Inequity in HPV school-based vaccination programmes: A COM-B synthesis in disadvantaged communities

Background

The WHO aims for 90% HPV vaccination coverage by 2030 to eliminate cervical cancer. However, significant disparities persist, particularly in disadvantaged communities within high-income countries. Inequities in these populations remain insufficiently researched and poorly understood. This narrative review synthesised evidence on barriers, facilitators, and interventions to improve HPV vaccination uptake in school-based programmes within disadvantaged communities.

Methods

PubMed, PsycINFO, and backward citation searching identified English-language studies published within the past 10 years. Findings were thematically mapped onto the COM-B model (Capability, Opportunity, Motivation - Behaviour).

Results

Fifteen articles examined barriers and facilitators: (1) Capability-Barriers: primarily limited parental and adolescent knowledge and awareness of HPV and the vaccine; (2) Capability-Facilitators: user-friendly resources and increased adolescent awareness; (3) Opportunity-Barriers: poor communication and information delivery, socioeconomic hardships, logistical challenges, and cultural/ethnic influences; (4) Opportunity-Facilitators: simplified consent processes, multi-channel promotion methods, proactive follow-up, strong school-parent relationships; (5) Motivation-Barriers: safety concerns and fears of side effects; (6) Motivation-Facilitators: positive attitudes, trust in healthcare providers, and perceived vaccine benefits. Seven studies evaluated interventions, with the most successful approaches combining integrated education with culturally and contextually tailored strategies and repeated reminders.

Conclusions

HPV vaccination disparities in disadvantaged communities are driven by a complex interplay of limited awareness and structural barriers. Education alone is insufficient to bridge the equity gap. School-based programmes should prioritise reducing logistical friction and reinforcing community trust alongside educational outreach.

Key messages

• Direct, culturally and linguistically appropriate information can reduce knowledge gaps, address misconceptions, support consent, and build trust between families, schools, and healthcare providers.

• Effective programmes should adapt to community needs through flexible consent processes, reminders, trusted local stakeholders, and culturally responsive delivery to improve uptake and equity.