HPV VACCINE ADHERENCE AMONG ADOLESCENTS: INTEGRATIVE REVIEW

integrative developed using the following data base: Medical Literature Analysis and Retrieval System Online and Web of Science, Cumulative Index to Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Latin-American and Caribbean Literature in Health Sciences), and Base de dados de Enfermagem (Nursing Database); using the descriptors and keywords: Papillomaviridae, immunization, vaccines. The final sample had 31 original articles.

Result:

Vaccine adherence predictors were identified as: knowledge about virus infection risk, vaccination and its benefits; cervical cancer and genital warts prevention; sexual activity; being over 14 years old; mothers’ intention to adhere to vaccination; mother-child communication about sexually transmitted infections, contraception and condoms; vaccination offered in school; recommendation by teachers and health professionals; vaccine safety and effectiveness.

Conclusion:

Evidence points towards the necessity to redesign the presentation strategy of the vaccine, because despite the cultural differences among the countries where the studies were carried out, it is noticeable that society shelters adolescents aged from 10 to 14 years old, considering it early for sexual initiation and presenting difficulties to broach sexuality-related topics with children.

DESCRIPTORS
Papillomaviridae; Immunization; Vaccines; Adolescent; Nursing

PICo	Search strategy	Applied Results
P	(((("teenagers") OR "adolescent") OR "adolescent" [MeSH Terms]) OR "adolescence") OR "adolescent" [MeSH Terms]	((((((("teenagers") OR "adolescent") OR "adolescent" [MeSH Terms]) OR "adolescence") OR "adolescent" [MeSH Terms])) AND (((((((("accession") OR "vaccines") OR "vaccines" [MeSH Terms]) OR "immunization") OR "immunization" [MeSH Terms]) OR "papillomaviridae") OR "papillomaviridae" [MeSH Terms]) OR "human papilloma virus")) AND (((("socio demographic factors") OR "social factors") OR "demographic factors") OR "demography" [MeSH Terms])
I	((((((("accession") OR "vaccines") OR "vaccines" [MeSH Terms]) OR "immunization") OR "immunization" [MeSH Terms]) OR "papillomaviridae") OR "papillomaviridae" [MeSH Terms]) OR "human papilloma virus"
Co	((("socio demographic factors") OR "social factors") OR "demographic factors") OR "demography" [MeSH Terms]

Author (study country/year)	Study design	EL*
Ogilvie GS, Remple VP, Marra F, McNeil SA, Naus M, Pielan K, et al.1313. Ogilvie GS, Remple VP, Marra F, McNeil SA, Naus M, Pielan K, et al Intention of parents to have male children vaccinated with the human papillomavirus vaccine Sexually Transmitted Infections [Internet]. 2008 [cited 2018 May 26]; 84:318-23. Available from: http://sti.bmj.com.ez17.periodicos.capes.gov.br/content/84/4/318.citation-tools http://sti.bmj.com.ez17.periodicos.capes... (Canada, 2006-2007)	Descriptive	IV
Kwan TTC, Chan KKL, Yip AMW, Tam KF, Cheung ANY, Young PMC et al.1414. Kwan TTC, Chan KKL, Yip AMW, Tam KF, Cheung ANY, Young PMC et al. Barriers and facilitators to human papillomavirus vaccination among Chinese adolescent girls in Hong Kong: a qualitative-quantitative study Sexually Transmitted Infections [Internet]. 2008 [cited 2018 May 26]; 84:227-32. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18256106 https://www.ncbi.nlm.nih.gov/pubmed/1825... (China, 2007)	Descriptive qualitative	VI
Read DS, Joseph MA, Polishchuk V, Suss AL.1515. Read DS, Joseph MA, Polishchuk V, Suss AL. Attitudes and perceptions of the HPV vaccine in Caribbean and African-American adolescent girls and their parents. J Pediatr Adolesc Gynecol [Internet]. 2010 Aug [cited 2018 May 26]; 23(4):242-5. Available from: https://www-sciencedirect-com.ez17.periodicos.capes.gov.br/science/article/pii/S1083318810000768?via%3Dihub https://www-sciencedirect-com.ez17.perio... (USA, 2007-2008)	Descriptive	IV
Kahn JA, Ding L, Huang B, Zimet GD, Rosenthal SL, Frazier AL.1616. Kahn JA, Ding L, Huang B, Zimet GD, Rosenthal SL, Frazier AL. Mothers' intention for their daughters and themselves to receive the human papillomavirus vaccine: a national study of nurses. Pediatrics [Internet]. 2009 June [cited 2018 May 26]; 123(6):1439-45. Available from: https://doi-org.ez17.periodicos.capes.gov.br/10.1542/peds.2008-1536 https://doi-org.ez17.periodicos.capes.go... (USA, 2007-2008)	Descriptive	IV
Krawczyk A, Knäuper B, Gilca V, Dubé E, Perez S, Joyal-Desmarais K, et al.1717. Krawczyk A, Knäuper B, Gilca V, Dubé E, Perez S, Joyal-Desmarais K, et al. Parents decision-making about the human papillomavirus vaccine for their daughters: I. Quantitative results. Human Vaccines & Immunotherapeutics [Internet]. 2015 [cited 2018 May 26]; 11(2):322-9. Available from: http://doi.org/10.1080/21645515.2014.1004030 . http://doi.org/10.1080/21645515.2014.100... (Canada, 2008)	Descriptive	IV
Keenan K, Hipwell A, Stepp, S.1818. Keenan K, Hipwell A, Stepp S. Race and Sexual Behavior Predict Uptake of the Human Papillomavirus Vaccine. Health Psychology [Internet]. 2012 Jan [cited 2018 May 26]; 31(1):31-4. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1037/a0026812 http://doi-org.ez17.periodicos.capes.gov... (USA, 2008)	Descriptive	IV
Baldwin AS, Bruce CM, Tiro JA.1919. Baldwin AS, Bruce CM, Tiro JA. Understanding how mothers of adolescent girls obtain information about the human papillomavirus vaccine: associations between mothers' health beliefs, information seeking, and vaccination intentions in na ethnically diverse sample. J Health Psychol [Internet]. 2013 Jul [cited 2018 May 26]; 18(7):926-38. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1177/1359105312445078 http://doi-org.ez17.periodicos.capes.gov... (USA, 2008-2010)	Descriptive	IV
Klötzler A, Kolip P.2020. Klötzler A, Kolip P. Decision for or against HPV vaccination - a qualitative study with adolescent girls. Gesundheitswesen [Internet]. 2012 Nov [cited 2018 May 26]; 74(11):716-21. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22012564 https://www.ncbi.nlm.nih.gov/pubmed/2201... (Germany, 2009)	Descriptive qualitative	VI
Marlow LA, Wardle J, Waller J.21 (United Kingdom, 200921. Marlow LA, Wardle J, Waller J. Attitudes to HPV vaccination among ethnic minority mothers in the UK: an exploratory qualitative study. Hum Vaccin [Internet]. 2009 Feb [cited 2018 May 26];5(2):105-10. Available from: https://dx.doi.org/10.4161/hv.5.2.7368 https://dx.doi.org/10.4161/hv.5.2.7368... )	Descriptive qualitative	VI
Tsui J, Singhal R, Rodriguez HP, Gee GC, Glenn BA, Bastani R.2222. Tsui J, Singhal R, Rodriguez HP, Gee GC, Glenn BA, Bastani R. Proximity to safety-net clinics and HPV vaccine uptake among low-income, ethnic minority girls. Vaccine [Internet]. 2013 Apr 12 [cited 2018 May 26]; 31(16):2028-34. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1016/j.vaccine.2013.02.046 http://doi-org.ez17.periodicos.capes.gov... (USA, 2009)	Descriptive	IV
Glenn BA, Tsui J, Singhal R, Sanchez L, Nonzee NJ, Chang LC, et al.2323. Glenn BA, Tsui J, Singhal R, Sanchez L, Nonzee NJ, Chang LC, et al. Factors associated with HPV awareness among mothers of low-income ethnic minority adolescent girls in Los Angeles. Vaccine [Internet]. 2015 Jan 3 [cited 2018 May 26]; 33(2):289-93. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1016/j.vaccine.2014.11.032 http://doi-org.ez17.periodicos.capes.gov... (USA, 2009-2010)	Descriptive	IV
Bowyer H, Forster A, Marlow L, Waller J.2424. Bowyer H, Forster A, Marlow L, Waller J. Predicting human papillomavirus vaccination behaviour among adolescent girls in England: Results from a prospective survey. J Fam Plann Reprod Health Care [Internet]. 2014 [cited 2018 May 26]; 40(1):14-22. Available from: http://dx.doi-org.ez17.periodicos.capes.gov.br/10.1136/jfprhc-2013-100583 http://dx.doi-org.ez17.periodicos.capes.... (England, 2009-2010)	Descriptive	IV
Katz IT, Nkala B, Dietrich J, Wallace M, Bekker LG, Pollenz K, et al.2525. Katz IT, Nkala B, Dietrich J, Wallace M, Bekker LG, Pollenz K, et al. A Qualitative Analysis of Factors Influencing HPV Vaccine Uptake in Soweto, South Africa among Adolescents and Their Caregivers. PLoS ONE [Internet]. 2013 [cited 2018 May 26]; 8(8):e72094. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1371/journal.pone.0072094 http://doi-org.ez17.periodicos.capes.gov... (South Africa, 2010)	Descriptive, multicentric and qualitative	IV
Hanley SJ, Yoshioka E, Ito Y, Konno R, Hayashi Y, Kishi R, et al.2626. Hanley SJ, Yoshioka E, Ito Y, Konno R, Hayashi Y, Kishi R, et al. Acceptance of and attitudes towards human papillomavirus vaccination in Japanese mothers of adolescent girls. Vaccine [Internet]. 2012 Aug 24 [cited 2018 May 26]; 30(39):5740-7. Available from: https://doi-org.ez17.periodicos.capes.gov.br/10.1016/j.vaccine.2012.07.003 https://doi-org.ez17.periodicos.capes.go... (Japan, 2010)	Descriptive	IV
Widdice LE, Hoagland R, Callahan ST, Kahn JA, Harrison CJ, Pahud BA, et al.2727. Widdice LE, Hoagland R, Callahan ST, Kahn JA, Harrison CJ, Pahud BA, et al. Caregiver and adolescent factors associated with delayed completion of the three-dose human papillomavirus vaccination series. Vaccine [Internet]. 2018 Mar 7 [cited 2018 May 26]; 36(11):1491-9. Available from: https://dx.doi.org/10.1016/j.vaccine.2017.12.060UR https://dx.doi.org/10.1016/j.vaccine.201... (USA, 2010-2011)	Descriptive	IV
Naggar RA, Bobryshev YV, Jashamy K, Musli M.2828. Naggar RA, Bobryshev YV, Jashamy K, Musli M. Practice of HPV vaccine and associated factors among school girls in Melaka, Malaysia. Asian Pac J Cancer Prev [Internet]. 2012 [cited 2018 May 26];13(8):3835-40. Available from: http:s//dx.doi.org/10.7314/APJCP.2012.13.8.3835 http:s//dx.doi.org/10.7314/APJCP.2012.13... (Malasia, 2011)	Descriptive	IV
Shao SJ, Nurse C, Michel L, Joseph MA, Suss AL.2929. Shao SJ, Nurse C, Michel L, Joseph MA, Suss AL. Attitudes and Perceptions of the Human Papillomavirus Vaccine in Caribbean and African American Adolescent boys and Their Parents. J Pediatr Adolesc Gynecol [Internet]. 2015 Oct [cited 2018 May 26]; 28(5):373-7. Available from: https://doi-org.ez17.periodicos.capes.gov.br/10.1016/j.jpag.2014.11.003 https://doi-org.ez17.periodicos.capes.go... (USA, 2011-2012)	Descriptive	IV
Khurana S, Sipsma HL, Caskey RN.3030. Khurana S, Sipsma HL, Caskey RN. HPV vaccine acceptance among adolescent males and their parents in two suburban pediatric practices. Vaccine [Internet]. 2015 Mar 24 [cited 2018 May 26]; 33(13):1620-4. Available from: https://doi-org.ez17.periodicos.capes.gov.br/10.1016/j.vaccine.2015.01.038 https://doi-org.ez17.periodicos.capes.go... (USA, 2011-2012)	Descriptive	IV
Ferrer BH, Trotter CL, Hickman M, Audrey S.3131. Ferrer BH, Trotter CL, Hickman M, Audrey S. Barriers and facilitators to uptake of the school-based HPV vaccination programme in an ethnically diverse group of young women. J Public Health (Oxf) [Internet]. 2016 Sept [cited 2018 May 26]; 38(3):569-77. Available from: https://doi-org.ez17.periodicos.capes.gov.br/10.1093/pubmed/fdv073 https://doi-org.ez17.periodicos.capes.go... (England, 2012-2013)	Descriptive qualitative	VI
Onyeabor OS, Martin N, Orish VN, Sanyaolu AO, Iriemenam NC.3232. Onyeabor OS, Martin N, Orish VN, Sanyaolu AO, Iriemenam NC. Awareness of Human Papillomavirus Vaccine Among Adolescent African American Males Who Have Sex with Males: a Pilot Study. J Racial Ethn Health Disparities [Internet]. 2015 Sept [cited 2018 May 26];2(3):290-4. Available from: https://dx.doi.org/10.1007/s40615-014-0068-5DO https://dx.doi.org/10.1007/s40615-014-00... (USA, 2013)	Descriptive qualitative	VI
Thomas TL, Strickland OL, DiClemente R, Higgins M, Haber M.3333. Thomas TL, Strickland OL, DiClemente R, Higgins M, Haber M. Rural African American parents' knowledge and decisions about human papillomavirus vaccination. J Nurs Scholarsh [Internet]. 2012 Dec [cited 2018 May 26]; 44(4):358-67. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1111/j.1547-5069.2012.01479.x http://doi-org.ez17.periodicos.capes.gov... (USA, 2010-2011	Descriptive	IV
Hanley SJ, Yoshioka E, Ito Y, Konno R, Sasaki Y, Kishi R, et al.3434. Hanley SJ, Yoshioka E, Ito Y, Konno R, Sasaki Y, Kishi R, et al. An exploratory study of Japanese fathers' knowledge of and attitudes towards HPV and HPV vaccination: does marital status matter? Asian Pac J Cancer Prev [Internet]. 2014 [cited 2018 May 26];15(4):1837-43. Available from: https://dx.doi.org/10.7314/apjcp.2014.15.4.1837 https://dx.doi.org/10.7314/apjcp.2014.15... (Japan, 2010)	Descriptive	VI
Gross TT, Laz TH, Rahman M, Berenson AB.3535. Gross TT, Laz TH, Rahman M, Berenson AB. Association between mother-child sexual communication and HPV vaccine uptake. Prev Med [Internet]. 2015 May [cited 2018 May 26]; 74:63-6. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1016/j.ypmed.2015.03.004 http://doi-org.ez17.periodicos.capes.gov... (USA, 2011-2013)	Descriptive	IV
Alder S, Gustafsson S, Perinetti C, Mints M, Sundström K, Andersson S.3636. Alder S, Gustafsson S, Perinetti C, Mints M, Sundström K, Andersson S. Mothers' acceptance of human papillomavirus (HPV) vaccination for daughters in a country with a high prevalence of HPV. Oncol Rep [Internet]. 2015 May [cited 2018 May 26]; 33(5):2521-8. Available from: https://dx.doi.org/10.3892/or.2015.3817 https://dx.doi.org/10.3892/or.2015.3817... (Argentina, 2012)	Descriptive	IV
Kepka D, Warner EL, Kinney AY, Spigarelli MG, Mooney K.3737. Kepka D, Warner EL, Kinney AY, Spigarelli MG, Mooney K. Low human papillomavirus (HPV) vaccine knowledge among Latino parents in Utah. J Immigr Minor Health [Internet]. 2015 Feb [cited 2018 May 26]; 17(1):125-31. Available from: https://www-ncbi-nlm-nih-gov.ez17.periodicos.capes.gov.br/pubmed/24609357 https://www-ncbi-nlm-nih-gov.ez17.period... (USA, 2013)	Descriptive qualitative	VI
Kruiroongroj S, Chaikledkaew U, Thavorncharoensap M.3838. Kruiroongroj S, Chaikledkaew U, Thavorncharoensap M. Knowledge, acceptance, and willingness to pay for human papilloma virus (HPV) vaccination among female parents in Thailand. Asian Pac J Cancer Prev [Internet]. 2014 [cited 2018 May 26]; 15(13):5469-74. Available from: https://www-ncbi-nlm-nih-gov.ez17.periodicos.capes.gov.br/pubmed/25041020 https://www-ncbi-nlm-nih-gov.ez17.period... (Thailand, 2013)	Descriptive	IV
Lee H, Kim M, Kiang P, Shi, L, Tan K, Chea P, et al.3939. Lee H, Kim M, Kiang P, Shi L, Tan K, Chea P, et al. Factors Associated with HPV Vaccination among Cambodian American Teenagers. Public Health Nurs[Internet]. 2016 [cited 2018 May 26]; 33: 493-501. Available from: https://dx.doi.org/10.1111/phn.12294 https://dx.doi.org/10.1111/phn.12294... (USA, 2014)	Descriptive	IV
Ogunbajo A, Hansen CE, North AL, Okoloko E, Niccolai LM.4040. Ogunbajo A, Hansen CE, North AL, Okoloko E, Niccolai LM. "I think they're all basically the same": parents' perceptions of human papilloma virus (HPV) vaccine compared with other adolescent vaccines. Child Care Health Dev [Internet]. 2016 Jul; [cited 2018 May 26]; 42(4):582-7. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1111/cch.12331 http://doi-org.ez17.periodicos.capes.gov... (USA, 2014)	Descriptive qualitative	VI
Alberts CJ, Van der Loeff MF, Hazeveld Y, Melker HE, Van der Wal MF, Nielen A, et al.4141. Alberts CJ, Van der Loeff MF, Hazeveld Y, Melker HE, Van der Wal MF, Nielen A, et al. A longitudinal study on determinants of HPV vaccination uptake in parents/guardians from different ethnic backgrounds in Amsterdam, the Netherlands. BMC Public Health [Internet]. 2017 Feb 21 [cited 2018 May 26]; 17(1):220. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1186/s12889-017-4091-4 http://doi-org.ez17.periodicos.capes.gov... (Netherlands, 2014)	Descriptive	IV
Lee KN, Chang KH, Cho SS, Park SH, Park ST.4242. Lee KN, Chang KH, Cho SS, Park SH, Park ST. Attitudes Regarding HPV Vaccinations of Children among Mothers with Adolescent Daughters in Korea. J Korean Med Sci [Internet]. 2017 Jan [cited 2018 May 26]; 32(1):130-4. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.3346/jkms.2017.32.1.130 http://doi-org.ez17.periodicos.capes.gov... (South Korea, 2016)	Descriptive	IV
Abou El-Ola MJ, Rajab MA, Abdallah DI, Fawaz IA, Awad LS, Tamim HM, et al.4343. Abou El-Ola MJ, Rajab MA, Abdallah DI, Fawaz IA, Awad LS, Tamim HM, et al. Low rate of human papillomavirus vaccination among schoolgirls in Lebanon: barriers to vaccination with a focus on mothers knowledge about available vaccines. Therapeutics and Clinical Risk Management [Internet]. 2018 [cited 2018 May 26]; 14:617-26. Available from: https://dx.doi.org/10.2147/TCRM.S152737 https://dx.doi.org/10.2147/TCRM.S152737... (Lebanon, 2016)	Descriptive	IV

Factors associated to HPV vaccine adherence	Factors associated to HPV vaccine non-adherence
Health professionals’ recommendation.1313. Ogilvie GS, Remple VP, Marra F, McNeil SA, Naus M, Pielan K, et al Intention of parents to have male children vaccinated with the human papillomavirus vaccine Sexually Transmitted Infections [Internet]. 2008 [cited 2018 May 26]; 84:318-23. Available from: http://sti.bmj.com.ez17.periodicos.capes.gov.br/content/84/4/318.citation-tools http://sti.bmj.com.ez17.periodicos.capes...	Limited knowledge about cervical cancer and HPV; high cost of vaccination; uncertain effectiveness duration; low perceived risk of infection; and fear of injection pain.1414. Kwan TTC, Chan KKL, Yip AMW, Tam KF, Cheung ANY, Young PMC et al. Barriers and facilitators to human papillomavirus vaccination among Chinese adolescent girls in Hong Kong: a qualitative-quantitative study Sexually Transmitted Infections [Internet]. 2008 [cited 2018 May 26]; 84:227-32. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18256106 https://www.ncbi.nlm.nih.gov/pubmed/1825...
Family perception about HPV risk, friends’ support and medical reassurance about vaccine safety and effectiveness.1414. Kwan TTC, Chan KKL, Yip AMW, Tam KF, Cheung ANY, Young PMC et al. Barriers and facilitators to human papillomavirus vaccination among Chinese adolescent girls in Hong Kong: a qualitative-quantitative study Sexually Transmitted Infections [Internet]. 2008 [cited 2018 May 26]; 84:227-32. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18256106 https://www.ncbi.nlm.nih.gov/pubmed/1825...
Sexual activity; knowledge about HPV as an etiological agent of cervical cancer.1515. Read DS, Joseph MA, Polishchuk V, Suss AL. Attitudes and perceptions of the HPV vaccine in Caribbean and African-American adolescent girls and their parents. J Pediatr Adolesc Gynecol [Internet]. 2010 Aug [cited 2018 May 26]; 23(4):242-5. Available from: https://www-sciencedirect-com.ez17.periodicos.capes.gov.br/science/article/pii/S1083318810000768?via%3Dihub https://www-sciencedirect-com.ez17.perio...	Age under 13 years.1616. Kahn JA, Ding L, Huang B, Zimet GD, Rosenthal SL, Frazier AL. Mothers' intention for their daughters and themselves to receive the human papillomavirus vaccine: a national study of nurses. Pediatrics [Internet]. 2009 June [cited 2018 May 26]; 123(6):1439-45. Available from: https://doi-org.ez17.periodicos.capes.gov.br/10.1542/peds.2008-1536 https://doi-org.ez17.periodicos.capes.go...
	Lack of knowledge about vaccine safety.1717. Krawczyk A, Knäuper B, Gilca V, Dubé E, Perez S, Joyal-Desmarais K, et al. Parents decision-making about the human papillomavirus vaccine for their daughters: I. Quantitative results. Human Vaccines & Immunotherapeutics [Internet]. 2015 [cited 2018 May 26]; 11(2):322-9. Available from: http://doi.org/10.1080/21645515.2014.1004030 . http://doi.org/10.1080/21645515.2014.100...
Susceptibility perception of HPV infection and knowing vaccine benefits.1717. Krawczyk A, Knäuper B, Gilca V, Dubé E, Perez S, Joyal-Desmarais K, et al. Parents decision-making about the human papillomavirus vaccine for their daughters: I. Quantitative results. Human Vaccines & Immunotherapeutics [Internet]. 2015 [cited 2018 May 26]; 11(2):322-9. Available from: http://doi.org/10.1080/21645515.2014.1004030 . http://doi.org/10.1080/21645515.2014.100...	Being black among minorities; lack of information about public funding for vaccination.1818. Keenan K, Hipwell A, Stepp S. Race and Sexual Behavior Predict Uptake of the Human Papillomavirus Vaccine. Health Psychology [Internet]. 2012 Jan [cited 2018 May 26]; 31(1):31-4. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1037/a0026812 http://doi-org.ez17.periodicos.capes.gov...
Intimate sexual behavior in the previous year.1818. Keenan K, Hipwell A, Stepp S. Race and Sexual Behavior Predict Uptake of the Human Papillomavirus Vaccine. Health Psychology [Internet]. 2012 Jan [cited 2018 May 26]; 31(1):31-4. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1037/a0026812 http://doi-org.ez17.periodicos.capes.gov...	No social circle to talk about the vaccine.1919. Baldwin AS, Bruce CM, Tiro JA. Understanding how mothers of adolescent girls obtain information about the human papillomavirus vaccine: associations between mothers' health beliefs, information seeking, and vaccination intentions in na ethnically diverse sample. J Health Psychol [Internet]. 2013 Jul [cited 2018 May 26]; 18(7):926-38. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1177/1359105312445078 http://doi-org.ez17.periodicos.capes.gov...
Recommendation by doctors and inter-personal sources.1919. Baldwin AS, Bruce CM, Tiro JA. Understanding how mothers of adolescent girls obtain information about the human papillomavirus vaccine: associations between mothers' health beliefs, information seeking, and vaccination intentions in na ethnically diverse sample. J Health Psychol [Internet]. 2013 Jul [cited 2018 May 26]; 18(7):926-38. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1177/1359105312445078 http://doi-org.ez17.periodicos.capes.gov...	Belief in a lack of vulnerability to cervical cancer; fear of vaccine adverse events.2020. Klötzler A, Kolip P. Decision for or against HPV vaccination - a qualitative study with adolescent girls. Gesundheitswesen [Internet]. 2012 Nov [cited 2018 May 26]; 74(11):716-21. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22012564 https://www.ncbi.nlm.nih.gov/pubmed/2201...
Protection against cervical cancer; gynecologists’ recommendation.2020. Klötzler A, Kolip P. Decision for or against HPV vaccination - a qualitative study with adolescent girls. Gesundheitswesen [Internet]. 2012 Nov [cited 2018 May 26]; 74(11):716-21. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22012564 https://www.ncbi.nlm.nih.gov/pubmed/2201...	Fear of vaccine adverse effects; age under 13 years; religious beliefs and low perceived risk of HPV infection.2121. Marlow LA, Wardle J, Waller J. Attitudes to HPV vaccination among ethnic minority mothers in the UK: an exploratory qualitative study. Hum Vaccin [Internet]. 2009 Feb [cited 2018 May 26];5(2):105-10. Available from: https://dx.doi.org/10.4161/hv.5.2.7368 https://dx.doi.org/10.4161/hv.5.2.7368...
Easier geographic access to vaccination services.2222. Tsui J, Singhal R, Rodriguez HP, Gee GC, Glenn BA, Bastani R. Proximity to safety-net clinics and HPV vaccine uptake among low-income, ethnic minority girls. Vaccine [Internet]. 2013 Apr 12 [cited 2018 May 26]; 31(16):2028-34. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1016/j.vaccine.2013.02.046 http://doi-org.ez17.periodicos.capes.gov...	Lack of knowledge about HPV, not speaking the local language, and absence of health insurance.2323. Glenn BA, Tsui J, Singhal R, Sanchez L, Nonzee NJ, Chang LC, et al. Factors associated with HPV awareness among mothers of low-income ethnic minority adolescent girls in Los Angeles. Vaccine [Internet]. 2015 Jan 3 [cited 2018 May 26]; 33(2):289-93. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1016/j.vaccine.2014.11.032 http://doi-org.ez17.periodicos.capes.gov...
Belief in the protection offered by vaccines, health professionals’ recommendations and impact on sexual practice.2323. Glenn BA, Tsui J, Singhal R, Sanchez L, Nonzee NJ, Chang LC, et al. Factors associated with HPV awareness among mothers of low-income ethnic minority adolescent girls in Los Angeles. Vaccine [Internet]. 2015 Jan 3 [cited 2018 May 26]; 33(2):289-93. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1016/j.vaccine.2014.11.032 http://doi-org.ez17.periodicos.capes.gov...	Being black or belonging to other ethnical minorities.2424. Bowyer H, Forster A, Marlow L, Waller J. Predicting human papillomavirus vaccination behaviour among adolescent girls in England: Results from a prospective survey. J Fam Plann Reprod Health Care [Internet]. 2014 [cited 2018 May 26]; 40(1):14-22. Available from: http://dx.doi-org.ez17.periodicos.capes.gov.br/10.1136/jfprhc-2013-100583 http://dx.doi-org.ez17.periodicos.capes....
Teenagers with autonomy for decision making.2525. Katz IT, Nkala B, Dietrich J, Wallace M, Bekker LG, Pollenz K, et al. A Qualitative Analysis of Factors Influencing HPV Vaccine Uptake in Soweto, South Africa among Adolescents and Their Caregivers. PLoS ONE [Internet]. 2013 [cited 2018 May 26]; 8(8):e72094. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1371/journal.pone.0072094 http://doi-org.ez17.periodicos.capes.gov...	Being black, smoking, lack of access to primary health consultations and to health insurance.2727. Widdice LE, Hoagland R, Callahan ST, Kahn JA, Harrison CJ, Pahud BA, et al. Caregiver and adolescent factors associated with delayed completion of the three-dose human papillomavirus vaccination series. Vaccine [Internet]. 2018 Mar 7 [cited 2018 May 26]; 36(11):1491-9. Available from: https://dx.doi.org/10.1016/j.vaccine.2017.12.060UR https://dx.doi.org/10.1016/j.vaccine.201...
Knowledge about HPV infection and its relation with cervical cancer.2626. Hanley SJ, Yoshioka E, Ito Y, Konno R, Hayashi Y, Kishi R, et al. Acceptance of and attitudes towards human papillomavirus vaccination in Japanese mothers of adolescent girls. Vaccine [Internet]. 2012 Aug 24 [cited 2018 May 26]; 30(39):5740-7. Available from: https://doi-org.ez17.periodicos.capes.gov.br/10.1016/j.vaccine.2012.07.003 https://doi-org.ez17.periodicos.capes.go...
Age (the older ones), being white, low income, knowledge about cervical cancer, about the vaccine and where it is offered. Recommendation by teachers and health professionals.2828. Naggar RA, Bobryshev YV, Jashamy K, Musli M. Practice of HPV vaccine and associated factors among school girls in Melaka, Malaysia. Asian Pac J Cancer Prev [Internet]. 2012 [cited 2018 May 26];13(8):3835-40. Available from: http:s//dx.doi.org/10.7314/APJCP.2012.13.8.3835 http:s//dx.doi.org/10.7314/APJCP.2012.13...	Habitual use of condoms.2929. Shao SJ, Nurse C, Michel L, Joseph MA, Suss AL. Attitudes and Perceptions of the Human Papillomavirus Vaccine in Caribbean and African American Adolescent boys and Their Parents. J Pediatr Adolesc Gynecol [Internet]. 2015 Oct [cited 2018 May 26]; 28(5):373-7. Available from: https://doi-org.ez17.periodicos.capes.gov.br/10.1016/j.jpag.2014.11.003 https://doi-org.ez17.periodicos.capes.go...
	Lack of parental consent, related to beliefs and values about sexual activity, to education and to language barriers.3131. Ferrer BH, Trotter CL, Hickman M, Audrey S. Barriers and facilitators to uptake of the school-based HPV vaccination programme in an ethnically diverse group of young women. J Public Health (Oxf) [Internet]. 2016 Sept [cited 2018 May 26]; 38(3):569-77. Available from: https://doi-org.ez17.periodicos.capes.gov.br/10.1093/pubmed/fdv073 https://doi-org.ez17.periodicos.capes.go...
Increase in the number of sexual partners.2929. Shao SJ, Nurse C, Michel L, Joseph MA, Suss AL. Attitudes and Perceptions of the Human Papillomavirus Vaccine in Caribbean and African American Adolescent boys and Their Parents. J Pediatr Adolesc Gynecol [Internet]. 2015 Oct [cited 2018 May 26]; 28(5):373-7. Available from: https://doi-org.ez17.periodicos.capes.gov.br/10.1016/j.jpag.2014.11.003 https://doi-org.ez17.periodicos.capes.go...
Vaccine protection against genital warts; knowing a relative or friend who is vaccinated; sexual activity; knowing somebody with genital warts.3030. Khurana S, Sipsma HL, Caskey RN. HPV vaccine acceptance among adolescent males and their parents in two suburban pediatric practices. Vaccine [Internet]. 2015 Mar 24 [cited 2018 May 26]; 33(13):1620-4. Available from: https://doi-org.ez17.periodicos.capes.gov.br/10.1016/j.vaccine.2015.01.038 https://doi-org.ez17.periodicos.capes.go...	Lack of knowledge about potential risks of HPV among men who have sex with other men and about HPV vaccine.3232. Onyeabor OS, Martin N, Orish VN, Sanyaolu AO, Iriemenam NC. Awareness of Human Papillomavirus Vaccine Among Adolescent African American Males Who Have Sex with Males: a Pilot Study. J Racial Ethn Health Disparities [Internet]. 2015 Sept [cited 2018 May 26];2(3):290-4. Available from: https://dx.doi.org/10.1007/s40615-014-0068-5DO https://dx.doi.org/10.1007/s40615-014-00...
Vaccine offered in school; knowledge about infection risks and cervical cancer prevention.3131. Ferrer BH, Trotter CL, Hickman M, Audrey S. Barriers and facilitators to uptake of the school-based HPV vaccination programme in an ethnically diverse group of young women. J Public Health (Oxf) [Internet]. 2016 Sept [cited 2018 May 26]; 38(3):569-77. Available from: https://doi-org.ez17.periodicos.capes.gov.br/10.1093/pubmed/fdv073 https://doi-org.ez17.periodicos.capes.go...	Lack of knowledge about HPV.3434. Hanley SJ, Yoshioka E, Ito Y, Konno R, Sasaki Y, Kishi R, et al. An exploratory study of Japanese fathers' knowledge of and attitudes towards HPV and HPV vaccination: does marital status matter? Asian Pac J Cancer Prev [Internet]. 2014 [cited 2018 May 26];15(4):1837-43. Available from: https://dx.doi.org/10.7314/apjcp.2014.15.4.1837 https://dx.doi.org/10.7314/apjcp.2014.15...
Culture, religion and faith influence the decision.3333. Thomas TL, Strickland OL, DiClemente R, Higgins M, Haber M. Rural African American parents' knowledge and decisions about human papillomavirus vaccination. J Nurs Scholarsh [Internet]. 2012 Dec [cited 2018 May 26]; 44(4):358-67. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1111/j.1547-5069.2012.01479.x http://doi-org.ez17.periodicos.capes.gov...	Lack of knowledge about the vaccine among parents.3737. Kepka D, Warner EL, Kinney AY, Spigarelli MG, Mooney K. Low human papillomavirus (HPV) vaccine knowledge among Latino parents in Utah. J Immigr Minor Health [Internet]. 2015 Feb [cited 2018 May 26]; 17(1):125-31. Available from: https://www-ncbi-nlm-nih-gov.ez17.periodicos.capes.gov.br/pubmed/24609357 https://www-ncbi-nlm-nih-gov.ez17.period...
Mother-child communication about sexually transmitted infections, contraception and condoms.3535. Gross TT, Laz TH, Rahman M, Berenson AB. Association between mother-child sexual communication and HPV vaccine uptake. Prev Med [Internet]. 2015 May [cited 2018 May 26]; 74:63-6. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1016/j.ypmed.2015.03.004 http://doi-org.ez17.periodicos.capes.gov...	Limited knowledge about HPV and the vaccine among parents.3838. Kruiroongroj S, Chaikledkaew U, Thavorncharoensap M. Knowledge, acceptance, and willingness to pay for human papilloma virus (HPV) vaccination among female parents in Thailand. Asian Pac J Cancer Prev [Internet]. 2014 [cited 2018 May 26]; 15(13):5469-74. Available from: https://www-ncbi-nlm-nih-gov.ez17.periodicos.capes.gov.br/pubmed/25041020 https://www-ncbi-nlm-nih-gov.ez17.period...
Mothers’ acceptance of the vaccine.3636. Alder S, Gustafsson S, Perinetti C, Mints M, Sundström K, Andersson S. Mothers' acceptance of human papillomavirus (HPV) vaccination for daughters in a country with a high prevalence of HPV. Oncol Rep [Internet]. 2015 May [cited 2018 May 26]; 33(5):2521-8. Available from: https://dx.doi.org/10.3892/or.2015.3817 https://dx.doi.org/10.3892/or.2015.3817...	Adverse events associated to the vaccine.4242. Lee KN, Chang KH, Cho SS, Park SH, Park ST. Attitudes Regarding HPV Vaccinations of Children among Mothers with Adolescent Daughters in Korea. J Korean Med Sci [Internet]. 2017 Jan [cited 2018 May 26]; 32(1):130-4. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.3346/jkms.2017.32.1.130 http://doi-org.ez17.periodicos.capes.gov...
Knowledge about HPV.3939. Lee H, Kim M, Kiang P, Shi L, Tan K, Chea P, et al. Factors Associated with HPV Vaccination among Cambodian American Teenagers. Public Health Nurs[Internet]. 2016 [cited 2018 May 26]; 33: 493-501. Available from: https://dx.doi.org/10.1111/phn.12294 https://dx.doi.org/10.1111/phn.12294...	Mothers’ lack of knowledge about the vaccine, uncertainty about its safety or effectiveness, worries about future sex life and vaccine costs.4343. Abou El-Ola MJ, Rajab MA, Abdallah DI, Fawaz IA, Awad LS, Tamim HM, et al. Low rate of human papillomavirus vaccination among schoolgirls in Lebanon: barriers to vaccination with a focus on mothers knowledge about available vaccines. Therapeutics and Clinical Risk Management [Internet]. 2018 [cited 2018 May 26]; 14:617-26. Available from: https://dx.doi.org/10.2147/TCRM.S152737 https://dx.doi.org/10.2147/TCRM.S152737...
HPV vaccine offer as part of the adolescent’s vaccination schedule, with the additional benefit of cancer prevention.4040. Ogunbajo A, Hansen CE, North AL, Okoloko E, Niccolai LM. "I think they're all basically the same": parents' perceptions of human papilloma virus (HPV) vaccine compared with other adolescent vaccines. Child Care Health Dev [Internet]. 2016 Jul; [cited 2018 May 26]; 42(4):582-7. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1111/cch.12331 http://doi-org.ez17.periodicos.capes.gov...
Mothers’ acceptance of the vaccine.4141. Alberts CJ, Van der Loeff MF, Hazeveld Y, Melker HE, Van der Wal MF, Nielen A, et al. A longitudinal study on determinants of HPV vaccination uptake in parents/guardians from different ethnic backgrounds in Amsterdam, the Netherlands. BMC Public Health [Internet]. 2017 Feb 21 [cited 2018 May 26]; 17(1):220. Available from: http://doi-org.ez17.periodicos.capes.gov.br/10.1186/s12889-017-4091-4 http://doi-org.ez17.periodicos.capes.gov...

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