A multilevel intervention to promote HPV vaccination among young adults in Texas: protocol for a randomized controlled trial.

BACKGROUND: Human papillomavirus (HPV) infections can cause cancers of the cervix, vagina, vulva, penis, anus, and oropharynx. The most recently approved HPV vaccine, Gardasil-9, protects against HPV infection and can prevent HPV-associated invasive cancers. However, Gardasil-9 is one of the most underused vaccines in the US today. Young adults are at risk for HPV infection, but many are not vaccinated. This study uses a randomized controlled trial (RCT) to test an innovative multilevel intervention to increase HPV vaccination rates among young adults. In this paper, we describe the research protocol. METHODS: The study uses a two by three factorial design. A total of 1200 young adults in Texas, age 18-26 years, who have not been previously fully vaccinated against HPV will be randomly assigned to one of six conditions to receive: (1) standard CDC information about HPV vaccination (control); (2) video narratives about HPV vaccination; (3) written narratives about HPV vaccination; or (4-6) enhanced access to HPV vaccine combined with (4) standard CDC information, (5) video narratives, or (6) written narratives. The two primary outcomes are the rate of HPV vaccination initiation by 3-month follow-up and rate of HPV vaccination completion by 9-month follow-ups. We will determine the impact of the individual level intervention (i.e., persuasive narratives through video or written format), the systemic level intervention (i.e., enhanced access to HPV vaccines), and the combination of both levels, on HPV vaccination initiation and completion. We will also use purposive sampling to select participants to take part in semi-structured interviews/focus groups to better understand the mechanisms of the intervention. DISCUSSION: Recruitment and data collection began in March 2022. We expect to complete data collection by March 2026. We expect that narratives, enhanced access, and the combination of both will improve HPV vaccination initiation and completion rates among young adults. If proven successful, these individual- and system-level interventions can be easily disseminated in regions with low HPV vaccination rates to improve HPV vaccination, and ultimately decrease HPV-related cancer burden. TRIAL REGISTRATION: NCT05057312.

When guilt works: a comprehensive meta-analysis of guilt appeals.

Introduction: Guilt appeals are widely used as a persuasive approach in various areas of practice. However, the strength and direction of the persuasive effects of guilt appeals are mixed, which could be influenced by theoretical and methodological factors. Method: The present study is a comprehensive meta-analysis of 26 studies using a random-effects model to assess the persuasive effects of guilt appeals. In total, 127 effect sizes from seven types of persuasive outcomes (i.e., guilt, attitude, behavior, behavioral intention, non-guilt emotions, motivation, and cognition) were calculated based on 7,512 participants. Results: The analysis showed a small effect size of guilt appeals [g = 0.19, 95% CI (0.10, 0.28)]. The effect of guilt appeals was moderated by the theoretical factors related to appraisal and coping of guilt arousal, including attributed responsibility, controllability and stability of the causal factors, the proximity of perceiver-victim relationship, recommendation of reparative behaviors, and different outcome types. The effect was also associated with methods used in different studies. Discussion: Overall, the findings demonstrated the persuasive effects of guilt appeals, but theoretical and methodological factors should be considered in the design and testing of guilt appeals. We also discussed the practical implications of the findings.

Entertainment-education to reduce internalized stigma, increase intimate partner status disclosure intentions, and increase antiretroviral medical adherence intentions: A randomized controlled trial targeting black women living with HIV in the Southern U.S.

BACKGROUND: Black women in the Southern U.S. account for 67% of all new HIV diagnoses across women of all races and ethnicities. In comparison to women of other racial and ethnic identities, Black women disproportionately experience internalized stigma, lower levels of disclosure self-efficacy, and lower rates of medical adherence. The disclosure processes model hypothesizes that persons living with HIV can be disclosure avoidance oriented or disclosure approach oriented. Disclosure avoidance is facilitated by various forms of stigma and negative outcome expectations. While disclosure approach orientation is facilitated by factors such as positive disclosure attitudes and disclosure self-efficacy. Despite the important role of disclosure in ending the HIV epidemic, extant interventions are limited. Recent research suggests entertainment-education (EE) may be an effective intervention for HIV status disclosure. Entertainment-education is a persuasive strategy that consists of intentionally embedding health and social messages into entertaining content. METHODS: The present study evaluated the comparative efficacy of the 90 DAYS film for improving internalized HIV stigma, disclosure beliefs, positive disclosure attitudes, disclosure self-efficacy, HIV disclosure intentions, and medical adherence intentions. A randomized controlled trial was employed consisting of 130 Black women living with HIV in the Southern U.S. Participants were recruited primarily via a Qualtrics panel and randomly assigned to either view the 90 DAYS film or a standard of care brochure. RESULTS: Results indicated the EE condition significantly outperformed the brochure condition on the following outcomes: disclosure beliefs (p = .046), positive disclosure attitudes (p = .008), disclosure self-efficacy (p = .007), and intentions to disclose to an intimate partner (p = .038). Statistically significant differences were not observed for internalized stigma or medical adherence intentions. CONCLUSION: Findings suggest that EE is an effective strategy for improving psychosocial influences of disclosure and disclosure intentions. Theoretical and practical implications of this work are discussed.

Evaluating a game-based randomized experiment to increase melanoma identification among adults living in the U.S.

BACKGROUND: Although cutaneous melanoma diagnoses are rising, morbidity and mortality can be reduced through early detection. This investigation seeks to improve melanoma identification accuracy, attitudes, and intentions among a lay population by comparing the effectiveness of different melanoma identification training strategies and the effect of real-time decisional feedback on a melanoma identification task. We developed an innovative, game-based approach and hypothesize differences among frequently used melanoma identification training modalities (i.e, the Asymmetry/Border/Color/Diameter [ABCD] rule, the Ugly Duckling Rule [UDS], and a modality that combines them both, ABCDF (where the F stands for 'funny looking"), and investigate differences in types of immediate feedback on a melanoma identification task. METHODS: We conducted a national online randomized experiment to test a 4 (melanoma training strategies: ABCD, UDS, ABCD-F, control) × 3 (feedback: Dermatological, Dermatological + Motivational, control) factorial design on melanoma identification, skin cancer beliefs (perceived susceptibility, severity, response efficacy, self-efficacy), attitudes, and prevention intentions. RESULTS: ABCD training (p < .001) and UDS training (p = .05) resulted in significantly higher melanoma identification than the control. All training types resulted in significantly higher self-efficacy than the control (p = .02). Both Dermatological (p = .02) and Dermatological + Motivational feedback (p = .01) elicited significantly lower melanoma identification than the control condition, although this effect may be due to differences observed among participants who received UDS training. There was a significant main effect of feedback on self-efficacy (p = .002), where both Dermatological and Dermatological + Motivational feedback elicited higher levels of self-efficacy than the control. CONCLUSIONS: Our results suggest that game-based ABCD and UDS training strategies could increase melanoma identification accuracy. Real-time feedback reduced accuracy, but was associated with increased self-efficacy related to melanoma detection outcomes.

The Development and Validation of the Colonoscopy Joking Scale.

Joking is an important communication behavior that helps people cope with colorectal cancer and colonoscopy screening. However, whether joking serves a beneficial or maladaptive function in the context of colorectal cancer screening remains unknown. The lack of a valid scale impedes our understanding of how joking influences colonoscopy uptake. This study aims to develop and validate the Colonoscopy Joking Scale, a scale of joking behaviors in colonoscopy screening. A sample of Mturk participants aged 50-75 (N = 105) who were not compliant with colonoscopy screening recommendations was recruited to rate items for three joking factors and a measure of colonoscopy screening intentions. Two joking factors (i.e., screening-related and sexual connotation) related to colonoscopy screening and one related to general health were identified in the analysis. The psychometric analysis demonstrated strong convergent, predictive, and discriminant validity. The Colonoscopy Joking Scale will be helpful to understand what joking factor is associated with specific barriers to colonoscopy for different patients so that effective educational and interventional programs can be implemented.

Human versus chatbot: Understanding the role of emotion in health marketing communication for vaccines.

Based on the theoretical framework of agency effect, this study examined the role of affect in influencing the effects of chatbot versus human brand representatives in the context of health marketing communication about HPV vaccines. We conducted a 2 (perceived agency: chatbot vs. human) × 3 (affect elicitation: embarrassment, anger, neutral) between-subject lab experiment with 142 participants, who were randomly assigned to interact with either a perceived chatbot or a human representative. Key findings from self-reported and behavioral data highlight the complexity of consumer-chatbot communication. Specifically, participants reported lower interaction satisfaction with the chatbot than with the human representative when anger was evoked. However, participants were more likely to disclose concerns of HPV risks and provide more elaborate answers to the perceived human representative when embarrassment was elicited. Overall, the chatbot performed comparably to the human representative in terms of perceived usefulness and influence over participants' compliance intention in all emotional contexts. The findings complement the Computers as Social Actors paradigm and offer strategic guidelines to capitalize on the relative advantages of chatbot versus human representatives.

Can a Social Norms Appeal Reduce Indoor Tanning? Preliminary Findings From a Tailored Messaging Intervention.

Perceived social norms are routinely observed as positive predictors of indoor tanning. Past research has suggested that messaging interventions target normative perceptions to reduce indoor tanning behavior. Despite this call, little empirical research has investigated the utility of taking a social norms approach in behavioral interventions. The present study addresses this gap by conducting a quasi-experiment (N = 206) assessing the effect of an intervention message correcting normative misperceptions on indoor tanning intentions at different levels of tanning frequency. Results suggest that tailored normative intervention messages can successfully reduce tanning intentions among high-frequency tanners, those who scored at the 75th and 90th percentile of tanning frequency (f2 for interaction = .015). These results provide preliminary empirical evidence to support previous theorizing on the efficacy of social norms interventions among high-frequency indoor tanners.