Sage Journals: Discover world-class research

Abstract

The human papillomavirus (HPV) vaccine is a critical tool in cervical cancer prevention, yet uptake remains suboptimal in the United States. This scoping review examines the multilevel determinants influencing HPV vaccine uptake among women, identifying key barriers and facilitators to vaccination. Using the socioecological model (SEM), this review categorizes factors affecting vaccine uptake across individual, interpersonal, community, and societal levels, providing a structured framework for analyzing multilevel influences. Studies published in English between 2009 and 2023 were systematically reviewed, focusing on HPV vaccine uptake determinants among U.S. females aged 9 to 45, aligning with vaccination guidelines. Fifteen studies were included in the final analysis. However, studies including older adults (up to 80 years) were analyzed to explore vaccine awareness trends and decision-making beyond the routinely recommended age groups. Excluded were studies focusing solely on healthcare providers’ perspectives, those conducted outside the United States, and non-English language publications. A comprehensive search of PsycINFO, CINAHL, and PubMed was conducted using relevant keywords to ensure a thorough literature review. Findings indicate that multiple interrelated factors, including misinformation, healthcare provider recommendations, socioeconomic status, insurance coverage, cultural beliefs, and geographic disparities, shape vaccine hesitancy. Key barriers include a lack of provider recommendations, financial constraints, and concerns about vaccine safety, while facilitators include strong provider communication and targeted educational interventions. Addressing these barriers through multilevel interventions such as provider training, policy reforms, and community-driven outreach will be essential for increasing HPV vaccine uptake and reducing cervical cancer disparities among underserved populations.

Keywords

HPV vaccine uptake determinants health disparities

Get full access to this article

View all access options for this article.

References

Adekanmbi

Sokale

Guo

Ngo

Hoang

T. N.

Hsu

C. D.

Oluyomi

Berenson

A. B.

(2024). Human papillomavirus vaccination and human papillomavirus–related cancer rates. JAMA Netw Open, 7(9), e2431807. https://doi.org/10.1001/jamanetworkopen.2024.31807

Agénor

Abboud

Delgadillo

J. G.

Pérez

A. E.

Peitzmeier

S. M.

Borrero

(2018). Intersectional nativity and racial/ethnic disparities in human papillomavirus vaccination initiation among U.S. Women: A national population-based study. Cancer Causes and Control, 29(10), 927–936. https://doi.org/10.1007/s10552-018-1069-1

Arksey

O’Malley

(2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616

American Cancer Society. (2024). Cancers linked with HPV. American Cancer Society. https://www.cancer.org/cancer/risk-prevention/hpv/hpv-and-cancer-info.html

Barnack-Tavlaris

J. L.

Garcini

L. M.

Macera

C. A.

Brodine

Klonoff

E. A.

(2016). Human papillomavirus vaccination awareness and acceptability among U.S.-born and U.S. Foreign-born women living in California. Health Care for Women International, 37(4), 444–462. https://doi.org/10.1080/07399332.2014.954702

Braun

Clarke

(2022). Thematic analysis: A practical guide. Sage Publications.

Bronfenbrenner

(1977). Toward an experimental ecology of human development. American Psychologist, 32(7), 513–531. https://doi.org/10.1037/0003-066X.32.7.513

Cates

J. R.

Brewer

N. T.

Fazekas

K. I.

Mitchell

C. E.

Smith

J. S.

(2009). Racial differences in HPV knowledge, HPV vaccine acceptability, and related beliefs among rural, Southern women. Journal of Rural Health, 25(1), 93–97. https://doi.org/10.1111/j.1748-0361.2009.00204.x

Centers for Disease Control and Prevention. (2024). About HPV. CDC. https://www.cdc.gov/hpv/about/index.html

10.

Cofie

L. E.

Tailor

H. D.

Lee

M. H.

(2022). HPV vaccination uptake among foreign-born blacks in the US: Insights from the national health interview survey 2013–2017. Cancer Causes and Control, 33(4), 583–591. https://doi.org/10.1007/s10552-021-01550-x

11.

Cohen

C. M.

Wentzensen

Castle

P. E.

Schiffman

Zuna

Arend

R. C.

Clarke

M. A.

(2023). Racial and ethnic disparities in cervical cancer incidence, survival, and mortality by histologic subtype. Journal of Clinical Oncology, 41(5), 1059–1068. https://doi.org/10.1200/JCO.22.01424

12.

Cui

Baldwin

S. B.

Wiley

D. J.

Fielding

J. E.

(2010). Human papillomavirus vaccine among adult women: Disparities in awareness and acceptance. American Journal of Preventive Medicine, 39(6), 559–563. https://doi.org/10.1016/j.amepre.2010.08.001

13.

Cunningham-Erves

Forbes

Ivankova

Mayo-Gamble

Kelly-Taylor

Deakings

(2018a). Black mother’s intention to vaccinate daughters against HPV: A mixed methods approach to identify opportunities for targeted communication. Gynecologic Oncology, 149(3), 506–512. https://doi.org/10.1016/j.ygyno.2018.03.047

14.

Cunningham-Erves

Forbes

Ivankova

Mayo-Gamble

Kelly-Taylor

Deakings

(2018b). Black mother’s intention to vaccinate daughters against HPV: A mixed methods approach to identify opportunities for targeted communication. Gynecologic Oncology, 149(3), 506–512. https://doi.org/10.1016/j.ygyno.2018.03.047

15.

Domgue

J. F.

Chido-Amajuoyi

O. G.

R. K.

Shete

(2019). Beliefs about HPV Vaccine’s success at cervical cancer prevention among adult US women. JNCI Cancer Spectrum, 3(4). https://doi.org/10/1093/jncics/pkz064

16.

Fields

E. J.

Hopfer

Warren

J. R.

BeLue

Lebed

Hecht

M. L.

(2022). Motivators and barriers to HPV vaccination: A qualitative study of underserved women attending planned parenthood. Vaccines, 10(7), 1126. https://doi.org/10.3390/vaccines10071126

17.

Glanz

Rimer

B. K.

Viswanath

(Eds.). (2015). Health behavior: Theory, research, and practice (5th ed). Jossey-Bass.

18.

Gray

Fisher

C. B.

(2023). Factors associated with HPV vaccine acceptability and hesitancy among Black mothers with young daughters in the United States. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1124206

19.

Kaiser Family Foundation. (2024). The HPV Vaccine: Access and Use in the U.S. Retrieved from https://www.kff.org/womens-health-policy/fact-sheet/the-hpv-vaccine-access-and-use-in-the-u-s/

20.

Kyei

G. K.

Kyei

E. F.

Ansong

(2025). HPV Vaccine hesitancy and uptake: A conceptual analysis using rodgers’. Evolutionary Approach. Journal of Advanced Nursing, 81(5), 2368–2381. https://doi.org/10.1111/jan.16653

21.

Levac

Colquhoun

O’Brien

K. K.

(2010). Scoping studies: Advancing the methodology. Implementation Science, 5(69). https://doi.org/10.1186/1748-5908-5-69

22.

Maness

S. B.

Reitzel

L. R.

Watkins

K. L.

McNeill

L. H.

(2016). HPV Awareness, knowledge and vaccination attitudes among church-going African-American women. American Journal of Health Behavior, 40(6), 771–778. https://doi.org/10.5993/AJHB.40.6.9

23.

McLeroy

K. R.

Bibeau

Steckler

Glanz

(1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377. https://doi.org/10.1177/109019818801500401

24.

Nuño

V. L.

Gonzalez

Loredo

S. M.

Nigon

B. M.

Garcia

(2016). A cross-sectional study of human papillomavirus vaccine utilization among university women: The role of ethnicity, race, and risk factors. Journal of Lower Genital Tract Disease, 20(2), 131–134. http://doi.org/10.1097/LGT.0000000000000174

25.

Ojinnaka

C. O.

McClellan

D. A.

Weston

Pekarek

Helduser

J. W.

Bolin

J. N.

(2017). Determinants of HPV vaccine awareness and healthcare providers’ discussion of HPV vaccine among females. Preventive Medicine Reports, 5, 257–262. https://doi.org/10.1016/j.pmedr.2017.01.005

26.

Okafor

Cook

R. L.

(2015). Racial/ethnic disparities in HPV vaccine uptake among a sample of college women. Journal of Racial and Ethnic Health Disparities, 2(3), 311–316. https://doi.org/10.1007/s40615-014-0074-7

27.

Pocock

Williams

Skinner

(2012). Conceptualizing work, family and community: A socio-ecological systems model, taking account of power, time, space and life stage. British Journal of Industrial Relations, 50(3), 391–411. https://doi.org/10.1111/j.1467-8543.2011.00852.x

28.

Pollock

Peters

M. D. J.

Khalil

McInerney

Alexander

Tricco

A. C.

Evans

de Moraes

ÉB

Godfrey

C. M.

Pieper

Saran

Stern

Munn

(2023). Recommendations for the extraction, analysis, and presentation of results in scoping reviews. JBI Evidence Synthesis, 21(3), 520–532. https://doi.org/10.11124/JBIES-22-00123

29.

Robinson

Nguyen

Wright

Holmes

Oliphant

Cleveland

Nies

M. A.

(2022). Factors contributing to vaccine hesitancy and reduced vaccine confidence in rural underserved populations. Humanities and Social Sciences Communications, 9(1), 416. https://doi.org/10.1057/s41599-022-01439-3

30.

Rodriguez

V. A.

Tucker

C. M.

(2020). Factors Associated with Cervical Cancer Screening Adherence in a Sample of Hispanic/Latina Women and Latinx Individuals with Cervixes. In ProQuest Dissertations and Theses. https://www.proquest.com/dissertations-theses/factors-associated-with-cervical-cancer-screening/docview/2735281516/se-2?accountid=28932

31.

Sims

Archie-Booker

Waldrop

R. T.

Claridy

Gerbi

(2018). Factors associated with human papillomavirus vaccination among women in the United States. ARC Journal of Public Health and Community Medicine, 3(1), 6. https://doi.org/10.20431/2456-0596.0301002

32.

Sinka

(2024). The global burden of sexually transmitted infections. Clinics in Dermatology, 42(2), 110–118. https://doi.org/10.1016/j.clindermatol.2023.12.002

33.

Truong-Vu

K. P.

(2023). Racial, ethnic, and gender differences in the timing of initiating the HPV vaccine in the United States: The case of southeast Asian Americans. Journal of Racial and Ethnic Health Disparities, 11(4), 2210–2223. https://doi.org/10.1007/s40615-023-01689-0

Determinants of HPV Vaccine Uptake in Women in the United States: A Scoping Review of Socioecological Influences

Abstract

Keywords

Get full access to this article

References