Document Type

Article

Publication Date

2026

DOI

10.3390/vaccines14050448

Publication Title

Vaccines

Volume

14

Issue

5

Pages

448

Abstract

Background/Objectives: Human papillomavirus (HPV) vaccination coverage among adolescents remains below public health targets despite strong evidence of vaccine effectiveness in preventing HPV-related cancers. Digital interventions (e.g., serious games) may improve HPV vaccine uptake, but evidence for effects on vaccination behavior remains limited. Methods: This secondary analysis of a randomized controlled trial evaluated a co-designed, game-based digital intervention to increase HPV vaccine initiation among unvaccinated youth aged 11-14 years and their parents. The sample included 64 parent-adolescent dyads (33 intervention and 31 usual care dyads). The primary outcome was HPV vaccine initiation at 2-month follow-up. Results: A significantly greater proportion of adolescents in the intervention group initiated HPV vaccination compared with controls (88.5% vs. 46.2%; Χ²(1) = 10.58, p = 0.001; risk difference = 0.423, 95% CI = [0.196, 0.650]). No significant between-group baseline differences were observed in parent HPV vaccination intention, knowledge, or psychosocial perceptions, although adolescent vaccination intention was higher in the intervention group. In adjusted logistic regression controlling for adolescent baseline HPV vaccination intention, intervention participants remained significantly more likely to initiate vaccination than controls (OR = 9.31, 95% CI = 2.13-40.70, p = 0.003). Intervention acceptability was high, with most parents and adolescents reporting that the game was easy to use, engaging, and relevant to vaccination decision-making. Conclusions: These findings provide preliminary evidence that a brief, family-centered, game-based digital intervention may help increase HPV vaccination initiation among adolescents. Larger trials with longer follow-up are needed to assess vaccine series completion and effectiveness across diverse settings.

Rights

© 2026 by the authors.

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International (CC BY 4.0) License.

Data Availability

Article states: "The data supporting the findings of this study are available from the corresponding author upon reasonable request and with the appropriate Institutional Review Board approval."

Original Publication Citation

Chen, A. C. C., Ou, L. H., Reifsnider, E., Arcoleo, K., Amresh, A., & Todd, M. (2026). Increasing HPV vaccination among early adolescents using a game-based digital intervention: A randomized controlled trial. Vaccines, 14(5), Article 448. https://doi.org/10.3390/vaccines14050448

ORCID

0000-0002-0486-0134 (Reifsnider)

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