Strategies, Barriers, and Facilitators for Healthcare Professionals to Recommend HPV Vaccination: A Systematic Review

Abstract

Background/Objectives: The HPV vaccine has demonstrated efficacy in preventing approximately 90% of HPV infection-associated cancers. However, the global HPV vaccination coverage rate remains low. Healthcare professionals are trusted sources of information on vaccination. Enhancing their capacities to deliver credible information through appropriate strategies to support HPV vaccination decisions can help increase vaccination coverage. There is a gap in the comprehensive summary of the strategies, barriers, and facilitators for healthcare professionals to recommend HPV vaccination. Methods: This review systematically evaluated the existing literature on healthcare professionals' strategies to recommend HPV vaccination worldwide, along with the barriers and facilitators. Results: A total of 96 original research articles were included in the analysis, comprising 25 qualitative studies, 67 cross-sectional quantitative studies, and four mixed-methods studies. Healthcare professionals typically recommend HPV vaccination by proactively sharing relevant information and emphasizing the benefits and necessity of vaccination. Although personalized and de-sexualized communication strategies may enable easier recommendation, these are often time-consuming and require a stronger level of knowledge and communication skills. The major barriers reported by Chinese healthcare professionals included concerns about the safety of the HPV vaccine and doubts regarding the necessity of HPV vaccination. In contrast, the main obstacles in other countries were limited working time and a lack of parental support. Conclusions: Enhancing external policy support and professional training for healthcare professionals is critical to improving healthcare provider willingness and the use of strategies to recommend HPV vaccination. Taking action to incorporate the HPV vaccine into the National Immunization Program is an essential pathway for expanding HPV vaccination coverage, narrowing disparities, and progressing towards the elimination of cervical cancer.

Keywords: HPV vaccine; healthcare professionals; recommendation; systematic review; vaccination.

Figure 1

A flowchart of the article inclusion process. Note: * Among the 12 relevant conference abstracts, 3 studies were published in full articles subsequently, with different titles but the same research contents, which were included as part of the 97 articles.

Figure 2

Distribution of countries of included studies (number of studies). * Numbers indicate number of studies; darker colors indicate more studies by country. (a) Country distribution of study subjects; (b) country distribution of sponsored institutions.

Figure 3

A summary of the risk of bias of the included studies. (a) Cross-sectional quantitative studies; (b) qualitative studies. Notes: Criterion 1: is there congruity between the stated philosophical perspective and the research methodology?; Criterion 2: is there congruity between the research methodology and the research question or objectives?; Criterion 3: is there congruity between the research methodology and the methods used to collect data?; Criterion 4: is there congruity between the research methodology and the representation and analysis of data?; Criterion 5: is there congruity between the research methodology and the interpretation of results?; Criterion 6: is there a statement locating the researcher culturally or theoretically?; Criterion 7: is the influence of the researcher on the research, and vice versa, addressed?; Criterion 8: are participants, and their voices, adequately represented?; Criterion 9: is the research ethical according to current criteria or, for recent studies, and is there evidence of ethical approval by an appropriate body?; Criterion 10: do the conclusions drawn in the research report flow from the analysis, or interpretation, of the data?

Figure 4

Healthcare professionals’ strategies to recommend HPV vaccination (in categories).

Figure 5

The categories of factors associated with the willingness of international and Chinese healthcare professionals to recommend HPV vaccination. (a) The categories of factors reported by international studies; (b) the categories of factors reported by studies conducted in China.