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Which interventions improve HPV vaccination uptake and intention in children, adolescents and young adults? An umbrella review
  1. Clare Bennett1,
  2. Deborah Edwards1,
  3. Sue M Sherman2,
  4. Peter Baker3,
  5. Dur-e-Nayab Waheed4,
  6. Alex Vorsters5,
  7. Hüsna Sarıca Çevik6,
  8. Emilie Karafillakis7,
  9. Gillian Prue8,
  10. Daniel Kelly1
  1. 1 College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
  2. 2 School of Psychology, Keele University, Staffordshire, UK
  3. 3 European Cancer Organisation, Brussels, Belgium
  4. 4 Faculty of Medicine, University of Antwerp, Wilrijk, Belgium
  5. 5 Vaccine & infectious disease institute, University of Antwerp, Antwerp, Belgium
  6. 6 Çankaya District Health Directorate, Ankara, Turkey
  7. 7 The Vaccine Confidence Project, London School of Hygiene & Tropical Medicine, London, UK
  8. 8 School of Nursing and Midwifery, Medical Biology Centre, Queen’s University Belfast, Belfast, UK
  1. Correspondence to Dr Clare Bennett, Cardiff University College of Biomedical and Life Sciences, Cardiff, Cardiff, UK; BennettCL3{at}


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 (Joanna Briggs Institute) methodology to evaluate routine or catch-up interventions to increase HPV vaccination uptake and/or intention for children aged 9 years and older, adolescents and young adults up to 26. Comprehensive searches for English language quantitative systematic reviews, published between January 2011 and 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 randomised controlled trials, 28 quasi-experimental studies, 14 cohort studies, 6 non-randomised pretest/post-test studies with control groups, 5 single-group pretest/post-test studies, 1 single-group post-test study and 1 randomised longitudinal study. Some interventions promoted change at the individual, community or organisational level, while others used a multicomponent approach. Face-to-face presentations, printed information and supplementing both strategies with additional components appear effective at increasing vaccination intention, while reminders and multicomponent 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.

Conclusion 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.


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  • Handling editor Laith J Abu-Raddad

  • Twitter @ClareBennettCU, @husnasarica

  • Contributors DK was responsible for the conceptualisation of this project. The conduct of the umbrella review was led by DE and CB, with DE, CB, SMS, D-e-NW, AV, HSÇ, EK and GP conducting the screening, quality assessment, data extraction and narrative that underpinned this paper. All members of the team contributed to the reporting of the review. All authors edited and approved the final manuscript.

  • Funding This research was co-ordinated by the European Cancer Organisation, who received some financial contributions towards its cost from Community 365 charity and healthcare industry partners: NOMAN, BD, MSD and Roche.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.