Date of Award

Summer 2021

Document Type

Open Access Dissertation


Pharmacology, Physiology and Neuroscience

First Advisor

Tessa J. Hastings


Background: Human Papillomavirus (HPV) is a sexually transmitted infection that can lead to 6 different types of cancer, including cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancer. Every year in the United States, nearly 35,000 cancer cases are estimated to be caused by HPV infection. While catch-up HPV vaccination is recommended through age 26 for those not previously vaccinated, only 21.5% of adults age 18-26 have completed the recommended number of HPV vaccine doses as of 2018. Many interventions have been tested to increase vaccination rates, and one such intervention, framed messaging, has shown promise in increasing intention to vaccinate. Tailored messages, targeted to patient-specific characteristics, may be more successful in improving vaccination uptake. This study proposes a novel way to increase HPV vaccination intention within this population by conducting a market segmentation and testing developed messages for effectiveness in increasing intention to vaccinate.

Methods: Semi-structured interviews were conducted to elicit barriers and facilitators of HPV vaccination. Individuals between the ages of 18 and 26 who had not yet received the vaccine, had partially completed the vaccine series, and who had completed the series were interviewed. A cross-sectional survey was used to conduct a market segmentation of this population. Promotional HPV vaccination messages were developed and tested for effectiveness in increasing intention to vaccinate. Qualtrics panels was used to recruit participants, including both males and females between the ages of 18 and 26.

Results: Through the qualitative interviews, it was found that cues to action was a strong facilitator of HPV vaccination intention. Subjective norms and perceived severity both had a mixed influence on intention, while perceived susceptibility, perceived barriers, and relationship status all played roles as barriers to intention. Through a hierarchical clustering technique, six segments were found to exist within this population. The first segment, “Keeping up with the Kardashians,” places a high importance on subjective norms. Segment #2, “Every day is a challenge,” faces the highest vaccine access barriers. Segment #3, “On the fence,” has safety concerns regarding the HPV vaccine and needs an in-depth discussion about the safety of this vaccine. Segment #4, “Busy (Intelligent) Bees,” wants this vaccine and has the highest knowledge scores out of all segments but faces the greatest time barriers. Segment #5, “That doesn’t apply to me, does it?” has the highest mean barriers, vaccine belief, and risk perception barriers. Segment #6, “No idea and not interested,” lacks knowledge and needs education about both HPV and the HPV vaccine in order to influence their intentions to vaccinate.

Interview participants reported a preference for four main types of messages to promote HPV vaccination: facts, personal, fear, and emotional. Based upon these results as well as the literature, nine messages and a control message were tested in their ability to improve baseline intentions. Messages 3 and 5, both Murdock style messages, increased intention within multiple segments. However, each segment had unique message preferences, underscoring the value of a targeted messaging approach.

Conclusions: This study represents a novel approach in conducting a market segmentation and testing targeted messaging to improve HPV vaccination intentions among adults 18-26 years of age. Based upon the results, it is evident that different segments need their own unique approach and messaging to improve intentions to vaccinate. This study provides the tools necessary for healthcare providers to identify and target HPV vaccine messaging to patients’ unique barriers.