Multi-Level Determinants of Parental Decision-Making on HPV Vaccination in West Africa: A Scoping Review protocol

Abstract: Background: Cervical cancer continues to be a significant contributor to cancer-related mortality among women worldwide, particularly in Sub-Saharan Africa (SSA), where the burden is notably higher. West Africa represents a significant proportion of cervical cancer mortality, primarily due to restricted access to screening and inadequate uptake of human papillomavirus (HPV) vaccination. The HPV vaccine demonstrates high efficacy; however, uptake among eligible girls aged 9–14 years is notably low in several West African nations. Decision-making by parents and caregivers is crucial for vaccine uptake and is influenced by a complex interaction of individual, social, cultural, and health-system factors. Objective: The objective of this scoping review is to systematically map and synthesize evidence on the multi-level determinants that influence parental and caregiver decision-making concerning HPV vaccination for pre-adolescent girls (aged 9–14 years) in West Africa, employing a socio-ecological framework. Methods: This review will adhere to the JBI methodology for scoping reviews and will be reported in accordance with PRISMA-ScR guidelines. A thorough search of both published and grey literature from 2007 onwards will be conducted across databases including MEDLINE (Ovid) and Embase, along with essential organizational sources such as WHO, UNICEF, Gavi, and national Ministries of Health. Two reviewers will independently evaluate studies and extract data utilizing a structured, spreadsheet-based extraction tool created in Microsoft Excel. The instrument integrates predefined binary (1/0) and Yes/No coded variables with free-text fields to capture contextual details at the individual, interpersonal, community, and health-system levels. Data will be synthesized through descriptive methods, including tabular summaries, ecological mapping, and narrative analysis. Expected outcomes: The anticipated results of this review include the identification of significant barriers and facilitators influencing parental decisions regarding HPV vaccination in West Africa, the highlighting of evidence gaps, and the provision of context-specific strategies aimed at enhancing vaccine uptake and cervical cancer prevention in the region.