# Conversational Agents to Improve HPV Vaccine Acceptance in Primary Care

> **NIH NIH R01** · TUFTS MEDICAL CENTER · 2024 · $648,684

## Abstract

Universal Human Papillomavirus (HPV) vaccination would significantly decrease cervical, vaginal, vulvar, anal,
and oral cancers, and reduce racial disparities in these cancers. However, HPV vaccination rates for U.S.
adolescents of all races, ethnicities, and income levels remain far below national targets. Increasing anti-vaccine
information, limited clinician time to engage with hesitant parents, and backlogs of preventive care incurred
during the COVID pandemic contributed to deficits of HPV vaccination that may years to resolve. Embodied
Conversational Agents (ECAs) are animated computer agents that simulate face-to-face conversation between
a patient and a caregiver, using both verbal and nonverbal conversational behavior, to provide a natural and
intuitive computer interface that is accessible to patients of all levels of health and computer literacy. We have
successfully developed and evaluated this interface in several clinical trials to motivate health behavior change
for a wide range of populations, including a pilot evaluation of an ECA that promotes HPV vaccination for the
families of patients with cervical pre-cancer and cancer. In this project we will adapt this technology to produce
English and Spanish smartphone ECAs for HPV vaccination (ECA-HPV) to provide vaccine recommendations
and motivational interviewing to parents/guardians and vaccine-eligible adolescents and facilitate
communication with clinic staff. HPV vaccine promotion over time can lead to acceptance among parents who
initially decline, and the ECA can provide continual interactions both prior to and following clinic visits. We will
evaluate ECA-HPV in a randomized controlled trial for HPV-vaccine eligible adolescents aged 9-12 to evaluate
ECA-HPV, comparing usual care (UC) (n=175) versus usual care plus four design variants of the ECA-HPV
(UC+ECA) (n= 175 x 4 = 700). All intervention participants will get the ECA-HPV for the parent; the design
variants include inclusion vs exclusion of ECA-HPV for the adolescent and inclusion vs exclusion of clinic
notification of information from the system in a 2x2 factorial design to differentiate the impact of the adolescent-
facing and clinic notification features of the intervention. The research team is nationally recognized as leaders
in HPV vaccination, health literacy, and innovative technologies to improve health. This study will advance our
research on the development of easy-to-use technologies to empower patients. This scalable approach has a
significant potential to reduce vaccine hesitancy and increase adolescent vaccination. If successful, our team
will promote the ECA-HPV through national networks for broad implementation and work to adapt ECA-HPV to
include other childhood, adolescent, maternal, and adult immunizations.

## Key facts

- **NIH application ID:** 10929945
- **Project number:** 5R01CA273208-04
- **Recipient organization:** TUFTS MEDICAL CENTER
- **Principal Investigator:** TIMOTHY W. BICKMORE
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $648,684
- **Award type:** 5
- **Project period:** 2022-09-01 → 2025-04-01

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10929945

## Citation

> US National Institutes of Health, RePORTER application 10929945, Conversational Agents to Improve HPV Vaccine Acceptance in Primary Care (5R01CA273208-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10929945. Licensed CC0.

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