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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