Opportunities

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• Opportunities Challenges in Planning and
  Implementing the HPV Vaccine Project

NC Immunization Conference 2009
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• Presentation Content

• HPV Vaccine Project Overview
• Planning Process
• Implementation
• Evaluation

spend bulk of time today talking about planning
and implementation evaluation is just getting
started, so available data is limited
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• HPV Vaccine Project Overview
• What? Who? When? Why?

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What is the HPV Vaccine Project?

• Collaborative public health effort that aimed to
  help prevent cervical cancer by increasing HPV
  vaccination among adolescent girls in South
  Central North Carolina.

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What is the HPV Vaccine Project?

• A research and practice partnership between
• the South Central Partnership for Public Health,
• UNC Gillings School of Global Public Health,
• UNC School of Journalism and Mass Communication,
• UNC Lineberger Comprehensive Cancer Center,
• North Carolina Division of Public Health and
• several other state, local, and regional
  partners.

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South Central Partnership for Public Health
Camden
Northampton
Gates
Currituck
Alleghany
Rockingham
Warren
Ashe
Surry
Caswell
Stokes
Pasquotank
Hertford
Vance
Person
Halifax
Perquimans
Wilkes
Watauga
Granville
Yadkin
Guilford
Orange
Bertie
Chowan
Forsyth
Franklin
Mitchell
Avery
Nash
Caldwell
Yancey
Alamance
Durham
Alexander
Davie
Edgecombe
Washington
Madison
Dare
Martin
Iredell
Tyrrell
Burke
Wake
Davidson
Wilson
Buncombe
Catawba
Chatham
McDowell
Randolph
Haywood
Pitt
Rowan
Beaufort
Swain
Hyde
Johnston
Lincoln
Greene
Graham
Rutherford
Lee
Henderson
Cabarrus
Jackson
Harnett
Gaston
Moore
Stanly
Lenoir
Wayne
Polk
Cleveland
Cherokee
Craven
Transylvania
Macon
Montgomery
Pamlico
Clay
Mecklenburg
Cumberland
Jones
Sampson
Richmond
Anson
Hoke
Union
Duplin
Scotland
Carteret
Onslow
Robeson
Bladen
Green HPV Vaccine Project pilot counties
Cumberland, Harnett, Richmond, and Robeson
Pender
New Hanover
Columbus
Brunswick
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What is the HPV Vaccine Project?

• A Social Marketing Campaign
• Health communication effort
• Educating mothers of 11 12 year old girls about
  HPV, the HPV vaccine, and how to access it for
  their daughters.
• Component for medical practices
• Promote the HPV vaccine project.
• Encourage conversations with parents.
• Improve access to HPV vaccine clarify VFC
  program, encourage referral to health department
  if necessary, and utilize NCIR to do client
  reminders.

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What we knew one year ago

• HPV vaccine awareness - high
• HPV vaccination rates - low
• Access is a complex issue
• Gardasil ads on TV
• Health Belief Model and Health Behavior Theory
• Cervical Cancer rates in SCPPH higher than
  elsewhere in NC
• Funding to SCPPH through NC Incubator
  Collaboratives
• 1 year project timeline remaining
• Initial set of partners already engaged
• Controversial issue
• HPV vaccine is recommended, not required

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What we didnt know

• HPV vaccine access in the region
• What moms in our counties were thinking about
  cervical cancer, HPV, the HPV vaccine
• Best way to reach moms of 1112 year olds with
  health messages
• Would a social marketing campaign get community
  support?
• How exactly do you implement a HPV vaccine
  intervention?
• (and many other things that we didnt know that
  we didnt know at that point!)

Where do you go from here?....
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• Planning

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Strategic Pause

• Project Advisory Group
• www.CommunityGuide.org
• Planning sessions to discuss intervention
  components
• Health Communication Campaign
• Access Mapping
• Formative Research
• Marketing Firm support
• Provider Reminders (explore)
• Client Reminders (explore)
• New access to vaccine (explore)

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Decisions

• Focus on reaching mothers/parents and not
  adolescents directly.
• Focus on cancer prevention.
• Focus on initiation of vaccine series
  
  not the 2nd and 3rd dose.
• Build intervention to supplement and enhance
  existing public health systems and processes.

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HPV/Cancer Prevention Social Marketing Campaign
Intervention Components
(short-term) OUTCOMES
(longer-term) OUTCOMES
OUTPUTS

• Health Communications Campaign
• target mothers of 9-18 year olds focus on
  11-12
• messages Phase 1 HPV vaccine benefit
  (physical, emotional) access (real perceived)
  Phase 2 community vaccine drives
• channels TBD
• place TBD
• counties involved Phase 1 in 4 pilot counties
  Phase 2 - Robeson Richmond

• Website developed by March 09.
• 100 of Family Resource line staff trained by
  April 09.
• dissemination of X of flyers with info on HPV
  vaccine benefit access by June 09
• posting of X of posters by June 09
• creation of 2 video clips to post on local TV,
  U-Tube, in Doctors offices by June 09
• XX newspaper articles printed on campaign
  activities in each county
• creation of materials in two counties to promote
  community vaccine drives by June 09

PARENTS
PARENTS Increased parent demand for HPV vaccine

• Positively influenced knowledge, attitudes and
  beliefs
• vaccine benefits
• vaccine safety
• physician recommendation
• severity of cervical cancer

ACCESS Enhanced HPV vaccine access
PROVIDERS Incr. of providers who recommend the
HPV vaccine

• Community Vaccine Drives offer HPV vaccine in
  community locations (school, Walmart, etc.)
• target 9-18 year olds focus on 11-12
• place schools community settings? TBD
• counties involved Robeson Richmond

Decrease perceived barriers to parental vaccine
access
ACCESS Increased of access points for
receiving HPV vaccine

• schools in 2 counties supportive of vaccine
  drive by April 09
• implementation of vaccine drive 3xs per year in
  at least 75 of local middle schools by June 2010

Increased HPV vaccine uptake

• Client Reminders
• target 9 -18 year old Health Check clients
• message HPV vaccine is part of routine well
  child exams - encourage girls to ask about the
  HPV vaccine, give 1-800 number and website.
• counties involved Pilot in 1-4 counties

PARENTS Parents reminded that the HPV vaccine is
recommended for their daughters at this age
(long term) IMPACT

• 75 of eligible girls enrolled in Health Check
  parents contacted to remind about HPV vaccine by
  June 09.

• Provider Education/Outreach
• target clinical practices
• message (1) inform about campaign, website, and
  1-800 number, (2) information on how to use NCIR
  and VFC program, (3) encourage them to refer
  girls to another provider who has the vaccine
  if they do not.
• counties Pilot in 1-4 counties

Decreased Incidence of HPV

• Deliver educational information to 90 of
  providers in pilot by June 09

• PROVIDERS
• Increased provider/clinic staff knowledge
  awareness of
• who offers which supply of HPV vaccine
• NCIR capability to support reminder systems for
  clients/providers

Assumption providers in the region will
recommend the vaccine if they can remember/are
reminded who should get it would refer to
somewhere else if they dont stock it
Decreased Incidence of Cervical Cancer
Context state mandate for HPV education al
materials through schools and Tdap vaccination
for 6th grade SCPPH support for HPV/Cervical
Cancer intervention HPV vaccine - recommended,
not required partners completed HPV vaccine
research and formative work Epi Racial
disparities in cervical cancer rates high
cervical cancer prevalence in the
region Resources funding for intervention paid
and in-kind staff support.
EXAMPLES ONLY (to be set when specific
intervention component activities are clarified)
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• Clarifying the Context

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Access Mapping

• Goal simplify message about where to get the HPV
  vaccine and what it will cost.
• Who in our region offers the HPV vaccine?
• Privately purchased/state supply?
• Contact information?
• Access Mapping Survey
• Team EpiAID student volunteers
• We knew who offered state supply
• Hired graduate student
• Developed and implemented telephone interview
  protocol

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Understanding Access

• Goal simplify message about where to get the HPV
  vaccine and what it will cost.
• Understanding VFC eligibility for recommended
  vaccine.
• Where are there holes in vaccine coverage between
  VFC and private insuranceand how big are they?
• Thought that we would have a clear message about
  access followed by a list a places they could go
  to get vaccine.
• (Ended up listing only the health department.)

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Formative Research

• Review of data and literature
• Focus groups and Key Informant interviews
• 2 student groups UNC 2 focus groups
• Project partners 2 focus groups
  14 key informant interviews

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Formative Research

• Focus on mother daughter together
• Focus on recommended age of vaccination 11-12
• Photos of multiple races/ethnicities on materials
• Focus on cancer prevention rather than HPV (sti)
  prevention make materials appropriate for
  parents of younger girls
• Provide details on safety, efficacy, and access
• Recommendations about how to get out the message

marketing plan from People Designs
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Modified Intervention Plan

• Small print media brochures, posters, radio
  (no paid media)
• Project website
• NC Family Health Resource Line (1-800 )
• Provider Outreach (vs. reminder systems)
• Client reminders using NCIR only (not HCCs)
• Vaccine clinics not moving forward in pilot
• Focus only on 4 pilot counties

Have specific provider outreach and community
outreach plans that clarify specifics of each
side of the project.
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• Message Material
• Development

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Message Material Development

• Focus on moms of 1112 year olds
• Include access information
• Message from a trusted source
• Appropriate language/educational level
• Focus on cancer prevention
• Tailor based on formative findings
• Message of hope, protection, prevention

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Message Material Development

• Student group proposals (Hopes Dreams, Protect)
• Marketing firm drafts of posters
• JOMC PhD student committed to message testing
  39 intercept interviews to see what messages and
  images resonated with moms of 11-12 year old
  girls
• Interviews in pilot counties with target audience
  
• Materials for KI and partner review

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Protect posters for pre-testing
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hopes dreams pre-testing posters
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Finalizing Messages

• Based on message testing and partner input
  moved forward in finalizing posters (and logo)
• Regional meeting with local health educators and
  clinic staff
• lots of text for a poster
• Moving on to other materials
• Brochure website relying on the experts (CDC,
  FDA, etc)
• Ads and web banners with similar look and
  message.

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Final 2 different posters, mixed races, English
Spanish
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Inside text
front cover
back cover
Available in English Spanish county specific
generic
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Supplemental materials
Web Banners
Ads
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Provider Outreach Materials
Provider Toolkit Cover
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Provider Outreach Materials

• Worked with NC Immunization Branch to clarify VFC
  and NCIR messages and materials
• Utilize FAQ developed for other side of the
  project (questions moms frequently ask about HPV
  and the HPV vaccine)
• Used available materials created very little
  new for this toolkitjust new packaging.
• Reviewed by some county contacts Added POST-IT.
  
• Develop button for office staff

Button
Sticky Note
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www.HPVvaccineproject.org

• Everything that we have discussed today will be
  available on our website when the campaign
  launches.

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(No Transcript)
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www.HPVvaccineproject.org

• Screen shot of website

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• Implementation

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Community Media Outreach

• PRE-LAUNCH PLANNING
• Community presentations
• Test the waters
• Build community partners and support
• Solicit help in dissemination of materials
• Media Outreach
• Press release tailored to each county
• FAQ and talking points for media contacts
• Outreach plan
• HBHE graduate student support Local Health
  Department staff input and involvement

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How can our partners help?

• COMMUNITY PARTNERS Help us get the word out!
• The success of this project will rely heavily on
  local partners and providers that can help
  support this important public health effort.
  Here are some ways your agency or organization
  can help promote the campaign
• Hang posters distribute brochures
• Wear an HPV Vaccine Project button
• Post a web link to our project on your website
• Include a message about HPV vaccine and our
  campaign in your agency newsletter, newspaper
  column, bulletin, or meeting agenda
• Invite us to come speak with mothers or partners
• Help us in contacting the media

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Outreach Prioritization Grid
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Provider Outreach

• PRE-LAUNCH PLANNING
• Community Care Network presentations
• Build support, partnership get input on how to
  prioritize practices and implement outreach
  efforts
• Presentation (testing) with 2 large pediatric
  practices
• Outreach plan
• HBHE graduate student support
• How do we reach a diverse group of providers?
  Lunch learns? One-on-one visits?
• Academic detailing
• Packaging information and providing clarification
  

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How providers can help

• Help us get the word out!
• Talk with parents
• Promote HPV vaccine access
• Providers can help promote HPV vaccination by
  talking with parents about HPV vaccine as well as
  taking steps to improve access and referral
  practices in their offices.

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How providers can help

• The HPV Vaccine Project toolkit for medical
  practices includes
• An overview of the HPV Vaccine Project
• Tips and tools for starting the conversation
• Frequently Asked Questions designed to address
  common questions and concerns of parents
• Clarification on which girls may be eligible for
  the states free vaccine program and where to
  send patients to access the HPV vaccine.
• Details on how to use the North Carolina
  Immunization Registry (NCIR) to help reach out to
  patients using client reminders

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• June 1st launch

• Fax for providers in Community Care Networks
• Press released out in 4 counties - published
• Distribution of materials in Cumberland, Harnett,
  Richmond, and Robeson Local Health Department
  staff UNC students
• Provider visits

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• Preliminary process data

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Preliminary Process Data

• 2 press releases, 1 radio PSA developed and
  disseminated
• 650 material placements in 4 county region
• 112 providers reached
• 2 Ads placed, 6 web banners
• Website Developed and FHRL staff trained
• Website hits 125 from NC, 13 from our region
• 2 calls to FHRL
• 6 conference presentations on formative data and
  message testing

still collecting process data in Auguststay
tuned!
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Campaign implementation
Table 1. Actual Distribution for All Counties by
Priority Level
Priority groups as listed on large
prioritization grid previously shown.
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Provider outreach
Totals 112 clinics reached 64 visited 48
reached via mail
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Google Analytics website use
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Evaluation

• Did all of this work impact immunization rates in
  our counties? well see!
• Evaluation underway
• September Spring

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Evaluation

• Mom survey awareness and response to campaign
  messages (eg., talking w/doctor, friends, family
  daughter about vaccine making an appt, getting
  vaccine etc.)
• Providers - satisfaction with and use of
  materials and vaccine recommendation as standard
  practice for 11-12 year olds
• NCIR - change in vaccination rates in pilot
  counties, region and control counties we'll look
  at 12 months of data to measure change.

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• Overall
• Challenges Opportunities

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Challenges

• System challenges (H1N1, state budget, etc.)
• NC Family Health Resource Line consistency
• Sufficient staff resources
• Competing priorities of partners
• Misinformation in the media
• Adolescent utilization of health system
• Engaging schools
• Project timeline
• Geographical distribution of staff

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Opportunities

• Research, practice, and community partners
• Local level understanding and connections to
  community, media, and partners agencies
• Supportive leadership
• Graduate student support for activities at every
  step
• HPV vaccine messaging in other vaccine efforts
• Supplement current system
• Schools
• Using Web 2.0 to disseminate health information
• New Medicaid guidelines more adolescent
  wellness

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• Special thanks to our project partners at the
  University, State, and Local levels for hanging
  in for this important journey!
• Acknowledgement and thanks to my client
• South Central NC Partnership for Public Health of
  the
• NC Public Health Incubator Collaboratives

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• We have hopes and dreams for her future and they
  dont include cervical cancer!
• Thank you for the role you play in helping
  promote health and prevent disease among North
  Carolinians!
• HPV Vaccine Project, info_at_HPVvaccineproject.org