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Study Protocol

A Comparative Analysis of Parent-Centered versus Parent-Adolescent Dyad Interventions to Enhance HPV vaccination Uptake in Children and Adolescents: Protocol for Systematic Review and meta-analysis

[version 1; peer review: 1 not approved]
PUBLISHED 09 Jan 2025
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Abstract

Background

Human papillomavirus (HPV) vaccination among children and adolescents is crucial for the prevention of HPV-related diseases later in life. However, HPV vaccination uptake remains suboptimal in this population. This protocol outlines a comprehensive review that aims to evaluate the effectiveness of interventions targeting parents and parent-adolescent dyads in improving HPV vaccination uptake among children and adolescents aged 9-18 years.

Objective

The objective of this study is to assess the impact of parent-directed and parent-adolescent dyad interventions on HPV vaccination uptake in children and adolescents aged 9-18 years. Specific objectives include reviewing existing literature on parent-oriented and parent-adolescent dyad interventions, assessing vaccination uptake, identifying influencing factors, and providing evidence-based recommendations for intervention development and implementation.

Methods

A systematic review will be conducted, encompassing literature published up to the present day. Various databases will be searched for relevant studies on parent-focused and parent-adolescent dyad interventions aimed at improving HPV vaccination uptake. Data extraction and analysis will be performed to assess the proportion of children and adolescents receiving HPV vaccination following interventions, factors influencing vaccination uptake, and completion rates of the recommended vaccine series.

Results

The review findings will be analyzed using appropriate statistical methods, including meta-analysis to estimate the overall effect size of interventions. Subgroup and sensitivity analyses will be conducted to explore heterogeneity and assess the robustness of the results.

Conclusion

This protocol outlines a comprehensive review that will contribute to the current understanding of the effectiveness of parent-oriented and parent-adolescent dyad interventions in improving HPV vaccination uptake among children and adolescents. The findings will inform the development and implementation of targeted interventions to address barriers and improve vaccination coverage, ultimately reducing the burden of HPV-related diseases.

Keywords

HPV vaccination, parent-cantered interventions, parent-adolescent dyad interventions, children, adolescents, systematic review

Introduction

Human papillomavirus (HPV) is a cancer-causing virus that is transmitted through sexual contact (Bruni et al., 2021; Wang & Palefsky, 2015). HPV vaccination is an effective virus-prevention strategy. However, uptake of the HPV vaccine among children and adolescents remains low. Parents play a significant role in their children’s HPV vaccination decisions. As techniques to enhance HPV vaccination uptake in children and adolescents, parent-directed interventions as well as parent-adolescent dyad interventions have been recommended (Choi et al., 2023). A comparison of these strategies will give healthcare practitioners and policymakers valuable information about the most effective interventions for improving HPV vaccination uptake in children and adolescents. The goal of this protocol is to undertake a comprehensive review of the effectiveness of interventions aimed at parents and parent-adolescent dyads in improving HPV vaccination uptake in order to influence policy and practice (Bhengu, 2024).

Research question

What is the impact of parent-directed and parent-adolescent dyad interventions on HPV vaccination uptake among children and adolescents between 9-18 years?

Objectives

General objective

To evaluate the effectiveness of interventions targeting parents and parent-adolescent dyads in improving HPV vaccination uptake among children and adolescents between 9-18 years.

Specific objectives

  • a) To systematically review and synthesize existing literature on parent-directed and parent-adolescent dyad interventions aimed at increasing HPV vaccination uptake.

  • b) To assess the proportion of children and adolescents between 9 and 18 years who receive at least one dose of HPV vaccine after parent-directed or parent-adolescent dyad interventions compared to the standard HPV vaccination program.

  • c) To determine the proportion of children and adolescents between 9 and 18 years who complete the recommended HPV vaccine series after parent-directed or parent-adolescent dyad interventions compared to the standard HPV vaccination program.

  • d) To identify factors influencing HPV vaccination uptake, including parental knowledge, attitudes, and barriers, within the context of parent-directed and parent-adolescent dyad interventions.

  • e) To provide evidence-based recommendations for the development and implementation of effective interventions to improve HPV vaccination uptake among children and adolescents between 9-18 years.

Methods

Criteria for considering studies for this review

We will evaluate randomized trials, non-randomized trials, interrupted time-series studies, and controlled before-and-after studies that fulfil the study design criteria for Cochrane Effective Practice and Organization of Care (EPOC, 2017). Only cluster-randomized control studies with at least two intervention and two comparison clusters will be considered. Interrupted time series investigations will be considered only if the data are collected during at least three time points before and three time points after the intervention. Only controlled before-and-after studies with at least two intervention groups and at least two comparison groups will be considered

Type of participants:

Participants are girls aged 9 to 18 years eligible for WHO recommended HPV vaccines and their parents.

Types of interventions:

The intervention will involve educational programs, counselling sessions, reminders, and other strategies targeting parents and parent-adolescent dyads to increase awareness and knowledge about HPV vaccination, address concerns, and promote vaccination uptake.

These might include:

  • * interventions to communicate with adolescents or their parents (or both) about adolescent HPV vaccination;

  • * financial and non-financial incentives for adolescents or their parents (or both); and

  • * mandatory vaccination i.e. vaccination requirement for school attendance

Exclusions:

We will exclude systematic reviews and studies that are not centered on parents or parent-adolescent dyads such as interventions focusing on providers or health systems improvement etc. We will also exclude studies not reporting separated data for girls between 9 and 18 years.

Comparisons:

The comparison group will include individuals who receive standard HPV vaccination services without any additional parent-directed or parent-adolescent dyad interventions. Additionally, alternative interventions and similar interventions implemented with different degrees of intensity might also be compared.

Types of outcome measures

Primary outcome:

  • - Proportion of children and adolescents aged 9-18 years who receive at least one dose of HPV vaccine.

Secondary outcomes:

  • - Proportion of children and adolescents aged 9-18 years who complete the recommended HPV vaccine series.

  • - Parental knowledge, attitudes, and barriers to HPV vaccination.

Search methods for identification of studies

We will collaboratework with an information specialist librarian to createdevelop a comprehensive search strategy for. We will do searches in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Web of Science, and Scopus. We shall then implement the strategy, searching for records indexed in these databases from their inception to beginning until the day of the search The following search terms will be used: “HPV vaccination,” “parent-centered interventions,” “parent-adolescent dyad interventions,” “children,” “adolescents,” “uptake,” “barriers,” and “facilitators.” We will also assess the proceedings of recent HPV-related conferences for potentially eligible articles not available from other sources.

Selection of studies

Two authors will independently evaluate the summaries of identified records to determine their potential eligibility. Full texts of studies deemed potentially relevant will then be retrieved and reviewed by both authors, resolving any discrepancy on the relevance of any article through discussion and mutual agreemenassess the titles and abstracts of records for potential eligibility. Following this, the full text of potentially relevant studies will be obtained and assessed in duplicate. Disagreements between the two review authors will be resolved by discussion and consensut

Data extraction and management

Two review authors will gather data from each included study independently using a systematic and consistent data extraction form. Extracted data will comprise study setting, study type, participant type, intervention type, comparator type, and outcomes monitored. Disagreements between the review authors will be settled through consensus and arbitration by third author.

Bias risk assessment in included studies

We will evaluate the risk of systematic errors in included studies, in duplicate, using the checklist developed by Cochrane (Higgins et al., 2022). The two review authors will independently describe what the research authors reported doing for each domain for each included study and then make a decision regarding the risk of systematic errors in the study through discussion and consensus.

Data synthesis

Data from selected studies will be extracted and analysed using appropriate statistical methods. Meta-analysis will be performed to estimate the overall effect size of parent-drected and parent-adolescent dyad interventions on HPV vaccination uptake. Subgroup analyses and sensitivity analyses will be conducted to explore heterogeneity and assess the robustness of the findings.

Limitations and strengths

Limitations:

  • - Potential variations in study design, interventions, and outcome measures across included studies.

  • - Limited availability of studies specifically focusing on parent-adolescent dyad interventions.

  • - Potential publication bias.

Strengths:

  • - Comprehensive search strategy to identify relevant studies.

  • - Utilization of meta-analysis to generate pooled effect estimates.

  • - Inclusion of both parent-directed and parent-adolescent dyad interventions, allowing for a comparative analysis.

Public health significance

This study’s findings will provide valuable insights into the effectiveness of parent-directed and parent-adolescent dyad interventions in improving HPV vaccination uptake among children and adolescents. The results will inform the development of evidence-based strategies and interventions to enhance HPV vaccination coverage, aligning with the objectives of the World Health Organization’sImmunization Agenda 2030. By promoting higher vaccination rates, this research has the potential to reduce HPV-related diseases, including cervical cancer, and contribute to improved public health outcomes.

Reporting guidelines

Harvard Dataverse: Checklist for article “A Comparative Analysis of Parent-Centered versus Parent-Adolescent Dyad Interventions to Enhance HPV vaccination Uptake in Children and Adolescents: Protocol for Systematic Review and meta-analysis” DOI: https://doi.org/10.7910/DVN/YOT2JG (Bhengu, 2024).

Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication).

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Bhengu P, Ndwandwe D, Kuodi P et al. A Comparative Analysis of Parent-Centered versus Parent-Adolescent Dyad Interventions to Enhance HPV vaccination Uptake in Children and Adolescents: Protocol for Systematic Review and meta-analysis [version 1; peer review: 1 not approved]. F1000Research 2025, 14:56 (https://doi.org/10.12688/f1000research.146725.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Key to Reviewer Statuses VIEW
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 1
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PUBLISHED 09 Jan 2025
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Reviewer Report 11 Aug 2025
Serena Xiong, University of Minnesota Medical School, Minnesota, USA 
Not Approved
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COMMENTS FOR AUTHORS

This manuscript outlines a protocol for a systematic review and meta-analysis of parent-centered and parent–adolescent dyad interventions and their effects on HPV vaccination uptake among children and adolescents aged 9–18. Below, I provide major ... Continue reading
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Xiong S. Reviewer Report For: A Comparative Analysis of Parent-Centered versus Parent-Adolescent Dyad Interventions to Enhance HPV vaccination Uptake in Children and Adolescents: Protocol for Systematic Review and meta-analysis [version 1; peer review: 1 not approved]. F1000Research 2025, 14:56 (https://doi.org/10.5256/f1000research.160840.r393982)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.

Comments on this article Comments (0)

Version 1
VERSION 1 PUBLISHED 09 Jan 2025
Comment
Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
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