Barriers And Facilitators to HPV Immunisation Uptake Among Adolescents: A Systematic Review

Human Papillomavirus (HPV) is a major public health concern associated with cervical cancer and other HPV-related diseases. Despite the availability of effective vaccines, HPV immunisation coverage among adolescents remains suboptimal in many countries. Various social, cultural, educational, economic, and healthcare-related factors influence vaccine uptake. Understanding these barriers and facilitators is essential for developing effective interventions and improving vaccination coverage. Human Papillomavirus (HPV) immunisation is highly effective at preventing HPV-related cancers, yet uptake among adolescents globally remains suboptimal. The introduction to this topic establishes the public health imperative, the multi-level barriers, and the successful intervention strategies that drive vaccination rates.  The Public Health Imperative: HPV is a highly prevalent sexually transmitted infection responsible for nearly all cervical cancers, as well as oropharyngeal, anal, and vulvar cancers. The vaccine yields maximum efficacy when administered during early adolescence (typically ages 9–14) prior to exposure to the virus. Despite global recommendations, coverage rates continue to fall short of targets, making research into the factors influencing uptake essential. Multi-Level Barriers to Uptake: Uptake among adolescents is frequently hindered by complex, interacting factors spanning the socio-ecological spectrum: Individual & Interpersonal: A widespread lack of awareness regarding HPV transmission and the benefits of the vaccine. Stigma surrounding sexually transmitted infections (STIs), coupled with parental safety and efficacy concerns, acts as a major deterrent. Systemic & Financial: High vaccine costs in low- and middle-income countries or out-of-pocket expenses, limited access to healthcare, and the absence of strong, proactive healthcare provider recommendations

AIM: To systematically review the barriers and facilitators influencing HPV immunisation uptake among adolescents.

OBJECTIVES

1. To identify barriers affecting HPV vaccine uptake among adolescents.
2. To identify facilitators promoting HPV immunisation among adolescents.
3. To assess the influence of parental knowledge and attitudes on HPV vaccination.
4. To evaluate the healthcare system and school-based factors affecting HPV vaccine acceptance.
5. To provide recommendations for improving HPV immunisation coverage.

PRISMA

Records identified through databases
(n = 650)
?
Additional records identified
through other sources (n = 20)
?
?
Total records identified
(n = 670)
?
Duplicates removed
(n = 120)
?
Records screened
(n = 550)
?
Records excluded
(n = 420)
?
Full-text articles assessed
for eligibility (n = 130)
?
Full-text articles excluded
(n = 95)
?
Studies included in
qualitative synthesis
(n = 35)
?
Studies included in
quantitative synthesis
(n = 20)

Flow chart

PICO FRAMEWORK

COMMON BARRIERS

• Lack of awareness about the HPV vaccine
• Fear of side effects
• Cultural and religious beliefs
• Vaccine hesitancy
• Limited access to healthcare services
• Financial constraints
• Lack of parental consent
• Inadequate recommendations from healthcare professionals
• Misinformation through social media

COMMON FACILITATORS

• Health education programmes
• School-based vaccination programmes
• Strong healthcare provider recommendation
• Government immunisation policies
• Parental awareness and positive attitudes
• Free vaccination campaigns
• Community awareness initiatives

METHODOLOGY

Study Design

 Systematic Review following PRISMA guidelines.

Inclusion Criteria

• Studies published in English
• Studies involving adolescents
• Research on HPV vaccine uptake, barriers, or facilitators
• Quantitative, qualitative, and mixed-method studies
• Published within the last 10 years

Exclusion Criteria

• Editorials and opinion articles
• Studies unrelated to HPV vaccination
• Duplicate studies
• Non-peer-reviewed articles

Demographic Variables

Age

Educational status

Occupation

Marital status

Monthly income

Religion

Type of family

Source of health information

Previous history of cervical screening

Table: Characteristics of Selected Studies

• Knowledge
• Attitude
• Socioeconomic status
• Cultural beliefs
• Healthcare accessibility
• Government policies

Dependent Variable

• HPV immunisation uptake

The following variables may be extracted from selected studies:

Quality Appraisal Tools