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Principal Investigator: TIMOTHY W. BICKMORE
Organization: TUFTS MEDICAL CENTER
Fiscal Year: 2024
Award: $648,684
Funding agency: National Cancer Institute
Universal Human Papillomavirus (HPV) vaccination would significantly decrease cervical, vaginal, vulvar, anal,
and oral cancers, and reduce racial disparities in these cancers. However, HPV vaccination rates for U.S.
adolescents of all races, ethnicities, and income levels remain far below national targets. Increasing anti-vaccine
information, limited clinician time to engage with hesitant parents, and backlogs of preventive care incurred
during the COVID pandemic contributed to deficits of HPV vaccination that may years to resolve. Embodied
Conversational Agents (ECAs) are animated computer agents that simulate face-to-face conversation between
a patient and a caregiver, using both verbal and nonverbal conversational behavior, to provide a natural and
intuitive computer interface that is accessible to patients of all levels of health and computer literacy. We have
successfully developed and evaluated this interface in several clinical trials to motivate health behavior change
for a wide range of populations, including a pilot evaluation of an ECA that promotes HPV vaccination for the
families of patients with cervical pre-cancer and cancer. In this project we will adapt this technology to produce
English and Spanish smartphone ECAs for HPV vaccination (ECA-HPV) to provide vaccine recommendations
and motivational interviewing to parents/guardians and vaccine-eligible adolescents and facilitate
communication with clinic staff. HPV vaccine promotion over time can lead to acceptance among parents who
initially decline, and the ECA can provide continual interactions both prior to and following clinic visits. We will
evaluate ECA-HPV in a randomized controlled trial for HPV-vaccine eligible adolescents aged 9-12 to evaluate
ECA-HPV, comparing usual care (UC) (n=175) versus usual care plus four design variants of the ECA-HPV
(UC+ECA) (n= 175 x 4 = 700). All intervention participants will get the ECA-HPV for the parent; the design
variants include inclusion vs exclusion of ECA-HPV for the adolescent and inclusion vs exclusion of clinic
notification of information from the system in a 2x2 factorial design to differentiate the impact of the adolescent-
facing and clinic notification features of the intervention. The research team is nationally recognized as leaders
in HPV vaccination, health literacy, and innovative technologies to improve health. This study will advance our
research on the development of easy-to-use technologies to empower patients. This scalable approach has a
significant potential to reduce vaccine hesitancy and increase adolescent vaccination. If successful, our team
will promote the ECA-HPV through national networks for broad implementation and work to adapt ECA-HPV to
include other childhood, adolescent, maternal, and adult immunizations.
Terms: <0-11 years old><21+ years old><Address><Adolescent><Adolescent Youth><Adult><Adult Human><Age><Ambulatory Care Facilities><Anal Cancer><Anal Cancers><Anus Cancer><Behavior><Boston><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Cancers><Care Givers><Caregivers><Cell Phone><Cellular Phone><Cellular Telephone><Cervical><Cervical Cancer><Cervix Cancer><Child><Child Youth><Childhood><Children (0-21)><Clinic><Clinic Visits><Clinical Trials><Communication><Computer Interface><Computer Literacy><Computers><Counseling><Data Systems><Development><Economic Income><Economical Income><Education><Educational aspects><Eligibility><Eligibility Determination><Ethnic Origin><Ethnicity><Evaluation><Exclusion><Family><HPV><HPV Vaccination><HPV Vaccine><HPV vaccination acceptability><HPV vaccination acceptance><HPV vaccination confidence><HPV vaccination uptake><HPV vaccine acceptability><HPV vaccine acceptance><HPV vaccine confidence><HPV vaccine uptake><Health><Health Care Professional><Health Facilities><Health Professional><Health Status><Health behavior change><Health care facility><Healthcare Facility><Healthcare professional><Hospitals><Human Papilloma Virus><Human Papilloma Virus Vaccination><Human Papilloma Virus Vaccine><Human Papillomavirus><Human Papillomavirus Vaccination><Human papillomavirus Vaccine><IT Systems><Immunization><Income><Infectious Human Wart Virus><Information Systems><Information Technology Systems><Intention><Intervention><Intervention Strategies><Intuition><Knowledge><Language><Level of Health><Malignant Anal Neoplasm><Malignant Anal Tumor><Malignant Cervical Neoplasm><Malignant Cervical Tumor><Malignant Neoplasm of the Cervix><Malignant Neoplasms><Malignant Oral Cavity Neoplasm><Malignant Oral Cavity Tumor><Malignant Oral Neoplasm><Malignant Tumor><Malignant Tumor of the Anus><Malignant Tumor of the Cervix><Malignant Tumor of the Cervix Uteri><Malignant Uterine Cervix Neoplasm><Malignant Uterine Cervix Tumor><Malignant Vagina Neoplasm><Malignant Vagina Tumor><Malignant Vaginal Neoplasm><Malignant Vaginal Tumor><Malignant Vulva Tumor><Malignant Vulvar Neoplasm><Malignant Vulvar Tumor><Malignant neoplasm of anus><Malignant neoplasm of cervix uteri><Malignant neoplasm of vulva><Medical><Medical center><Misinformation><Mobile Phones><Monitor><Mouth Cancer><New England><Northeastern United States><Notification><Oral Cancer><Outcome><Outpatient Clinics><Parents><Participant><Patients><Population><Preventative care><Preventive care><Primary Care><Protocol Screening><Race><Races><Randomized, Controlled Trials><Recommendation><Research><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Series><Severe 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hesitancy><vaccine hesitancy><vaccine hesitant><verbal><vulval cancer><wart virus><youngster>