Evidence of Knowledge, Attitude, and Practice Regarding Human Papilloma Virus Vaccination at the Community Level in India: A Systematic Review and Meta-analysis

Abstract

Background: Effective vaccines for the prevention of cervical cancers are available in India. The existing knowledge and attitude regarding the Human Papillomavirus (HPV) vaccine varies widely among available studies. Our study aimed to estimate pooled prevalence related to knowledge, attitude, and practice of HPV vaccination in India. Methodology: We conducted systematic searches in PUBMED, EMBASE, CINHAL, PROQUEST, and Cochrane Library databases using database-specific search strategies. The random effects model was used for estimating the pooled proportion of knowledge, attitude, and practice. The outlier studies were identified using the Baujat test. Egger's regression test and funnel plots were used to identify publication bias. Results: Database-specific search strategies yielded 2,377 records from five databases. We identified 48 studies for full-text retrieval after screening titles and abstracts. Finally, 27 studies were included in the meta-analysis. The pooled prevalence of knowledge regarding HPV vaccines in India was 0.22 (CI;0.14-0.31, I2 =99.5%). The pooled prevalence of positive attitudes towards the uptake of HPV vaccines in India was 0.45 (CI;0.33-0.57, I2 =100%). The pooled prevalence of coverage of HPV vaccines in India was 0.04 (CI;0.02-0.07, I2 =96%). Significant publication bias was present for the studies' reported knowledge and coverage. Conclusion: The knowledge, attitude, and coverage of the HPV vaccine were low in India. It suggests effective strategies to improve knowledge and attitudes towards HPV vaccination in India.

Methodological Assessment of a Review of Knowledge, Attitude and Practice about Human Papilloma Virus Vaccination in India

“…Overall, Pal et al [1] review could guide clinical practitioners and policymakers to plan strategies to improve HPV vaccine uptake in India. However, the review should be carefully interpreted due to concerns related to literature screening and the combination of the studies through meta-analysis, which impedes the review's reproducibility and validity of findings.…”

“…It is important that the review is as rigorous and as fully reported as possible if the evidence from the review is incorporated into clinical practice. We read, with great interest, the systematic review and meta-analysis by Pal et al (2024) titled 'Evidence of Knowledge, Attitude, and Practice Regarding Human Papilloma Virus Vaccination at the Community Level in India: A Systematic Review and Meta-Analysis' that attempts to give information on the prevalence of knowledge, attitude, and practice of HPV vaccination in the Indian population. [1].…”

“…We read, with great interest, the systematic review and meta-analysis by Pal et al (2024) titled 'Evidence of Knowledge, Attitude, and Practice Regarding Human Papilloma Virus Vaccination at the Community Level in India: A Systematic Review and Meta-Analysis' that attempts to give information on the prevalence of knowledge, attitude, and practice of HPV vaccination in the Indian population. [1]. The information is useful for planning strategies to improve HPV vaccine uptake by the target population in India.…”

“…In response to the valuable comments of the letter regarding our published article titled "Evidence of Knowledge, Attitude, and Practice Regarding Human Papilloma Virus Vaccination at the Community Level in India: A Systematic Review and Meta-analysis" [1]. We appreciate the author's interest in carefully understanding our paper and acknowledging that this review could guide clinical practitioners and policymakers in planning strategies to improve HPV vaccine uptake.…”