Context
Despite current recommendations, human papillomavirus vaccine uptake remains low.
A systematic review and meta-analysis assessed the effectiveness of interventions
targeting human papillomavirus vaccine initiation and completion among children, adolescents,
and young adults aged 9–26 years.
Evidence acquisition
Three electronic databases (CINAHL, OVID, and Web of Science) were searched for articles
published in English peer-reviewed journals between January 2006 and January 2017
of U.S. studies that evaluated intervention strategies and reported post-intervention
human papillomavirus vaccine initiation or completion rates among individuals aged
9–26 years. Study characteristics and outcomes were extracted. Data were collected
in 2016 and analyzed in 2017.
Evidence synthesis
Reviewers screened 983 unique titles and abstracts, read 241 full-text articles, and
extracted data from 30 articles meeting the inclusion criteria (12 behavioral, ten
environmental, four informational, and four combination strategies). Published EQUATOR
(Enhancing the Quality and Transparency of Health Research) guidelines were used to
assess study quality. Random effects meta-analyses were conducted. The meta-analyses
included 17 RCTs and quasi-experiments involving 68,623 children, adolescents, and
young adults. The pooled relative incidence estimates were 1.84 (95% CI=1.36, 2.48)
for human papillomavirus vaccine initiation and 1.50 (95% CI=1.23, 1.83) for completion.
Behavioral and informational interventions doubled human papillomavirus vaccine initiation
(relative incidence estimate=2.04, 95% CI=1.36, 3.06 and relative incidence estimate=1.92,
95% CI=1.27, 2.91, respectively). Behavioral interventions increased completion by
68% (relative incidence estimate=1.68, 95% CI=1.25, 2.27).
Conclusions
Evidence supports behavioral interventions for increasing human papillomavirus vaccine
initiation and completion. Future studies are needed to assess the effectiveness of
interventions in reaching diverse populations and reducing missed opportunities for
human papillomavirus vaccination.
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Article info
Publication history
Published online: February 15, 2019
Identification
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© 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
