About This Guide
This messaging guide is designed for health insurance companies, government health authorities, and other entities seeking to take action to prevent cervical cancer in Colombia through increased rates of HPV vaccination.
Health insurance companies and government authorities can utilise this guide to develop an action plan to empower parents and increase HPV vaccination rates. An action plan template and other tools are included in the resource library to help prioritise activities.
Unless otherwise cited, data and information informing this guide come from formative research conducted by the Inter-American Development Bank, La Liga Colombiana Contra el Cancer, and the Government Lab at Universidad del Rosario. Read more about this research here.
The Role of Health Insurance Companies in Increasing HPV Vaccination Rates
In Colombia, health insurance companies are responsible for the population under their care, organising the healthcare service network, and managing healthcare quality. With universal health insurance coverage in Colombia, health insurance companies play a key role in promoting and ensuring the uptake of HPV vaccination and other cancer prevention initiatives. Thanks to their extensive reach, health insurance companies can impact various stakeholders in vaccination, such as healthcare providers and parents. They also have the unique opportunity to facilitate access to the HPV vaccine and implement various programmes and incentives to boost vaccination rates.
The Role of Government Institutions in Increasing HPV Vaccination Rates
Colombian government institutions such as the Ministry of Health and Secretariats of Health play a crucial role in shaping and implementing public health policies, including vaccination programmes. The comprehensive data collected by government agencies can inform targeted interventions and facilitate the development of effective evidence-based strategies to address specific challenges to HPV vaccination. Moreover, as key stakeholders in the healthcare system, government institutions are well-positioned to collaborate with health insurance companies and civil society organisations to create a unified and impactful approach to enhance HPV vaccination rates across the population. Government-led HPV vaccination programmes help prevent the spread of infectious disease, reducing the overall burden on the healthcare system. Vaccinated populations are healthier and less likely to miss work in the future due to illness.
Challenges to HPV Vaccination In Colombia
HPV vaccination rates lag significantly compared to other vaccines administered through the National Immunisation Programme in Colombia, despite the impact and health benefits of HPV vaccination. Research conducted in Colombia elicited the following key community knowledge, attitudes, and beliefs contributing to lower HPV vaccination uptake.
Key parental knowledge and beliefs
- Government Support: A perceived decrease in government support for the HPV vaccine contributes to mistrust in the community and adds complexity to parental decision-making to vaccinate. Health professionals believe that a more explicit endorsement from the government would increase trust and parents’ acceptance of vaccine recommendations.
- Expectation of a provider recommendation: Many parents wait to receive a recommendation from their doctor to vaccinate. It is critical to increase recommendations to parents through multiple channels of communication, including from their healthcare providers.
- HPV vaccine viewed as ‘non-essential’: Although the HPV vaccine is part of the complete vaccination schedule and appears on the vaccination card, parents do not put the same effort into vaccinating their daughters against HPV as they deem other vaccines “more essential.” Parents frequently believe the HPV vaccine does not appear on the national vaccination card and is not a part of the free National Immunisation Programme.
- Lack of urgency to vaccinate: There is little immediate perceived consequence for failing to vaccinate among parents and paediatricians since HPV infections usually do not cause illness until adulthood. HPV vaccination thus becomes something that parents feel they can put off for the future.
- Lack of information and visibility: Information about the benefits of HPV vaccination is not readily available to parents. In addition, prompts to receive the vaccine and reminders for parents are not consistent or frequent. As a result, parents place a lower emphasis on vaccinating their children.
Take Action
Health insurance companies and health authorities play a critical role in preventing HPV cancers. Studies from Colombia indicate that parents are the main decision-makers in their children’s vaccinations. The actions below, informed by evidence from research in Colombia, focus on reaching parents through messaging that addresses their knowledge, attitudes, and beliefs and nudges them to vaccinate their children.
Form a Team: Determine who is going to do the work of developing and implementing an HPV vaccine communication plan.
Assess and Review: Understand current efforts in HPV vaccination.
Make a Plan: Create an action plan that will guide your HPV vaccination communication work.
Monitor and Refine: Track your HPV vaccination communication actions and outcomes.
Action 1
Form a team
It is important to determine who is going to do the work of developing and implementing an HPV vaccine communication plan.
Actions to consider
Identify people within your organisation who engage in HPV vaccination work, including but not limited to those who will:
- Review current communication practices (examples: email/SMS campaigns, social media, reminder phone calls)
- Design communication for the public, healthcare providers, and insured populations
- Manage HPV vaccination data
Determine the frequency the team will meet to assess current activities, develop an action plan, monitor progress, and celebrate success.
Engage external partners that are needed for success, for example:
- Central health authorities
- Local cancer organisations
- Health centres or providers
- Medical professional societies
- Other health insurance companies
- Schools/ministry of education
- Influential individuals in the community
Action 2
Assess and review
Before creating a plan, it is important to understand current efforts in HPV vaccination. If a recent audit of HPV activities has occurred, you can skip this step and move on to planning. If not, use the guidance below to gather HPV vaccination activities.
Actions to consider
Review your HPV vaccination data and consider the following:
- Compare the last several years to the current year
- Compare vaccination rates for HPV to other adolescent vaccines
- Compare geographies or other variables that can help you focus on a target population
Assess the strategies your organisation currently employs to communicate about HPV vaccination to members, healthcare providers, and the public (for example, website, social media, brochures, emails, member portal, etc.)
Review current messages for any misalignment with the following recommended message framing:
- HPV vaccination is framed as cancer prevention. Framing HPV vaccination as cancer prevention (rather than prevention of a sexually transmitted infection) is the most effective framing
- Provides clear directions for parents on the timing of HPV vaccination
- Makes clear the HPV vaccine is free for targeted ages
- Language is clear and simple
- Communicates physician and central health authority support for the HPV vaccine
- Communicates that HPV vaccination is part of completing the regular/recommended vaccine schedule
Make note of any current messaging that is not in alignment with the recommended framing.
Action 3
Make a Plan
After forming a team, reviewing data, and assessing your current HPV vaccine communication, create an action plan that will guide your HPV vaccination communication work. Consider the following actions in your plan:
Actions to consider
Determine the target audience(s) for your communication based on the HPV vaccination data found during action 2.
Identify barriers and facilitators that may impact the effectiveness of the message. For example, cultural beliefs, social paradigms, and/or geographical barriers. This may vary according to each region of the country.
Determine messages for the target audience using recommended messages, modify your current messages, or create new messages based on the following frames:
- Increase trust in the vaccine by sharing physician and institutional support and information on the vaccine’s safety.
- remind parents of their responsibility to get their children vaccinated against HPV.
- Provide decision aids and clear direction for parents to schedule a specific time when they can vaccinate their children.
Develop a communications calendar using recommended messages to prompt parents to vaccinate their children against HPV cancers.
- Communicate with parents through multiple channels, including SMS, email, mailings, patient portal, website, and/or social media.
- Create a budget for the communication plan.
- Procure necessary technologies or subscriptions to deliver messages.
- Partner with other trusted organisations to reach parents to reinforce cancer prevention messaging.
Prepare healthcare systems and healthcare workers by communicating with them about:
- The burden of HPV cancers, including cervical cancer in Colombia
- The pivotal role physicians play in increasing HPV vaccination rates by strongly recommending the HPV vaccine to parents and caregivers
- Key messages to use with parents when recommending the vaccine (and recommended message framing from Action 2)
- HPV vaccination rates for the clinic compared to other doctors, clinics, or coverage rates of other vaccines in the expanded immunisation programme
- The importance of using in-clinic reminders such as posters and parent handouts that reinforce key messaging about HPV vaccination
- Future HPV vaccination campaigns that will be directed at parents
Parents and caregivers view physicians as the most trusted source of medical information; thus, they wait for physicians to recommend the vaccine for their children. Health insurance companies and government institutions should strategically engage with healthcare providers to ensure they are properly educated on effective communication with parents.
Action 4
Monitor and Refine
It is important to track your HPV vaccination communication actions and outcomes. Here are some key elements to consider:
Actions to consider
Establish a goal(s) for the communication plan.
Determine which metrics you will track to evaluate the goal and how often you will monitor them.
Identify which messages/images/emoticons work best with your population.
Engage the target audience in evaluating the strategies and effectiveness of the messages.
- For example, conduct surveys or focus groups to gather feedback on the clarity and impact of your communications.
Refine your communication plan as you review the results of your efforts.
Recognise and celebrate success and lessons learned within your organisation and with your partners.
Most Impactful Messages
To address current challenges to HPV vaccination uptake, this guide recommends a set of field-tested messages that health insurance companies and government health authorities can use to support parents’ decisions to vaccinate their children against HPV.
Please note that the original messages tested were all signed by the Secretary of Health and referred to “daughters” only since boys hadn’t yet been added to the programme.
Recommended messaging by behavioural tactic
Tactic: Highlight physician
and institutional support
and the safety of
the vaccine.
- Hi [Parent’s name], medical doctors recommend that you vaccinate your child against HPV. There is a vaccine waiting for your child at the nearest vaccination centre. [central health authority or health insurance company]
- Hi [Parent’s name], the [central health authority] recommends that you vaccinate your child against HPV. There is a vaccine waiting for your child at the nearest vaccination centre. [central health authority or health insurance company]
- Hi [Parent’s name], did you know the HPV vaccine is the safest in the vaccination plan? There is an HPV vaccine waiting for your child. [central health authority or health insurance company]
Tactic: Remind parents of their responsibility to get their child vaccinated
- Hi [Parent’s name], your child does not have the HPV vaccine yet ☹. There is a vaccine waiting for your child at the nearest vaccination centre [central health authority or health insurance company]
- Hi [Parent’s name], your child is supposed to have 21 vaccines on their vaccination card, and they are still missing the vaccine against HPV. There is a vaccine waiting for your child at the nearest vaccination centre [central health authority or health insurance company]
- Hi [Parent’s name], there is a vaccine waiting for your child at the nearest vaccination centre [central health authority or health insurance company]
Tactic: Provide clear direction and decision aids for parents
- Hi [Parent’s name], you have an appointment on the [xx] of [month] at [x am/pm] to vaccinate your child against HPV. There is a vaccine waiting for your child at the nearest vaccination centre [central health authority or health insurance company]
- Hi [Parent’s name], x of every 10 parents in your town vaccinated their children to protect them from HPV cancer, an increase of 300% since 2016. Secretariat of Health [central health authority or health insurance company]
HPV vaccination message tips
If you need to revise or create new messages, keep the following in mind:
- Personalise your message to attract the recipient’s attention
- Use emoticons in your communications, where appropriate, to show that lack of vaccination goes against parents’ responsibility
- Use simple reminders to counter parents’ forgetfulness
- Schedule tentative dates to spark the intention of parents to vaccinate their children against HPV to follow through on their intentions
- Leverage the need for completion by framing the HPV vaccine as the last one from a larger set of vaccines necessary for their child’s health
- Show a positive trend to motivate parents to follow the social norm
- Virtually assign them a vaccine to give parents an advance sense of loss if they don’t get the vaccine that belongs to them
HPV vaccination communication/messaging things to avoid:
- Avoid obscure web links so recipients don’t believe that the message is malicious/spam.
- Avoid weak (unclear) messages that leave parents wondering what is the main objective of the message.
- Avoid difficult to understand information that confuses more than informs parents.
Organisational Considerations for Health Insurance Companies
Secure leadership support for HPV vaccination
Organisations that do not already have leadership buy-in should start by securing a commitment from their leadership to increase their involvement in HPV vaccination efforts. Fortunately, health insurance companies can leverage available research and data that quantifies the cost burden of cancer and the cost savings associated with HPV vaccination to build a case for support. Building a case for support could include potential cost savings specific to the health insurance company. They can examine their plan’s spending on HPV cancers, cancer screenings, and genital warts to help them put forth a tangible explanation to leadership on how investing in HPV vaccination can contribute to the sustainability of the health system, optimise resources, and achieve health outcomes for the target population.
Create a cancer prevention narrative
A significant barrier to improving HPV vaccination rates is getting past the messaging and narrative that HPV is a sexually transmitted infection. Frequently, one of the first things physicians mention when talking to parents about HPV is how it is transmitted, which can perpetuate stigma around the HPV vaccine and make parents hesitant to vaccinate their child. Health insurance companies have an important role to play in changing the narrative among providers, parents, and within their own organisation. Health insurance companies should emphasise cancer prevention and the benefits of immunisation in all HPV vaccination efforts, interventions, and communications, and develop a clear and simple message that emphasises that the HPV vaccine is a cancer-prevention vaccine that is best given on time.
Leverage and create HPV vaccination partnerships
Health insurance companies are not alone in their efforts to improve HPV vaccination rates and reduce the burden of HPV cancers. They can connect with cancer organisations, the Ministry of Health, and the Ministry of Education for resources and collaborative opportunities. Additionally, health insurance companies can consider creating partnerships with health professional organisations.
Our Research
Cervical Cancer Prevention Through HPV Vaccination: An Action Guide for Medical Societies in India and its resources were informed by behaviour change communications research with physicians on their perceptions about cervical cancer and HPV vaccination.
Resources
Cervical Cancer Prevention Through HPV Vaccination: An Action Guide for Medical Societies in India offers medical societies resources – fact sheets, provider education and training materials, clinic posters, and more – to motivate and support physicians to recommend the HPV vaccine routinely and confidently. Some of these tools can be customised with your organisation’s logo, as desired.