Shielding the Next Generation: Predictors of Parental Acceptance of the HPV Vaccine against Cervical Cancer: A Cross-Sectional Study from North Karnataka

Abstract

Introduction: Cervical cancer remains the second most common cancer among women in India, despite being largely preventable through HPV vaccination. Parental acceptance is critical for vaccine uptake, particularly in rural areas where awareness, access, and sociocultural influences strongly shape health decisions. This study examines the sociodemographic, attitudinal, and contextual predictors of parental acceptance of the HPV vaccine in rural North Karnataka.
Methods: A community-based cross-sectional study was conducted among parents of children aged 8–14 years in selected rural regions of Belagavi, Karnataka (October 2024–January 2025). Using systematic household sampling, 321 consenting parents completed a structured and interviewer-administered questionnaire assessing HPV-related knowledge, attitudes, perceived barriers, facilitators, and vaccine acceptability. Reliability testing yielded a Cronbach’s alpha of 0.80. Data were analysed using descriptive statistics, ROC curve analysis, and stepwise multiple logistic regression to identify independent predictors of high vaccine acceptability.
Results: Perceived barriers were the strongest predictor of high acceptability (AUC = 0.735, p < 0.0001), followed by facilitators (AUC = 0.694, p < 0.0001), number of children (AUC = 0.701, p < 0.0001), and parental attitude (AUC = 0.652, p < 0.0001). Regression analysis showed significantly higher odds of acceptance among Muslim parents (AOR = 5.49, p = 0.012), parents with two to four children (AOR range 12.38–15.14, p < 0.05), those with positive attitudes (AOR = 4.37, p = 0.013), low perceived barriers (AOR = 17.11, p < 0.0001), and strong facilitators (AOR = 5.77, p = 0.0001). Higher knowledge levels were inversely associated with acceptance (AOR = 0.03, p < 0.0001). Monthly income also showed a negative association with acceptance.
Discussion: Psychosocial and contextual influences—specifically perceived barriers, facilitators, and attitudes—play a more decisive role in HPV vaccine acceptance than demographic factors or knowledge alone. These findings align with global evidence indicating that misinformation, fear, and structural barriers reduce vaccine uptake, while strong provider recommendations and community support enhance acceptance. The inverse association between knowledge and acceptability suggests that increased exposure to misinformation or conflicting narratives may shape parental perceptions in rural settings.
Conclusion: Improving HPV vaccine uptake in rural India requires targeted strategies that address perceived barriers, strengthen positive attitudes, and enhance supportive factors rather than focusing solely on knowledge dissemination. Implementing culturally sensitive, community-based, and provider-driven interventions could substantially increase HPV vaccine acceptability and contribute to cervical cancer prevention in underserved regions.