Which interventions improve HPV vaccination uptake and intention in children, adolescents and young adults? An umbrella review

Abstract

Background
Human papillomavirus (HPV) vaccination offers protection against the virus responsible for cervical, oropharyngeal, anal, vulval and penile cancers. However, there is considerable variation across, and even within, countries as to how HPV vaccination is offered and accepted. This review aimed to identify what interventions exist to promote uptake and how effective they are.
Methods
We conducted an umbrella review using the JBI methodology to evaluate routine or catch-up interventions to increase HPV vaccination uptake and/or intention for children aged nine years and older, adolescents and young adults up to 26. Comprehensive searches for English language quantitative systematic reviews, published between January 2011 to July 2021, were conducted across five databases. After reviewing titles and abstract, relevant papers were independently assessed in detail.
Main results
From 1046 records identified, 10 articles were included in the review. They reported on 95 RCTs, 28 quasi-experimental studies, 14 cohort studies, six non-randomized pre-test/post-test studies with control groups, five single group pre-test/post-test studies, one single group post-test study and one randomised longitudinal study. Some interventions promoted change at the individual, community or organisational level, whilst others used a multi-component approach. Face to face presentations, printed information and supplementing both strategies with additional components appear effective at increasing vaccination intention, while reminders and multi-component strategies, especially ones that include some intervention aimed at provider level, appear effective at increasing vaccination uptake. Interventions that did not lead to an improvement in HPV vaccination intention or uptake varied in design and impacts were inconsistent across children/adolescents, young adults or parents.

Conclusions
The evidence suggests that there is no single solution to increasing vaccination uptake and that different approaches may be better suited to certain populations. However, generalisations are limited by poor reporting and a paucity of studies beyond the USA. Further high-quality studies, therefore, are needed to understand how best to increase HPV vaccination uptake in different target populations.