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BACKGROUND: LACK OF INSIGHT IN ROLE OF VACCINATION AND SCREENING IN DECISION MAKING

Human papillomavirus (HPV) vaccines prevent infection with HPV types 16 and 18, which are responsible for approximately 70% of cervical cancers and have proven to be highly efficacious on precursors of cancer. In the Netherlands, HPV vaccination is offered to girls in the age of 12-13 since 2010, from 2021 girls (and boys) will be invited in the year that they turn 10 years old (Health Council Netherlands, 2019). When women turn 30, they are invited for cervical cancer (CC) screening every 5 years. Invitees are expected to make an informed decision, i.e. understand the purpose of the program, the associated probabilities and uncertainties, weigh pros and cons, and take own values into account in decision-making.

From 2023 onwards, the first group of women vaccinated against HPV will be first invited for CC screening. This new situation could imply that at some point a one size fits all screening protocol would be replaced by tailored screening protocols based on the vaccination status. This raises new questions about information provision to the target populations of HPV vaccination and CC screening and will increase the challenge of informed decision-making, especially among individuals from low socioeconomic and non-Western ethnic background who generally have low health literacy skills.

 

AIM: ASSESS INFORMATION NEEDS FOR INFORMED DECISION MAKING

The general aim of this project is to assess target populations’ information needs for informed decision-making in HPV vaccination and CC screening. We will therefore gain insight in the role of HPV vaccination status in women’s decision-making in CC screening and in the role of the existence of CC screening in parents’ decision-making in HPV vaccination, and explore perceived acceptability of possible adaptations of the CC screening interval. Together with the target populations we will develop information prototypes that will be tested on relevance, understandability and usability.

 

RESEARCH POPULATION AND RECRUITMENT

In workpackage 1 we assess to what extent and how HPV vaccination status plays a role in women’s decision-making in CC screening. The research population consists of women that received an offer of HPV vaccination in the year they became 13 years old, and will be invited to participate in the CC screening program in 2023 and onwards. Both women that were vaccinated and those that were not vaccinated will be included in the research population.

In workpackage 2 we assess to what extent and how the existence of CC screening plays a role in parents’ decision-making in HPV vaccination. The research population consists of parents that received an offer for HPV vaccination for their daughter.

We ensure diversity in the research population regarding socioeconomic, ethnic background and health literacy. We therefore use respondent-driven sampling (RDS) that leverages social networks. We thereby work together with ‘Stichting Gezondheid Allochtonen Nederland’ and citizen participants that are already involved in this project.

 

METHODS: MENTAL MODEL APPROACH AND CO-CREATION PROTOTYPE INFORMATION

The workpackages will be performed simultaneously. By qualitative interviews (n=60) and surveys (n=400) among women and parents we assess beliefs (mental models) regarding HPV vaccination and CC screening and acceptability of possible adaptations of the CC screening interval. Based on interviews with experts in the field of HPV vaccination and CC screening (n=20) and document analyses we construct an expert model. By comparing this expert model with the mental models, we will assess information needs of both target populations. Based on these information needs, we will develop information prototypes in three co-creation sessions with women, experts in the field of HPV vaccination and CC screening, and designers we will develop information prototypes. The Centre for Population Screening (CvB) and Centre for Infectious Diseases (CIB) will be involved in every step in the co-creation process. In qualitative interviews among women (n=20) and parents (n=20) we will explore the relevancy, comprehensibility and usability of the information prototypes.

 

IMPLICATIONS AND IMPLEMENTATION

The results of this project will be used to formulate recommendations for the National Institute of Public Health and Environment (RIVM) that can be applied in optimization of the provision of CC screening and HPV vaccination from a life course perspective. This will support decision-making in HPV vaccination and CC screening for invitees from various ethic and socioeconomic backgrounds.

 

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