Message framing's limited efficacy in counteracting parental hesitancy towards human papillomavirus vaccination for female adolescents: Insights from a randomized trial

Abstract

Background: Parental acceptance of HPV vaccination remains low. This study investigates the influence of different message framing on Chinese parental intentions to vaccinate their daughters against HPV. Methods: A 2 (appeal framing: gain vs. loss) × 2 (cultural value: individualism vs. collectivism) × 2 (evidence type: narrative vs. non-narrative) factorial design was used in an online experiment. Parents of unvaccinated junior high school girls were recruited and included in the experiment. The primary outcome assessed was the reduction in HPV vaccine hesitancy (VH). The analysis of variance tests (ANOVAs) and hierarchical regression analyses were conducted to test the hypotheses. Results: Of 4012 participants, the majority were women with low VH. Only loss-framing exerted a direct effect on advocacy (p =.036). Initial VH negatively moderated this effect (p =.027). Except for narrative evidence (p =.068), message framings showed significant small effects in low-hesitant participants (p =.032). An incentive policy negatively moderated the initial VH's effect on advocacy (p =.042). Persuasion was evident only among low-hesitant participants not receiving incentives (p =.002). In contrast, for highly hesitant individuals without incentive policies, loss-framing (p =.024) and collectivism perspective (p =.033) produced counterintuitive effects. Conclusions: Message framing is effective among low-hesitant parents of female adolescents in improving HPV vaccination decisions without economic incentives. Non-narrative evidence and loss-framing messages should be prioritized over narrative evidence and gain-framing messages. Nonetheless, caution is warranted when engaging with highly hesitant parents.