Hmong Promoting Vaccines eHealth website: a community-based participatory research pilot to evaluate dissemination and implementation strategies for primary care and educational contexts.

BACKGROUND

Human papillomavirus (HPV) vaccination rates among Hmong American adolescents are significantly lower than national averages, despite higher cervical cancer rates in this population. eHealth can improve vaccine uptake, especially in the COVID-19 era. Our community-based participatory research team developed and evaluated a culturally-tailored website ( https://hmonghpv.com ) featuring educational modules on HPV and HPV vaccines in Hmong and English for Hmong adolescents and their parents. This pilot study aimed to determine the most effective dissemination and implementation (D&I) strategies within schools and primary care clinics using community-engaged methods, including community-based participatory research (CBPR), an understudied area in D&I research. CBPR has been underutilized in D&I research, yet its participatory approach ensures that marginalized voices are included, offering valuable insights for implementing and sustaining culturally adapted interventions to enhance uptake and long-term impact.

METHODS

Our CBPR team included Hmong researchers, university researchers, a public health advocate, and a family medicine physician-researcher. We conducted pre- and post-implementation interviews with six user organizations and seven disseminator community-based organizations to guide the development and assessment of D&I strategies for the website. Using template analysis, we analyzed the pre-implementation data. We then partnered with the user organizations to co-design individualized D&I plans that they implemented during an eight-week pilot period. We used Google Analytics and a Qualtrics survey to assess website use post-implementation.

RESULTS

During implementation, user organizations promoted the website to 300 new users, who spent an average of nearly 12 min on the site. The most robust dissemination (n = 117) occurred in a Hmong charter school that integrated the website into their health education curriculum. Post-implementation interviews revealed that D&I plans that fit into clinic workflows and school curricula had the most robust implementation, and that clinic staff found discussing HPV vaccines most useful during adolescent preventive health visits. Challenges included time constraints, lower receptivity to vaccine conversations at non-preventive visits, and adolescents' preference for alternatives to paper handouts. Disseminator organizations showed strong interest in scaling the website for greater reach in Hmong and non-Hmong populations.

CONCLUSION

This pilot study demonstrated the feasibility of disseminating and implementing a culturally-tailored educational website for HPV education in educational and primary health care settings. Health education curricula in culturally-specific schools proved to be the most effective dissemination modality. A dissemination toolkit with support materials is available to facilitate using the website within educational and primary care contexts. Additionally, using a CBPR approach provided valuable implementation insights to enhance the intervention's contextual validity and sustainability.