming new scenes to produce a new fotonovela and TIMI. We conducted content analysis to ensure intervention messages corresponded to change objectives. Conclusion: IM provided a systematic methodology for program development and adaptation to produce two educational interventions to increase HPV vaccination among Hispanic adolescents. Tasks in each step built upon one another integrating findings from the literature, previous research, qualitative findings, and theory. The systematic process allowed us to develop messages and materials targeting factors beyond HPV knowledge or awareness to create behavior change.