Effects of online tailored education on informed HPV-vaccination decision making among mothers of invited girls

Abstract

Background: The HPV-vaccination uptake in the Netherlands among 12-year old girls is low (61%). Mothers indicated their need for more interactive, tailored education. This study evaluates the effects of online tailored education on informed decision making (IDM) among mothers of invited girls. Methods: In 2015, we conducted a randomized controlled trial with two arms using a pre-posttest design. The control arm received the usual education (i.e., brochure and reference to web-based generic education), the intervention arm was also allocated to online tailored education guided by two virtual assistants. Outcomes were IDM outcome, process and determinants (i.e., knowledge, attitudes and intention). Mothers (N = 38,483) were recruited via internet panels and the national immunization register. The online tests were completed by 8,599 (i.e., pretest) and 4,443 (i.e., posttest) mothers. Multiple regression analyses were used to examine effects. Findings: Two thirds (68%) of the mothers in the intervention arm visited the online tailored education, 26% of them twice. The online tailored education and virtual assistants were evaluated with a mean grade of 7.6 (SD = 1.3) and 7.4 (SD = 1.5), respectively. Compared to those in the control arm, mothers in the intervention arm significantly increased their IDM (Outcome: OR=1.71; Process: Cohen’s d=0.07), increased their knowledge (Cohen’s d=0.03), had more positive attitudes (Cohen’s d=0.01) and a more positive intention towards the HPV-vaccination of their daughter (Cohen’s d=0.01; all p<0.001). Discussion: This study shows that online tailored education can be used to improve IDM regarding the HPV-vaccination.