{"id":{"repo_id":"washington","oai_identifier":"oai:digital.lib.washington.edu:1773/45726"},"canonical_url":"https://search.dev.ndltd.org/etd/washington/oai:digital.lib.washington.edu:1773/45726","repository":{"repo_id":"washington","name":"University of Washington","base_url":"https://digital.lib.washington.edu/server/oai/request"},"display":{"title":"The impact of a comic book intervention on increasing East African-American adolescents’ HPV vaccine-related knowledge, attitudes and intentions to receive vaccine","abstract":"Background: HPV vaccine uptake is low among East African-American (EAA) adolescents in the U.S. To improve HPV vaccine uptake in EAA communities, we developed a theory-based, community-informed comic book for adolescents as a part of an intervention targeting mothers and adolescents. We evaluated the impact on participating adolescents’ HPV and HPV vaccine knowledge, attitudes and vaccination intentions. Methods: The culture-specific comic book intervention was delivered to unvaccinated EAA adolescents who participated in ethno-linguistic-specific dinners with their mothers in Washington (8 dinners in Somali, 2 in Amharic) between 2017-2018. English-speaking adolescents aged 14-17 were assigned to complete a self-administered survey either before or after reading the comic book. Surveys were identical and assessed knowledge, barriers, communication with parents, and intention. Responses between adolescents completing the pre- vs post-test were compared with chi-squared tests. We used generalized estimating equation (GEE) models to estimate relative risks (RRs) and 95% confidence intervals (CIs) to measure the magnitude of the impact of the intervention on each construct. We also stratified the GEE models by gender to enumerate gender-specific intervention effects and tested for the presence of interaction between the participants’ gender and the assigned survey group (e.g., pre- or post-intervention). Results: Among 136 (Pre-test=64, Post-test=72) participants, 90% were Somali and 54% female. Adolescents assigned to the post-test were more likely to correctly answer questions on HPV/HPV-vaccine knowledge than those assigned to the pre-test (correct responses ranged from 27%-67% on the pre-test vs. 66%-90% post-test). The differences were statistically significant (p<.001) for 10 of 11 questions. Overall, the adolescents in the post-intervention survey group were 1.87 (95% CI: 1.54-2.27) times and 1.74 (95% CI: 1.46-2.07) times more likely than adolescents in the pre-intervention group to correctly answer questions related to HPV and HPV vaccine knowledge, respectively. Significant pre/post differences were also observed for comfort talking with a parent (58% vs. 90% somewhat/very comfortable, RR: 1.55 [95% CI: 1.24-1.94]), willingness (38% vs. 83% probably/definitely willing, RR: 2.16 [95% CI: 1.55-3.01]) and intention to get vaccinated (34% vs. 86% very/somewhat likely, RR: 2.39 [95% CI: 1.69-3.37]). The impact of the comic book tended to be stronger in male versus female adolescents for all constructs (RR between the pre- and post-test groups ranged from 1.40-3.20 for males vs. 1.30-2.00 for females). Conclusion: The comic book improved the EAA adolescents’ HPV and HPV vaccine knowledge, attitudes and intentions to receive vaccine. This intervention could be adapted for other EAA and ethnic-minority communities.","abstract_html":"Background: HPV vaccine uptake is low among East African-American (EAA) adolescents in the U.S. To improve HPV vaccine uptake in EAA communities, we developed a theory-based, community-informed comic book for adolescents as a part of an intervention targeting mothers and adolescents. We evaluated the impact on participating adolescents’ HPV and HPV vaccine knowledge, attitudes and vaccination intentions. Methods: The culture-specific comic book intervention was delivered to unvaccinated EAA adolescents who participated in ethno-linguistic-specific dinners with their mothers in Washington (8 dinners in Somali, 2 in Amharic) between 2017-2018. English-speaking adolescents aged 14-17 were assigned to complete a self-administered survey either before or after reading the comic book. Surveys were identical and assessed knowledge, barriers, communication with parents, and intention. Responses between adolescents completing the pre- vs post-test were compared with chi-squared tests. We used generalized estimating equation (GEE) models to estimate relative risks (RRs) and 95% confidence intervals (CIs) to measure the magnitude of the impact of the intervention on each construct. We also stratified the GEE models by gender to enumerate gender-specific intervention effects and tested for the presence of interaction between the participants’ gender and the assigned survey group (e.g., pre- or post-intervention). Results: Among 136 (Pre-test=64, Post-test=72) participants, 90% were Somali and 54% female. Adolescents assigned to the post-test were more likely to correctly answer questions on HPV/HPV-vaccine knowledge than those assigned to the pre-test (correct responses ranged from 27%-67% on the pre-test vs. 66%-90% post-test). The differences were statistically significant (p&lt;.001) for 10 of 11 questions. Overall, the adolescents in the post-intervention survey group were 1.87 (95% CI: 1.54-2.27) times and 1.74 (95% CI: 1.46-2.07) times more likely than adolescents in the pre-intervention group to correctly answer questions related to HPV and HPV vaccine knowledge, respectively. Significant pre/post differences were also observed for comfort talking with a parent (58% vs. 90% somewhat/very comfortable, RR: 1.55 [95% CI: 1.24-1.94]), willingness (38% vs. 83% probably/definitely willing, RR: 2.16 [95% CI: 1.55-3.01]) and intention to get vaccinated (34% vs. 86% very/somewhat likely, RR: 2.39 [95% CI: 1.69-3.37]). The impact of the comic book tended to be stronger in male versus female adolescents for all constructs (RR between the pre- and post-test groups ranged from 1.40-3.20 for males vs. 1.30-2.00 for females). Conclusion: The comic book improved the EAA adolescents’ HPV and HPV vaccine knowledge, attitudes and intentions to receive vaccine. This intervention could be adapted for other EAA and ethnic-minority communities.","abstract_has_math":false,"creators":["Shin, Michelle"],"institution":null,"degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":["Winer, Rachel"],"committee_chairs":[],"committee_members":[],"year":2020,"date_issued":"2020-08-14","date_published":"2020-08-14","updated_at":"2026-07-24T05:57:59Z","subjects":["Public health"],"languages":["en_US"],"rights":["none"],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"http://hdl.handle.net/1773/45726","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Winer, Rachel"]},{"key":"dc:creator","label":"Author","values":["Shin, Michelle"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2020-08-14T03:23:05Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2020-08-14T03:23:05Z"]},{"key":"dc:date.issued","label":"Date","values":["2020-08-14"]},{"key":"dc:type","label":"Dc Type","values":["Thesis"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Public health"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language.iso","label":"Language (ISO)","values":["en_US"]},{"key":"dc:rights","label":"Dc Rights","values":["none"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.other","label":"Dc Identifier Other","values":["Shin_washington_0250O_21869.pdf"]},{"key":"dc:identifier.uri","label":"Identifier URI","values":["http://hdl.handle.net/1773/45726"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["Thesis (Master's)--University of Washington, 2020"]},{"key":"dc:description.abstract","label":"Abstract","values":["Background: HPV vaccine uptake is low among East African-American (EAA) adolescents in the U.S. To improve HPV vaccine uptake in EAA communities, we developed a theory-based, community-informed comic book for adolescents as a part of an intervention targeting mothers and adolescents. We evaluated the impact on participating adolescents’ HPV and HPV vaccine knowledge, attitudes and vaccination intentions. Methods: The culture-specific comic book intervention was delivered to unvaccinated EAA adolescents who participated in ethno-linguistic-specific dinners with their mothers in Washington (8 dinners in Somali, 2 in Amharic) between 2017-2018. English-speaking adolescents aged 14-17 were assigned to complete a self-administered survey either before or after reading the comic book. Surveys were identical and assessed knowledge, barriers, communication with parents, and intention. Responses between adolescents completing the pre- vs post-test were compared with chi-squared tests. We used generalized estimating equation (GEE) models to estimate relative risks (RRs) and 95% confidence intervals (CIs) to measure the magnitude of the impact of the intervention on each construct. We also stratified the GEE models by gender to enumerate gender-specific intervention effects and tested for the presence of interaction between the participants’ gender and the assigned survey group (e.g., pre- or post-intervention). Results: Among 136 (Pre-test=64, Post-test=72) participants, 90% were Somali and 54% female. Adolescents assigned to the post-test were more likely to correctly answer questions on HPV/HPV-vaccine knowledge than those assigned to the pre-test (correct responses ranged from 27%-67% on the pre-test vs. 66%-90% post-test). The differences were statistically significant (p<.001) for 10 of 11 questions. Overall, the adolescents in the post-intervention survey group were 1.87 (95% CI: 1.54-2.27) times and 1.74 (95% CI: 1.46-2.07) times more likely than adolescents in the pre-intervention group to correctly answer questions related to HPV and HPV vaccine knowledge, respectively. Significant pre/post differences were also observed for comfort talking with a parent (58% vs. 90% somewhat/very comfortable, RR: 1.55 [95% CI: 1.24-1.94]), willingness (38% vs. 83% probably/definitely willing, RR: 2.16 [95% CI: 1.55-3.01]) and intention to get vaccinated (34% vs. 86% very/somewhat likely, RR: 2.39 [95% CI: 1.69-3.37]). The impact of the comic book tended to be stronger in male versus female adolescents for all constructs (RR between the pre- and post-test groups ranged from 1.40-3.20 for males vs. 1.30-2.00 for females). Conclusion: The comic book improved the EAA adolescents’ HPV and HPV vaccine knowledge, attitudes and intentions to receive vaccine. This intervention could be adapted for other EAA and ethnic-minority communities."]},{"key":"dc:format.mimetype","label":"Dc Format Mimetype","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["The impact of a comic book intervention on increasing East African-American adolescents’ HPV vaccine-related knowledge, attitudes and intentions to receive vaccine"]}]}],"canonical_facts":{"dc:contributor.advisor":["Winer, Rachel"],"dc:creator":["Shin, Michelle"],"dc:date.accessioned":["2020-08-14T03:23:05Z"],"dc:date.available":["2020-08-14T03:23:05Z"],"dc:date.issued":["2020-08-14"],"dc:description":["Thesis (Master's)--University of Washington, 2020"],"dc:description.abstract":["Background: HPV vaccine uptake is low among East African-American (EAA) adolescents in the U.S. To improve HPV vaccine uptake in EAA communities, we developed a theory-based, community-informed comic book for adolescents as a part of an intervention targeting mothers and adolescents. We evaluated the impact on participating adolescents’ HPV and HPV vaccine knowledge, attitudes and vaccination intentions. Methods: The culture-specific comic book intervention was delivered to unvaccinated EAA adolescents who participated in ethno-linguistic-specific dinners with their mothers in Washington (8 dinners in Somali, 2 in Amharic) between 2017-2018. English-speaking adolescents aged 14-17 were assigned to complete a self-administered survey either before or after reading the comic book. Surveys were identical and assessed knowledge, barriers, communication with parents, and intention. Responses between adolescents completing the pre- vs post-test were compared with chi-squared tests. We used generalized estimating equation (GEE) models to estimate relative risks (RRs) and 95% confidence intervals (CIs) to measure the magnitude of the impact of the intervention on each construct. We also stratified the GEE models by gender to enumerate gender-specific intervention effects and tested for the presence of interaction between the participants’ gender and the assigned survey group (e.g., pre- or post-intervention). Results: Among 136 (Pre-test=64, Post-test=72) participants, 90% were Somali and 54% female. Adolescents assigned to the post-test were more likely to correctly answer questions on HPV/HPV-vaccine knowledge than those assigned to the pre-test (correct responses ranged from 27%-67% on the pre-test vs. 66%-90% post-test). The differences were statistically significant (p<.001) for 10 of 11 questions. Overall, the adolescents in the post-intervention survey group were 1.87 (95% CI: 1.54-2.27) times and 1.74 (95% CI: 1.46-2.07) times more likely than adolescents in the pre-intervention group to correctly answer questions related to HPV and HPV vaccine knowledge, respectively. Significant pre/post differences were also observed for comfort talking with a parent (58% vs. 90% somewhat/very comfortable, RR: 1.55 [95% CI: 1.24-1.94]), willingness (38% vs. 83% probably/definitely willing, RR: 2.16 [95% CI: 1.55-3.01]) and intention to get vaccinated (34% vs. 86% very/somewhat likely, RR: 2.39 [95% CI: 1.69-3.37]). The impact of the comic book tended to be stronger in male versus female adolescents for all constructs (RR between the pre- and post-test groups ranged from 1.40-3.20 for males vs. 1.30-2.00 for females). Conclusion: The comic book improved the EAA adolescents’ HPV and HPV vaccine knowledge, attitudes and intentions to receive vaccine. This intervention could be adapted for other EAA and ethnic-minority communities."],"dc:format.mimetype":["application/pdf"],"dc:identifier.other":["Shin_washington_0250O_21869.pdf"],"dc:identifier.uri":["http://hdl.handle.net/1773/45726"],"dc:language.iso":["en_US"],"dc:rights":["none"],"dc:subject":["Public health"],"dc:title":["The impact of a comic book intervention on increasing East African-American adolescents’ HPV vaccine-related knowledge, attitudes and intentions to receive vaccine"],"dc:type":["Thesis"]},"updated_at":"2026-07-24T05:57:59Z"}