Feel more confident in your understanding of HPV vaccination

Context

In 2008, two HPV vaccines that protect against cervical cancer were made available in Greece. Despite cumulative evidence of their safety and efficacy, vaccination rates among adolescents in the country remain low. In Greek culture, it is typically the mothers who make decisions regarding their children’s health, as taking care of children has traditionally been viewed as a woman’s role. The key factors that tend to sway parents towards a positive attitude about vaccines are being well-informed and receiving timely information. Unfortunately, many Greek mothers of eligible girls lack sufficient knowledge about the HPV vaccines and struggle to evaluate the available information on the topic.

PuRPOSE

Thus, the e-learning course ‘Feel more confident in your understanding of HPV vaccination’ was developed to improve mothers’ knowledge of the HPV vaccine and provide a potentially effective training solution that could be incorporated into the design of an educational campaign carried out by a Greek competent authority with the purpose of increasing the HPV vaccination rates.

DESIGN & DEVELOPMENT

The course content focused on concepts from the Health Belief Model that aim to understand the failure of people to adopt disease prevention strategies. It addressed perceived susceptibility (e.g. HPV transmission), perceived severity (e.g. cervical cancer), perceived benefits (e.g. vaccine efficacy), and perceived barriers (e.g. vaccine safety).

Two instructional design models, ARCS and Mayer’s principles, were used.

The ARCS model was selected because engaging learners in an online course is more challenging than in face-to-face courses. Learning about diseases that do not apply to the immediate future of their daughters and trying to understand medical terminology makes it hard for mothers to stay focused. An ‘attention’ strategy is evident in the variability of elements present in the course: sliding images, hotspots, flipping cards, videos, multiple-choice questions. A ‘relevance’ strategy is evident, for example, in some videos that address mothers’ interest in the wellbeing of their daughters.

Mayer’s principles were selected to facilitate cognitive processing. Segmenting & pretraining principles are evident for example, in the course’s structure, where the information is chunked and each new piece (e.g. cervix) of information is based on the previous one (e.g. female reproductive system). The multimedia principle is evident for example in the abundance of anatomy/biology figures that enhance understanding. The learners are mothers who have no knowledge of anatomy or biology and this way they do not have to build mental images. Placing body parts into context, no confusing unnecessary details, no depictures (eg syringes) that make the learner feel discomfort were principles followed when designing the figures. Application of the personalization principle was challenging. Wording such as ‘your immune system’, ‘your body’ was used only when writing about subjects that did not concern directly the disease. When the disease was mentioned, wording such as ‘the body’, ‘the immune system’ was used.

The authoring tool chosen was Evolve, as it is responsive by default, and the majority of learners use mobile devices. The anatomy/biology figures were designed using Biorender. The rest of the vectors were obtained from Adobe Stock and modified using Adobe Illustrator. Videos were created using Screenpal, Adobe After Effects and WellSaid Labs. The course was uploaded to Scormcloud for tracking completion and assessment (information potentially useful for the state competent authority).

Results

Results showed a significant increase in knowledge among participants (mothers of girls eligible for vaccination) compared to a control group that received web-based text-only intervention. Participants’ responses regarding comprehension, credibility, relevance, attention, confidence, and satisfaction were positive.