Barriers and facilitators to HPV vaccination among adult men: A systematic review and qualitative meta-synthesis

Human papillomavirus (HPV) infection is widespread and a leading cause of preventable cancers, yet HPV vaccination uptake among adult men remains suboptimal. Qualitative evidence on multilevel determinants of men's vaccination decisions and healthcare responses remains limited. This qualitative meta-synthesis aimed to synthesize barriers and facilitators to HPV vaccination among adult men guided by the Social Ecological Model (SEM), and to explore how vaccination-related health needs are reflected in healthcare resources and translated into service utilization using a health service evaluation framework informed by WHO health service concepts. Ten electronic databases, including PubMed, Embase, and PsycINFO, were searched from inception to December 2025 using controlled vocabulary and free-text terms. Ten studies across four countries were included. The evidence base was concentrated among sexual minority men, sex workers, and healthcare-engaged men, with fewer studies among general male populations; six of the ten studies were conducted in the United States, limiting generalizability to adult men more broadly. Thematic synthesis followed Thomas and Harden's approach, with findings organized across five SEM levels. Key barriers included gendered perceptions of HPV, low perceived susceptibility, stigma and disclosure concerns, provider communication failures, economic constraints, and structural access challenges. Facilitators included provider recommendation, supportive relationships, integrated care pathways, and health information access. Health service evaluation identified gaps between needs, resources, and utilization, particularly outside preventive care. These findings highlight that improving HPV vaccination among adult men requires multilevel behavioral strategies alongside healthcare system improvements that better recognize and respond to men's vaccination needs.