| Summary of review finding | Studies contributing to the review finding | Illustrative quotes | CERQual assessment | Explanation of GRADE-CERQual assessment |
|---|---|---|---|---|
| Barriers to HPV vaccination uptake | ||||
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Lack of knowledge about HPV, HPV-related disease, and the HPV vaccine Participants lacked knowledge about HPV in general, transmission in MSM, and the connection between HPV and male associated cancers. Participants often confused HPV and other STIs. There was a pervasive lack of knowledge of HPV vaccination and misunderstandings about efficacy. There was a widespread perception that only cisgender women are vulnerable to HPV and that the vaccine was predominantly or exclusively for women. |
“I’ve heard it doesn’t affect men, but they can transmit it. I don’t know if that’s true” “I didn’t know like it affected guys at all’ “My own ignorance was that HPV was something that really only affected women and cervical cancer. I didn’t hear it as much as something that was affecting men” | Moderate confidence | Downgraded because of moderate concerns regarding methodological limitations | |
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Questions over vaccine effectiveness and potential side effects Participants wanted clear information about the vaccine and any possible side effects. They questioned vaccine effectiveness. |
“I think like with all vaccines there are probably side effects” “I mean I don’t know, I mean I’m not too fond of the guinea pig thing, so I don’t know, it depends on the side effects, I actually [inaudible] that. So I would have to see—weigh my options and see what my side effects are” | Moderate confidence | Downgraded because of moderate concerns regarding methodological limitations | |
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Vaccination series, including timing of doses Participants discussed barriers to vaccine completion due to long time intervals between doses, multiple doses, and the inconvenience of work conflicting with clinic hours. |
“... you know, going back and coming back, and going back [for 3 doses], it’s too much work” “It is hard to remember, keep track of all the shots” | Low confidence | Downgraded because of moderate concerns regarding methodological limitations and adequacy of data | |
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Possible stigma Participants described stigmas related to being gay, gay health, acceptance by HCPs, and STIs. They were concerned that they would be labelled as promiscuous upon receiving vaccination. Participants described the importance of being able to discuss sexual activity with healthcare professionals. There was some concern about people being singled out by their sexuality when offering the vaccine |
“If there’s another virus, like HPV, it’s going to be strongly linked to gay men community again. I don’t think it’s a good thing for people because it will strengthen the gay label to this specific disease. I don’t think people will like it. Since they just got rid of HIV labels and they don’t want another stigma again” “...some people will consider somebody very promiscuous. ‘Oh, you’re getting a vaccine because you’re sleeping with multiple people,’ and there’s just a stigma associated with that” | Moderate confidence | Downgraded because of moderate concerns regarding methodological limitations | |
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Clinical settings Most participants suggested sexual health clinics were the most suitable setting to reach MSM as the openness and non-judgemental attitudes of staff in these settings may be reassuring. Others suggested GP practices may be more suitable as some young men do not access specialist sexual health services. Some noted the difficulty of discussing their sexual health with their GPs. Participants also noted that MSM who do not identify as gay may not benefit from the vaccine if it was only targeted to gay or bisexual men. |
“Well, it was offered right there while I was getting the physical done. So I didn’t even have to make a special trip or anything” “I feel like he judges me. I feel like if I had a provider or somebody who is a little more open-minded ... my doctor is a staunch Republican, white dude who is like 65 and I’m sitting there like a gay little Puerto Rican kid, and you know, it is just always awkward when I go to my doctor. We come from opposite ends of the earth” | Low confidence | Downgraded because of moderate concerns regarding methodological limitations and minor concerns regarding adequacy of data | |
| Facilitators for increasing HPV vaccination uptake | ||||
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Awareness of vaccines and the health benefits of getting vaccinated Participants acknowledged the physical and psychological health benefits of HPV vaccination, including reducing their anxieties around the risk of anal cancer. Participants were also enthusiastic about the ability to protect both themselves and their partner(s). They discussed the need to raise public awareness and suggested that HPV education should be widespread and more inclusive of all sexes, particularly in the sexual health education curriculum in schools. Participants believed that better understanding of the benefits and side effects of the vaccine would encourage uptake. |
“Yeah like I care about my health, but I also care about other people’s health too and I don’t want anyone else to get infected or have to go through with something like that” “I would be less susceptible to anal cancer at least from HPV” “If there was more education about it [HPV vaccine], if the vaccine gets known, then it won’t be as taboo” | Moderate confidence | Downgraded because of moderate concerns regarding methodological limitations | |
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Interactions with health care practitioners (HCPs) Participants perceived healthcare providers and doctors to be the most trusted source of information, and their opinions as well as recommendations would substantially influence their decision to obtain the vaccine |
“I think I’d be more likely to accept it if it were offered than I would actively request it. I think because if it was, if it was recommended to you it would be coming from a trusted source” “It was the doctor’s recommendation. I honestly wouldn’t have thought about it had he not recommended it” | Moderate confidence | Downgraded because of moderate concerns regarding methodological limitations | |
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Support from friends and family Participants highlighted that most people in their lives would be supportive of their decision to get vaccinated. Participants with unsupportive referents typically mentioned their parents (notably their father). Awareness and knowledge about the HPV vaccine was primarily limited to female friends and siblings. |
“Maybe my dad. Because he’s just ignorant with regard to sexuality and vaccines and stuff like that. He’s kind of a anti-government conspiracies person, so I don’t really have a good relationship with him” “I know [about HPV vaccine] because my sister got it” | Very low confidence | Downgraded because of moderate concerns regarding methodological limitations and serious concerns about adequacy | |
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Making HPV vaccination part of other clinical interactions Participants described wanting to combine HPV vaccination with other types of visits like annual physical examinations, general sexual health screening or other STI tests. |
“Well, it was offered right there while I was getting the physical done. So I didn’t even have to make a special trip or anything” “If they start routinely testing for this at GUM clinics, and you’re negative and not carrying it, then it should be suggested to you at the same point [like] they would suggest a hepatitis A and C vaccine” | Low confidence | Downgraded because of moderate concerns regarding methodological limitations and adequacy of data | |
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Mobile applications Participants suggested the use of mobile applications for booking appointments and creating a reminder system. They felt that flexibility in scheduling and app-based reminder systems would facilitate 3-dose completion | Fontenot, 2016 | “People are uncomfortable having to make phone calls. . . it’s a lot easier to just do something on your phone, like an appointment confirmation, so that you can go in without having to talk [to someone] or feel uncomfortable disclosing things [on the phone]” | Very low confidence | Downgraded because of moderate concerns regarding methodological limitations and very serious concerns regarding adequacy |
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