Mobile App Strategy to Facilitate Human Papillomavirus Vaccination Among Young Men Who Have Sex With Men: Pilot Intervention Study

Research on barriers to vaccination indicates that both attitudinal (e.g., health beliefs) and logistical (e.g., lack of healthcare provider recommendation) factors interfere with vaccine uptake. With regard to the human papillomavirus (HPV) vaccine and young men who have sex with men (MSM), there are additional factors that have led to poor uptake, such as the fact that the initial marketing of the "cervical cancer vaccine" focused on women; also, many young MSM, who are more vulnerable to HPV, do not disclose their sexual orientation to their healthcare provider due to stigma and discrimination. However, the heavy use among young MSM of social media and mobile apps to seek sexual health information and sexual partners presented a strategy for a group of United States (US)-based researchers to consider for HPV vaccine promotion among this group. This report describes a pilot study that evaluated an app-focused approach to facilitate HPV vaccination among young MSM.

The intervention is theory based and is grounded in:

• Implementation intention theory, which proposes that the gap between intention and behaviour can be bridged by concrete action plans that address when, where, and how the intention can be translated into action. The mHealth tool sought to bridge the gap by addressing known barriers to vaccination among young MSM and serving as a bridge between the virtual community and an MSM-affirming health centre.
• Design thinking, which is a human-centred framework that places the intended audience (in this case, the end user of the mHealth tool) at the centre of all key design decisions. (As described in a 2019 paper by this group of researchers, 48 young MSM participated in online focus groups about what they would like to see in an app, expressing the desire for credible, relatable, secure, and easy-to-use interfaces that provided sexual health and HPV information in a positive context. Click here to learn more.) Informed by these young MSM, the tool content included education on HPV, HPV vaccine, prevention of HIV/sexually transmitted infection (STI), and how the health centre, which primarily cares for sexual and gender minority adolescents and adults up to age 29 years, could help with health insurance enrollment and vaccine cost assistance. Tool functionalities included geolocation/directions to the health centre, appointment scheduling, and appointment reminder system.

The researchers recruited 42 MSM aged 18-26 years in Boston, Massachusetts, US, through an online dating app and linked them to the mHealth tool. Out of these, 33 completed the study questionnaire, and 67% (22/33) completed the questionnaire during the initial mHealth tool download.

Results of the study questionnaire supported previous research that young MSM view HPV vaccination as an important preventative health intervention. However, results indicate a continued need to enhance knowledge regarding HPV vaccine safety, appropriateness of vaccination for MSM, and HPV-associated cancers in men (e.g., anal cancer).

Of those who were either unvaccinated, not up to date, or did not report vaccine status, 23% used the mHealth tool to obtain HPV vaccination. Participants primarily used the tool's educational components and functionalities that facilitated development of concrete action plans (e.g., appointment reminders).

The researchers note that enrollment was challenged by participants' willingness to download the study mHealth tool and engage in the study questionnaire. Thus, they suggest that future mHealth research and interventions with young MSM might consider recruitment via Facebook or Instagram and/or different engagement strategies (e.g., website-based rather than app-based) that have shown greater evidence of success.

They conclude: "Interventions aimed at reducing stigmas and increasing access to MSM-affirming health environments that also provide inclusive health education show promise...and are warranted, so that young MSM can comfortably seek health care and gain knowledge of risks and complications associated with HPV disease among MSM."