Interventions to Increase HBV Vaccinations in Sexually Transmitted Disease (STD) Clinics

The goal of this study is to evaluate two sets of interventions to increase acceptance of
hepatitis B virus (HBV) vaccination in patients attending sexually transmitted disease (STD)
clinics. The 1st specific aim is to assess the effect of message-framing on vaccine
acceptance. Framing theory suggests that positively framed messages (i.e., benefits of
getting vaccine) are more effective than negatively framed messages (i.e., dangers of not
getting vaccine) in stimulating preventive health behaviors. Research on Framing Theory and
engagement in health behaviors suggests also that the effects may be moderated by other
attitudinal factors, including perceived risk of the behavior and degree of involvement in
the message. The 2nd aim is to evaluate the effect of provider-based interventions. Prior
research suggests that recommendations by health providers are very important in patients'
decisions regarding acceptance of health care procedures. Patients (18 years and older) will
be recruited and followed from Chicago and Indianapolis STD clinics during routine medical
visits. An audio computer-assisted self-interview (A-CASI) will cover demographics, risk
behaviors, and perceived risk associated with vaccination. Subjects then will be randomized
to receive a gain-framed, loss-framed, or information only message regarding HBV immunization
(also delivered by A-CASI). Upon completion of the message-framing intervention, subjects
will complete additional attitude questions via A-CASI. Upon completion of the A-CASI
subjects will be randomly assigned to one of two provider intervention conditions: 1. vaccine
offered or 2. vaccine recommended. For both conditions free HBV immunization will be provided
by a nurse practitioner. Subsequently, postcard reminders will be sent and phone call
reminders made for follow-up appointments for those receiving the first and second doses of
vaccine. The primary outcome measure is HBV vaccination.

Inclusion Criteria:

- Age 18 and older males and females

- No prior self-reported history of HBV immunization or infection

- Fluent in English

- Not known to be HIV positive.

Exclusion Criteria:

- Under age 18

- Received any prior HBV vaccination

- Prior infection of Hepatitis B

- Unable to read or comprehend the English language

- HIV positive