Barriers to Human Papillomavirus Vaccination Among US Adolescents

Abstract

IMPORTANCE Since licensure of the human papillomavirus (HPV) vaccine in 2006, HPV vaccine coverage among US adolescents has increased but remains low compared with other recommended vaccines. OBJECTIVE To systematically review the literature on barriers to HPV vaccination among US adolescents to inform future efforts to increase HPV vaccine coverage. EVIDENCE REVIEW We searched PubMed and previous review articles to identify original research articles describing barriers to HPV vaccine initiation and completion among US adolescents. Only articles reporting data collected in 2009 or later were included. Findings from 55 relevant articles were summarized by target populations: health care professionals, parents, underserved and disadvantaged populations, and males. FINDINGS Health care professionals cited financial concerns and parental attitudes and concerns as barriers to providing the HPV vaccine to patients. Parents often reported needing more information before vaccinating their children. Concerns about the vaccine’s effect on sexual behavior, low perceived risk of HPV infection, social influences, irregular preventive care, and vaccine cost were also identified as potential barriers among parents. Some parents of sons reported not vaccinating their sons because of the perceived lack of direct benefit. Parents consistently cited health care professional recommendations as one of the most important factors in their decision to vaccinate their children. CONCLUSIONS AND RELEVANCE Continued efforts are needed to ensure that health care professionals and parents understand the importance of vaccinating adolescents before they become sexually active. Health care professionals may benefit from guidance on communicating HPV recommendations to patients and parents. Further efforts are also needed to reduce missed opportunities for HPV vaccination when adolescents interface with the health care system. Efforts to increase uptake should take into account the specific needs of subgroups within the population. Efforts that address system-level barriers to vaccination may help to increase overall HPV vaccine uptake.

A model of health care provider decision making about HPV vaccination in adolescent males

“…These studies have found that public insurance status, Hispanic race, lower family income, having received flu vaccine, increased perceived vaccine effectiveness, peer acceptance and anticipated inaction regret, were associated with increased vaccine uptake or uptake intent in males (6)(7)(8)(9)(10).…”

Interventions to Improve HPV Vaccine Uptake: A Systematic Review

“…[10][11][12][13][14][15][16][17][18] Although vaccination intent was increased, it was neither sustained nor translated into vaccination behavior. Furthermore, there has been speculation that parents from different ethnic and socioeconomic groups may face different barriers to vaccination and thus require different intervention strategies, 17,19 a critical point in the context of disparate HPV disease outcomes.…”

Parents who refuse or delay HPV vaccine: Differences in vaccination behavior, beliefs, and clinical communication preferences

“…2 These studies, including our own, have typically examined the relationship between parents' vaccination beliefs, their intention to vaccinate their adolescents, and adolescents' ultimate vaccination status. [3][4][5][6] This research has been important for identifying potentially modifiable barriers to HPV vaccination, such as parents' need for more information and their perception that their children's risk of HPV infection is low. [3][4][5][6] However, despite the large volume of existing literature, basic gaps in our understanding of parents' decision making processes remain.…”