Global parental acceptance, attitudes, and knowledge regarding human papillomavirus vaccinations for their children: a systematic literature review and meta-analysis

Abstract

Background: This systematic literature review aims to summarize global research on parental acceptance, attitudes, and knowledge regarding human papillomavirus vaccinations.

Methods: The literature search was conducted in PubMed, Web of Science and Scopus, and included publications from 2006 to 2023. Study quality was assessed using the Newcastle-Ottawa Scale. The Grading of Recommendations Assessment, Development, and Evaluation guidelines were used to assess the strength of evidence for the primary outcome. Meta-analyses were performed using random-effects models to estimate pooled parental acceptance of HPV vaccinations. Studies were stratified by study years, and a subgroup analysis was conducted to estimate vaccine acceptance rates by world regions. Additionally, sensitivity analyses examined the role of parents in accepting HPV vaccinations for children of different sexes.

Results: Based on 86 studies, we found that parents generally supported HPV vaccinations for their children, yet HPV vaccine acceptance rates showed high variation (12.0 to 97.5%). The subgroup analysis revealed geographical variations in pooled parental HPV vaccine acceptance rates, with the highest rate observed in Africa (79.6%; 95% CI: 73.5-85.2; I² = 98.3%; p < 0.01) and the lowest in North America (56.7%; 95% CI: 49.3-64.0; I² = 99.4%; p < 0.01). Sensitivity analyses showed that acceptance was higher for daughters than for sons, with mothers more willing to get their daughters vaccinated. The proportion of parents reporting barriers or benefits regarding HPV vaccinations varied widely (0.3-95.8%) between study regions. Across all world regions, fear of adverse effects and concerns about vaccine safety were the main barriers, whereas the desire to protect their children from cancer was a significant predictor of vaccine acceptance. Knowledge levels varied widely (6.5 to 100%) between world regions and according to the questions asked. In most studies, knowledge e.g., that HPV is sexually transmitted, and that HPV vaccination provides protection against cervical cancer, ranged from moderate to high.

Conclusions: The results indicated moderate parental acceptance of HPV vaccines. Public knowledge of HPV infection should be promoted, and special efforts should be made to minimize the existing barriers and increase vaccination accessibility and uptake.

Keywords: Acceptance; Human papillomavirus; Meta-analysis; Systematic review; Vaccination.

Fig. 1

Flow diagram of the study selection process. ^a Studies that were conducted or published outside the specified inclusion period from January 1, 2006, to August 31, 2023; ^b Studies that did not focus on parents or guardians of children eligible for HPV vaccinations; ^c Studies with inappropriate designs (qualitative studies, interventional studies)

Fig. 2

Forest plot for HPV vaccine acceptance rates among parents and their children showing individual study estimates and pooled estimate (random-effects model) (n = 62). CI = Confidence interval; df = Degrees of freedom; Events = The number of parents/guardians in each study who reported acceptance of the HPV vaccine for their children; I² = I-squared statistic, indicating the percentage of variation due to heterogeneity; p < 0.01 = p-value, indicating statistical significance; Q = Cochran’s Q statistic for heterogeneity; RE Model = Random-effects model; Total = The total number of parents/guardians in each study included in the meta-analysis

Fig. 3

Forest plot for HPV vaccine acceptance rates among parents by world regions showing individual study estimates as well as pooled estimates (random-effects models) (n = 62). CI = Confidence interval; df = Degrees of freedom; Events = The number of parents/guardians in each study who reported acceptance of the HPV vaccine for their children; I² = I-squared statistic, indicating the percentage of variation due to heterogeneity; p < 0.01 = p-value, indicating statistical significance; Q = Cochran’s Q statistic for heterogeneity; RE Model = Random-effects model; Total = The total number of parents/guardians in each study included in the meta-analysis

Fig. 4

Forest plot for HPV vaccine acceptance rates among parent/children’s subgroups showing individual study estimates as well pooled estimates (random-effects models) (n = 62). CI = Confidence interval; df = Degrees of freedom; Events = The number of parents/guardians in each study who reported acceptance of the HPV vaccine for their children; I² = I-squared statistic, indicating the percentage of variation due to heterogeneity; p < 0.01 = p-value, indicating statistical significance; Q = Cochran’s Q statistic for heterogeneity; RE Model = Random-effects model; Total = The total number of parents/guardians in each study included in the meta-analysis