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Public health
Research
Parents’ uptake of human papillomavirus vaccines for their children: a systematic review and meta-analysis of observational studies
  1. Peter A Newman1,
  2. Carmen H Logie1,
  3. Ashley Lacombe-Duncan1,
  4. Philip Baiden2,
  5. Suchon Tepjan1,
  6. Clara Rubincam1,
  7. Nick Doukas1,
  8. Farid Asey1
  1. 1 Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
  2. 2 School of Social Work, The University of Texas at Arlington, Arlington, Texas, USA
  1. Correspondence to Dr. Peter A Newman; p.newman{at}utoronto.ca

Abstract

Objective To examine factors associated with parents’ uptake of human papillomavirus (HPV) vaccines for their children.

Design Systematic review and meta-analysis.

Data sources Cochrane Library, AIDSLINE, CINAHL, EMBASE, PsycINFO, Social Sciences Abstracts, Ovid MEDLINE, Scholars Portal, Social Sciences Citation Index and Dissertation Abstracts International from inception through November 2017.

Methods We included studies that sampled parents and assessed uptake of HPV vaccines for their children (≤18 years) and/or sociodemographics, knowledge, attitudes or other factors associated with uptake. Study risk of bias was assessed using the Effective Public Health Practice Project tool. We pooled data using random-effects meta-analysis and conducted moderation analyses to examine variance in uptake by sex of child and parent.

Results Seventy-nine studies on 840 838 parents across 15 countries were included. The pooled proportion of parents’ uptake of HPV vaccines for their children was 41.5% (range: 0.7%–92.8%), twofold higher for girls (46.5%) than for boys (20.3%). In the meta-analysis of 62 studies, physician recommendation (r=0.46 (95% CI 0.34 to 0.56)) had the greatest influence on parents’ uptake, followed by HPV vaccine safety concerns (r=−0.31 (95% CI −0.41 to −0.16)), routine child preventive check-up, past 12 months (r=0.22 (95% CI 0.11 to 0.33)) and parents’ belief in vaccines (r=0.19 (95% CI 0.08 to 0.29)). Health insurance-covered HPV vaccination (r=0.16 (95% CI 0.04 to 0.29)) and lower out-of-pocket cost (r=−0.15 (95% CI −0.22 to −0.07)) had significant effects on uptake. We found significant moderator effects for sex of child.

Conclusions Findings indicate suboptimal levels of HPV vaccine uptake, twofold lower among boys, that may be improved by increasing physician recommendations, addressing parental safety concerns and promoting parents’ positive beliefs about vaccines, in addition to expanding insurance coverage and reducing out-of-pocket costs. Limitations of this meta-analysis include the lack of intervention studies and high risk of bias in most studies reviewed. Further studies should disaggregate HPV vaccine uptake by sex of child and parent.

  • public health
  • social medicine
  • preventive medicine
  • hpv vaccination
  • systematic review

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-019206

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    Footnotes

    • CHL, AL-D and PB contributed equally.

    • Contributors PAN had full access to all of the data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis. PAN conceptualised and designed the study, contributed to data analysis and interpretation, drafted the initial and final manuscript, provided funding support, and supervised study implementation. CHL contributed to study conceptualisation and design, led and supervised statistical analysis, and critically reviewed the manuscript. AL-D led article screening, data extraction and assessment of risk of bias, contributed to data analysis and drafting the manuscript, and provided administrative support. PB contributed to article screening, data extraction, risk of bias assessment, statistical analysis and revision of the manuscript. ST, CR, ND and FA contributed to article screening, data extraction and risk of bias assessment, and reviewed the manuscript.

    • Funding This work was supported in part by the Canadian Institutes of Health Research (THA-118570), the Canada Research Chairs Program (Canada Research Chair in Health and Social Justice) and the Canada Foundation for Innovation.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no additional data available.