Behavioural factors impacting parents' attitude towards human papillomavirus vaccine : a systematic review

Abstract

Introduction Human Papillomavirus caused 528,000 new cases of cervical cancer in 2012, resulting in 7.5% of all female cancer deaths globally. Three prophylactic vaccines are available: quadrivalent targeting HPV 6, 11, 16 and 18, bivalent targeting HPV 16 and HPV 18 and the most recent, Gardasil 9 targeting additional 5 types (31, 33, 45, 52, and 58) of the virus. Recommendation of administration of the vaccine is during adolescence hence the parents’ attitude towards the vaccine plays an important role in vaccine uptake. Objectives To identify key factors underlying parents’ attitude towards HPV vaccine in order to improve the HPV vaccine uptake and to appreciate where interventions to increase HPV vaccine initiation needs to be applied. Method Pubmed, Medline and Proquest were used as electronic resources with last search done in April 2016. Studies identified were critically evaluated and reviewed. Only observational or cross sectional studies, published in English between 2006 to 2016 were included. Participants were parents or main caregivers with daughters aged 9-18 years from countries where the HPV vaccine is included in the national immunisation schedule and used for prevention of cervical cancer. Primary outcome measures were parents’ attitudes toward the vaccine. Results Out of 636 studies identified, 20 articles were included in the results, the majority (n=15) originating from the US. No study received a very high score from the quality assessment tool. Factors impacting parents’ attitude towards HPV vaccine was divided into five categories: Beliefs, barriers, behaviour, influences (sub category: social norms, trust in government and/or pharmaceutical industry, provider recommendation, media influence, past cancer experience) and awareness. Discussion Beliefs about safety, knowledge of HPV, influences from friends/family and recommendations from healthcare professionals seem to be important factors affecting vaccine acceptance; conversely lack of knowledge and fear of side effects also need to be considered. Relevant interventions based on these findings should be tested so as to identify effective means of improving vaccine uptake.