Promoting General Awareness of HPV, its Link to Cancer & Genital Warts: A Social

Marketing Approach

Allison Friedman, MSEileen Dunne, MD

Hilda Shepeard, MBA

The findings & conclusions in this presentation are those of the authors and do not necessarily represent the views of CDC/ATSDR

Background

Most sexually active people acquire genital HPV at some time in their lives.

Yet there have been no national public health efforts to educate the public about HPV & its link to genital warts (GW) or cervical cancer (CC).

What little HPV information is available through the Internet & the popular/news media has been found to be unreliable, inaccurate, & incomplete.(1)

National surveys suggest that the public is largely unaware of HPV; most do not know about the HPV-CC link. (2)

1. Anhang et al., 2003; Brandt et al., 2005; Perrin et al., 2002; Stevens et al., 20042. ARHP, 2005; Wirthlin Worldwide, 2005; Kaiser Family Foundation, 2000

In 2001, Congress mandated CDC to “prepare and distribute educational materials for the public that include information on genital HPV,” addressing:

a) modes of transmission

b) consequences of infection, including the HPV-CC link

c) available scientific evidence on condom effectiveness for HPV prevention

d) importance of regular Pap tests & other diagnostics for CC prevention

To be effective, these materials should be audience-centered, appropriate for, and relevant to target audiences (i.e., sexually active men & women).

MethodsBetween 2003-2005, CDC conducted formative research with men & women

in the US. Participants were segmented by age, race/ethnicity (White, African American, Hispanic*), gender, and geographic location.

Exploratory Research: 35 focus groups explored the public’s (ages 25-45 yrs) awareness, perceptions & information needs regarding HPV (N=315).

Concept Testing: 14 focus groups** tested effectiveness of various communciation approaches in capturing attention & achieving intended results among audiences, ages 18-45yrs (N=117).

Message Testing: 15 focus groups** with adults (ages 18-29yrs) tested draft messages (Eng & Span) and designs for understandability, appropriateness & effectiveness (N=134).

*Intention to expand/adapt materials in 5 languages (5 populations)

**Also segmented by language (English/Spanish)

Exploratory ResearchAssessed public awareness of HPV, reactions to HPV information, and

reactions to a hypothetical vaccine.

Findings:

High awareness of GW; low awareness of HPV across all groups

Audience shock, fear, & concern in response to:• Commonness & potential consequences of HPV • Apparent ‘secrecy’ of government/public health agencies (AA)

Needed more information to assess vaccine acceptability

STD-associated stigma possible barrier to further info seeking & acceptance of a hypothetical vaccine

Exploratory Research: Implications

Communication effort should: Raise public awareness about HPV transmission, prevention,

treatment and prevalence.

Be approached with caution in light of public fears/concerns, government distrust, and potential stigma (of HPV and CC)

Further research is needed to: determine how to frame messages to minimize potential

consequences assess audience reactions to messages

Concept Testing

Goal: Identify effective communciation approaches that capture audience attention & prompt further information-seeking, without instilling public fear or stigmatizing HPV or CC.

- Assessed audience reactions to HPV fact sheet - Tested 3 approaches, 13 identify images, 28 headlines, 30 visuals/tones

Concept Testing: ResultsParticipants reacted to HPV fact sheet with fear, confusion & anxiety.

Fear & shock: Commonness & potential severity, asymptomatic nature, lack of

practical prevention, lack of cure, & lack of detection (men) of HPV

Confusion: HPV natural history, transmission, prevention, detection, clearance Is HPV the same as cancer? HIV? Is it related to hygiene? (Hispanics)

Concerns & anxieties: Desire/urgency to get tested for HPV Doubts/distrust of partners & intentions to be more selective Blame befalling women since only they can get diagnosed (women)

STD approach preferred by Latinas, younger women(<30yrs) & men for its personal & shared relevance. All groups wanted to know source of HPV acquisition.

Women >30yrs preferred a cervical cancer approach, but this approach was seen as irrelevant to men, and Latinas worried it would place the burden on women.

Identity images that stressed commonness & personal relevance preferred.

Headlines addressing the commonness & asymptomatic nature of HPV were viewed as most appealing.

Tones/images depicting men & women (real people), diversity, intimacy & couples were preferred.

Concept/Approach Preferences

Recommendations for HPV Communication

STD approach may have broadest appeal

Need for two unique sets of materials: 1. General HPV info resources for both genders2. Resources with more detailed HPV info for women

More research is needed to:

• Assess possible unintended consequences of STD approach • Assess headlines emphasizing HPV prevalence, asymptomatic

nature, & consequences• Clarify most appropriate tones & images for HPV messaging

Message TestingTested:- 2 versions of brochure content - 3 designs/headlines- 4 identity images

Results: Message Testing Information useful, understandable, informative

Reactions to info reflected an appropriate level of concern, rather than a sense of alarm

Audience confusion about:• seriousness of HPV (no need to get tested for HPV?)• HPV-CC link: HPV types, notion of a “low-risk” virus• HPV vs. HIV vs. HSV• Pap test vs. HPV test• incurable yet transient nature of HPV

Audience anxiety about:• ease of HPV transmission• asymptomatic & incurable nature of HPV• lack of practical prevention options

Audiences preferred serious, eye-catching messages/designs, emphasizing indiscriminant, asymptomatic nature of HPV

Preference for statistics (↑ credibility, relevance), plain language, Q&A format, and messages minimizing blame

While message of ‘no blame/shame’ was clear, some felt HPV diagnosis would still prompt suspicions of partner infidelity

Hispanics appreciated guidance on how to discuss HPV with partner

Women did not want HPV framed as a women’s-only issue

Men wanted to know personal relevance & importance of HPV

All wanted clear guidance/ action steps (prevention, diagnosis)

Message/Design Preferences

Motivated intentions: Seek additional information Talk to doctor/ friend/partner about HPV Get regular Pap tests (women) Be more cautious re. partner selection

Unintended Reactions: Desire to ‘get tested for HPV’ Feelings of helplessness/frustration (men)

Trusted HPV information sources: Public health/government, healthcare providers, hospitals, clinics Some participants expressed distrust of government sources

Content Recommendations/Revisions

Target messages to minimize audience anxiety & stigma: • Promote HPV as a common but important issue to know about

• Be upfront about transmission of HPV, but don’t lead with it

• Call-to-action should not emphasize urgent behavior change

Provide action steps for HPV, CC & STI prevention/risk reduction

Use statistics to convey high HPV prevalence

Add messaging to clarify identified points of confusion & address unintended reactions, e.g.,:

• Highlight info for men, reinforcing rarity of health consequences

Disseminate through trusted community-based organizations

Conclusions HPV science may be inherently stigmatizing & confusing to audiences

This may have implications for current & future prevention efforts

A normalizing approach to HPV = most effective for maximizing audience awareness & empowerment, while minimizing undue fear/stigma & motivating information-seeking

Posters & booklets are available through CDC; currently being expanded

Broader communication effort developed to support this effort

Acknowledgments

Herschel Lawson (CDC) Margo Gillman (Ogilvy PR) Yolan Laporte (Ogilvy PR) Jenny Mullen (Ogilvy PR) Karen Toll (Ogilvy PR) Emily Yu (Ogilvy PR) Ogilvy PR Creative Team

Roxanne Barrow (CDC) Mona Saraiya (CDC) Amy Pulver (CDC) John Douglas (CDC) Lily Blasini-Alcivar (CDC) Susan Delisle (CDC) Donna McCree (CDC)

For More Information

1-800-CDC-INFOwww.cdc.gov/std/hpv

Allison Friedman

(404) 639-8537

alf8@cdc.gov