Factors Influencing Parental Decision Making for the Human Papillomavirus (HPV) Vaccine: A Literature Review

IntroductionThe human papillomavirus (HPV) is the most common sexually transmitted infection (STI) worldwide, with about 75% of Canadians developing at least one HPV infection in their lifetime (1, 2). A greater risk of exposure are attributed towards individuals who are sexually active at an earlier age, with the highest prevalence of HPV being among people between the ages of 15 and 24 (2, 3).HPV infections are often asymptomatic, but the most obvious symptom is the development of genital warts (2, 4). However, HPV has also been known to be linked to various cancers, accounting for 5.2% of cancers worldwide (4). More specifically, HPV accounts for the cause of almost all cervical cancers, 88% of anal cancers, and 50% of penile cancers (4). HPV has also been known to cause some vaginal cancers, vulvar cancers, and head and neck cancers (2).Pap screening in women are helpful in detecting abnormal cervical cells before said cells become cancerous. The HPV test is another procedure that can help detect infections and precancerous lesions. The HPV test can detect HPV-types that are of high oncogenic risk through detection of the epithelial and cervical cells (5). Although the HPV test is more sensitive than the pap test, the HPV test is currently not standard, routine, or available for men. However, even though the pap test is a standard routine, 15% of Canadian women claim to have never received a pap test and 30% of Canadians have not been screened within the past three years (4).Unfortunately there is currently no cure for HPV; however, the HPV vaccine can help protect again certain types of HPV infections (6). For instance, Gardasil and Cervarix are licensed vaccines that help protect against specific HPV-types. Cervarix protects against types 16 and 18, while Gardasil protects against types 6, 11, 16, and 18 (4). The government of Canada allocated $300 million in 2006 towards the implementation of provincial universal HPV vaccination programs for girls between the ages of nine and 16 (7). The grade eight vaccination program was introduced in Ontario in 2007 which offers an optional HPV vaccine to girls with the consent of their parents. The vaccine (Gardasil) is administered in a three-dose treatment schedule with the first dose being baseline, followed by a second dose two months after baseline, and a third dose six months after baseline (2). Although the public vaccination program has been implemented throughout Canada, the HPV vaccine uptake rate varies across the country from as low as 50% in Alberta, to as high as 86% in Quebec (8).The HPV infection also remains an important issue in men as both men and women can be infected with HPV. Men can transmit HPV to sexual partners; however, there are currently no routine tests to screen men. Furthermore, there is currently no publicly funded HPV vaccination program for boys in Ontario (2). There has been much debate about implementing a publicly funded HPV vaccination program for boys (4).Whether the issue is increasing uptake of the HPV vaccine in boys or girls, the key common underlying factor is the obtainment of parental consent. Considering HPV is an STI, the most effective point of administration of the HPV vaccine is before becoming sexually active. Thus, parents play a critical role in ensuring optimal uptake of the HPV vaccine in children by providing consent (4). However, several studies have shown that there are many factors that influence parental decision making when it comes to providing consent for their children to uptake the HPV vaccine (1,3,6). There are a variety of factors that are often rooted in parental knowledge, beliefs, and attitudes (4). As such, it is important to identify and address these factors to improve vaccination rates across Canada, and worldwide.The primary objective of this study was to explore the literature to determine common factors that influence parental decision making regarding uptake of the HPV vaccine for their sons and daughters. …

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