Methods: We conducted a comprehensive search across multiple electronic databases for studies published from Jan 2000-Aug 2015 on parents’ uptake of HPV vaccines for children. Studies with sufficient data on correlates of HPV vaccine uptake were included in meta-analysis. The primary outcome variable was parents’ uptake of HPV vaccines for children. We computed effect sizes for each variable using a random effects model to compensate for clinical and methodological diversity between studies, and moderation analyses on child gender. We followed preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines.
Results: Across 50 studies (n=557,613), parents’ uptake of HPV vaccines for children ranged from 0.7%-89.0%, mean uptake=36.7% (weighted mean [WM]=13.7%), with higher uptake for girls (WM=53.1) than boys (WM=2.7; p<0.001). Factors associated with parents’ uptake include physician recommendation (r=0.50 [95% CI 0.34–0.67]), routine parent preventive check-up (r=0.34 [95% CI 0.21–0.46]), safety concerns (r=-0·31 [95% CI -0.41–-0.16]), HPV vaccine awareness (r=0.24 [95% CI 0.19–0.29]), health insurance for HPV vaccine (r=0.23, [95% CI 0.06–0.39]), belief in vaccines (r=0.21 [95% CI 0.07–0.34]) and perceived HPV vaccine benefits (r=0.11 [95% CI 0.06–0.17]). Significant moderation effects were found for child gender; physician recommendation and parent preventive check-up were associated with higher likelihood of uptake for girls than boys.
Conclusions: This meta-analysis highlights the importance of physician recommendation to HPV vaccine uptake, and suggests the need to increase recommendations for boys, in particular. Public health campaigns to promote parents’ HPV vaccine awareness and perceived benefits, and dispel undue safety concerns, and broadening insurance coverage for HPV vaccination may increase parents’ uptake of HPV vaccines for their children.