A Behavioral Economic Approach to improve human papillomavirus (HPV) vaccination

Objective: Despite recommendations for universal HPV vaccination, only 38% of 13-17-year-old females and 14% of 13-17 year-old males have completed the 3-dose series.  Our objective is to measure the impact of a behavioral economic intervention based on principles of loss aversion and escalation of commitment on HPV vaccination rates.

Methods:  In October 2013 we began a demonstration project to compare the impact of a delayed cash reward (Intervention) compared to usual care (Control) on HPV vaccine series completion.  We recruited unvaccinated adolescents (11-17 yr) and a parent or legal guardian from a general pediatric clinic at an academic medical center. At the time of recruitment, a personal deposit account was created for the parent. They receive certificates indicating a $25 deposit for their child’s receipt of each of the first two doses.  After receipt of the third dose, the participant is given $50 in cash.

Results:  Within one year, a total of 1169 dyads were approached, of which 85 enrolled in the study.  We identified 101 unvaccinated control-group subjects within the same year.  To date, data is available for 50% of enrolled participants and 90% of control-group members. HPV vaccine initiation was more likely in the intervention group compared to the control group [OR 4.15]. Similarly, HPV vaccine series dose completion was more likely in the intervention group compared to the control group [OR 3.76].

Significance: To date, our behavioral economic intervention significantly increases HPV vaccine series initiation and completion among study participants.

Learning Areas:

Biostatistics, economics
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related research
Social and behavioral sciences

Learning Objectives:
Explain how principles of behavioral economics can be used to ‘nudge’ HPV vaccination behavior by transforming decision biases.

Keyword(s): Behavioral Research, Immunizations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the research coordinator for this project since we began recruitment in 2013. I participate in the day-to-day study management, in addition to frequent analysis and progress reports. I was hired by, and work closely with Dr. Rachel Caskey, the primary investigator. Dr. Caskey is also an assistant professor at the University of Illinois School of Public Health, where I am working towards my MPH.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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