Fregnani et al., 2013¹²

1574

The parents or legal guardians filled out a questionnaire.

Factors associated with uptake of the HPV vaccine:

Reasons given by the parents and guardians for refusing to participate in the vaccination program (responders could report more than one reason):

1) Fear of adverse events (27.4%);

2) Undisclosed personal reasons (20.2%);

3) The girl doesn’t want to receive the vaccine shot (14.5%);

4) Belief that the girl was too young (9.7%);

5) Girl has a health problem (9.7%);

6) Belief that the vaccine is not necessary (8.9%);

7) Incorrect information about the vaccine (6.5%);

8) Physician (pediatrician/gynecologist) advise against it (5.6%);

9) Does not want to participate in a research study (4.0%);

10) No trust in vaccine efficacy (2.4%);

11) Difficulties travelling to the hospital to get the vaccine (1.6%).

Ladner et al., 2012¹³

Bhutan (2009) - 3200

Bolivia (2009) - 3480

Bolivia (2010) - 30,900

Cambodia (2009) - 2000

Cameroon (2010) - 1600

Haiti (2009) - 3300

Lesotho (2009) - 40,100

Nepal (2010) - 3000

For the qualitative analysis, textual data were extracted from application forms and progress reports and then indexed. This enabled the generation of specific analytical categories. Qualitative data on a variety of indicators were systematically collected and analyzed for each program in the form of field notes and transcripts. The analysis was conducted according to the three defined delivery models.

Factors associated with uptake of the HPV vaccine:

1) Lack of explanation of basic information on cervical cancer in very plain language;

2) Lack of more in-depth discussion sessions with parents and caregivers and evaluation of the knowledge of and attitudes toward HPV vaccination in these audiences.

Barriers to service delivery:

1) Low number of vaccination sites and lack of administration sites easily accessible;

2) The lower effectiveness of Health-centre-based delivery compared to School-based delivery;

3) Lack of specific resources allocated to sensitize and train schoolteachers to assist in recruitment of and follow-up with girls during HPV vaccination campaigns;

4) Lack of variety of communication vehicles like community meetings informational posters, flyers, television, radio and newspapers;

5) Lack of community involvement, important for the definition of key messages, recruitment of participants and follow-up with participants.

LaMontagne et al., 2011¹⁴

India (2009) - 3921

Peru (2008) - 575

Uganda (2008) - 761

Uganda (2009) - 728

Vietnam (2008) - 780

Vietnam (2009) - 504

Reasons for accepting or not accepting vaccination were assessed using an open-ended question without prompting a response. A respondent was any adult who could respond accurately to survey questions, but the parents were preferred.

Factors associated with uptake of the HPV vaccine:

1) Reason for partial or non-vaccination: school absenteeism.

2) Programme-related issues: not aware of the program; difficulty to determine eligibility.

3) Vaccine-related issues: concerns about safety; vaccine is new; vaccine is experimental; impact on fertility; insufficient information about the vaccine; fear of injections; do not believe vaccine is good for health; allergic to vaccines; followed the advice of others.

Barriers to service delivery:

1) Being absent from school on the vaccination day;

2) Insufficient information about cervical cancer, the HPV vaccine or the HPV vaccination programme;

3) Lack of community sensitization.