Parent-Directed Hesitancy-Addressing Strategies in School-Based HPV Vaccination Programs: A Systematic Review and Meta-Analysis of Effects on Vaccine Uptake Among School-Aged Girls

Human papillomavirus (HPV) vaccination is safe and effective in preventing cervical and other HPV-related cancers, yet coverage remains below public health targets in many countries. School-based vaccination programmes provide an important platform for reaching large numbers of adolescents. However, vaccination uptake often depends on parental consent and support, as parents play a central role in vaccination decision-making for school-aged children. Parental concerns about vaccine safety, perceived necessity, potential effects on sexual behaviour, and trust in vaccine-related information are widely reported barriers to HPV vaccine acceptance and uptake. To address these barriers, school-based HPV vaccination programmes may incorporate parent-directed components designed to address parental concerns and facilitate informed vaccination decisions. Such approaches may include tailored education and recommendations, vaccine safety and risk communication, misinformation correction, decision-support tools, provider–parent counselling, and digital communication. These strategies target different cognitive, emotional, and interpersonal determinants of parental vaccine hesitancy, and may be delivered individually or as part of multicomponent interventions. Understanding the relative contributions of these approaches is important for identifying effective strategies to improve actual vaccination uptake. Existing systematic reviews have examined HPV vaccination behaviour change interventions across different populations and settings, the effects of specific behaviour change techniques and intervention targets within school-based vaccination programmes, parent-centred versus parent–adolescent dyad interventions, and multilevel strategies targeting parents, healthcare providers, and vaccination practices across high-income and low- and middle-income countries (Bennett et al., 2022; Bland et al., 2025; Gray & Fisher, 2025; Bhengu et al., 2026). Other reviews have examined school-based health education interventions, primarily targeting students (Rosso et al., 2026). However, to our knowledge, no review has specifically focused on parent-directed interventions designed to address parental HPV vaccine hesitancy within school-based vaccination programmes, while systematically examining the effectiveness of different hesitancy-addressing strategies on actual vaccine uptake among school-aged girls. In particular, the extent to which intervention effects vary according to vaccination delivery models and country income groups remains insufficiently understood. This review will therefore synthesize randomized and controlled quasi-experimental evidence to identify which parent-directed hesitancy-addressing strategies are associated with higher HPV vaccine uptake among school-aged girls, and explore variations in effectiveness across different implementation contexts. Effects on parental vaccine hesitancy, vaccination intention or acceptance, and HPV-related knowledge will also be examined.