Social Determinants of Health and Human Papillomavirus Vaccination Uptake: A Systematic Review

OBJECTIVES: This study aimed to examine the influence of the World Health Organization's social determinants of health (SDoHs) as barriers or facilitators to human papillomavirus (HPV) vaccination among females aged under 18 years and their guardians in countries with publicly funded vaccination programs. STUDY SELECTION: A systematic review was conducted using Ovid Medline, Embase, and CINAHL from inception to June 21, 2022. Eligible studies included females aged under 18 years or their guardians in jurisdictions offering HPV vaccination free of charge. Cohort, cross-sectional, qualitative, and mixed-methods designs were included. Two reviewers independently screened and appraised studies using Joanna Briggs Institute tools; those scoring below 75% were excluded. DATA SYNTHESIS: Data from 75 studies were synthesized according to 5 SDoH domains: economic stability, education access and quality, health care access and quality, neighbourhood and built environment, and social and community context. CONCLUSIONS: Key barriers included low socioeconomic status, unemployment, limited parental health literacy, lack of health care provider recommendation, and religious or cultural opposition. Lower vaccination rates were observed among marginalized, immigrant, and Indigenous populations. Facilitators included higher household income, parental or adolescent education, comprehensive vaccine information, and school-based vaccination programs that provided free and convenient access. HPV vaccination uptake among adolescent girls is shaped by inter-related SDoHs. Interventions that address socioeconomic disparities, strengthen health literacy and provider communication, and promote culturally sensitive outreach are critical to improving equitable vaccine coverage.