Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
School of Social Work, The University of Texas at Arlington, Arlington, Texas, USA.
BMJ Open. 2018 Apr 20;8(4):e019206. doi: 10.1136/bmjopen-2017-019206.
To examine factors associated with parents' uptake of human papillomavirus (HPV) vaccines for their children.
Systematic review and meta-analysis.
Cochrane Library, AIDSLINE, CINAHL, EMBASE, PsycINFO, Social Sciences Abstracts, Ovid MEDLINE, Scholars Portal, Social Sciences Citation Index and Dissertation Abstracts International from inception through November 2017.
We included studies that sampled parents and assessed uptake of HPV vaccines for their children (≤18 years) and/or sociodemographics, knowledge, attitudes or other factors associated with uptake. Study risk of bias was assessed using the Effective Public Health Practice Project tool. We pooled data using random-effects meta-analysis and conducted moderation analyses to examine variance in uptake by sex of child and parent.
Seventy-nine studies on 840 838 parents across 15 countries were included. The pooled proportion of parents' uptake of HPV vaccines for their children was 41.5% (range: 0.7%-92.8%), twofold higher for girls (46.5%) than for boys (20.3%). In the meta-analysis of 62 studies, physician recommendation (r=0.46 (95% CI 0.34 to 0.56)) had the greatest influence on parents' uptake, followed by HPV vaccine safety concerns (r=-0.31 (95% CI -0.41 to -0.16)), routine child preventive check-up, past 12 months (r=0.22 (95% CI 0.11 to 0.33)) and parents' belief in vaccines (r=0.19 (95% CI 0.08 to 0.29)). Health insurance-covered HPV vaccination (r=0.16 (95% CI 0.04 to 0.29)) and lower out-of-pocket cost (r=-0.15 (95% CI -0.22 to -0.07)) had significant effects on uptake. We found significant moderator effects for sex of child.
Findings indicate suboptimal levels of HPV vaccine uptake, twofold lower among boys, that may be improved by increasing physician recommendations, addressing parental safety concerns and promoting parents' positive beliefs about vaccines, in addition to expanding insurance coverage and reducing out-of-pocket costs. Limitations of this meta-analysis include the lack of intervention studies and high risk of bias in most studies reviewed. Further studies should disaggregate HPV vaccine uptake by sex of child and parent.
探讨与父母为子女接种人乳头瘤病毒（HPV）疫苗相关的因素。
系统评价和荟萃分析。
Cochrane 图书馆、AIDSLINE、CINAHL、EMBASE、PsycINFO、Social Sciences Abstracts、Ovid MEDLINE、Scholars Portal、Social Sciences Citation Index 和 Dissertation Abstracts International，从创建到 2017 年 11 月。
我们纳入了对父母进行抽样并评估其子女（≤18 岁）接种 HPV 疫苗的情况以及与接种相关的社会人口统计学、知识、态度或其他因素的研究。使用有效公共卫生实践项目工具评估研究的偏倚风险。我们使用随机效应荟萃分析汇总数据，并进行调节分析以检验按子女和父母的性别对疫苗接种率的差异。
在 15 个国家进行的 79 项研究中，共有 840 838 名父母参与。父母为子女接种 HPV 疫苗的比例为 41.5%（范围：0.7%-92.8%），女孩（46.5%）是男孩（20.3%）的两倍。在 62 项研究的荟萃分析中，医生推荐（r=0.46（95%CI 0.34 至 0.56））对父母接种的影响最大，其次是 HPV 疫苗安全性顾虑（r=-0.31（95%CI -0.41 至 -0.16））、过去 12 个月常规儿童预防检查（r=0.22（95%CI 0.11 至 0.33））和父母对疫苗的信任（r=0.19（95%CI 0.08 至 0.29））。HPV 疫苗接种纳入医疗保险（r=0.16（95%CI 0.04 至 0.29））和降低自付费用（r=-0.15（95%CI -0.22 至 -0.07））对接种有显著影响。我们发现子女性别存在显著的调节效应。
研究结果表明 HPV 疫苗接种率不理想，男孩接种率低两倍，这可能通过增加医生的推荐、解决父母对安全性的担忧以及促进父母对疫苗的积极信念，以及扩大保险覆盖范围和降低自付费用来改善。本荟萃分析的局限性包括缺乏干预研究和大多数研究的偏倚风险较高。进一步的研究应按子女和父母的性别细分 HPV 疫苗接种率。
