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Table 1 Summary of characteristics of studies included in the systematic review

From: HPV knowledge and vaccine acceptance among European adolescents and their parents: a systematic literature review

Author Year of publication Country Interviewed population Study setting Sample size Study aim Study design MMAT score
Alberts CJ et al. [19] 2017 Netherlands Parents (mother and father) of female children 13 y.o. Regional sample 1257 To explore the possible impact of ethnicity on the determinants of both HPV vaccination intention and HPV vaccination uptake among parents/guardians having a daughter to whom the HPV vaccination is proposed. Quantitative non-randomized 75
Anagnostou PA et al. [20] 2017 Greece Adolescents (male and female) 12–18 y.o. National sample 268 (1) To develop an instrument to assess knowledge of HPV and its vaccine and utilize this instrument to measure knowledge levels of Greek adolescents in Lyceum schools of Western Thessaloniki; and (2) to examine the associations of the resulting knowledge measure scores with sociodemographic characteristics. Quantitative non-randomized 75
Grandahl M et al. [21] 2017 Sweden Parents (mother and father) of female children 11–12 y.o. Regional sample 366 To examine the association between parents’ refusal and sociodemographic background, knowledge and beliefs about HPV and the HPV vaccination in relation to the Health Belief Model. Quantitative non-randomized 50
Grandahl M et al. [22] 2017 Sweden Adolescents (male and female) 16 y.o. National sample 751 To examine HPV catch-up vaccination status in adolescents in relation to (1) socioeconomic factors, (2) beliefs and knowledge about HPV prevention, and (3) sexual behavior. Quantitative non-randomized 100
Navarro-Illana P et al. [23] 2017 Spain Female adolescents and parents of female children 12–16 Regional sample 833 To describe the drivers associated with HPV vaccination in adolescent girls and their parents’ opinion about the vaccine. Quantitative non-randomized 100
Patel H et al.et al [24] 2017 Latvia Adolescents (male and female) 18 (16–21) y.o. Regional sample 121 To evaluate awareness of HPV and its vaccine among Latvian adolescents. Quantitative non-randomized 50
Vaidakis D et al. [25] 2017 Greece Adolescents (male and female) 17–18 y.o. National sample 4507 To identify sexual behaviour, attitudes, beliefs and knowledge of sexually transmitted infections (STIs) focused on HPV in the Greek adolescent population. Quantitative non-randomized 100
Balla B et al. [26] 2016 Hungary Female adolescents 18–19 y.o. Regional sample 492 To explore the attitudes towards the HPV vaccine and the knowledge of cervical cancer among senior high-school girls in Budapest. Quantitative non-randomized 50
Borena W et al. [27] 2016 Austria Parents (mother and father) of children (male and female) 9–10 y.o. National sample 439 To assess parental factors associated with decision to let children receive gender-neutral, free of- charge, school-based HPV immunization. Quantitative non-randomized 100
Oddsson K et al. [28] 2016 Iceland Parents (mother and father) of female children 12 y.o. National sample 583 To assess attitude and knowledge among parents or guardians of 12 y.o. girls about HPV, cervical cancer and HPV vaccination. Quantitative non-randomized 75
Schülein S et al. [29] 2016 Germany Female adolescents 9–17 y.o. National sample 2,224 To determine HPV vaccine uptake as well as factors associated with uptake in 9 to 17-year-old girls in Germany during the first year of vaccine availability. Quantitative non-randomized 75
Voidăzan S et al. [30] 2016 Romania Parents (mother and father) of children (male and female) 7–10 y.o. Regional sample 918 To evaluate the level of parental knowledge about HPV infection and HPV vaccination including the information obtained from general practitioners and identification of barriers in implementing a vaccination strategy. Quantitative non-randomized 100
Agorastos T et al. [31] 2015 Greece Mothers of children (male and females) 13 y.o. National sample 10,758 To investigate the possible effect of demographic factors on HPV vaccination acceptance in Greece. Quantitative non-randomized 25
Firenze A et al. [32] 2015 Italy Female adolescents 15 (13–17) y.o. Regional sample 378 To evaluate knowledge and factors associated with HPV unvaccinated girls after five years of vaccination program implementation in Sicily, an Italian region with low vaccination coverage (< 50.0%). Quantitative non-randomized 50
Forster A et al. [33] 2015 United Kingdom Female adolescents 15–16 y.o. Regional sample 2163 To explore reasons for being un-/under vaccinated. Quantitative non-randomized 100
La Torre G et al. [34] 2015 Italy Mothers of female children under and over 18 y.o. Regional sample 444 To evaluate the knowledge and attitudes of Italian mothers—whose daughters had been vaccinated in 2012—towards primary (anti-HPV vaccination) and secondary (Pap test screening) cervical cancer prevention, as well as sources of information and mother-daughter communication on health issues. Quantitative non-randomized 50
Lee Mortensen G et al. [35] 2015 UK, France, Germany, and Italy. Parents (mother & father) of male children 12–17 y.o. Multinational sample 1,837 To examine parental attitudes to HPV vaccination of their sons given brief information about HPV Mixed Method 75
Maier C et al. [36] 2015 Romania Adolescents (male and female) 16–18 y.o. Regional sample 524 To explore the barriers to HPV vaccination with a view to developing strategies for expanding primary HPV infection prevention. Quantitative non-randomized 50
Navarro-Illana P et al. [37] 2015 Spain Mothers of female children 12–16 y.o. Regional sample 833 To assess knowledge about HPV infection and its vaccine among the mothers of girls and to identify factors associated with the willingness to vaccinate their daughters. Quantitative non-randomized 100
Bianco AS et al. [38] 2014 Italy Parents (mother and father) of male children 10–14 y.o. National sample 1021 To elicit information about parents’ knowledge, attitudes, and acceptability toward HPV infection and vaccination of male adolescents in Italy; to identify subgroups of this population who exhibit poor knowledge about prevention of HPV infection and reveal negative attitudes toward HPV vaccination in relation to their male sons. Quantitative non-randomized 75
Bowyer HL et al. [39] 2014 United Kingdom Female adolescents 16–17 y.o. Regional sample 650 To examine psychosocial predictors of HPV vaccine uptake and the association between vaccine intention and uptake 1 year later in adolescent girls (aged 16–17 years) in England. Quantitative non-randomized 100
Giambi C et al. [40] 2014 Italy Parents (mother and father) of female children 12–14 y.o. National sample 1738 To explore reasons for non-vaccination HPV in Italy. Quantitative non-randomized 50
Mollers M et al. [41] 2014 Netherlands Female adolescents 16–17 y.o. National sample 2989 To explore differences between vaccinated and unvaccinated girls with regards to characteristics such as education, ethnicity, (sexual) risk behaviour and knowledge of HPV. Understanding the features of these two groups could provide insight in future vaccine and screening targeting efforts. Quantitative non-randomized 75
Navarro - Illana P et al. [42] 2014 Spain Female adolescents 15 y.o. Regional sample 833 To assess the knowledge and attitudes of 15-year-old Spanish girls (who were candidates to receive the vaccine) towards HPV infection and the vaccine, and to identify independently associated factors that could potentially be modified by an intervention. Quantitative non-randomized 100
Wegwarth O. et al. [43] 2014 Germany Parents (mother and father) of female children 12–17 y.o. Regional sample 225 To learn how balanced versus unbalanced information about HPV vaccination influences (1) girls’ and parents’ knowledge of the risk of cervical cancer and the effectiveness of the HPV vaccine (both being the basis for informed decisions), (2) their perceived risk of developing cervical cancer without having the HPV vaccine, (3) the intention to have the vaccine, (4) the actual vaccination decision, and (5) the phenomenon of the “knowledge–behavior gap” Quantitative non-randomized 100
Bowyer HL et al. [44] 2013 United Kingdom Female adolescents 15–16 y.o. Regional sample 1033 To examine knowledge about HPV and the HPV vaccine, in girls based in London, England, three years after the introduction of routine school-based vaccination. Quantitative non-randomized 100
Hofman R et al. [45] 2013 Netherlands Female adolescents 11–14 y.o. Regional sample 237 To evaluate to what extent reading an official information leaflet about HPV contributes to girls’ knowledge levels, and to what extent an increase in knowledge is boosted by a pre-test measurement. Quantitative randomized controlled 75
Stöker P et al. [46] 2013 Germany Female adolescents 15 (14–18) y.o. Regional sample 476 To assess HPV-vaccination coverage and knowledge among students in Berlin, to identify factors influencing HPV-vaccine uptake. Quantitative non-randomized 75
Sopracordevole F et al. [47] 2013 Italy Adolescents (male and female) 16 (13–20) y.o. Regional sample 1105 To assess the knowledge of teenage girls on HPV infection and vaccination 12 months after the start of a vaccine administration and information campaign. Quantitative non-randomized 100
Tisi G et al. [48] 2013 Italy Parents (mother and father) of male children 11–15 y.o. Regional sample 161 To evaluate the comprehension and acceptance of HPV vaccination in parents of adolescent boys aged 11 to 15 years. Quantitative non-randomized 75
van Keulen H et al. [49] 2013 Netherlands Female adolescents and Mothers of female adolescents 13–14 y.o. National sample 1594 To examine the social and psychological determinants of the HPV vaccination intentions of girls aged 13 to 16 years and their mothers who were targeted by the Dutch catch-up campaign of 2009. Quantitative non-randomized 75
Forster A et al. [50] 2012 United Kingdom Male adolescents 16–18 y.o. Regional sample 528 To assess boys’ willingness to have HPV vaccination, eliciting reasons for their decisions. Quantitative randomized controlled 75
Gefenaite G et al. [51] 2012 Netherlands Parents (mother and father) of female children 13–16 y.o. Regional sample 609 To identify the most important determinants of refusing the vaccination. Quantitative non-randomized 75
Haesebaert J et al. [52] 2012 France Mothers of female children 14–18 y.o. Regional sample 210 To assess knowledge about cervical cancer, the Pap test and HPV vaccination in 18–65-year-old French women one year after the introduction of the vaccine. The second objective was to assess mothers’ acceptance of HPV vaccination for their 14–18-year-old daughters and determinants of that acceptability. Mixed Method 60
Marek E et al. [53] 2012 Hungary Adolescents (male and female) 14–19 y.o. Regional sample 394 To explore the impact of a brief, HPV-focused program on adolescents’ knowledge, beliefs and attitudes. Quantitative non-randomized 100
Samkange-Zeeb F et al. [54] 2012 Germany Female adolescents 12–20 y.o. Regional sample 632 To assess awareness of HPV and of vaccination status among girls attending grades 8–13 in Bremen and Bremerhaven, two German cities. Quantitative non-randomized 75
Sopracordevole F et al. [55] 2012 Italy Adolescents (male and female) 16 y.o. Regional sample 1105 To assess teens’ knowledge of HPV infection and vaccination one year after the initiation of the public vaccination programme and information campaign on the disease and the opportunity of vaccination. Quantitative non-randomized 75
Balemans R et al. [56] 2011 Belgium Adolescents (male and female) 14-17 y.o. Regional sample 186 To investigate knowledge among adolescents in Antwerp about vaccination and to describe their information sources, motives and barriers for vaccination. Quantitative non-randomized 75
Chadenier GMC et al. [57] 2011 Italy Mothers of female children 12 y.o. Regional sample 475 To observe the coverage of the first vaccination campaign in two suburbs of Milan, to assess knowledge about HPV and cervical cancer among mothers of recipients, and to collect opinions of healthcare professionals involved in the organization of the campaign. Quantitative non-randomized 100
Marek E t al [58]. 2011 Hungary Adolescents (male & female) 12-19 y.o. National sample 1,769 To determine factors and motivations affecting the uptake of HPV vaccination among Hungarian adolescents. Quantitative non-randomized 100
Dahlström L et al. [59] 2010 Sweden Parents (mother and father) of children (male and female) 12–15 y.o. National sample 20,000 To examine Swedish parents’ perceptions and concerns about HPV vaccination, their willingness to vaccinate their children against HPV when the vaccine is free or not and correlates of acceptability of the new HPV vaccine. Quantitative randomized controlled 100
Lee Mortensen G et al. [60] 2010 Denmark Parents (mother and father) of male children 12–15 y.o. Regional sample 450 To assess parental attitudes to HPV vaccination of their sons. Quantitative non-randomized 75
Morison L et al. [61] 2010 United Kingdom Parents (mother and father) of female children 11–12 y.o. Regional sample 245 To evaluate the role of temporal perspective in the formation of attitudes and intentions towards the vaccine. Mixed Method 67
Pelucchi C et al. [62] 2010 Italy Adolescents (male and female) and parents 14–19 y.o. Regional sample 858 and 2331 To provide data on the knowledge of Italian adolescents and parents concerning HPV infection and its prevention in order to allow the development of adequate training programmes. Quantitative non-randomized 100
Gottvall M et al. [63] 2009 Sweden Adolescents (male and female) 15–16 y.o. Regional sample 608 To investigate knowledge of HPV and attitudes to HPV vaccination and condom use among Swedish first year upper secondary school students. Quantitative non-randomized 100
Höglund A et al. [64] 2009 Sweden Adolescents (male and female) 16 (15–20) y.o. Regional sample 459 To investigate knowledge of and attitudes to sexually transmitted infection (STI) and STI prevention with special focus on HPV and the vaccine against HPV, among 16-year-old high school students in a Swedish context. Quantitative non-randomized 100
Marlow L et al. [65] 2009 United Kingdom Female adolescents 16–19 y.o. Regional sample 335 To assess acceptability of HPV vaccination among female adolescents (16–19 years) and investigate socio-cultural variation in intended acceptance. Quantitative non-randomized 100
Tozzi A et al .[66] 2009 Italy Mothers of female children 10–12 y.o. Regional sample 1,007 To assess parents’ knowledge about HPV and HPV vaccination and their willingness to have their daughters immunized, and to investigate the roles of the different medical specialists in the immunization strategy as perceived by parents. Quantitative non-randomized 75
De Visser R et al. [67] 2008 United Kingdom Parents (mother and father) of children (male and female) 12-13 y.o. Regional sample 353 To examine how intentions to vaccinate against HPV are influenced by general beliefs about vaccination, specific beliefs about HPV vaccination, knowledge about HPV and cervical cancer, and beliefs about adolescent sexual behavior. Quantitative non-randomized 75
Lenselink C et al. [68] 2008 Netherlands Parents (mother and father) of children (male and female) 10–12 y.o. Regional sample 356 To determine whether parents would accept HPV vaccination for their children and which variables may influence their decision, including knowledge about cervical cancer and HPV. Quantitative non-randomized 75
Stretch S et al. [69] 2008 United Kingdom Parents (mother and father) of female children 12-13 y.o. Regional sample 651 To assess parental attitudes and information needs in an adolescent HPV vaccination programme Quantitative non-randomized 75
Brabin L et al. [70] 2007 United Kingdom Parents (mother and father) of children (male and female) 11–12 y.o. Regional sample 317 To investigate parents’ views on making HPV vaccination available to adolescent minors at sexual health clinics without parental consent. Mixed Method 100
Marlow L et al. [71] 2007 United Kingdom Mothers of female children 11 (8–14) y.o. Regional sample 684 To examine the association between general vaccine attitudes, trust in doctors and the government, past experience with vaccination and acceptance of HPV vaccination. Quantitative non-randomized 50
Marlow L et al. [72] 2007 United Kingdom Mothers of female children 11 (8–14) y.o. Regional sample 684 To determine the acceptability of childhood HPV vaccination and examine demographic, cultural, and psychosocial predictors of vaccine acceptance. Quantitative non-randomized 75
Woodhall S et al. [73] 2007 Finland Adolescents (male and female) and their parents 14–15 y.o. Regional sample 1124 To evaluate acceptance of HPV vaccination by adolescents and their parents. Quantitative non-randomized 75
Brabin L et al. [12] 2006 United Kingdom Parents (mother and father) of children (male and female) 11–12 y.o. Regional sample 317 To assess parental consent and potential HPV vaccine uptake in eight secondary schools using stratified randomization according to school type and ethnicity Quantitative non-randomized 50
  1. List of studies are ordered by author, year, and country