HPV
Cervical cancer, which is typically the result of an HPV, infection ranks as the second leading cause of female cancer and the most common cancer in African women aged 15 to 44 years. Despite the proven effectiveness of the HPV vaccine, many individuals remain hesitant to allow their children to be vaccinated or receive the vaccine themselves.
Problem Statement
HPV is a significant global health concern, contributing to a high burden of preventable diseases, especially cervical cancer. Despite the effectiveness of HPV vaccines, uptake remains low, particularly in Africa, where 425.68 million women aged 15 and older are at risk. In 2020, global coverage dropped to 13% due to COVID-19 disruptions.
In Kenya, only 33% received the first dose and 16% the second dose in 2020. With similar low coverage in Côte d'Ivoire, these numbers were 34% and 41% in 2021.
Barriers to vaccine adoption include healthcare disparities, funding issues, supply shortages, and limited access to health facilities. Additionally, societal stigmas, misconceptions about vaccine safety, and religious beliefs hinder uptake.
Decision-making is further complicated by the need for parental consent and the stigma associated with sexually transmitted infections. Addressing these challenges requires a holistic approach, focusing on the social, structural, economic, and behavioral factors influencing vaccine confidence and uptake.
Methodology
Psycho-behavioral segmentation offers a targeted approach to address barriers to HPV vaccination by understanding the psychological and behavioral drivers among families of adolescent girls in Kenya and Côte d’Ivoire.
This method identifies family "archetypes" requiring tailored strategies to activate latent demand for vaccination. Insights from this approach will guide the creation of targeted messages, service delivery methods, and identify effective messengers to resonate with diverse caregivers and adolescents. By understanding user needs and co-designing interventions, this strategy aims to accelerate HPV vaccine coverage by engaging families who might otherwise choose not to vaccinate.
Research
Intervention Design
Immersion
1
Hypothesis to be explored
Identify drivers of and barriers to uptake of HPV vaccines
Live
Prototyping
6
Build guidance materials and tools to support implementers
Quantification of barriers
Formative
Research
2
Assess the prevalence and clustering of the drivers and barriers in different segments of the population
Psycho-behavioral segment & strategies
Quantitative Research
3
Identify effective levers of behavior change
Build & Prioritize Concepts
Ideation &
Co-Creation
4
Co-develop segment targeted solution concepts
Select prototypes to further develop
Concept
Prototyping
5
Conduct iterative prototyping of targeted, tailored interventions with implementers
Formative Research Learnings
The HPV vaccine is typically the introduction to HPV and cervical cancer
With low relevance and risk salience of cervical cancer, girls and caregivers are typically introduced to HPV and cervical cancer through the vaccine introduction. However, in a few cases where a caregiver has close association with loss due to cervical cancer, the HPV vaccine can be a welcome relief.
There is now a ‘new vaccine’ mental model
The COVID-19 vaccine has disrupted patterns of uptake and trust created by legacy child immunization, creating a ‘new vaccine’ mental model which has an emerging trust issue.
HPV vaccine seen as ‘routine immunization’ by health system yet ‘new vaccine’ by caregivers
Dissonance arises as the health system sees the HPV vaccine as a ‘routine child immunization’ where service delivery aims to defaulted action yet caregivers see the HPV vaccine as a ‘new vaccine’ therefore an active decision needs to be made.
Caregivers feel a lack of agency in the decision process
Caregivers view HPV vaccine uptake as a high stakes health decision and want to have control over making this decision given the perceived potential high risk and negative implications. Caregivers see the service delivery modality as keeping them away from the decision and giving more agency to their 9-14 year old girls within current school vaccination programs, which can lead to both girls and caregivers needing to cope.
Trust is critical
Institutional trust and trusted messengers serve as a means to drive uptake and a means to cope with the uncertainty of a new vaccine. But trust can be severely impacted by myths/misinformation and poor service delivery experience of the HPV vaccine which can negatively impact future vaccinations and health engagement.
Service delivery can be a demand lever
Service delivery needs to be looked upon as a demand generation lever, including building assurance for caregivers and involvement for 9-14 year old girls.
The Elements
Trust
Trust
Under uncertainty and scarce or low awareness context, trust becomes a key decision driver for vaccination action (uptake/avoidance or rejection).
Disease
Context
Disease Context
Low to no disease context or risk salience for HPV and cervical cancer lead to low demand.
Coping
Coping
9-14 year old girls’ concerns are centered on coping in the hot state and immediate risks (needle fear), while caregivers’ concerns are centered on coping with the long term risks (infertility, side effects) ,and decision burden.
Vaccine
Mental Model
Vaccine Mental Model
Vaccine mental models informed from previous vaccines (child immunization but more recently COVID), beliefs and experiences impact HPV vaccine uptake.
Household
Decision Making
Household
Decision Making
Caregivers see 9-14 year olds as children who are unable to make independent health decisions. 9-14 is a diverse cohort with differing needs for agency and independence.
Service
Delivery
Service Delivery
Variation in service delivery within and across countries, based on whether a push or pull approach has been adopted for HPV vaccine roll out creates different uptake and experiences for caregivers and girls.
Service
Delivery
Interactions
The interactions of the different elements outlined above of the HPV decision making and uptake framework, including the service delivery experience, gives rise to unique emotions related to how caregivers experience each journey. These emotions have implications for uptake of the HPV vaccine and trust in future vaccines, resulting in three distinct outcomes as illustrated below:
Minimal time exists between these stages. It could be day of or the next day.
Call to Action
Collaboration is key to support ongoing and future HPV vaccine uptake efforts. While we have insights, the HCD process and resources, it is critical to collaborate with implementing partners within the health system and community so that a sustainability plan can be developed with tested, contextualized interventions. If you are an implementing partner in Cote d’Ivoire or Kenya involved with the HPV vaccine and interested in collaborating with us for our upcoming design phase, please contact Christina at christina.hanschke@thefinalmile.com