Health beliefs and parental responses to human papillomavirus vaccination in the Middle East: a theory-informed narrative synthesis guided by the health belief model
Year: 2026
Type: article
Study design: Systematic Review
Abstract: Background Human papillomavirus (HPV) is the most common sexually transmitted infection in women and the primary cause of cervical cancer (CC). HPV vaccination and screening programs have significantly reduced CC incidence and mortality worldwide, preventing up to 70% of HPV-related CC and 90% of genital warts. Developing effective vaccination strategies is therefore essential. Objectives This study systematically synthesizes the attitudes and health beliefs of Middle Eastern (ME) parents regarding HPV vaccination, examines parental vaccine uptake, and assesses uptake among their children. Methods This systematic review followed PRISMA guidelines. PubMed/MEDLINE, Web of Science, CINAHL, and Google Scholar were searched for studies published between January 2006 and May 2025. Thirty-three studies were included. A theory-informed narrative synthesis of predominantly quantitative evidence was conducted, with deductive mapping of findings to the health belief model (HBM) constructs. The review protocol was registered in PROSPERO (CRD42025645551). Results The review included 32 quantitative cross-sectional studies and one qualitative study, involving 18,170 participants. Findings were organized according to HBM constructs, including perceived susceptibility, severity, barriers, benefits, self-efficacy, and cues to action. Parents generally demonstrated limited knowledge of HPV and vaccination. Major barriers included safety concerns, cost, limited access, lack of healthcare provider recommendations, and insufficient information. Cultural and systemic factors were also associated with vaccine uptake. Conclusion HPV-related knowledge in ME countries remains insufficient and is frequently associated with vaccination attitudes and acceptance across the included studies. Improving uptake requires targeted educational interventions, healthcare provider engagement, public health campaigns, financial support, and policy-level initiatives. Strengthening awareness and addressing structural barriers are critical for enhancing vaccination acceptance. Self-efficacy, where directly reported, appeared to be associated with more favorable vaccine attitudes; however, direct evidence for parental self-efficacy as a distinct HBM construct was limited across the included studies and should not be overstated. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/myprospero/CRD42025645551 .
Source: Frontiers in Public Health
Institutions: University of Bradford, Linnaeus University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223268593