Influence of Social Media Messaging on HPV Vaccine Attitudes & Confidence Among Adolescent Males: A Qualitative Study (Preprint)

BACKGROUND Despite the human papillomavirus (HPV) vaccine being available to males for the past 12 years, adolescent males continue to lag in HPV vaccine uptake due to a variety of factors stemming from socio-demographic characteristics, provider and parent recommendations, and overall education about HPV and its health implications. With the ubiquitous nature of social media use among this priority population, further research is needed to improve HPV vaccine confidence among young adolescent males utilizing these platforms. OBJECTIVE Using the Elaboration Likelihood Model (ELM), this study sought to better understand knowledge, attitudes, and beliefs (KAB) about HPV and HPV vaccination among male adolescents (ages 14-17) and examine how social media messaging influences vaccine perceptions and explore the characteristics of persuasion and trustworthiness of digital content narratives across age and vaccination status. METHODS The study team recruited 18 adolescent males to participate in a series of online focus groups and interviews stratified by age (14-15 and 16-17) and HPV vaccination status. The study team worked with our in-house national probability survey panel, AmeriSpeak® Teen Panel, to recruit for the focus groups. All focus groups were recorded, transcribed, and coded using NVIVO 1.6.1. Emergent themes were identified and the full team participated in coding and analysis. Data were analyzed using rigorous thematic analysis to identify patterns across groups. RESULTS Knowledge of HPV varied by age and vaccination status. Older, vaccinated adolescents were more likely to understand that HPV affects both genders and is sexually transmitted, while younger, unvaccinated adolescents often had little to no prior awareness. Parents—especially mothers—were the primary decision-makers for vaccinated adolescents, with older adolescents more likely to be engaged in that decision. Trust in social media health messages was low overall, with participants relying on perceived source credibility over content format or style. Trusted sources included parents, doctors, and well-known health organizations. Younger adolescents were more influenced by personal anecdotes, while older adolescents preferred statistics, facts, and reliable sources. CONCLUSIONS Our findings highlight the importance of tailoring HPV vaccine messaging by age and developmental stage. Trusted messengers, clear factual content, and platform appropriateness are critical for engaging adolescent males. The ELM provides a useful lens for interpreting these findings: younger adolescents were more influenced by peripheral cues, personal stories or visual appeal, while older adolescents engaged in more central processing, evaluating the credibility of the source and the factual content of the message. This underscores the need to match message strategies with adolescents’ cognitive and motivational readiness. Future interventions should consider dual strategies targeting both youth and parents, especially for younger adolescents. As the digital landscape continues to evolve, further research should also examine how generative AI may serve as a trusted source or tool for communicating accurate, engaging health information to adolescents audiences.