title: Self-reported barriers and facilitators to preventive human papillomavirus vaccination among adolescent girls and young women: a systematic review.
abstract: OBJECTIVE
  Widespread uptake of preventive human papillomavirus vaccination among target groups is an important public health goal. To evaluate barriers and facilitators to human papillomavirus vaccination, we conducted a systematic review of self-reported views of adolescent girls and young women.
  
  
  METHODS
  Twenty-two studies including 8079 females aged 9-26 years in North America, published between 2008 and 2011 (representing studies conducted post-vaccine availability), were included. Two reviewers performed all levels of screening and data abstraction in duplicate. We collated findings pertaining to vaccination barriers and facilitators, study characteristics, and study quality.
  
  
  RESULTS
  Participants were mainly unvaccinated (70%) and sexually active. Twenty-one barriers to vaccination were identified. Cost was the most frequently reported barrier, followed by feelings that vaccination was unnecessary, and concerns regarding vaccine safety and side effects. Facilitators included perceived benefit of vaccination, health care provider recommendations, and social norms. Few studies specifically sought to isolate the views of adolescents, though not being sexually active was the most commonly reported barrier among this group.
  
  
  CONCLUSIONS
  Understanding factors which arbitrate in vaccination decisions among key target groups can improve the success of health promotion interventions. Additional studies of superior methodological quality are needed to produce reliable data to inform health promotion strategies.
authors.affiliation: Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario K1H 8L6, Canada. Electronic address: lrambout@ottawahospital.on.ca.
authors.forename: Lisa
authors.initials: L
authors.lastname: Rambout
authors.affiliation: Applied Health Research Centre of St. Michael's Hospital, Toronto, Ontario M5B 1M8, Canada. Electronic address: TashkandiM@smh.ca.
authors.forename: Mariam
authors.initials: M
authors.lastname: Tashkandi
authors.affiliation: Division of Gynaecologic Oncology, The Ottawa Hospital, Ottawa, Ontario K1H 8L6, Canada. Electronic address: mhopkins@fhs.csu.mcmaster.ca.
authors.forename: Laura
authors.initials: L
authors.lastname: Hopkins
authors.affiliation: Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario M5B 1T8, Canada. Electronic address: TriccoA@smh.ca.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Tricco
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics; D057566:Self Report; D012725:Sexual Behavior; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Adolescence; Barrier; Facilitator; HPV; HPV vaccination; HPV vaccine acceptability; HPV vaccine uptake; Human papillomavirus; Self-report; Systematic review