A Scoping Review on the Factors Influencing the General Acceptance of Southeast Asians Towards HPV Vaccination

Main Article Content

Leonard Lim


Background: Southeast Asia is known to have one of the highest Human Papillomavirus (HPV) prevalence rates globally. HPV vaccination has been shown to be successful in the prevention of infection.

Objectives: This study aims to perform a scoping review of the factors influencing HPV acceptance in Southeast Asia, extract dominant themes, identify factors, describe subgroup representation, and suggest considerations in the creation of interventional and delivery strategies to increase vaccine uptake.

Methodology: PubMed was used to identify papers discussing vaccine acceptance, published  from January 2009 to March 2020. After review, 41 studies were included in qualitative synthesis.

Findings: The following outcomes were measured in the included studies: knowledge of HPV, attitudes towards vaccination, factors influencing attitudes towards vaccination, and the effectiveness of interventions and strategies in increasing vaccine uptake. There was an overall level of low to moderate knowledge, with generally high vaccine acceptance. Literacy was found to have a direct relationship with uptake, although limited by one’s resources and capability to get vaccinated. Price was noted to be the most crucial factor behind accessibility. Among delivery strategies, school-based and national immunization programs were found to be the most effective.

Conclusion: Factors influencing attitudes towards vaccination include economic, personal, social, and cultural factors. Culturally-specific research and interventions that would better grasp the contexts of target communities are recommended.

Key words: vaccine acceptance, vaccine hesitancy, vaccine uptake, health literacy, HPV

Article Details

How to Cite
Lim, L. (2023) “A Scoping Review on the Factors Influencing the General Acceptance of Southeast Asians Towards HPV Vaccination”, Journal of Asian Medical Students’ Association. Kuala Lumpur, Malaysia, 10(1). Available at: https://jamsa.amsa-international.org/index.php/main/article/view/190 (Accessed: 21May2024).
Review Articles


[1] World Health Organization (2020). WHO | Track 2: Health literacy and health behaviour. [Internet] World Health Organization. Available at: http://www.who.int/healthpromotion/conferences/7gchp/track2/en/ [Accessed 10 Apr. 2020].
[2] MacDonald, N. and Pickering, L. (2009). Canada's eight-step vaccine safety program: Vaccine literacy. Paediatrics & Child Health , 14(9), pp.605-608.
[3] Biasio, L. R. Vaccine hesitancy and health literacy. Hum Vaccin Immunother [Internet]. 2017 [cited 2020 Apr 9]; 13(3): 701–702. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5360145/. doi: 10.1080/21645515.2016.1243633
[4] MacDonald, N. (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine ,
33(34), pp.4161-4164.
[5] World Health Organization. Human papillomavirus vaccines: WHO position paper, May 2017. Weekly epid rec [Internet]. 2017 [cited 2020 Apr 9]; 92(19): 241-268. Available from http://www.who.int/wer
[6] Bruni, L., Diaz, M., Barrionuevo-Rosas, L., Herrero, R., Bray, F., Bosch, X., et al. Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis. The Lancet [Internet]. 2016 [cited 2020 Apr 9]; 4(7): 453-463. Available from https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30099-7/fulltext. doi:https://doi.org/10.1016/S2214-109X(16)30099-7
[7] World Health Organization (2020). WHO | About social determinants of health .
[Internet] World Health Organization. Available at:
https://www.who.int/social_determinants/sdh_definition/en/ [Accessed 9 Apr. 2020].
[8] Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018 10 2;169(7):467-73.
[9] Wadhera P, Evans JL, Stein E, Gandhi M, Couture MC, Sansothy N, et al. Human papillomavirus knowledge, vaccine acceptance, and vaccine series completion among female entertainment and sex workers in Phnom Penh, Cambodia: the Young Women's Health Study. Int J STD AIDS. 2015 Oct;26(12):893-902.
[10] Kruiroongroj S, Chaikledkaew U, Thavorncharoensap M. Knowledge, acceptance, and willingness to pay for human papilloma virus (HPV) vaccination among female parents in Thailand. Asian Pac J Cancer Prev. 2014;15(13):5469-74.
[11] Spagnoletti BRM, Bennett LR, Wahdi AE, Wilopo SA, Keenan CA. A Qualitative Study of Parental Knowledge and Perceptions of Human Papillomavirus and Cervical Cancer Prevention in Rural Central Java, Indonesia: Understanding Community Readiness for Prevention Interventions. Asian Pac J Cancer Prev. 2019 08 1;20(8):2429-34.
[12] Charakorn C, Rattanasiri S, Lertkhachonsuk AA, Thanapprapasr D, Chittithaworn S, Wilailak S. Knowledge of Pap smear, HPV and the HPV vaccine and the acceptability of the HPV vaccine by Thai women. Asia Pac J Clin Oncol. 2011 Jun;7(2):160-7.
[13] Touch S, Oh JK. Knowledge, attitudes, and practices toward cervical cancer prevention among women in Kampong Speu Province, Cambodia. BMC Cancer. 2018 03 15;18(1):294.
[14] Zhuang QY, Wong RX, Chen WM, Guo XX. Knowledge, attitudes and practices regarding human papillomavirus vaccination among young women attending a tertiary institution in Singapore. Singapore Med J. 2016 Jun;57(6):329-33.
[15] Danial M, Sivasangari S, Arulappen A, Ong L. Journey of the Human Papillomavirus (HPV) in a Developing Country over 5 Years (2010 - 2015). Asian Pac J Cancer Prev. 2016;17(3):1363-8.
[16] Rashwan H, Lubis SH, Ni KA. Knowledge of cervical cancer and acceptance of HPV vaccination among secondary school students in Sarawak, Malaysia. Asian Pac J Cancer Prev. 2011;12(7):1837-41.
[17] Khoo CL, Teoh S, Rashid AK, Zakaria UU, Mansor S, Salleh FN, Nawi MN. Awareness of cervical cancer and HPV vaccination and its affordability among rural folks in Penang Malaysia. Asian Pac J Cancer Prev. 2011;12(6):1429-33. PMID: 22126476.
[18] Jaspers L, Budiningsih S, Wolterbeek R, Henderson FC, Peters AA. Parental acceptance of human papillomavirus (HPV) vaccination in Indonesia: a cross-sectional study. Vaccine. 2011 Oct 13;29(44):7785-93.
[19] Sam IC, Wong LP, Rampal S, Leong YH, Pang CF, Tai YT, et al. Maternal acceptance of human papillomavirus vaccine in Malaysia. J Adolesc Health. 2009 Jun;44(6):610-2.
[20] Pitts M, Smith A, Croy S, Lyons A, Ryall R, Garland S, et al. Singaporean women's knowledge of human papillomavirus (HPV) and attitudes toward HPV vaccination. Women Health. 2009 Jun;49(4):334-51.
[21] Juntasopeepun P, Thana K. Parental acceptance of HPV vaccines in Chiang Mai, Thailand. Int J Gynaecol Obstet. 2018 Sep;142(3):343-8.
[22] Endarti D, Satibi S, Kristina SA, Farida MA, Rahmawanti Y, Andriani T. Knowledge, Perception, and Acceptance of HPV Vaccination and Screening for Cervical Cancer among Women in Yogyakarta Province, Indonesi. Asian Pac J Cancer Prev. 2018 Apr 27;19(4):1105-11.
[23] Widjaja VN. Awareness, Knowledge and Attitudes of Human Papillomavirus (HPV) among Private University Students- Malaysia Perspective. Asian Pac J Cancer Prev. 2019 07 1;20(7):2045-50.
[24] Paul P, LaMontagne DS, Le NT. Knowledge of cervical cancer and HPV vaccine post- vaccination among mothers and daughters in Vietnam. Asian Pac J Cancer Prev. 2012;13(6):2587-92.
[25] Bingham A, Drake JK, LaMontagne DS. Sociocultural issues in the introduction of human papillomavirus vaccine in low-resource settings. Arch Pediatr Adolesc Med. 2009 May;163(5):455-61.
[26] Songthap A, Pitisuttithum P, Kaewkungwal J, Fungladda W, Bussaratid V. Knowledge, attitudes, and acceptability of a human papilloma virus vaccine among students, parents and teachers in Thailand. Southeast Asian J Trop Med Public Health. 2012 Mar;43(2):340-53.
[27] Juntasopeepun P, Davidson PM, Suwan N, Phianmongkhol Y, Srisomboon J. Human papillomavirus vaccination intention among young women in Thailand. Asian Pac J Cancer Prev. 2011;12(12):3213-9.
[28] Songthap A, Pitisuttithum P, Kaewkungwal J, Fungladda W, Bussaratid V, Koonsaeng S. Knowledge, attitudes, and acceptability of a human papillomavirus vaccine among healthcare providers. Southeast Asian J Trop Med Public Health. 2009 Sep;40(5):1048-56.
[29] Maharajan MK, Rajiah K, Num KS, Yong NJ. Knowledge of Human Papillomavirus Infection, Cervical Cancer and Willingness to pay for Cervical Cancer Vaccination among Ethnically Diverse Medical Students in Malaysia. Asian Pac J Cancer Prev. 2015;16(14):5733-9.
[30] Wong LP. Knowledge of and attitudes toward the HPV vaccine among multi-ethnic women from urban/university and rural areas. Int J Gynaecol Obstet. 2011 Feb;112(2):146-7.
[31] Badgujar VB, Ahmad Fadzil FS, Balbir Singh HK, Sami F, Badgujar S, Ansari MT. Knowledge, understanding, attitude, perception and views on HPV infection and vaccination among health care students and professionals in Malaysia. Hum Vaccin Immunother. 2019;15(1):156-62.
[32] Grandahl M, Paek SC, Grisurapong S, Sherer P, Tydén T, Lundberg P. Parents' knowledge, beliefs, and acceptance of the HPV vaccination in relation to their socio-demographics and religious beliefs: A cross-sectional study in Thailand. PLoS ONE. 2018;13(2):e0193054.
[33] Cover JK, Nghi NQ, LaMontagne DS, Huyen DT, Hien NT, Nga le T. Acceptance patterns and decision-making for human papillomavirus vaccination among parents in Vietnam: an in-depth qualitative study post-vaccination. BMC Public Health. 2012 Aug 9;12:629.
[34] Poulos C, Yang JC, Levin C, Van Minh H, Giang KB, Nguyen D. Mothers' preferences and willingness to pay for HPV vaccines in Vinh Long Province, Vietnam. Soc Sci Med. 2011 Jul;73(2):226-34.
[35] Basnyat I, Lim C. Perspectives of young Chinese Singaporean women on seeking and processing information to decide about vaccinating against human papillomavirus. Women Health. 2018 08;58(7):806-21.
[36] Juntasopeepun P, Suwan N, Phianmongkhol Y, Srisomboon J. Factors influencing acceptance of human papillomavirus vaccine among young female college students in Thailand. Int J Gynaecol Obstet. 2012 Sep;118(3):247-50.
[37] Young AM, Crosby RA, Jagger KS, Richardson MB, Kloha RA, Safarian V. HPV vaccine acceptability among women in the Philippines. Asian Pac J Cancer Prev. 2010;11(6):1781-7.
[38] Asiedu GB, Breitkopf CR, Kremers WK, Ngo QV, Nguyen NV, Barenberg BJ, et al. Vietnamese Health Care Providers' Preferences Regarding Recommendation of HPV Vaccines. Asian Pac J Cancer Prev. 2015;16(12):4895-900.
[39] Ling WY, Razali SM, Ren CK, Omar SZ. Does the success of a school-based HPV vaccine programme depend on teachers' knowledge and religion? -- A survey in a multicultural society. Asian Pac J Cancer Prev. 2012;13(9):4651-4.
[40] Markowitz LE, Dunne EF, Saraiya M, Chesson HW, Curtis CR, Gee J, et al. Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2014 Aug 29;63(RR-05):1-30.
[41] Al-Naggar RA, Bobryshev YV. Practice towards human papillomavirus vaccines among Malaysian women: a survey of a general youth population. Asian Pac J Cancer Prev. 2011;12(8):2045-9.
[42] Dinh Thu H, Nguyen Thanh H, Hua Thanh T, Nguyen Hai L, Tran Thi V, Nguyen Manh T, et al. Mothers' willingness to pay for daughters' HPV vaccine in northern Vietnam. Health Care Women Int. 2018 04;39(4):450-62.
[43] Al-Naggar RA, Bobryshev YV, Al-Jashamy K, Al-Musli M. Practice of HPV vaccine and associated factors among school girls in Melaka, Malaysia. Asian Pac J Cancer Prev. 2012;13(8):3835-40.
[44] Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE. Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019 Aug 16;68(32):698-702.
[45] LaMontagne DS, Barge S, Le NT, Mugisha E, Penny ME, Gandhi S, et al. Human papillomavirus vaccine delivery strategies that achieved high coverage in low- and middle-income countries. Bull World Health Organ. 2011 Nov 1;89(11):821-830B.
[46] Nghi NQ, Lamontagne DS, Bingham A, Rafiq M, Mai le TP, Lien NT, Khanh NC, Hong DT, Huyen DT, Tho NT, Hien NT. Human papillomavirus vaccine introduction in Vietnam: formative research findings. Sex Health. 2010 Sep;7(3):262-70. doi: 10.1071/SH09123. PMID: 20719213.
[47] Biellik R, Levin C, Mugisha E, LaMontagne DS, Bingham A, Kaipilyawar S, et al. Health systems and immunization financing for human papillomavirus vaccine introduction in low-resource settings. Vaccine. 2009 Oct 19;27(44):6203-9.
[48] Galagan SR, Paul P, Menezes L, LaMontagne DS. Influences on parental acceptance of HPV vaccination in demonstration projects in Uganda and Vietnam. Vaccine. 2013 Jun 26;31(30):3072-8.
[49] Le AT, Tran VT, Dinh HT, Dau CX, Pham BQ, Nguyen HT, et al. Effectiveness of Community Intervention Program on Knowledge and Practice of HPV Prevention Among Married Females in Vietnam Rural Areas. Cancer Control. 2019 Jan-Dec;26(1):1073274819862792.
[50] Phan DP, Pham QT, Strobel M, Tran DS, Tran TL, Buisson Y. [Acceptability of vaccination against human papillomavirus (HPV) by pediatricians, mothers and young women in Ho Chi Minh City, Vietnam]. Rev Epidemiol Sante Publique. 2012 Dec;60(6):437-46.
[51] Wong LP. HPV information needs, educational messages and channel of delivery preferences: views from developing country with multiethnic populations. Vaccine. 2009 Feb 25;27(9):1410-5.