Effectiveness of the e-health Communication Intervention for Middle School Girls and Mothers on HPV Vaccination

Abstract

In South Korea, the number of cervical cancer patients in the younger age group under the age of 20 years is increasing. Human papillomavirus (HPV), a significant cause of cervical cancer, is transmitted through sexual contact. HPV is the leading cause of cervical cancer and is transmitted through sexual contact. As the age of sexual intercourse among Korean adolescents is gradually decreasing, HPV vaccination is necessary at an early stage before exposure to HPV infection. Korea provides two free doses of HPV vaccination to 12-year-old girls. Nonetheless, the vaccination rate is lower than other free vaccinations such as DTaP and HepB due to distrust or misunderstanding of vaccines and poor health beliefs. Previous studies found that school health education on HPV vaccination for adolescents was insufficient. Mothers, who are decision-makers in health care for adolescents, had high concerns about the side effects of HPV vaccination and lacked access to credible information about the vaccine. Therefore, it was found that for girls to be vaccinated against HPV infection, mothers and daughters must raise HPV vaccination intentions and provide interventions that improve the health responsibility of adolescents and communication about sexual health with their mothers. Health communications such as campaigns and health professional education are included as cues to action to induce preventive health behaviors. Recently, social media platforms with less time and space constraints have been used in various studies to deliver e-health communication. Therefore, this study was conducted to develop and provide an e-health communication intervention for middle school girls and their mothers to get HPV vaccination in middle school girls. This study was developed in six steps according to the development stage of the intervention mapping program, as follows. In step 1, needs assessment, a focus group interview was conducted with middle school girls who had completed two doses of HPV vaccination. Ten studies on health communication related to HPV vaccination were reviewed. In step 2, the expected behavioral outcome of the intervention was set, and in step 3, theory and practical strategies were selected. In this study, the theoretical framework was a health belief model, and health communication messages were constructed based on behavior change techniques and the main concepts of the parallel expansion process model. In step 4, an e-health communication intervention was developed, and the KakaoTalk chatbot was developed based on need assessment and the theoretical framework as a delivery tool for intervention. In step 5, the specific plan of intervention implementation was established, and in step 6, the validity and feasibility of e-health communication intervention were evaluated. This study used a quasi-experimental design, with 40 people in the experimental group (20 middle school girls and 20 mothers) and 40 people in the control group (20 middle school girls and 20 mothers) participated in the intervention. The experimental group was provided with HPV vaccination health communication for 4 weeks through the KakaoTalk chatbot. Further, activities to increase health beliefs, self-efficacy, knowledge, and sexual communication about vaccination were provided. Meanwhile, the control group was provided with HPV vaccination information in PDF format. Through an online survey, HPV vaccination health beliefs, self-efficacy, vaccination knowledge, sexual communication, health responsibility, vaccination intentions, HPV vaccination initiation were investigated. Data were collected three times: pre-test, first post-test after 4 weeks of intervention, and second post-test 4 weeks after the end of the intervention. The change between groups over time was confirmed through a generalized estimation equation to evaluate the effectiveness of e-health communication interventions. Consequently, the primary goal of HPV vaccination initiation among middle school girls was higher in the experimental group than in the control group. In addition, the HPV vaccination beliefs, self-efficacy, knowledge, and vaccination intentions in the experimental group increased significantly compared to the control group over time. In mothers, HPV vaccination self-efficacy, knowledge, and vaccination intentions of the experimental group increased significantly compared to the control group over time. The e-health communication intervention developed in this study developed adolescent-friendly health communication messages through systematic program development steps. Consequently, it was confirmed that it effectively improved HPV vaccination initiation and intention to complete the vaccination. It is expected that this study will help middle school girls enhance their self-efficacy and self-care agency for early participation in health promotion behavior to prevent cervical cancer.

국내 20대 미만의 젊은 연령층에서 자궁경부암 환자 수가 증가하고 있다. 자궁경부암의 주요 원인인 인유두종바이러스(Human papillomavirus, HPV)는 성접촉으로 전파되는데 우리나라 청소년의 성 관계 연령이 점점 낮아지고 있으므로 HPV 감염에 노출되기 전 조기에 HPV 예방접종이 필요하다. 우리나라는 만 12세 여성청소년에게 HPV 예방접종을 무료로 2회 시행하고 있으나 백신에 대한 불신과 낮은 건강신념으로 다른 국가무료예방접종보다 접종률이 낮은 편이다. 선행연구에서는 청소년 대상 HPV 예방접종에 대한 학교보건교육이 미비하고 청소년의 건강관리 의사결정권자인 어머니는 HPV 예방접종에 대한 부작용 우려가 높으며 예방접종의 신뢰있는 정보 접근이 부족한 것으로 나타났다. 그러므로 자녀의 HPV 예방접종을 위해서는 어머니와 자녀가 함께 예방접종에 대한 인식 개선이 필요하며 어머니와 자녀의 성 의사소통과 암 예방행위 실천을 위한 청소년의 건강책임을 향상시키는 중재 제공이 필요한 것으로 나타났다. 예방적 건강행위 실천을 유도하는 행동의 계기로 캠페인, 의료진 교육 등 헬스커뮤니케이션이 포함되는데, 최근 시공간의 제약이 적은 소셜미디어 플랫폼이 e-헬스커뮤니케이션 전달방법으로 다양한 연구에서 활용되고 있다. 따라서 본 연구는 여중생의 HPV 예방접종 실천을 위해 여중생과 어머니를 대상으로 e-헬스커뮤니케이션 중재를 개발 및 제공하고자 수행되었다. 본 연구는 Intervention mapping 프로그램 개발 단계에 따라 6단계로 개발되었다. 1단계 요구도 조사에서는 문헌고찰과 HPV 예방접종 2회를 완료한 여중생을 대상으로 초점집단면담을 시행하였고, 2단계는 중재의 기대되는 행동결과를 설정하고 3단계에서 건강신념모델에 기반한 이론적 기틀과 헬스커뮤니케이션 구성전략으로 병행확장과정모델의 개념과 행동변화기술을 적용하였다. 4단계는 요구도 조사와 이론적 기틀을 바탕으로 카카오톡 챗봇으로 전달되는 e-헬스커뮤니케이션 중재를 개발하고 5단계에서 중재실행계획을 세우고 마지막 6단계에서는 개발된 중재의 전문가 타당도 검증과 대상자의 실행가능성 평가를 통해 최종적으로 e-헬스커뮤니케이션 중재가 완성하였다. 비동등성 대조군 전후설계에 따라 실험군 40명(여중생 20명, 어머니 20명), 대조군 40명(여중생 20명, 어머니 20명)이 중재에 참여하였다. 실험군에게는 4주간 HPV 예방접종 헬스커뮤니케이션을 카카오톡 챗봇으로 제공하고, 대조군에게는 PDF로 HPV 예방접종 정보를 제공하였다. 온라인 설문조사를 통해 HPV 건강신념, 예방접종 자기효능감, 예방접종 지식, 성 의사소통, 건강책임, 예방접종 의도, HPV 예방접종 1차 실천을 조사하였으며, 사전조사, 4주간 중재 후 1차 사후조사, 중재종료 4주 후 2차 사후조사의 총 3회에 걸쳐 자료가 수집되었다. e-헬스커뮤니케이션 중재의 효과 평가는 일반화 추정 방정식을 통해 시간에 따른 그룹 간 변화를 확인하였다. 자료분석 결과 일차적 목표인 여중생의 HPV 예방접종 1차 실천은 실험군이 대조군에 비해 높았다. 또한 실험군의 여중생과 어머니 모두 HPV 예방접종 자기효능감, 지식, 예방접종 의도는 시간에 따라 대조군에 비해 유의하게 증가하였다. 본 연구에서 개발된 e-헬스커뮤니케이션 중재는 체계적인 프로그램 개발 단계를 거쳐 청소년 친화적인 헬스커뮤니케이션 메시지로 구성되었으며 HPV 예방접종 실천과 예방접종 완료 의지를 향상시키는데 효과적인 것으로 확인되었다. 향후 여중생들이 자궁경부암을 예방하기 위한 건강증진행위 조기 참여에 대한 자기효능감과 자가건강관리역량을 향상시키는데 도움을 줄 것으로 기대한다.