Factors Influencing Parents' Uptake of Human Papillomavirus Vaccine for Their Children: A Meta-Analysis of Observational Studies

Background and objectives: Human papillomavirus (HPV) is the most common sexually transmitted infection globally. HPV infection is directly linked to cervical cancer, with an estimated half million women diagnosed each year worldwide. HPV infection is also strongly associated with anal, penile and oropharyngeal cancers among men. HPV vaccination significantly reduces the risk of HPV infection and is recommended for girls and boys aged 11-12 years, before sexual debut, to prevent HPV-associated cancers. HPV vaccine coverage rates in the U.S. of 34.5% for girls and 2.3% for boys indicate serious gaps in uptake. Earlier systematic reviews have assessed factors associated with parents’ intention to vaccinate their children, rather than vaccine uptake. The purpose of this meta-analysis is to synthesize results from quantitative cross-sectional investigations of parents’ uptake of HPV vaccine for their children to understand: (1) rates of parents’ uptake of HPV vaccine and (2) factors correlated with parents’ uptake of HPV vaccine for their children.

Methods: We conducted a systematic search of the scientific literature across multiple electronic databases to locate empirical studies published by December 31, 2013 that examined rates and/or correlates of parents’ uptake of HPV vaccine for their children. Two reviewers independently screened all titles and abstracts for relevance with final decisions regarding inclusion based on the full article. Article information (year of publication, author(s), journal); descriptive data (sample size, country, participant demographics); methods and study design; and outcomes/key findings were extracted. We performed meta-analysis on studies examining similar correlates of HPV vaccine uptake and calculated effect sizes for each variable, with a random-effects model to compensate for clinical and methodological diversity between studies, following PRISMA guidelines.

Results: Across 31 studies (n = 33,838) examined, parental uptake of HPV vaccine for their children ranged from 10% to 89%; weighted mean = 43.1 (SD=25.5). Factors associated with parents’ uptake of HPV vaccine for their children include HPV vaccine attitudes/perceived benefits; HPV risk perceptions; HPV knowledge/awareness; health beliefs; religiosity; parent risk factors; healthcare provider recommendation; health insurance; out-of-pocket cost; as well as child age, gender and race/ethnicity.

Conclusions and implications: The findings of this meta-analysis suggest the importance of social workers’ engagement in tailoring educational campaigns for parents and other adults to provide accurate information about HPV prevalence and associated cancer risks for both women and men. Interventions to promote positive HPV vaccine attitudes and HPV risk awareness, to mitigate concerns about safety and encouraging youth sexual behavior, and to reduce structural and logistical barriers may support parents’ uptake of HPV vaccine for their children. The impact of healthcare provider recommendation on parental HPV vaccine uptake suggests that frontline social service and healthcare providers may contribute to parental uptake through providing clear information on vaccine benefits and safety. Policies to support HPV vaccine cost subsidies may increase uptake and help to reduce racial disparities in uptake. Investigations using more rigorous designs and intervention studies are needed to guide evidence-informed policy and practice recommendations to support parents’ uptake of HPV vaccines for their children.