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. 2025 Sep 4;20(9):e0331592.
doi: 10.1371/journal.pone.0331592. eCollection 2025.

Impact of health promotion strategies on HPV vaccination uptake: A descriptive epidemiological study (2019-2024)

Mirjana Štrbac  1 , Snežana Ukropina  1 , Nataša Nikolić  1   2 , Katarina Mašić  3 , Smiljana Rajčević  1   2 , Dušan Čanković  1   2 , Vesna Vuleković  4 , Ljerka Popov  4 , Mioljub Ristić  1   2
Affiliations

Impact of health promotion strategies on HPV vaccination uptake: A descriptive epidemiological study (2019-2024)

Mirjana Štrbac et al. PLoS One. .

Abstract

Introduction/objectives: The effectiveness of vaccines depends not only on resource availability but also on broad public acceptance and the uptake of widely accessible vaccines. A vaccination campaign is a strategically coordinated initiative designed to enhance vaccine coverage within a specific population. This study evaluated the impact of health promotion strategies (HPS), including social marketing and education, on human papillomavirus (HPV) vaccine uptake among adolescents aged 9-19 years in City of Novi Sad, Serbia (population ~300,000). Since 2020, efforts have transitioned from individual to organized, publicly funded initiatives.

Materials and methods: A descriptive epidemiological study was conducted using anonymized data from the electronic immunization registry (2019-2024). Data on HPS implementation were obtained from the Institute of Public Health of Vojvodina. Statistical analyses included Mann-Whitney U test, ANOVA, correlation, and multiple regression with time lag.

Results and discussion: From 2019 to 2024, 6,395 adolescents received the HPV vaccine, with sharp increases in 2023-2024. Among the different strategies analyzed, health promotion through educational media content delivered by physicians (TV, radio, social networks) and the implementation of the "Open Door" initiative had the most consistent and positive association with increased vaccination coverage. Vaccination uptake was strongly associated with frequent and accessible promotional activities, especially the "Open Door" initiative (r =.668, p <.01; β =.687, p <.001). Media activities showed moderate effects (r =.270, p <.05). Educational activities show only a weak or non-significant correlation with vaccination rates, except for their modest association with website updates (r =.282, p <.05).

Conclusions: Accessible, action-oriented interventions, particularly "Open Door" days, were the most effective strategy for increasing adolescent HPV vaccination. Social marketing combining convenience and multi-channel communication significantly enhanced uptake. These findings support the implementation of targeted, barrier-reducing public health strategies to improve vaccine coverage.

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Conflict of interest statement

No authors have competing interests.

Figures

Fig 1
Fig 1. Number of vaccinated individuals aged 9–19 years (2019-2024).
Fig 2
Fig 2. Monthly trends of HPV vaccination among individuals aged 9–19 years (2019–2024).
Legend: The green line representing the number of vaccinated individuals aged 9–19 years shows the highest peaks in March and October 2024, the months during which the “Open Door” campaign was implemented most intensively.
Fig 3
Fig 3. Promotional activities and HPV vaccination uptake (2019–2024).
Legend: The red line in the graph represents the number of promotional campaigns, which does not consistently correlate with the number of vaccinated individuals (blue bars) from 2019 to 2024. However, in 2024, when the “Open Door” campaign was implemented, both the number of promotional campaigns and the number of vaccinated individuals reached their highest levels.
Fig 4
Fig 4. Number of vaccinated individuals by age and gender (2019-2024).
See this image and copyright information in PMC

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