Barriers and facilitators to HPV vaccination of young women in high-income countries: a qualitative systematic review and evidence synthesis

Jul 10, 2014BMC public health

Factors that help or hinder HPV vaccination in young women from wealthy countries

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Abstract

Forty-one studies were included, revealing that decisions by policy makers, healthcare professionals, and parents significantly influence HPV vaccination uptake among young women.

Financial considerations may limit access to the HPV vaccine, though universal healthcare systems could mitigate this by offering it at no cost.
Social norms and values regarding sexual activity play a critical role in the decision-making process for vaccination.
Trust in vaccination programs and healthcare providers is essential for encouraging HPV vaccine uptake.
Judgements by healthcare professionals regarding vaccine recommendations can restrict access for young women, regardless of their personal beliefs.
Cultural or religious views held by parents may lead to decisions against allowing their daughters to receive the vaccine.
Barriers identified could impact young women's future sexual, physical, and reproductive health.

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BACKGROUND: Vaccination against Human Papillomavirus (HPV) is recommended for adolescent young women prior to sexual debut to reduce cervical cancer related mortality and morbidity. Understanding factors affecting decision-making of HPV vaccination of young women is important so that effective interventions can be developed which address barriers to uptake in population groups less likely to receive the HPV vaccine.

METHODS: We undertook a qualitative systematic review and evidence synthesis to examine decision-making relating to the HPV vaccination of young women in high-income countries. A comprehensive search of databases from inception to March 2012 was undertaken to identify eligible studies reporting the perspectives of key stakeholders including policy makers, professionals involved in programme, parents, and young women. Factors affecting uptake of the vaccine were examined at different levels of the socio-ecological model (policy, community, organisational, interpersonal and intrapersonal).

RESULTS: Forty-one studies were included. Whether young women receive the HPV vaccine is strongly governed by the decisions of policy makers, healthcare professionals, and parents. These decisions are shaped by: financial considerations; social norms and values relating to sexual activity, and; trust in vaccination programmes and healthcare providers. Financial constraints may be overcome through universal healthcare systems offering the HPV vaccine free at the point of delivery. In the healthcare setting, judgements by healthcare professionals about whether to recommend the vaccine may restrict a young woman's access to the vaccine irrespective of her own beliefs and preferences. Parents may decide not to allow their daughters to be vaccinated, based on cultural or religious perceptions about sexual activity.

CONCLUSIONS: Barriers to the uptake of the HPV vaccine have implications for young women's future sexual, physical and reproductive health. Interventions to address barriers to uptake of the vaccine should target appropriate, and multiple, levels of the socio-ecological model. Issues of trust require clear, accessible, and sometimes culturally appropriate, information about the HPV vaccination programme. Although young women are central to the HPV vaccination programme, their views are underrepresented in the qualitative literature. Future research should consider young women's perceptions of, and involvement in, consent and decision-making.

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Abstract

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