Table 3 Development of the comic book structure and content

Characters

• Characters should look like the target population, and should be in appropriate, modest dress

• Characters wearing hijab for Somali comic book and non-hijab wearing characters for Eritrean and Ethiopian comic books; names of the characters are from the community for all three comic books

• Include girls and boys as characters

• Two boys in Scene 2

• Include a grandmother

• A grandmother in Scene 3

• Mother represents the whole family

• Mother and grandmother in Scene 3

HPV information

• Include information about HPV knowledge (transmission, symptoms, and consequences)

• Differentiate HPV from HIV

• Spread through sexual contact

• Most won’t know they are infected because there are no symptoms

• The types of cancer caused by HPV

• A student mistakes HPV for HIV when asked in class, and doctor emphasizes the ‘P’ in HPV when written on the board

HPV vaccine information

• Include information about cancer prevention

• Grandma approves the vaccine and states that there were no such vaccines to prevent cancer when she was young

• Include information about early vaccination

• A doctor tells the students to get the vaccine now to prevent cancer later by comparing the HPV vaccine to putting on a seatbelt before driving

• Include information about side effects

• A doctor mentions common side effects of the vaccine, and that the vaccine has been shown to be safe from serious or long-term side effects

Social influence

• Friends play an influential role to each other

• Main character discusses the vaccine with her friends who have already been vaccinated and they encourage each other to discuss the vaccine with their parents.

• Adolescents get information from multiple sources, not just from parents

• HPV and HPV vaccine information is disseminated by a member of the health department (Scene 1), adolescents’ peers (Scene 2), and family (Scene 3)