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Virtual focus groups uncover clues to rural and urban HPV vaccination disparities


Researchers at Virginia Commonwealth University’s Massey Cancer Center and Dartmouth College are using social media to understand differences in attitudes about human papillomavirus vaccination among hundreds of thousands of parents in rural and urban areas. 

Using a generic, unbranded health page they created on Facebook, the researchers developed a series of posts to pose more than 30 HPV-related questions to parents in Vermont and New Hampshire. By targeting specific ZIP codes, they were able to reach parents in primarily rural and urban areas.

The researchers used text-based analyses to review the comments and identify potential factors and linguistic patterns underlying parental decisions about HPV vaccinations. In comparison to their urban peers, they found that parents in rural areas were more likely to use emotional language, words with certainty and biology related words.

“Our goal was to use an evidence-based approach to understand why parents in rural areas have or have not vaccinated their children against HPV,” said Sunny Jun Kim, Ph.D., a member of the Cancer Prevention and Control program at Massey and lead researcher on the study. “To do this at a relatively low cost, we conducted virtual focus groups on Facebook and then analyzed the comments to uncover trends and other insights.” 

While HPV vaccination rates are on the rise, the federal Centers for Disease Control and Prevention reports that in 2017 only about half of all adolescents were up to date on HPV vaccinations and those living in rural areas were approximately 11 percent less likely to be vaccinated than their peers in urban areas. HPV is responsible for the majority of cervical cancers, and experts warn of an epidemic of head and neck cancers caused by the virus. 

Sunny Jun Kim, Ph.D.
Sunny Jun Kim, Ph.D., is the lead researcher on the study. “Our goal was to use an evidence-based approach to understand why parents in rural areas have or have not vaccinated their children against HPV,” she said. (Photo by Thomas Kojcsich, University Marketing)

The researchers recently presented their findings at the Society for Behavioral Medicine’s annual meeting in Washington, D.C., and are working to publish the complete findings and methodology. They are already using the data to inform HPV vaccination campaign and messaging strategies that directly reflect the needs and concerns of their target audiences.

“We’ve shown that implementing evidence-based research in social media environments offers an unprecedented opportunity to reach out and engage large populations in real-world settings,” said Kim, an assistant professor in the department of Health Behavior and Policy in the VCU School of Medicine. “This is true participatory science as it provides an outlet for the audience to interact with others and have their voices heard.

“While high-speed internet access can be challenging in certain rural areas, many are still connected to social media via their smartphones,” Kim said. “We were pleased with the level of engagement we received from our rural parents.” 

Kim collaborated on the study with Dartmouth College researchers Ardis Olson, M.D., Jenna E. Schiffelbein and Inger Imset. The National Cancer Institute funded this research.