ABSTRACT
An estimated 80 million Americans are currently infected with human papilloma virus (HPV). HPV is strongly
associated with cancers for females and males. High morbidity, mortality, and economic burden are
attributable to HPV-associated cancers. Given the high infection rate of HPV in the US, vigorous prevention
efforts are needed—including timely and effective HPV vaccination for boys and girls. Before COVID-19, the
youth vaccination rate was suboptimal with about 50% youth 13-17 years having been vaccinated in contrast to
the national goal of 80%. Vaccination rates dropped dramatically during the pandemic. Evidence for game-
based health interventions is promising to facilitate knowledge acquisition and retention, and to promote
vaccination behaviors in youth. As healthcare providers often find it challenging to promote HPV education and
vaccination in clinical settings, an educational gamed-based intervention to promote HPV vaccination among
youth in clinical settings offers an innovative and scalable approach to address this disparity in children’s
healthcare. Guided by Social Cognitive Theory, we propose to (1) examine the feasibility and acceptability of a
new HPV preventive intervention, the HPV Detective video game, designed for youth and their parents; (2)
explore pre-post, intervention-related change in vaccine intent and uptake as well as change in theoretically
posited intervention mediators; and (3) assess the potential for broader intervention implementation. Using a
sequential mixed-methods, 2-group (intervention vs usual care), longitudinal design, 64 parent-youth dyads
(32/per study condition) will be recruited. Parent-youth dyads in the intervention will play HPV Detective (tablet
format) at the clinic prior to the healthcare provider visits. The control dyads will receive standard clinic
treatment. Youth ages 11-14 need to receive two doses, 6-12 months apart, for maximum protection; thus,
three weekly reminder messages will be sent 6-mos post enrollment to participants in both conditions. Data will
be collected at T0 (baseline), T1 (immediately post game for intervention only) and at T2 (7-mos post
enrollment). At 7-mo post enrollment, semi-structured interviews will be conducted with a subset of 8 parent-
youth dyads in the intervention group, representing differences in child sex, age, and game completion, to
solicit parent/youth feedback about factors that influenced their engagement in the intervention during the
clinical visit; interviews with 3 healthcare providers (1 administer, 2 providers) will be conducted to examine
factors related to intervention implementation. This study addresses the significant public health problem of
HPV-associated cancers through timely youth vaccination, aligning with the mission of NIH. If the findings are
promising, we will conduct a larger-scale RCT to examine the efficacy and effectiveness of the intervention that
is likely to impact cancer-related morbidity and mortality, and reduce economic and social costs related to
HPV-associated diseases. The findings will also extend prevention science with respect to the use of
innovative computer technology to reduce incidence of HPV-associated cancers.
