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Abstract

Human papillomavirus (HPV) is a leading cause of preventable cancers, yet vaccination rates among children remain low in the United States, especially in rural and Hispanic/Latino communities. This study addresses the significant gap in HPV vaccination coverage in rural Washington State, where rates fall below national targets due to barriers like limited health care access, low awareness, and socioeconomic challenges. Hispanic/Latino communities in these areas face additional risks, including higher cervical cancer incidence and unique barriers to vaccination. To address these disparities, we applied an adapted Boot Camp Translation (BCT) approach within the PREVENT study, co-creating culturally tailored HPV vaccination messages and materials with English- and Spanish-speaking parents and caregivers. Through a collaborative process involving community members, health care providers, and researchers, we co-developed messaging and materials about HPV vaccination that emphasize its safety, effectiveness, and role in cancer prevention. The engagement approach led to positive shifts in vaccination intentions, particularly among Spanish-speaking participants, and identified key message themes and preferred dissemination channels such as patient mailers, text messaging outreach, live call outreach, educational website resources, and clinic materials. These findings underscore the value of community-engaged, culturally responsive interventions to address vaccine barriers and improve uptake in underserved populations. The adapted BCT model provides a scalable framework for developing effective and relevant health communication strategies, contributing to improved health equity and reduced cancer disparities.

Keywords

cancer prevention & screening cancer health communications health equity Latino/Latina/Latinx or Hispanic population groups

Human papillomavirus (HPV) is a common viral infection and a leading cause of several cancers, including cervical, oropharyngeal, anal, penile, vaginal, and vulvar cancers (Lewis et al., 2021). Each year, over 37,000 people in the United States are diagnosed with HPV-related cancers (CDC, 2024a). Vaccination against HPV is safe and effective, preventing up to 90% of these cancers when administered before exposure. Early vaccination, recommended for children ages 9–17, is therefore critical for long-term cancer prevention (CDC, 2024b; Kjaer et al., 2021).

Despite the vaccine’s proven safety and efficacy, HPV vaccination coverage in the United States remains suboptimal. As of 2022, fewer than 40% of children ages 9–17 had received at least one dose (Villarroel et al., 2024). In Washington State, vaccination rates fall well below the Healthy People 2030 goal of 80%, leaving many children at risk for preventable cancers (Washington Chapter of the American Academy of Pediatrics [WCAAP], 2023). Disparities are especially pronounced in rural communities, where vaccine coverage is 10–13 percentage points lower than in urban areas and HPV-related cancer rates are higher (Villarroel et al., 2024; WCAAP, 2023). Contributing factors include limited access to care, low awareness and knowledge of HPV, and socioeconomic barriers (Khalil et al., 2023).

Within rural and Hispanic/Latino communities, social trust and community cohesion play an important role in HPV vaccination uptake, while affordability, transportation, scheduling challenges, and access to reliable information remain significant barriers (Frietze et al., 2023; Roncancio et al., 2017). To address these challenges, several studies have explored innovative strategies such as text message-based interventions, which have proven effective in improving HPV vaccination completion among both Hispanic/Latino and low-income communities (Aragones et al., 2015; Kepka et al., 2011; McGlone et al., 2024; Wynn et al., 2021). These findings highlight the potential of novel health strategies to reduce disparities and expand access, particularly in underserved communities. The urgency of these efforts is underscored by persistent health inequities: Hispanic/Latino women experience a 36%–40% higher incidence of cervical cancer compared to non-Hispanic/Latino White women (American Cancer Society, 2024). Tailored communication strategies that leverage trust, cultural values, and community networks have been shown to strengthen vaccination uptake in these groups (Harrington et al., 2021).

Community-engaged approaches, such as Boot Camp Translation (BCT), have shown success in developing locally relevant and culturally appropriate health messages that improve vaccine awareness and uptake (Brewer et al., 2020). The effectiveness of the BCT approach in fostering community engagement and improving HPV vaccination attitudes has been previously documented (Brewer et al., 2020). BCT is a dynamic, collaborative process in which community members and health partners work together through ongoing dialogue to design health communication that reflects local cultural values and community preferences. Few interventions have specifically addressed the intersection of rurality and Hispanic/Latino heritage in HPV vaccine promotion, with recent studies highlighting the need for tailored approaches in these communities (Fernandez-Pineda et al., 2021).

To address this gap, our study used an adapted BCT approach within the PREVENT study to co-create HPV vaccination messages and materials with English- and Spanish-speaking parents and caregivers in rural Washington State. As the primary decision-makers for adolescent health, parents and caregivers play a critical role in shaping vaccination attitudes and uptake, particularly within Hispanic/Latino and rural communities (Colón-López et al., 2021). Their perspectives on cultural values, trusted information sources, and logistical challenges guided the development of messages tailored to family needs. This collaborative process aimed to generate community-informed strategies that enhance HPV vaccination awareness and improve higher vaccination rates in underserved populations.

Methods

Study Details

This community-engagement effort was part of the PREVENT study, a collaborative project between the University of Utah Huntsman Cancer Institute, the Kaiser Permanente Center for Health Research, and Sea Mar Community Health Centers—a large, multi-site federally qualified health center (FQHC) in Washington State. PREVENT (Practice-based Approaches to Promote HPV Vaccination in the Safety Net) is a National Cancer Institute–funded randomized trial. It tests low-cost automated and culturally tailored live reminders to increase HPV vaccination among adolescents in rural communities, aiming to reduce rural–urban disparities in HPV-related cancers. The study protocol was approved by the University of Utah Institutional Review Board (IRB #00161649). Verbal informed consent was obtained from all participants prior to the BCT activities. Spanish-speaking participants were assisted by a certified interpreter to ensure full comprehension of the project.

Study Population

Sea Mar operates 37 primary care clinics, serving over 320,000 patients across Washington. According to electronic health records, 40% of the patient population identified as Hispanic/Latino in 2023. Eligible participants were parents or caregivers of at least one child aged 9–18 who received care at Sea Mar and had medical record evidence of at least one previous vaccination (e.g., flu, MMR, DTAP). Inclusion criteria required English or Spanish language preference to ensure accessibility.

Participants were recruited through purposive sampling in collaboration with clinic staff, with the goal of enrolling 10–15 individuals per BCT session. Recruitment focused on parents and caregivers with moderate views on vaccination to encourage open and constructive dialogue. Participants received a $100 gift card for their involvement in the in-person meeting.

Study Procedures

A modified BCT approach was used to develop community-informed HPV vaccination messages and materials. BCT is a collaborative, iterative process in which community members and health partners co-create health communication tailored to local culture and preferences. The process typically involves in-person and virtual meetings, totaling 20–25 hours of engagement over 4–12 months. For this study, the BCT model was adapted to include one 5-hour in-person session and two 1-hour virtual follow-up calls, reflecting prior successful implementations by the research team. An overview of the BCT process is provided in Figure 1.

Figure 1.

BCT Overview.

The initial in-person BCT meetings were held at two rural clinics: one in Aberdeen, Washington (English, February 17, 2024) and one in Bellingham, Washington (Spanish, March 2, 2024). Sessions included presentations from local health care providers and HPV experts, group discussions on HPV knowledge, beliefs, and barriers, and interactive small-group activities focused on message development and dissemination strategies. Review and discussion of existing HPV messaging served as a foundation for these activities.

Two follow-up virtual sessions (April 13 and July 20, 2024) allowed participants to review and provide feedback on draft materials, including suggestions on content, design, imagery, and delivery methods. Participants received a $25 gift card for each follow-up session.

Data Collection and Analysis

Field notes were collected during the in-person and virtual discussions to capture the diverse attitudes, beliefs, and preferences of English- and Spanish-speaking caregivers in rural Washington communities. The research team debriefed and outlined a summary of key learnings, with message themes formulated based on participant input. Participants shared their preferences on multiple aspects of existing materials, including content, layout, imagery, tone, message length, comprehension, and emotional impact. These insights directly informed the development of new messages and guided recommendations for effective delivery within the community. The BCT process was designed to ensure that the resulting HPV vaccination messages and materials were responsive to the unique needs of rural and Hispanic/Latino populations.

Pre- and Post-BCT Survey Responses

The study team developed brief pre- and post-BCT surveys specifically tailored to the project’s objectives (see Supplemental Appendix 1 and 2). To ensure language preference and cultural appropriateness, all surveys were administered in the language of the corresponding session, with English surveys used for English language sessions and Spanish surveys used for Spanish language sessions. The surveys were developed specifically to address the project’s goals. Survey items were informed by the team’s prior community-engagement work and reviewed for linguistic and cultural appropriateness by the research team and community advisors.

The eight-item pre-survey, designed to take 1–2 minutes, was completed in the morning following registration, while the post-survey, requiring 2–3 minutes, was administered at the end of the in-person session. The post-survey included 14 multiple choice and Likert-type-scale items, along with an open-ended prompt with general feedback. Both surveys were self-administered and distributed in hard copy format to participants during check-in. The surveys assessed participants’ HPV knowledge and attitudes, such as perceived importance of the vaccine, intent to vaccinate, and perceived barriers to HPV vaccination. For example, items included awareness of HPV and cervical cancer, knowledge of vaccine eligibility, and vaccination intent (e.g., “A vaccine to prevent HPV infection is available. Have you ever heard that cancer can be prevented by the HPV vaccine?” and “How likely are you to get the HPV vaccine for your child[ren] this year?”). Demographic information—including age, sex, race/ethnicity, education, income, insurance status, and employment—was collected exclusively on the post-survey. In addition, the post-survey included a session feedback section in which participants rated their experiences using a 5-point Likert-type scale (1 = Strongly Disagree to 5 = Strongly Agree). Items included statements such as: “Today’s session helped me understand the importance of the HPV vaccine.” These items captured participants’ perceptions of knowledge gained, clarity of communication, session pacing, respect, and overall satisfaction.

Results

Participants

A total of 24 adults participated in the in-person sessions, conducted in English and Spanish. Eighteen were parents and caregivers of children between the ages of 9–15, and their children had at least one vaccination. The remaining participants included four staff members and two health educators. The participants were divided into two language groups: the English language (EL) group, which included eight parents and two clinic staff, and the Spanish language (SL) group, consisting of 10 parents, 2 clinic staff, and 2 health promoters.

Educational attainment and socioeconomic characteristics varied across the groups. Overall, 66% of participants were high school graduates or higher, with significant variation between language groups (87% in the EL group versus 50% in the SL group). Only 17% of participants reported household incomes of $50,000 or greater, with the EL group showing a higher proportion (25%) compared to the SL group (10%). A higher percentage of the English group reported being employed (57.1%) compared to the Spanish group (40%). A significantly larger percentage of the Spanish language participants (70%) reported not having health-care insurance compared to the English language group (12.5%), which were primarily insured through public programs such as Medicare, Medicaid, or Washington Apple Health (62.5%). The English language session participants demonstrated diverse demographic characteristics. Approximately 37% of these individuals self-identified as Hispanic/Latino. The racial composition was diverse, comprising 25% American Indian/Alaska Native, 12.5% Asian, 25% Black/African American, and 62.5% White; total percentage exceeds 100% because individuals could identify with more than one race. The Spanish session was comprised of 90% Hispanic/Latino participants. Notably, all participants in both sessions identified as female.

Pre- and Post-Survey Responses

Most of the findings reported below are based on pre-survey responses collected during the in-person BCT sessions. Only one item—“How likely are you to get the HPV vaccine for your child(ren) this year?”—was included on both the pre- and post-surveys and is used to assess change in vaccination intent following the session.

The English session pre-survey indicated a high level of awareness among participants, with 87.5% familiar with HPV and 100% aware of cervical cancer. In addition, 87.5% recognized that the HPV vaccine can help prevent cancer. Regarding their children’s vaccination status, 50% reported their children had received the HPV vaccine, 25% said their children had not been vaccinated, and the remainder were unsure. The proportion of participants who were extremely likely or likely to vaccinate their children increased from 50% before the BCT session to 87.5% after the session, indicating a substantial shift toward stronger vaccination intent following the community-engagement session.

The Spanish session pre-survey results showed moderate awareness of HPV (60%) and cervical cancer (80%), with 70% aware that the vaccine can prevent cancer. Only 20% of participants reported that their children were vaccinated, while 50% said their children were not; the remainder either did not know or chose not to answer. Initial intentions to vaccinate were mixed: 30% were likely, 10% were neutral, 10% were unlikely, and 40% preferred not to answer. After the BCT session, the proportion extremely likely or likely to vaccinate increased from 30% to 60%, reflecting a more positive attitude and greater confidence toward HPV vaccination.

Both sessions demonstrated positive shifts in vaccination intentions, with the English session showing a more pronounced increase in those extremely likely to vaccinate. The results from the Spanish session suggest that the BCT session effectively addresses cultural barriers in health communication by increasing awareness through culturally appropriate and accessible health education.

Preferred Key Messages

The key messages from the BCT sessions emphasized the importance of reassuring parents about the safety and effectiveness of the HPV vaccine. Messages should emphasize the vaccine’s long-standing safety record, having been administered to millions of children worldwide since 2006. The emotional appeal to parents’ desire to protect their children’s future should be central, with phrases like “Protect your child’s future” resonating deeply. In addition, the connection between the HPV vaccine and cancer prevention must be highlighted, with messages such as “HPV vaccination is cancer prevention” underscoring the importance of the vaccine in protecting against six types of HPV cancers, and its effectiveness in preventing 90% of these HPV cancers. Participants also highlighted the significance of discussing the benefits of beginning vaccination at age 9, stressing that vaccinating before exposure to the virus, maximizes the vaccine’s effectiveness. Messages should address caregivers’ concerns about vaccine side effects and highlight the latest research, while also reassuring parents that it is “not too late” to vaccinate, and vaccination is beneficial up to age 26 and, depending on risk, up to age 45. The role of trusted health care providers is critical, with messaging being most effective when it comes directly from doctors and is tailored to individual concerns. Local statistics and community support can further strengthen the message, as can the option for parents to share information with family and friends. Finally, gender-neutral language should be consistently used to ensure both boys and girls are equally encouraged to receive the vaccine. Peer-to-peer messaging can encourage teens to discuss the vaccine, framing it as a means of mutual protection against HPV.

Preferred Dissemination Channels

Participants identified several channels for disseminating and receiving HPV vaccine messages and materials, including patient-friendly print materials, text message outreach, live call outreach, educational website resource, and in-clinic materials. First, a patient mailer—including a clear, introductory letter and an accompanying fact sheet about HPV vaccination—was recommended to deliver essential information directly to families in an accessible and understandable format. Second, text messages with links to short, animated videos and the ability to schedule vaccine appointments were viewed as efficient and engaging ways to reach parents. Third, both English and Spanish language groups highlighted the value of live phone calls from health care providers—particularly from a care coordinator—to answer questions and assist with appointment scheduling. These calls should emphasize the importance, safety, and benefits of the HPV vaccine, supporting parents and caregivers in making informed health decisions. Fourth, BCT participants expressed a preference for educational HPV vaccination websites that are easy to understand and accessible from mobile devices. Simple, dynamic websites were identified as effective tools for reaching both teens and busy parents, as well as for disseminating HPV vaccination information and resources. Finally, print materials (e.g., posters), especially those available in clinic settings such as lobbies, waiting areas, and patient rooms, were also seen as a strong option for delivering information.

While there were many similarities in the groups’ feedback, a few differences emerged. Spanish language participants placed more emphasis on including specific statistical details, such as the types of cancers prevented by the vaccine and wanted to provide more in-depth information on HPV strains and their prevalence. They also suggested providing posters for teenagers with the message “It’s not too late” to get vaccinated. The Spanish language group also highlighted the use of motivational interviewing techniques as an effective way to engage patients in decision-making in a respectful and supportive manner, addressing concerns while reinforcing the benefits of vaccination. Overall, both sessions agreed on the importance of safety, cancer prevention, early vaccination, clear communication, and respectful provider-patient interactions.

Final Co-designed Materials

Guided by the preferred HPV vaccination messaging themes identified by BCT participants, our team collaboratively co-designed a set of materials to promote and increase HPV vaccination uptake in rural communities throughout Washington State (Table 1). We solicited feedback on draft materials and concepts, then refined these materials during two follow-up virtual sessions, each involving a subset of participants from the initial in-person BCT meetings. The finalized materials will be utilized in the main PREVENT trial intervention. All materials are publicly available at: www.PreventHPVCancers.com.

Table 1.

Co-designed HPV Vaccination Materials and Messages by Dissemination Channel.

Materials	Description	Key messages
Patient outreach mailer
HPV Vaccination is Cancer Prevention La Vacunación Contra el VPH es Prevención del Cáncer	Double-sided mailer featuring a patient introductory letter (front) and an HPV vaccination fact sheet (back)	Patient letter content incorporates preferred messaging about HPV vaccination—including information on protection, safety, efficacy, and cost—and serves to notify recipients of an upcoming text message prompting parents to schedule their child’s HPV vaccination appointment. Patient fact sheet content includes easy-to-understand information about HPV, the effectiveness of the vaccine, who should get vaccinated, and why vaccination matters; preferred messaging focuses on the recommended starting age of 9 and noting it’s not too late for adults—encouraging patients to talk with their provider, key statistics on HPV infection rates, number of cancers caused by HPV, and cancers prevented by the vaccine.
Text message outreach
HPV Vaccination Reminder	Bilingual text message sent as part of text outreach campaign	Text message content emphasizes provider trust and recommendations, vaccine safety, recommended vaccination age, protective benefits of the HPV vaccine, and offers easy HPV vaccination scheduling. English: Thank you for trusting Sea Mar with @[Patient First Name]’s care. Your provider recommends an HPV vaccination for your child. The HPV vaccination is safe for children starting at age 9. PROTECT your child! Make an appointment today. Please reply A, B, or C: A- I’m ready. Call me. B- I’d like to learn more. C- Other Spanish: Gracias por confiar en Sea Mar para el cuidado de @[Patient First Name]. Su médico recomienda la vacuna contra el virus del papiloma humo (VPH). La vacuna de VPH es segura para niños a partir de los 9 años. ¡PROTEJA a su hijo/a! Programe una cita hoy. Responda A, B, o C: A-Estoy listo/a, llámame B-Me gustaría saber más C-Otro
Live call outreach support
Clinic Staff Frequently Asked Questions (FAQs)	FAQ document to help staff better understand HPV and the vaccine, enhancing their knowledge and confidence when discussing it with patients over the phone	Document highlights frequently asked questions about HPV and HPV vaccination, providing clinic staff with BCT-informed responses—covering what HPV is, how it prevents six types of cancer, vaccine safety and efficacy, who should be vaccinated, recommended ages and dosing, cost, and available resources.
Motivational Interviewing Phone Guide for HPV Vaccine Conversations	Phone guide integrating motivational interviewing techniques to equip patient-facing clinic staff with strategies for addressing HPV vaccine barriers, fostering patient engagement, and increasing vaccination uptake	Guide highlights brief motivational interviewing techniques to address patient concerns about HPV vaccination, foster informed decision-making, and build trust; features conversation prompts, reflective listening strategies, importance and readiness scales, and a self-evaluation tool for staff to assess and strengthen motivational interviewing skills.
Educational website (storytelling approach)
LearnAboutHPV.org	Bilingual, user-friendly, and engaging educational website about HPV vaccination designed for parents and caregivers	Website is designed to present HPV vaccination information using a simple, visually appealing storytelling format with scrolling navigation, and enhanced by easy-to-understand cartoon characters to engage and educate users effectively. Website content includes preferred HPV vaccination information with key message, “We know you would do anything to protect your child. Help protect them from cancers caused by HPV later in life.” Website also shares important facts such as statistics, the recommended age to begin vaccination, vaccine safety and efficacy.
Clinic posters
Cancer Prevention Starts with HPV Vaccination! La prevención del cáncer comienza con la vacuna contra el virus del papiloma humano (HPV)	In-clinic poster designed to increase HPV vaccination awareness	Poster content uses gender-neutral language promoting equal cancer prevention access for all children; provides a brief overview of HPV, its prevalence, and that vaccination prevents over 90% of HPV-related cancers; includes an image illustrating six HPV-related cancers to aid parental understanding, recommended dosing schedule, and resource link. Messaging emphasizes HPV vaccine safety, effectiveness, and recommendation for all children starting at age 9, with images of boys and girls reinforcing that HPV affects everyone. Tailored messaging improves communication between providers, patients, and families.
Protect Yourself, Protect Others ¡Protégete y Protege a los Demás!	In-clinic poster designed to increase HPV vaccination awareness	Poster content features HPV basics for teens and young adults—what it is, how it spreads, health risks, and six cancer types linked to HPV; includes annual infection and cancer statistics, explains that vaccination can prevent over 90% of HPV-related cancers, and provides the recommended dosing schedule. Preferred messaging focuses on protecting yourself and others, emphasizes it’s not too late, and features an image of a couple to reflect shared responsibility and future health, and was developed with insights from the Spanish language session.
Protect Their Future Proteger su futuro	In-clinic poster designed to increase HPV vaccination awareness	Poster content focuses on raising parent awareness about the importance of HPV vaccination, especially for boys. It outlines the six cancers caused by HPV and shares key statistics on vaccine effectiveness in preventing these cancers. Messaging covers vaccine safety, why vaccination is recommended starting at age 9, and the dosing schedule. The main message, “We know you would do anything to protect their future,” emphasizes vaccinating early, before exposure. An image of a mother and son reinforces that HPV affects everyone and boys need protection too.

Evaluation of Modified BCT Sessions

The evaluation of both the English and Spanish sessions revealed high levels of participant satisfaction and effectiveness in conveying information about HPV and its vaccine.

In the English session, all participants rated their satisfaction as either "extremely satisfied" (9 or 10 on the scale) or "very positive." Participants unanimously agreed that the facilitators communicated clearly and maintained an appropriate pace, making the information easily understandable. The session was particularly effective in enhancing participants’ understanding of the HPV vaccine’s importance. All participants reported a sense of accomplishment and felt they had gained valuable knowledge about HPV and the vaccine.

Similarly, the evaluation of the Spanish session revealed highly positive outcomes. Sixty percent of participants reported being "extremely satisfied" with the session, while the remaining attendees also provided favorable ratings. An impressive 90% agreed that the facilitators communicated clearly, making the information easy to understand. All participants agreed that the session’s pace was appropriate. Furthermore, 80% indicated that their understanding of the importance of the HPV vaccine had improved, and 70% strongly agreed that they gained valuable information and felt a sense of accomplishment as a result of their participation.

Both sessions fostered an environment of mutual respect, with most participants in both groups agreeing that differing viewpoints were respected. Overall, these results indicate that both the English and Spanish sessions were highly successful in engaging participants, respecting diverse opinions, and effectively conveying crucial information about HPV and its vaccine. The positive outcomes were consistent across both groups, suggesting the effectiveness of this community educational approach in different cultural contexts.

Discussion

This study offers valuable new insights into the effective delivery of HPV vaccination messages in rural communities, with a particular emphasis on Hispanic/Latino families. By engaging parents and caregivers through a modified BCT process, we co-created messaging and educational materials that directly address the unique barriers and motivators within these populations.

Providers reported a slight uptick in vaccination numbers after the BCT sessions which, while not conclusive, suggests a positive impact of the engagement approach. This observation aligns with prior research, including a systematic review by Escoffery and colleagues, which found that community-engaged and culturally tailored interventions can increase HPV vaccination uptake (Escoffery et al., 2023). Consistent with earlier studies of community-based participatory approaches, our findings underscore the potential of partnership-driven materials to address health disparities and improve vaccination outcomes in underserved populations through non-traditional delivery formats (Christy et al., 2023; Niccolai & Hansen, 2015). By identifying evidence-based methods to develop HPV vaccination materials that promote community-centered solutions, this research takes an important step toward reducing disparities in HPV vaccination rates and cervical cancer incidence.

Our results highlight several key findings. First, both English- and Spanish-speaking participants demonstrated increased willingness to vaccinate their children against HPV following the BCT sessions, with the most pronounced shift among English language participants and a notable increase in engagement among the Spanish group. This suggests that culturally and linguistically tailored, community-engaged messaging can meaningfully shift attitudes and intentions, even among groups with initially moderate or uncertain views about vaccination.

Second, the study revealed important differences between English- and Spanish-speaking caregivers in baseline knowledge, concerns, and communication preferences. Spanish-speaking participants started with lower awareness of HPV and the vaccine’s cancer-prevention benefits but expressed a strong desire for detailed, specific information about the cancers prevented and the scientific evidence supporting vaccine safety. They also valued motivational interviewing and respectful, supportive communication from providers. English-speaking participants, meanwhile, focused more on general vaccine safety, efficacy, and the emotional appeal of protecting their children’s future. Both groups agreed that messaging should emphasize the vaccine’s safety record, its cancer-prevention role, the importance of early vaccination, and the use of clear, gender-neutral language.

Third, a unique contribution of this study is the identification of trusted and practical dissemination channels for rural settings. Participants from both language groups endorsed a multi-modal approach, including patient mailers, text messages with website links, live phone calls from trusted clinic staff, educational websites, and clinic materials. Spanish-speaking caregivers especially valued materials that could be shared with extended family and community members, as well as direct conversations with bilingual coordinators for questions and appointment assistance. These findings highlight the importance of flexible, accessible communication strategies that extend beyond traditional clinic-based approaches.

Several limitations should be acknowledged. Participant attrition limited the final sample size, which may affect the generalizability of our findings. The study was conducted in only two rural clinics in Washington State, so results may not represent all rural or Hispanic/Latino communities nationwide. In addition, the low participation of fathers may have influenced the perspectives captured. Finally, the surveys were not adapted from existing validated instruments, as they were tailored to the project’s goals of message development. As such, psychometric properties (e.g., reliability) were not calculated.

These findings hold important implications for practitioners and health educators. First, HPV vaccination efforts in rural, Hispanic/Latino-serving clinics should prioritize bilingual, culturally responsive materials that integrate both scientific evidence and motivational narratives. Second, dissemination strategies should incorporate multiple delivery modes—particularly text message reminders, phone calls from trusted staff, and family-shareable educational materials—to reach households with varied information preferences and ensure broader message penetration within extended family networks. Finally, health systems working in rural areas should invest in training bilingual coordinators and community health workers, who may serve as vital cultural brokers and trusted intermediaries.

Future research should focus on recruiting parents of younger children, particularly those aged 8 to 10, to better understand barriers to early vaccination. It is also important to evaluate the effectiveness of BCT-developed materials on HPV vaccination rates and to expand this approach to other rural and minority communities. Furthermore, investigating the cost-effectiveness of community-engaged health communication strategies will be critical. This study highlights the ongoing tension between evidence-based practice and patient-centered care, particularly for non-native English-speaking populations in rural areas. The outcomes of this BCT process may inform the development of robust messaging frameworks for future interventions, ensuring that diverse patient populations receive the information they need to make well-informed decisions about HPV vaccination.

Supplemental Material

sj-docx-1-heb-10.1177_10901981251399649 – Supplemental material for Co-creating HPV Vaccination Messages for Rural Washington: Application of a Boot Camp Translation Approach

Supplemental material, sj-docx-1-heb-10.1177_10901981251399649 for Co-creating HPV Vaccination Messages for Rural Washington: Application of a Boot Camp Translation Approach by Jamie H. Thompson, Jennifer S. Rivelli, Priyanka Gautom, Amanda F. Petrik, Matthew Najarian, Anna C. Edelmann, Ludy Villegas, Rebecca Slagle, Kaila Christini, Gloria D. Coronado and Deanna Kepka in Health Education & Behavior

Supplemental Material

sj-docx-2-heb-10.1177_10901981251399649 – Supplemental material for Co-creating HPV Vaccination Messages for Rural Washington: Application of a Boot Camp Translation Approach

Supplemental material, sj-docx-2-heb-10.1177_10901981251399649 for Co-creating HPV Vaccination Messages for Rural Washington: Application of a Boot Camp Translation Approach by Jamie H. Thompson, Jennifer S. Rivelli, Priyanka Gautom, Amanda F. Petrik, Matthew Najarian, Anna C. Edelmann, Ludy Villegas, Rebecca Slagle, Kaila Christini, Gloria D. Coronado and Deanna Kepka in Health Education & Behavior

Supplemental Material

sj-docx-3-heb-10.1177_10901981251399649 – Supplemental material for Co-creating HPV Vaccination Messages for Rural Washington: Application of a Boot Camp Translation Approach

Supplemental material, sj-docx-3-heb-10.1177_10901981251399649 for Co-creating HPV Vaccination Messages for Rural Washington: Application of a Boot Camp Translation Approach by Jamie H. Thompson, Jennifer S. Rivelli, Priyanka Gautom, Amanda F. Petrik, Matthew Najarian, Anna C. Edelmann, Ludy Villegas, Rebecca Slagle, Kaila Christini, Gloria D. Coronado and Deanna Kepka in Health Education & Behavior

Footnotes

Acknowledgements

We gratefully acknowledge the support of Sea Mar Community Health Centers for their partnership in this project. Sea Mar served as the primary performance site for this work, and their commitment to community health and collaboration was instrumental in the successful implementation of the study. We especially thank the staff and patients who contributed their time, insights, and lived experiences to co-create culturally relevant HPV vaccination messages and materials. We also thank Stephen Gubler for project management assistance at the beginning of this study, specifically during the community-engagement work.

ORCID iDs

Jamie H. Thompson

Jennifer S. Rivelli

Priyanka Gautom

Anna C. Edelmann

Rebecca Slagle

Gloria D. Coronado

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The PREVENT study (Practice-Based Approaches to Promote HPV Vaccination), led by Principal Investigator Deanna Kepka at the University of Utah, is funded by the National Cancer Institute (NCI) of the National Institutes of Health (NIH) under grant number 1R01CA279973. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.

Declaration of Conflicting Interests

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Deanna Kepka has worked as a consultant for Merck. Other authors have no financial disclosures or conflicts of interest.

Supplemental Material

Supplemental material for this article is available online.

References

American Cancer Society. (2024). Cancer facts & figures for Hispanic/Latino people 2024-2026. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/2024-cancer-facts-figures.html

Aragones

Bruno

D. M.

Ehrenberg

Tonda-Salcedo

Gany

F. M.

(2015). Parental education and text messaging reminders as effective community based tools to increase HPV vaccination rates among Mexican American children. Preventive Medicine Reports, 2, 554–558. https://doi.org/10.1016/j.pmedr.2015.06.015

Brewer

S. E.

Simpson

M. J.

Rice

J. D.

Skenadore

O’Leary

S. T.

(2020). Engaging practices and communities in the development of interventions to promote HPV vaccine uptake: A protocol for implementing Boot Camp Translation in the private practice setting. BMJ Open, 10(12), e041685. https://doi.org/10.1136/bmjopen-2020-041685

CDC. (2024a). Cancers linked with HPV each year —Cancer. https://www.cdc.gov/cancer/hpv/cases.html

CDC. (2024b). HPV vaccine safety and effectiveness data —HPV. https://www.cdc.gov/hpv/hcp/vaccination-considerations/safety-and-effectiveness-data.html

Christy

S. M.

Fuzzell

L. N.

Lake

P. W.

Staras

Colon Lopez

Best

Hull

P. C.

Vadaparampil

S. T.

(2023). Community-based interventions for HPV vaccination. In Halbert

C. H.

(Ed.), Cancer health disparities (pp. 147–181). Springer. https://doi.org/10.1007/978-3-031-37638-2_10

Colón-López

Medina-Laabes

D. T.

Abreu

R. S.

Díaz Miranda

O. L.

Ortiz

A. P.

Fernández

M. E.

Hull

P. C.

(2021). Understanding parents’ views toward the newly enacted HPV vaccine school entry policy in Puerto Rico: A qualitative study. BMC Public Health, 21(1), 1938. https://doi.org/10.1186/s12889-021-11952-w

Escoffery

Petagna

Agnone

Perez

Saber

L. B.

Ryan

Dhir

Sekar

Yeager

K. A.

Biddell

C. B.

Madhivanan

Lee

English

A. S.

Savas

Daly

Fernandez

M. E.

(2023). A systematic review of interventions to promote HPV vaccination globally. BMC Public Health, 23(1), 1262. https://doi.org/10.1186/s12889-023-15876-5

Fernandez-Pineda

Cianelli

Villegas

Matsuda

Iriarte

Fernandez

Montano

N. P.

(2021). Preferred HPV and HPV vaccine learning methods to guide future HPV prevention interventions among rural Hispanics. Journal of Pediatric Nursing, 60, 139–145. https://doi.org/10.1016/j.pedn.2021.04.026

10.

Frietze

Padilla

Cordero

Gosselink

Moya

(2023). Human Papillomavirus Vaccine Acceptance (HPV-VA) and Vaccine Uptake (HPV-VU): Assessing the impact of theory, culture, and trusted sources of information in a Hispanic community. BMC Public Health, 23(1), 1781. https://doi.org/10.1186/s12889-023-16628-1

11.

Harrington

Chen

O’Reilly

A. M.

Fang

C. Y.

(2021). The role of trust in HPV vaccine uptake among racial and ethnic minorities in the United States: A narrative review. AIMS Public Health, 8(2), 352–368. https://doi.org/10.3934/publichealth.2021027

12.

Kepka

Coronado

G. D.

Rodriguez

H. P.

Thompson

(2011). Evaluation of a radionovela to promote HPV vaccine awareness and knowledge among Hispanic parents. Journal of Community Health, 36(6), 957–965. https://doi.org/10.1007/s10900-011-9395-1

13.

Khalil

Russo

Venkatakrishnan

Mazul

A. L.

Zevallos

J. P.

(2023). Barriers to human papillomavirus vaccination initiation and completion among adults aged 18-26 years in a large healthcare system. Cancers, 15(17), 4243. https://doi.org/10.3390/cancers15174243

14.

Kjaer

S. K.

Dehlendorff

Belmonte

Baandrup

(2021). Real-world effectiveness of human papillomavirus vaccination against cervical cancer. Journal of the National Cancer Institute, 113(10), 1329–1335. https://doi.org/10.1093/jnci/djab080

15.

Lewis

R. M.

Laprise

J. F.

Gargano

J. W.

Unger

E. R.

Querec

T. D.

Chesson

H. W.

Brisson

Markowitz

L. E.

(2021). Estimated prevalence and incidence of disease-associated human papillomavirus types among 15- to 59-year-olds in the United States. Sexually Transmitted Diseases, 48(4), 273–277.

16.

McGlone

M. S.

Stephens

K. K.

Jia

Montagnolo

(2024). Multiple messaging strategies for increasing HPV vaccination intentions among English- and Spanish-speaking parents in the United States and Mexico. Vaccines (Basel), 12(6), 650. https://doi.org/10.3390/vaccines12060650

17.

Niccolai

L. M.

Hansen

C. E.

(2015). Practice- and community-based interventions to increase human papillomavirus vaccine coverage: A systematic review. JAMA Pediatrics, 169(7), 686–692. https://doi.org/10.1001/jamapediatrics.2015.0310

18.

Roncancio

A. M.

Ward

K. K.

Carmack

C. C.

Muñoz

B. T.

Cribbs

F. L.

(2017). Hispanic mothers’ beliefs regarding HPV vaccine series completion in their adolescent daughters. Health Education Research, 32(1), 96–106. https://doi.org/10.1093/her/cyw055

19.

Villarroel

Galinksy

P.-J.

Pingali

Valenzuela

(2024). Human papillomavirus vaccination coverage in children ages 9–17 years: United States, 2022. National Center for Health Statistics. https://doi.org/10.15620/CDC:145593

20.

Washington Chapter of the American Academy of Pediatrics (WCAAP). (2023). Opportunity to increase HPV vaccination in rural Washington starting at age 9. https://wcaap.org/opportunity-to-increase-hpv-vaccination-in-rural-washington-starting-at-age-9/

21.

Wynn

C. S.

Catallozzi

Kolff

C. A.

Holleran

Meyer

Ramakrishnan

Stockwell

M. S.

(2021). Personalized reminders for immunization using short messaging systems to improve human papillomavirus vaccination series completion: Parallel-group randomized trial. JMIR mHealth and uHealth, 9(12), e26356. https://doi.org/10.2196/26356

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