Morgane Michel

Impact of a shared medical decision-making aid on patient decisional conflict regarding human papillomavirus vaccination: a mixed-methods study

Abstract Introduction Human papillomaviruses (HPVs) cause several vaccine-preventable cancers, including cervical cancer. In France, HPV vaccination coverage remains low. Decision aids (DAs) can help individuals make informed health choices. This study assessed the impact of an online DA (SOSHPV) on decisional conflict and vaccination intention, and explored user perceptions in real-life contexts. Methods A convergent mixed-methods design was used (November 2023–June 2024). The quantitative component included a pre–post questionnaire assessing knowledge, vaccination intention, and decisional conflict. The qualitative component involved semistructured interviews with a subsample of users, analyzed using grounded theory. Results Among 943 website visitors, 187 participants (54 males, 12 adolescents) completed the presurvey, and 44 (12 males, 6 adolescents) completed both assessments. Over half (54%) were young parents using the tool to support HPV vaccination decisions for their child. Post-intervention, knowledge improved (P < 0.001), and decisional conflict decreased (P < 0.001). Vaccination intention shifted: 55%–75% in favor and 32%–18% undecided (P < 0.001). Qualitative analysis (n = 12) revealed three themes: social ambivalence around vaccination, the DA as a support for informed choices, and its role in enhancing communication with healthcare providers. Discussion This study showed a reduction in decisional conflict and increased vaccination intention. These findings suggest that DAs may play an important role in addressing vaccine hesitancy and supporting value-aligned choices in real-world settings. Conclusion This study highlights the potential of an online DA to improve vaccine acceptance by reducing decisional conflict and enhancing dialog. Further research is needed to assess its large-scale impact on vaccine uptake.

Optimising HPV vaccination communication to adolescents: A discrete choice experiment

Human Papillomavirus (HPV) vaccine coverage in France is below 30%, despite proven effectiveness against HPV infections and (pre-)cancerous cervical lesions. To optimise vaccine promotion among adolescents, we used a discrete choice experiment (DCE) to identify optimal statements regarding a vaccination programme, including vaccine characteristics. Girls and boys enrolled in the last two years of five middle schools in three French regions (aged 13-15 years) participated in an in-class cross-sectional self-administered internet-based study. In ten hypothetical scenarios, participants decided for or against signing up for a school-based vaccination campaign against an unnamed disease. Scenarios included different levels of four attributes: the type of vaccine-preventable disease, communication on vaccine safety, potential for indirect protection, and information on vaccine uptake among peers. One scenario was repeated with an added mention of sexual transmission. The 1,458 participating adolescents (estimated response rate: 89.4%) theoretically accepted vaccination in 80.1% of scenarios. All attributes significantly impacted theoretical vaccine acceptance. Compared to a febrile respiratory disease, protection against cancer was motivating (odds ratio (OR) 1.29 [95%-CI 1.09-1.52]), but not against genital warts (OR 0.91 [0.78-1.06]). Compared to risk negation ("vaccine does not provoke serious side effects"), a reference to a positive benefit-risk balance despite a confirmed side effect was strongly dissuasive (OR 0.30 [0.24-0.36]), while reference to ongoing international pharmacovigilance without any scientifically confirmed effect was not significantly dissuasive (OR 0.86 [0.71-1.04]). The potential for indirect protection motivated acceptance among girls but not boys (potential for eliminating the disease compared to no indirect protection, OR 1.57 [1.25-1.96]). Compared to mentioning "insufficient coverage", reporting that ">80% of young people in other countries got vaccinated" motivated vaccine acceptance (OR 1.94 [1.61-2.35]). The notion of sexual transmission did not influence acceptance. HPV vaccine communication to adolescents can be tailored to optimise the impact of promotion efforts.