Attitudes and Practices towards HPV Vaccination and Its Social Processes in Europe: An Equity-Focused Scoping Review
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Search Strategy
2.3. Inclusion and Exclusion Criteria
2.4. Data Extraction and Synthesis
3. Results
3.1. Who Is Being Studied and How?
Author, Date | Journal, Quartile | Area of Expertise | Country | Population | Methods, Study Design | HPV Outcomes |
---|---|---|---|---|---|---|
Alberts et al., 2017 [40] | BMC Public Health, Q1 | Medical and Health Sciences | The Netherlands | Parents/guardians of daughters (n = 1309) from different ethnic groups | Longitudinal study Database of the Youth Health Service of the Public Health Service of Amsterdam Self-completion questionnaire | Determinants of HPV vaccination intention and uptake |
Amdisen et al., 2018 [46] | Vaccine, Q1 | Medical and Health Sciences | Denmark | Girls who were residing in Denmark between their 12th and 13th birthday (n = 161,528) | Register-based cohort study Data from the Danish Vaccination Register were linked with demographic data from the Danish Civil Registration System | Determinants and uptake of the first dose of the HPV vaccine (HPV1) |
Conroy et al., 2009 [26] | Journal of Women’s Health Q1 | Medical and Health Sciences | England | Girls and women aged 13–26, of black, white, or other ethnicity (n = 262) | A baseline survey, linked with demographic data, gynecological history, and attitudes associated with vaccination at follow-up | Determinants of HPV vaccination uptake and follow-up |
Craciun and Baban, 2012 [37] | Vaccine, Q1 | Medical and Health Sciences | Romania | Romanian mothers aged 30–50 who decline vaccine of their daughters), aged 10–11 (n = 24) | Data from the project “Psychosocial, Political and Gendered Dimensions of Preventive Technologies in Bulgaria and Romania: HPV Vaccine Implementation”, Semi-structured interviews and focus groups | Determinants of HPV vaccination intention |
Forster et al., 2015 [27] | BMC Public Health Q1 | Medical and Health Sciences | England | Girls aged 15–16, of White, Black, Asian, or another ethnicity (n = 2163) | Data was collected through surveys from an ethnically diverse sample of girls from twelve London schools | Determinants of HPV vaccination status |
Forster et al., 2017 [29] | Psycho-Oncology Q1 | Medical and Health Sciences | England | Ethnic minority/White British parents of girls (36–62) (n= 33) | Data from parents was collected via interviews and analyzed using Framework Analysis | Determinants of HPV vaccination intention and uptake |
Grandahl et al., 2014 [43] | Acta Paediatrica Q1 | Medical and Health Sciences | Sweden | Parents who refused their daughters from receiving the HPV vaccination, aged 10–12 (n = 25) | Data from parents was gathered via interviews | Determinants of HPV vaccination intention and uptake |
Grandahl et al., 2017 [44] | PLoS One Q1 | Medical and Health Sciences | Sweden | Upper secondary school students, boys and girls aged 16 (n = 832) | Cross-sectional study Data from the project Prevention of HPV in a school-based setting Health Belief Model (HBM) and reports of cross-sectional studies | Determinants of HPV vaccination follow-up uptake and status |
Hansen et al., 2015 [51] | Preventive Medicine Q1 | Medical and Health Sciences | Norway | Girls and parents of Norwegian nationality (n = 90,842) | Data collected from national registries for all Norwegian girls eligible for routine school-based HPV vaccination and their registered mother and father were merged | Determinants of HPV vaccination uptake and follow-up |
Marlow et al., 2008 [31] | Journal of Medical Screening Q1 | Medical and Health Sciences | England | Women aged 25–64, of white or non-white ethnicity (n = 994) |
Random sampling of postcode address Self-reported cervical screening and intention to accept an HPV test; In a subsample (n = 296) with a young daughter’s self-reported willingness to accept HPV vaccination | Determinants of HPV vaccination intention |
Marlow, et al., 2009 [30] | Vaccine, Q1 | Medical and Health Sciences | England | Female students, aged 16–19, of White, Black, Asian, or another ethnicity (n = 367) | Participants from two further-education colleges reported on acceptability and attitudes (based on the Health Belief Model) after reading information about HPV | Determinants of HPV vaccination intention |
Marlow et al., 2009 [32] | Journal of Epidemiology and Community Health Q1 | Medical and Health Sciences | England | Ethnic minority women (n = 750) and white British women (n = 200), aged 16–55+ | Cross-sectional study with quota sampling to ensure adequate representation of ethnic minority women and a comparison sample of white British women | Determinants of HPV vaccination intention |
Marlow et al., 2009 [33] | Human Vaccines Q3 | Medical and Health Sciences | England | Black/Black British (n = 10) and Asian/Asian British mothers (n = 10) of daughters at least 16 years old | Face-to-face interviews | Determinants of HPV vaccination intention |
Miko et al., 2019 [38] | Medicine Q3 | Medical and Health Sciences | Romania | Romanian parents/guardians (n = 452) | Cross-sectional survey based on the Matrix of Determinants for Vaccine Hesitancy designed by SAGE | Determinants of HPV vaccination intention |
Møller et al., 2018 [47] | European Journal of Cancer Prevention Q1 | Medical and Health Sciences | Denmark | Refugee girls (n = 3264) Danish-born girls (n = 19,584) | Register-based cohort design Data from the National Danish Health Service, identifying all contacts for HPV immunization in the ordinary and catch-up HPV immunization program | Determinants of HPV vaccination uptake |
Mollers et al., 2014 [41] | BMC Public Health Q1 | Medical and Health Sciences | The Netherlands | Girls aged 16–17, Dutch, Turkish, Moroccans, Surinamese, Antilleans, Arubans, and other (n = 2989) | Nationwide online questionnaire with knowledge and other variables associated with vaccination status | Determinants of HPV vaccination status |
Navarro-Illana P. et al., 2018 [52] | Gaceta Sanitaria Q2 | Medical and Health Sciences | Spain | Adolescent girls and their parents, aged 25–60+, (n = 1278) | Cross-sectional study on knowledge and attitudes related to HPV infection and vaccine | Determinants of HPV vaccine intention and uptake |
Pop, 2016 [39] | Medical Anthropology Quarterly Q1 | Medical and Health/Social Sciences | Romania | Parents from South Romania, women (n = 43) | In-depth semi-structured interviews, | Determinants of HPV vaccination intention |
Restivo et al., 2018 [53] | International Journal of Environmental Research and Public Health Q2 | Medical and Health Sciences | Italy | Women aged 18–21 without starting or completing HPV vaccination (n = 141) | A cross-sectional study using a telephone questionnaire, with items on HPV infection and vaccination knowledge based on the Health Belief Model framework | Determinants of HPV vaccination intention and uptake follow-up |
Reszka et al., 2021 [50] | Journal of Preventive Medicine and Hygiene (JPMH) Q3 | Medical and Health Sciences | Poland | Hetero and homosexual men, aged 14–39 (n = 169) | Cross-sectional study with open-ended, close-ended, and nominal, multiple-choice questions | Determinants of HPV vaccination status |
Riza et al., 2020 [49] | International Journal of Environmental Research and Public Health Q2 | Medical and Health Sciences | Greece | Vulnerable population of Roma women aged 18–70 (n = 142 in 2012; n = 122 in 2017) | Cross-sectional study, interviewer-administered questionnaire based on the behavioral model for vulnerable populations | Determinants of HPV vaccination status |
Rockliffe et al., 2017 [34] | BMJ Q1 | Medical and Health Sciences | England | Data from 195 schools obtained for girls from diverse ethnic backgrounds uptake rates | Uptake rates for the three recommended vaccine doses from 2008 to 2010 from schools combined to census data related to the postcode of each school for the ethnic characterization of the resident population | Determinants of HPV vaccination uptake |
Salad et al., 2015 [42] | International Journal for Equity in Health Q1 | Medical and Health Sciences | The Netherlands | Somali women aged 17–21, (n = 14); Somali mothers, two groups, aged 30–46 and 23–66 (n = 6) | Semi-structured interviews; thematic content analysis | Determinants of HPV vaccination intention |
Schreiber et al., 2015 [48] | Journal of Adolescent Health Q1 | Medical and Health Sciences | Denmark | Girls in childhood immunization program (n = 65,926) | Data obtained by linkage to Statistics Denmark and the Danish National Health Insurance Service Register | Determinants of HPV vaccination status uptake and follow-up |
Spencer et al., 2014 [35] | BMJ Q1 | Medical and Health Sciences | England | Mothers; daughters, aged 12–13 | Index of Multiple Deprivation scores and census ethnicity data | Determinants of HPV vaccination status and initiation |
Stearns et al., 2020 [36] | International Journal of Environmental Research and Public Health Q2 | Medical and Health Sciences | England | Men who have sex with men, ethnicity mostly white 84% (n = 115) | Cross-Sectional Survey Design | Determinants of HPV vaccination status and uptake |
Walsh et al., 2008 [28] | BMC Public Health Q1 | Medical and Health Sciences | England | Participants mix of social class and ethnicity aged 16–54 (n = 420) | Street survey with semi-structured interview questionnaire Setting: three areas of Birmingham to target a mix of social class and ethnicity | Determinants of HPV vaccination intention |
Wang et al., 2019 [45] | Preventive Medicine Q1 | Medical and Health Sciences | Sweden | Girls born between 1990 and 2003 (n = 689,676) | Cumulative incidence of receiving the first dose of the vaccine | Determinants and uptake of the first dose of the HPV vaccine (HPV1) |
3.2. Barriers and Facilitators of Vaccination Uptake
- Access and Affordability
Barriers | Facilitators | |
---|---|---|
Access | ||
Affordability |
|
|
Awareness |
| |
Acceptance |
| |
Activation towards vaccination uptake |
- Awareness and Acceptance
- Activation towards vaccination uptake
3.3. Attitudes and Beliefs about the HPV Vaccine
4. Discussion
4.1. Strengths and Limitations of the Research
4.2. Recommendations for Research and Action
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Country | Year of Introduction | Age Targets for Vaccination in Years (Female, Male) | Delivery | HPV Vaccination Coverage Rate (Most Recent Year) | HPV Vaccine Funding | |||
---|---|---|---|---|---|---|---|---|
Primary | Catch-Up | |||||||
Female | Male | Female | Male | |||||
Denmark | 2009 | 12 | <18 | Health Council | F-58% (2019) | Full | ||
From 1 January 2014 to 21 December 2015, any girl or woman born between 1993 and 1997 was eligible for HPV vaccination. From 1 February to 31 December 2018, boys aged 15 to 20 who are attracted to boys could receive free HPV vaccination. From 2019, both boys and girls in Denmark are eligible for HPV vaccination. | ||||||||
Greece | 2008 | 11–18 | 11–14 (2nd) 15–18 (3rd) | Health Council | No data available | Full (Partial for boys *) | ||
HPV vaccination is provided free of charge to girls aged 11–18, as a 2-dose scheme for those aged 11–14, and as a 3-dose scheme for those aged 15–18. * It is also provided at no cost to boys aged 11 to 18 who are members of high-risk populations, such as those who are immunocompromised. | ||||||||
Italy | 2008 | 11–12 | 11–12 (from 2015, some regions) | Differs by region | - | Health Council | F-50% M-5% (2017) | Full |
In all Italian regions, girls up to the age of 12 are offered free HPV vaccination. Some regions have extended the vaccination offer to girls of other ages. Some areas also provide free HPV vaccination to people living with HIV. Most regions also consider a lower payment for ages that are not included in the primary target. Male vaccination became free in six regions in 2015. | ||||||||
Netherlands | 2009 | 12–13 (until 2021) 10 (from 2022) | 10 (from 2022) | - | - | Health Council | F-46% (2019) | Full |
An HPV vaccination catch-up campaign was organized in 2009 for girls born between 1993–1996 (13–16 years old then). Since 2010, 12-year-old girls born in 1997 or later were eligible to receive the HPV vaccination as part of the National Immunization Programme. Since 2021, boys are offered the vaccination as well and in 2022 vaccination for children can be taken at the age of 10. To give boys the opportunity to protect themselves against HPV, a catch-up campaign took place 2022 which will continue in 2023 too. Boys born in 2004, 2006, 2008, 2009 and 2012 received an invitation, and girls from these years who had not yet been vaccinated against HPV. Adolescents born in 2005, 2007, 2010, 2011 and 2013 will be invited starting 2023. The vaccination is free and voluntary. | ||||||||
Norway | 2009 | 12 | 12 | ≤25 (2016–2018) | - | School (7th grade) | F-88% (2018) | Full |
Women born in 1991 or later have been offered free HPV vaccination for two years, beginning on November 1, 2016. As part of the childhood immunization program, the government provided HPV vaccine to all 7th-grade boys in the 2018–2019 school year. | ||||||||
Poland | No data available–absence of a national program | 11–12 | - | - | - | No data available | No data available | None |
HPV vaccination has been recommended in the national immunization program for girls aged 11 to 12 years since 2008. The expert committee, formed in 2010 at the initiative of the Polish Pediatric Society, also recommended HPV vaccines for girls aged 13 to 18 who had not previously been vaccinated. This vaccination was not included in Poland’s mandatory immunization program. Due to the additional cost of prophylactic HPV vaccination in primary healthcare centers, the coverage of Polish teenagers vaccinated against HPV is said to be between 7.5% and 10%. Some districts have decided to fund prophylactic HPV vaccination programs. | ||||||||
Romania | 2013 | 11–14 | - | - | - | Health Council | No data available | Full |
The Romanian Ministry of Health launched a school-based immunization campaign in 2008, offering free HPV vaccination to girls aged 10–11. Only 2.6% of the girls were vaccinated, hence the program was terminated. An information campaign was launched in 2009, followed by a second vaccination program aimed at 12–14-year-old girls. A catch-up program was also offered, in which adult women could get the vaccine for free through their healthcare provider. Despite the vaccine’s availability, uptake remained low, and the school-based program was terminated at the end of 2011. In April 2013, the program was relaunched for the third time. HPV vaccination is included in the National Vaccination Programme under the category ‘Vaccination of Population at Risk,’ and is intended for girls aged 11 to 14. The National Health System does not fund the program. | ||||||||
Spain | 2007-8 | 12 | - | - | - | School and/or health center (depending on the region) | F-73% F-85% (2018) | Full |
In 2007, the Inter-Territorial Council of the National Health System, the coordination body for the various health services approved a recommendation to begin routine HPV vaccination in Spain. To vaccinate a cohort of girls aged 11 to 14, with a preference for age 14, and a deadline for implementation in 2010. Following that, each autonomous community developed its implementation plan, with the first three communities launching in 2007, and the rest following in 2008. Since 2015, as agreed by the Interterritorial Council, HPV vaccination is recommended for girls aged 12 in all regions. Since 2018, HPV vaccination has also been recommended for the following risk groups: those with warts, hypogammaglobulinemia, immunodeficiency, and myelokathexis (WHIM) syndrome (a primary immunodeficiency); women with solid organ and hematopoietic transplants up to the age of 26; people living with HIV (with a 3-dose schedule and up to the age of 26); sex workers up to the age of 26 (3-dose schedule). Since 2019, females up to the age of 18 have received catch-up vaccination. | ||||||||
Sweden | 2012 | 10–12 | - | <18 | - | School (5–6th grades) | F-84% (2019) | Full |
In 2010, the HPV vaccine was included in a free national vaccination program for girls born in 1999 or later who are in the fifth or sixth grade. However, due to procurement delays, vaccinations did not begin until 2012. During the same period, all counties provided free catch-up vaccinations to girls between 1993 and 1998. According to a child vaccination regulation update (HSLF-FS 2016:51), all girls should now be offered HPV vaccinations up to the age of 18. The vaccination will soon be available to boys as well (starting from those born in 2009). | ||||||||
United Kingdom | 2008-12 | 11–13 | No data available | <18 | No data available | School (8–10th grades) Health Council (catch-up) | F-84% (2019) | Full |
Vaccination programs, along with the year they begin, differ slightly by region. Girls who missed their first HPV vaccination can get a catch-up vaccination up to the age of 18. There was a catch-up period at the beginning of the program for girls born between 1991 and 1995. As of 2019, the United Kingdom has made HPV vaccination available to both boys and girls. |
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Alarcão, V.; Zdravkova, B. Attitudes and Practices towards HPV Vaccination and Its Social Processes in Europe: An Equity-Focused Scoping Review. Societies 2022, 12, 131. https://doi.org/10.3390/soc12050131
Alarcão V, Zdravkova B. Attitudes and Practices towards HPV Vaccination and Its Social Processes in Europe: An Equity-Focused Scoping Review. Societies. 2022; 12(5):131. https://doi.org/10.3390/soc12050131
Chicago/Turabian StyleAlarcão, Violeta, and Bilyana Zdravkova. 2022. "Attitudes and Practices towards HPV Vaccination and Its Social Processes in Europe: An Equity-Focused Scoping Review" Societies 12, no. 5: 131. https://doi.org/10.3390/soc12050131