Background
Methods
Search strategy
Selection criteria
Data extraction
Quality assessment
Data analysis
Consent statement
Results
Screening process
Study characteristics
Study | Regiona
| Study instrumentb
|
N
| Population (age) | F/(F + M) | Sampling method | Ethnicity | ||
---|---|---|---|---|---|---|---|---|---|
Range |
\( \overline{\mathrm{x}}\pm \mathrm{s} \)
| Groupc
| |||||||
Huang He, 2013 [33] | CLDA | Q | 470 | NA | 20.09 ± 1.33 | CS | 0.504 | Randomized | Han |
Ma Xiaojing, 2013 [12] | EDA | IAQ | 1451 | NA | 45.1 ± 10.8 | A | 1 | Convenience | Mixed |
He Mei, 2011 [41] | CLDA | Q | 10,611 | 18–82 | 38.02 ± 9.57 | A | 1 | Convenience | Han |
Cui Bo, 2010 [13] | EDA | IAQ | 1160 | 15–59 | 35.66 ± 11.72 | A | 1 | Randomized | Mixed |
He Xin, 2010 [29] | NA | SAQ | 903 | 16–26 | 19.14 ± 1.01 | CS | 0.52 | Cluster | Han |
Xu Jing, 2014 [11] | CLDA | Q | 353 | 18–24 | 20.96 | CS | 0.683 | Cluster | Han |
Feng Suwen, 2010 [46] | EDA | Q | 1432 | 18–50 | 35.3 | A | 1 | Cluster | Han |
Yan Jun, 2013 [43] | WUDA | IAQ | 1681 | 30–49 | NA | A | 1 | Cluster | Han |
Long Xiange, 2011 [21] | EDA | Q | 286 | NA | 18.5 | CS | NA | Convenience | Han |
Hu Haishan, 2014 [28] | EDA | Q | 542 | 31–60 | 41.57 ± 5.77 | P | 0.685 | Cluster | Mixed |
Wu Ying, 2011 [25] | EDA | IAQ | 489 | 15–50 | NA | A | 1 | Randomized | Han |
Li Juan, 2011 [14] | EDA | IAQ | 160 | NA | 36.55 ± 9.59 | A | 0.738 | Randomized | Mixed |
Fan Baojian, 2009 [23] | EDA | Q | 962 | 19–72 | 43.38 ± 8.29 | A | 1 | Cluster | Mixed |
Xiao Wei, 2009 [45] | NA | Q | 378 | 21–74 | 36.19 | A | 1 | Convenience | Han |
Wang Xuemin, 2012 [15] | WUDA | IAQ | 2269 | 25–73 | 43.54 ± 7.67 | A | 1 | Cluster | Han |
Shao Shujuan, 2013 [17] | EDA | Q | 594 | ≤60 | 36.02 ± 10.54 | A | 1 | Randomized | Han |
Xu Wenyu, 2013 [18] | EDA | Q | 3000 | 20–30 | A | 1 | Convenience | Han | |
Ma Dong, 2013 [40] | NA | Q | 258 | 17–24 | 19.23 ± 0.89 | CS | 0.55 | Cluster | Han |
Zhou Lixia, 2011 [42] | EDA | IAQ | 752 | 16–55 | NA | A | 1 | Randomized | Han |
Huang Yanhua, 2014 [39] | EDA | Q | 378 | 15–50 | NA | A | 0.5 | Randomized | Han |
Wang Haiqiu, 2011 [31] | CLDA | Q | 257 | 20–53 | 33.6 ± 0.5 | A | 1 | Randomized | Han |
Ma Dong, 2012 [30] | CLDA | Q | 198 | 20–54 | 31.8 ± 7.0 | A | 0.89 | Convenience | Han |
Yao Chenglian, 2012 [19] | EDA | Q | 1198 | 16–65 | NA | A | 1 | Convenience | Han |
Xamxinuer Ablimit, 2009 [26] | WUDA | Q | 245 | 23–85 | 48.8 | A | 1 | Convenience | Mixed |
Xu Lina, 2013 [22] | NA | Q | 1666 | 15–59 | NA | A | 1 | Randomized | Han |
Zhang Hui, 2014 [37] | CLDA | Q | 341 | 32–50 | 39.56 ± 3.47 | P | 0.63 | Cluster | Han |
Yu Jing, 2013 [44] | CLDA | Q | 750 | 15–59 | 35.75 ± 9.4 | A | 1 | Randomized | Han |
Guzalnur Abduxkur, 2012 [32] | WUDA | IAQ | 560 | NA | NA | A | 0 | Convenience | Mixed |
Cai Jing, 2013 [24] | WUDA | Q | 648 | NA | NA | A | 0 | Randomized | Mixed |
Li Li, 2010 [27] | WUDA | Q | 1989 | 16–59 | NA | A | 1 | Cluster | Mixed |
Ying Wen, 2014 [35] | CLDA | Q | 1878 | 17–25 | NA | CS | 0.679 | Randomized | Mixed |
Zhang Shaokai, 2013 [38] | NA | Q | 2895 | NA | 40.4 ± 4.68 | P | 0.628 | Cluster | Mixed |
Wang Shaoming, 2014 [20] | NA | Q | 3368 | NA | 19.82 ± 1.31 | CS | 0.51 | Randomized | Mixed |
Yan Hong, 2013 [16] | EDA | SAQ | 360 | 18–36 | 25.1 ± 3.5 | A | 1 | Convenience | Mixed |
Li Jing, 2009 [34] | NA | Q | 6024 | 14–59 | 34.6 ± 1.7 | A | 1 | Cluster | Han |
Zhao Fanghui, 2012 [36] | NA | Q | 11,681 | NA | 34 ± 11.8 | A | 0.705 | Randomized | Han |
Ayizuoremu · mutailipu, 2015 [64] | WUDA | Q | 1900 | 16–60 | NA | A | 1 | Cluster | Mixed |
Zeng Xiaomin, 2015 [55] | EDA | SAQ | 2004 | NA | NA | C | 1 | Cluster | Han |
Wang Ling, 2015 [49] | CLDA | Q | 125 | 18–23 | 20.5 | C | 1 | Convenience | Han |
Liu Qiong, 2015 [57] | CLDA | Q | 590 | 14–20 | 15.34 ± 1.3 | C | 0.91 | Convenience | Han |
She Qian, 2015 [59] | EDA | IAQ | 209 | 19–45 | NA | A | 1 | Randomized | Han |
Chen Ling, 2015 [50] | NA | IAQ | 300 | 21–28 | 24 ± 0.8 | C | 1 | Randomized | Han |
Cheng Lihong, 2015 [51] | EDA | Q | 1256 | 19–55 | NA | A | 1 | Convenience | Han |
Zhu Qiaoyang, 2015 [58] | EDA | Q | 362 | 18–66 | 42.2 ± 6.3 | A | 1 | Convenience | Han |
Lei Juhong, 2015 [61] | EDA | Q | 300 | 15–64 | NA | A | NA | Randomized | Han |
Zhao Bixia, 2015 [63] | CLDA | Q | 138 | 25–50 | NA | A | NA | Convenience | Han |
Xie Wenliu, 2015 [48] | CLDA | Q | 192 | 15–70 | NA | A | 0.51 | Convenience | Han |
Zhou Yanqiu, 2015 [47] | EDA | SAQ | 600 | ≥21 | NA | A | NA | Convenience | Han |
Meng Liping, 2015 [60] | EDA | SAQ | 1652 | 20–65 | 38.09 ± 8.21 | A | NA | Cluster | Han |
Zou Huachun, 2015 [53] | EDA | SAQ | 368 | NA | NA | A | 0 | Convenience | Han |
Zou Huachun, 2015 [52] | EDA | SAQ | 351 | 16–25 | NA | C | 0.524 | Cluster | Mixed |
Gu Can, 2015 [62] | CLDA | Q | 117 | 19–23 | 20.8 ± 1 | C | 1 | Convenience | Han |
Wang Wei, 2015 [56] | EDA | Q | 360 | NA | 41.77 ± 3.33 | P | 0.522 | Cluster | Mixed |
Abida Abudukadeer, 2015 [65] | WUDA | IAQ | 5000 | 20–51 | NA | A | 1 | Convenience | Mixed |
Zhang Shaokai, 2015 [54] | CLDA | Q | 2895 | NA | 40.4 ± 4.68 | P | 0.628 | Cluster | Mixed |
Pan Xiongfei, 2015 [66] | CLDA | Q | 1878 | 17–25 | 20.8 ± 1.3 | C | 0.679 | Convenience | Mixed |
Fu Chunjing, 2015 [67] | CLDA | SAQ | 605 | 18–26 | 21.6 ± 1 | C | 0.689 | Randomized | Mixed |
Hu Shangying, 2105 [68] | EDA | IAQ | 316 | 18–25 | 23.2 ± 1.7 | C | 1 | Cluster | Han |
Studies | 1 | 2 | 3 | 4 | 5 | 6 | 7 | Scores | Grade |
---|---|---|---|---|---|---|---|---|---|
Huang He, 2013 [33] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Ma Xiaojing, 2013 [12] | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 | A |
He Mei, 2011 [41] | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 4 | B |
Cui Bo, 2010 [13] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
He Xin, 2010 [29] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Xu Jing, 2014 [11] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Feng Suwen, 2010 [46] | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 | A |
Yan Jun, 2013 [43] | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 | A |
Long Xiange, 2011 [21] | 1 | 0 | 1 | 0 | 1 | 1 | 1 | 5 | B |
Hu Haishan, 2014 [28] | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 | A |
Wu Ying, 2011 [25] | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 6 | A |
Li Juan, 2011 [14] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Fan Baojian, 2009 [23] | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 6 | A |
Xiao Wei, 2009 [45] | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 5 | B |
Wang Xuemin, 2012 [15] | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 | A |
Shao Shujuan, 2013 [17] | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 5 | B |
Xu Wenyu, 2013 [18] | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 6 | A |
Ma Dong, 2013 [40] | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 6 | A |
Zhou Lixia, 2011 [42] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Huang Yanhua, 2014 [39] | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 6 | A |
Wang Haiqiu, 2011 [31] | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 6 | A |
Ma Dong, 2012 [30] | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 6 | A |
Yao Chenglian, 2012 [19] | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 5 | B |
Xamxinuer Ablimit, 2009 [26] | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 5 | B |
Xu Lina, 2013 [22] | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 | A |
Zhang Hui,2014 [37] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Yu Jing, 2013 [44] | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 | A |
Guzalnur Abduxkur, 2012 [32] | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 5 | B |
Cai Jing, 2013 [24] | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 | A |
Li Li, 2010 [27] | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 | A |
Ying Wen, 2014 [35] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Zhang Shaokai, 2013 [38] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Wang Shaoming, 2014 [20] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Yan Hong, 2013 [16] | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 | A |
Li Jing, 2009 [34] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Zhao Fanghui, 2012 [36] | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 | A |
Ayizuoremu · mutailipu, 2015 [64] | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 | A |
Zeng Xiaomin, 2015 [55] | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 6 | A |
Wang Ling, 2015 [49] | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 | A |
Liu Qiong, 2015 [57] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
She Qian, 2015 [59] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Chen Ling, 2015 [50] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Cheng Lihong, 2015 [51] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Zhu Qiaoyang, 2015 [58] | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 6 | A |
Lei Juhong, 2015 [61] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Zhao Bixia, 2015 [63] | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 6 | A |
Xie Wenliu, 2015 [48] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Zhou Yanqiu, 2015 [47] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Meng Liping, 2015 [60] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Zou Huachun, 2015 [53] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Zou Huachun, 2015 [52] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Gu Can, 2015 [62] | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 | A |
Wang Wei, 2015 [56] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Abida Abudukadeer, 2015 [65] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Zhang Shaokai, 2015 [54] | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 | A |
Pan Xiongfei, 2015 [66] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Fu Chunjing, 2015 [67] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 | A |
Hu Shangying, 2105 [68] | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 | A |
Awareness and knowledge of HPV vaccine
Studied items | No. of studies | Pooled rates(95 % CI) | Heterogeneity (I
2
,%) | Publication bias(P value) |
---|---|---|---|---|
Awareness | 43 | 15.95 (12.87–19.29) | 98.9 | >0.05 |
Knowledge | 21 | 17.55 (12.38–24.88) | 99.8 | >0.05 |
Acceptability | 35 | 67.25 (58.75–75.21) | 99.8 | >0.05 |
Reasons for unwillingness to be HPV vaccinated | ||||
Assumed low risk | 14 | 33.63 (27.50–40.05) | 97.2 | >0.05 |
Limited use to date | 14 | 36.31 (29.67–43.22) | 97.7 | >0.05 |
Safety | 10 | 50.46 (40.00–60.89) | 96.6 | >0.05 |
Efficacy | 14 | 30.18 (23.96–36.79) | 97.3 | >0.05 |
Vaccine source | 11 | 32.17 (21.14–43.30) | 99.2 | >0.05 |
High price | 6 | 23.72 (13.64–35.59) | 98.2 | >0.05 |
Acceptability (for daughters) | 12 | 60.32 (51.25–69.04) | 99.2 | >0.05 |
Reasons for unwillingness of parents to vaccinate their daughters | ||||
Limited use to date | 4 | 32.61 (22.03–44.18) | 94.5 | >0.05 |
Safety and efficacy | 7 | 68.19 (53.13–81.52) | 98.6 | >0.05 |
Vaccine source | 7 | 17.24 (13.87–20.90) | 82.8 | >0.05 |
Too young to vaccinate | 7 | 28.37 (13.69–45.90) | 99 | >0.05 |
Acceptability of HPV vaccination
Reasons for unwillingness to be HPV vaccinated
Reasons for unwillingness of parents to vaccinate their daughters
Subgroup analysis and meta-regression
Subgroups | No. of studies | Incidence % (95 % CI) |
I
2
(%) |
P value |
---|---|---|---|---|
Awareness (all studies) | ||||
Age | 0.698 | |||
CS | 12 | 19.07 (11.72,27.71) | 99.0 | |
A | 27 | 15.14 (11.11,19.68) | 99.1 | |
P | 5 | 15.62 (13.13,18.28) | 85.4 | |
Sex | 0.033 | |||
Fa
| 23 | 17.39 (13.06,22.20) | 98.8 | |
F, Ma
| 17 | 18.55 (14.14,23.42) | 98.8 | |
Mb
| 3 | 1.82 (0.50,11.20) | 98.5 | |
Sample method | 0.504 | |||
Randomized | 16 | 18.88 (13.60,24.80) | 99.0 | |
Cluster | 16 | 13.74 (7.66,21.24) | 99.1 | |
Convenience | 12 | 16.03 (12.12,20.36) | 97.7 | |
Ethnicity | 0.017 | |||
Han | 29 | 20.17 (16.42,24.20) | 98.3 | |
Mixed | 15 | 9.61 (5.95,14.03) | 99.0 | |
Region | 0.031 | |||
EDAa
| 20 | 17.57 (13.36,22.21) | 98.0 | |
CLDAa
| 12 | 17.78 (12.18,24.19) | 97.6 | |
WUDAb
| 5 | 1.80 (0.02,6.33) | 98.9 | |
Knowledge (all studies) | ||||
Age | 0.171 | |||
CS | 10 | 40.94 (20.11,63.64) | 99.8 | |
A | 11 | 15.52 (10.22,21.69) | 98.7 | |
P | 1 | 16.27 | ||
Sex | 0.841 | |||
F | 13 | 27.2 (17.56,38.07) | 99.5 | |
F, M | 9 | 24.51 (10.28,42.45) | 99.7 | |
M | 0 | |||
Sample method | 0.757 | |||
Randomized | 11 | 29.87 (13.02,50.19) | 99.7 | |
Cluster | 7 | 19.16 (12.41,26.98) | 98.7 | |
Convenience | 0 | |||
Ethnicity | 0.893 | |||
Han | 14 | 25.40 (14.41,38.28) | 99.4 | |
Mixed | 8 | 27.46 (13.87,43.62) | 99.8 | |
Region | 0.837 | |||
EDA | 8 | 19.58 (11.76,28.82) | 98.6 | |
CLDA | 9 | 27.80 (11.97,47.20) | 99.7 | |
WUDA | 2 | 13.96 (2.44,32.70) | 99.7 | |
Acceptability (for themselves) | ||||
Age | 0.338 | |||
CS | 10 | 71.71 (64.06,78.77) | 97.9 | |
A | 24 | 64.82 (52.80,75.95) | 99.9 | |
P | 2 | 44.92 (26.00,64.63) | 98.7 | |
Sex | 0.208 | |||
F | 21 | 68.50 (54.40,81.05) | 99.9 | |
F, M | 15 | 61.65 (52.47,70.43) | 99.4 | |
M | 0 | |||
Sample method | 0.022 | |||
Randomized | 12 | 70.42 (63.63,76.79) | 98.8 | |
Clustera
| 12 | 72.45 (52.22,88.76) | 99.9 | |
Convenienceb
| 12 | 53.53 (41.95,64.92) | 99.5 | |
Ethnicity | 0.939 | |||
Han | 24 | 65.14 (53.62,75.83) | 99.8 | |
Mixed | 12 | 66.76 (51.25,80.60) | 99.7 | |
Region | 0.407 | |||
EDA | 14 | 65.31 (54.68,75.21) | 99.2 | |
CLDA | 12 | 64.10 (46.56,79.87) | 99.7 | |
WUDA | 3 | 82.15 (35.87,99.68) | 99.9 | |
Acceptability (for daughters) | ||||
Age | 0.014 | |||
CS | 1 | 38.61 | ||
Aa
| 10 | 64.72 (55.57,73.36) | 99.2 | |
Pb
| 3 | 33.78 (26.26,41.74) | 88.3 | |
Sex | 0.068 | |||
F | 8 | 67.04 (57.46,75.96) | 99.2 | |
F, M | 4 | 46.06 (27.07,65.66) | 97.6 | |
M | 0 | |||
Sample method | 0.038 | |||
Randomizeda
| 5 | 72.75 (67.66,77.56) | 92.9 | |
Clusterb
| 6 | 48.54 (32.37,64.88) | 99.4 | |
Convenience | 3 | 56.36 (34.63,76.88) | 98.8 | |
Ethnicity | 0.253 | |||
Han | 8 | 57.84 (47.89,67.48) | 99.5 | |
Mixed | 6 | 61.04 (44.36,76.50) | 99.3 | |
Region | 0.689 | |||
EDA | 6 | 59.03 (41.51,75.44) | 98.9 | |
CLDA | 4 | 56.36 (37.18,74.60) | 99.3 | |
WUDA | 2 | 51.49 (33.81,68.97) | 99.3 |