Viliam Tomljenovic

Teaching Institute of Public Health, Croatia

Title: Factors Contributing to Parental Hesitation Toward HPV Vaccination: A Literature Review

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Biography

Viliam Tomljenovic is a medical doctor working at the Department of School and Adolescent Medicine at the Teaching Institute of Public Health "Dr. Andrija Stampar" in Zagreb. He graduated from the University of Zagreb School of Medicine and is currently engaged in preventive care for school and university population. His professional interests include scientific research in public and adolescent health.

Abstract

Human papillomavirus (HPV) vaccination represents a critical public health intervention aimed at preventing HPV-related malignancies, including cervical, anal, and oropharyngeal cancers. Despite robust evidence demonstrating the safety and efficacy of vaccines such as Gardasil 9, global vaccine uptake among adolescents remains suboptimal, predominantly due to parental hesitancy. This literature review synthesizes findings from peer-reviewed empirical studies to elucidate the multifactorial determinants of parental HPV vaccine hesitancy. Central themes include knowledge deficits, whereby parents often lack adequate understanding of HPV transmission, associated disease burden, and vaccine benefits, contributing to undervaluation of vaccination importance. Safety concerns emerge as a predominant barrier, fueled by fears of long-term adverse effects such as infertility and autoimmune disorders, despite absence of credible scientific evidence. Sociocultural and religious factors further complicate decision-making, with some communities perceiving HPV vaccination as conflicting with sexual morality or abstinence norms. The review also highlights the pivotal role of trust in healthcare providers and systems, noting that explicit, culturally sensitive recommendations from clinicians significantly enhance vaccine acceptance, whereas mistrust exacerbates hesitancy, especially among marginalized groups. Additionally, parental fears that vaccination might encourage early or promiscuous sexual behavior persist despite consistent evidence refuting such claims. Structural and logistical challenges, including limited access to vaccination services and administrative barriers, contribute to lower uptake independently of attitudinal hesitancy. The pervasive influence of misinformation disseminated via social media platforms is identified as a powerful driver of parental doubts, amplifying risk perceptions and undermining confidence in public health messaging. Methodological limitations in the existing literature include reliance on cross-sectional designs and underrepresentation of diverse parental perspectives, notably fathers and non-Western populations. This review concludes that parental HPV vaccine hesitancy is a complex, interrelated phenomenon necessitating multifaceted intervention strategies. Effective approaches must integrate accurate and transparent health communication, culturally tailored outreach, trusted provider engagement, and systemic facilitation of vaccine access. Advancing research through longitudinal studies and inclusive sampling will further inform evidence-based policies to enhance vaccination coverage and realize the full public health benefits of HPV immunization programs.