How the use of technology to increase vaccination rates has the potential to beneficially impact our entire population through decreased risk of HPV infection and related cancers, increased quality of life, and reduced financial burden

e. The vaccine, approved by the Food and Drug Administration (FDA), in June of 2006, consists of 2 or 3 doses depending on the age of series initiation (Gardasil, 2015). There are three types of HPV vaccines approved: bivalent, quadrivalent, and 9-valent- with only the 9-valent available for administration in the United States (UpToDate, 2021). The 9-valent vaccine provides individuals with protection against HPV strains that are known to cause 70% of all cervical cancers, 90% of all genital warts, as well as five more cancer-causing subtypes of HPV (Fuller & Hinyard, 2017; CDC, 2018).

Not only is the preventative vaccine effective, but the price of the vaccine is also substantially lower than the HPV-related burdens previously mentioned. The 9-valent HPV vaccine costs anywhere from $140 to $190 per injection, and according to the American Cancer Society, most insurances cover this cost (American, n.d.). From its inception, however, the HPV vaccine has been marketed more toward the female population. This is explained by the simple fact that HPV can be screened for in women but there is no screening tool for men (HPV test, 2020), and as a result, historically HPV has been thought of as more of a feminine disease (Daley et al., 2017). Current vaccination rates still reflect this initial misunderstanding as females still lead their male counterparts in HPV vaccination rates. Vaccine series completion is significantly higher in females than males. As of 2020, 61% of women reported completing the full HPV vaccine series, whereas only 56% of males reported the same (Jenco, 2021).

Many initiatives have attempted to address the inadequacy of the U.S. HPV vaccination rates to lessen the burden caused by HPV and cancers associated with it, but none have focused their efforts directly on adolescent males. Beasley et al. (2019) found that when implemented into a school vaccination program, a two-text message reminder system increased HPV vaccination rates equally in males and females up to 3.29% and did not report any differences in the outcomes of vaccination uptake when comparing different types of text messages (reminder, motivational, or self-regulatory.)

Feinberg and Keeshin (2017) conducted a similar study using text message reminders for HPV vaccination in HIV infected individuals, ages 16 to 26 years, both males and females. Similarly, this study found a significant increase in vaccination uptake with the text messaging system and argued that it increased rates of the first vaccine in the series, as well as entire series completion. Albertin et al. (2015) also found a 3% increase in the uptake of the first dose of the HPV vaccine series with electronic reminders sent to parent or guardian of publicly insured adolescents, aged 11 to 16 years, with no prior HPV vaccinations.

Evidence from past studies supports and even recommends further research into the idea of utilizing text message reminders as a method of increasing HPV vaccination rates. While studies have focused on different characteristics such as insurance status, individuals with specific ailments, ethnic backgrounds, and environment, no research has solely focused on adolescent males. This lack of data combined with the significantly lower HPV vaccination rate of males demonstrates the need for further investigation into methods that support improved vaccination rates. The purpose of his study was to determine if the use of text message reminders increases HPV vaccination rates of adolescent males.

Methodology

The study was conducted in four nurse-led Federally Qualified Health Centers in rural Indiana. At the time of the study, the clinics had 1,459 adolescent males enrolled for routine care. A convenience sample including only guardians of adolescent males, ages 11-18, who had not yet started the HPV vaccination series was selected for participation (n=975). A de-identified report using the clinic’s electronic health records was run by the Director of Quality Improvement to determine sample size and given to study personnel. Of note, while the HPV vaccine can be administered as early as 9 years of age, the health centers follow the CDC’s routine guidelines which recommend starting the vaccine series at 11 years of age (Vaccines, 2020). Participants were included in the study if they were a parent or guardian of a male adolescent, aged 11-18 who had not yet completed the HPV vaccine series, were enrolled in care at the rural, nurse-led clinic in Indiana, and had agreed to receive Care Messages as part of their routine care.

Following approval from the university’s IRB, Care Message reminders were sent by the clinic’s Patient Care Coordinator to the eligible participants. An initial 975 care messages were sent out. However, taking into consideration the 11 participants that chose to opt out of the study, the 453 incomplete me