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Review
. 2025 Mar 11;13(3):300.
doi: 10.3390/vaccines13030300.

Multilevel Targets for Promoting Pediatric HPV Vaccination: A Systematic Review of Parent-Centered, Provider-Centered, and Practice-Centered Interventions in HIC and LMIC Settings

Aaliyah Gray  1 , Celia B Fisher  2   3
Affiliations
Review

Multilevel Targets for Promoting Pediatric HPV Vaccination: A Systematic Review of Parent-Centered, Provider-Centered, and Practice-Centered Interventions in HIC and LMIC Settings

Aaliyah Gray et al. Vaccines (Basel). .

Abstract

Background/objectives: Human papillomavirus (HPV) is a predominant cause of cervical cancer globally in women. HPV-related cancers in men are also on the rise. Immunization against HPV infection is a highly effective preventative against these cancers. However, HPV vaccine programs are not easily implemented globally. The objective of this systematic review was to identify multilevel strategies associated with improved pediatric HPV vaccination in high-income countries (HICs) and low- and middle-income countries (LMICs) that target parent, provider, and practice points of interventions.

Methods: Through a systematic search of electronic databases, we identified 159 peer-reviewed articles published between the years 2011 and 2023.

Results: Ninety-five percent of the included studies were conducted in HICs. Just eight studies were set in LMICs. A variety of HPV vaccination outcomes were assessed including uptake, initiation of the series, continuation of the series, missed opportunities, time, and refusal. Eighty percent of studies reported improved pediatric HPV vaccination, including a third of studies with mixed findings. Parent-centered strategies included education programs and reminder/recall procedures. Provider-centered strategies also included education programs and training in communication. Practice-centered strategies included vaccine access programs, vaccine bundling protocols, provider prompts, standing orders, vaccine messaging, and lowering the initiation age to 9 years. Multilevel, multi-component programs were highly effective.

Conclusions: Multilevel strategies can be adopted in a variety of settings to promote HPV vaccination among youth globally. However, this research is disproportionately conducted in high resource environments. Further work is needed in LMIC settings as more countries begin to adopt HPV immunization programs.

Keywords: HPV; adolescents; childhood immunization; human papillomavirus; intervention; multilevel; parent; pediatric vaccine; practice; provider; strategies.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram illustrating study selection process.
Figure 2
Figure 2
Efficacy of the study findings across single- and multilevel intervention targets. Results indicate a high prevalence of improvement in HPV across parent-, practice-, and multilevel studies; provider-level studies reported more mixed findings. LMICs stand for low- and middle-income countries of which 7 of 8 LMIC studies were practice level that reported improvement in HPV vaccination (n = 4, 57%) or mixed findings (n = 3, 43%), and 1 of 8 studies was multilevel that saw improved HPV vaccination.
Figure 3
Figure 3
Multilevel model of HPV pediatric vaccine facilitators. Adapted from Rodriguez et al. 2020 [16].
See this image and copyright information in PMC

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