Danish health literacy campaign restores confidence in HPV vaccination

Danish health authorities have launched a media campaign to restore public confidence in response to negative media reports questioning the safety of the human papillomavirus (HPV) vaccine and a related decline in the number of teenage girls getting it. The vaccine protects against cervical cancer.

“We knew that we had to do something to turn the trend around,” said Stine Ulendorf Jacobsen, a consultant with the Danish Health Authority. “We needed to raise public awareness by increasing health literacy so that people could make an informed medical choice about the vaccine.”

Every year in the WHO European Region, approximately 69 000 women contract cervical cancer and nearly 30 000 die from it. The HPV vaccine has been proven safe and very effective in preventing precancerous lesions in the cervix that can lead to cervical cancer. However, parents opting out of having their daughters receive the vaccine became a big problem in Denmark. Around 2015, national reports about girls suffering from symptoms, such as long-lasting pain and tiredness, began circulating and it was suggested that these symptoms were linked to HPV vaccination. Although there was no evidence to suggest that these symptoms were caused by the vaccine, vaccine coverage plummeted from 90% to nearly 40% among some cohorts of girls.

“We began an integrated media campaign to build awareness and lift health literacy here in Denmark so that people could make their own decisions,” said Jacobsen, adding that the results have been impressive. “In 2017 around 30 000 girls began the HPV vaccination program, which is a doubling compared to the year before.”

Using data to design an effective campaign

In May 2017, authorities conducted a survey and created several focus groups to better understand the concerns parents had with the HPV vaccination. Authorities were eager to know who to target, and the results from the survey told them that it was primarily mothers who made the decisions.

“We could tell from the parent survey that there were lots of things they didn’t know about the vaccine, such as what the vaccine actually prevents and that you should take the vaccine before becoming sexually active. Some very basic facts needed to get out there,” said Jacobsen.

One of the most important facts gleaned from the survey and the focus groups was that parents wanted to learn more about the HPV vaccine. With that information the Danish Health Authority partnered up with the Danish Cancer Society and the Danish Medical Association to design the information campaign, Stop HPV – stop cervical cancer.

“We focus on balancing facts and personal stories from women with cervical cancer to communicate why vaccination is important. We hired a public relations firm to help us communicate our messages,” Jacobsen said. “We also developed a website and used Facebook and other social media platforms to reach the target group.”

When target group members post stories on Facebook, they can add comments or questions. The campaign partners are then able to have an open dialogue with them and refer them to additional information on the website or elsewhere if necessary.

“We also use a so-called evidence pyramid on the website,” Jacobsen said. “We put it there because we know from experience that sometimes media take one study and make a big story out of it. The evidence pyramid helps determine how much you can trust a study.”

The idea behind this, Jacobsen points out, is to help readers evaluate studies and specific information for themselves. Health authorities underscore that this is an important tool for raising awareness among people when they are having discussions about the HPV vaccine.

If a study is lower in the pyramid, its methods or information being discussed  are less reliable; the higher it is on the pyramid, the more the user can trust its results.

“We see the campaign as a success but we know that we’re not done yet. We know that there is a lot of work that still needs to be done. And the progress is fragile. We need to keep on top of this,” said Jacobsen.