The HPV vaccine provides protection against HPV infection and protects against 90% of cervical cancers. Uninsured and Medicaid-eligible children younger than 19 years old may receive free HPV vaccination through the Vaccines for Children program. If used appropriately, the vaccine has the potential to decrease cervical cancer-related health disparities among Hispanics yet HPV vaccination rates in Texas are much lower than Healthy People 2020 targets (80% of girls 13 to 15 years received three doses of the HPV vaccine).

The CDC estimates that fewer girls (ages 13 to 17) in Texas receive one or more doses of the HPV vaccine compared to girls nationwide (about 56%) and in Houston even few...

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The HPV vaccine provides protection against HPV infection and protects against 90% of cervical cancers. Uninsured and Medicaid-eligible children younger than 19 years old may receive free HPV vaccination through the Vaccines for Children program. If used appropriately, the vaccine has the potential to decrease cervical cancer-related health disparities among Hispanics yet HPV vaccination rates in Texas are much lower than Healthy People 2020 targets (80% of girls 13 to 15 years received three doses of the HPV vaccine).

The CDC estimates that fewer girls (ages 13 to 17) in Texas receive one or more doses of the HPV vaccine compared to girls nationwide (about 56%) and in Houston even fewer receive all three scheduled doses compared to girls nationwide (33.9 vs.37.6). Among Texas male adolescents, only 15% have received all three scheduled doses.

Effective educational interventions that inform parents about the HPV vaccine and address their questions and barriers are important for increasing HPV vaccination. Despite substantial investments in cancer control research, the availability of effective prevention methods, and the availability of evidence-based programs to increase preventive behaviors such as HPV vaccination, these are rarely well diffused to maximize clinical and public health benefit.

With CPRIT Research funding, our team developed and evaluated two interventions designed to educate and to motivate Hispanic parents to vaccinate their children. The Por Nuestros Hijos (PNH) programs include a print photonovella and a tailored interactive multimedia intervention (TIMI) running on iPads and now available on the web and mobile platforms. They were designed to be delivered by Community Health Workers (CHWs) or be available in clinic settings. A group randomized trial showed that this program was effective for increasing HPV vaccination.

We now propose to increase use of this program in both clinical and community settings to enhance the overall impact of the program on HPV vaccination rates across Texas. The overall goal is to increase the reach, adoption, and implementation of a HPV educational program for parents, with a particular emphasis on reducing HPV-related health disparities among Hispanics. We will develop and implement a dissemination and implementation (D&I) intervention grounded in D&I theory and new information about factors influencing adoption and implementation (PNH Implementation Intervention (PNH-II)) designed to increase PNH program use.

We will deliver PNH-II in two phases. During Phase 1 (targeted dissemination for adopting agencies), we will provide training and technical assistance for clinics and CHW associations that have already expressed interest in implementing PNH. During Phase 2 (dissemination of PNH through clinical and community networks), we will work closely with the Texas Department of State Health Services Breast and Cervical Cancer Services Program (BCCS) and Community Health Worker Program (CHW) to increase awareness about PNH, garner interest, identify additional potential adopting clinics and CHW organizations and assess organizational readiness. Newly identified adopting clinics and organizations will then receive training and technical assistance.

Specific Goals: Goal 1: Identify the contextual and behavioral factors that influence the adoption and implementation of an evidence-based HPV vaccination intervention by community clinics and community health worker programs serving Hispanic communities; Goal 2: Develop dissemination and implementation interventions (strategies) to accelerate and improve PNH adoption and implementation by BCCS contractors and CHW programs, and adapt and package the evidence-based HPV intervention; Goal 3: Deliver the implementation intervention using both passive and active implementation strategies to community clinics and community health workers; Goal 4: Evaluate the effectiveness of the implementation intervention and to increase adoption and implementation of the HPV vaccination intervention (PNH) in clinics and by community health workers.

The proposed program will not only provide training and technical assistance to interested agencies but will also develop a theory and evidence-based intervention that can be used to increase adoption and implementation of an effective HPV vaccination program in clinical and community settings across Texas. Even in the short term, the organizations collaborating on the proposed program (DSHS, BCCS and CHW Programs) provide an extensive network of agencies for rapid scale up of this effective program. Since program impact is a function of both efficacy and reach, the dissemination of the PNH program has the potential of increasing vaccination and thus decreasing HPV-related diseases including cervical cancer among Hispanics in Texas.

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