Views of parents regarding human papillomavirus vaccination: A systematic review and meta-ethnographic synthesis of qualitative literature

S. Marshall, A. Fleming, A.C. Moore, L.J. Sahm

Human papillomavirus (HPV) is the most common viral infection of the reproductive tract. Three prophylactic HPV vaccines are available for the prevention of HPV-related disease. Despite clinical success, immunisation rates remain sub-optimal. The purpose of this systematic review is to synthesise qualitative literature to achieve an understanding of the drivers and barriers to HPV vaccine acceptability and to determine targets for an intervention to improve vaccine uptake. The seven-step model of meta-ethnography described by Noblit and Hare was used. The quality of the studies was assessed using the CASP (Critical Appraisal Skills Programme) for qualitative research. The ENTREQ (Enhancing transparency in reporting the synthesis of qualitative research) statement was used to guide reporting of results. Thirty-three studies were included in the final analysis, compiling the opinions of 1280 parents/guardians from 14 countries. Five key concepts that reflected the principal findings of studies were determined: is prevention better than cure; the fear of the unknown; limited knowledge and understanding; complex vaccination decisions and; parental responsibility. Third-order interpretations were developed and linked using a 'line of argument' to develop a conceptual model. The majority of parents are motivated to protect their children and prevent disease. The link to sexual intercourse associated with the HPV vaccine often complicates the vaccination decision. Vaccine manufacturers, national healthcare systems and healthcare providers can reinforce the importance of HPV immunisation and reiterate the rationale behind vaccination recommendations, by providing unambiguous information in a timely manner, transparently addressing parental concerns regarding vaccine safety and efficacy, whilst taking account of cultural and religious sensitivities and varying health literacy levels. In recent years, there has been a reduction in HPV vaccine uptake worldwide. Currently, there is a paucity of published qualitative studies addressing these new vaccine concerns. Therefore, such research is required to guide intervention development, to improve HPV vaccine uptake.