Cancer Causes & Control

, Volume 29, Issue 11, pp 1115–1130 | Cite as

Acceptability of two- versus three-dose human papillomavirus vaccination schedule among providers and mothers of adolescent girls: a mixed-methods study in five countries

  • Jessica Yasmine Islam
  • Alexis M. Hoyt
  • Silvina Ramos
  • Karen Morgan
  • Chan Joo Kim
  • Sylvia de Sanjose
  • Nicole Butera
  • Virginia Senkomago
  • Karin L. Richter
  • Mary Anne McDonald
  • Nadja A. Vielot
  • Jennifer S. SmithEmail author
Original paper



The World Health Organization revised its human papillomavirus (HPV) vaccination recommendations to include a two (2-) dose schedule for girls aged ≤ 15 years. We investigated acceptability of 2- versus 3-dose schedule among adolescent vaccination providers and mothers of adolescent girls in five countries.


Adolescent vaccination providers (N = 151) and mothers of adolescent girls aged 9–14 years (N = 118) were recruited from Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers’ preference for a 2- versus 3-dose HPV vaccination schedule via quantitative surveys. Mothers’ attitudes towards a 2-dose schedule were assessed through focus group discussions.


Most adolescent providers preferred a 2- over a 3-dose HPV vaccination schedule (overall: 74%), with preference ranging from 45.2% (South Africa) to 90.0% (South Korea). Lower cost, fewer clinic visits, and higher series completion were commonly cited reasons for 2-dose preference among providers and mothers. Safety and efficacy concerns were commonly cited barriers to accepting a 2-dose HPV vaccination schedule among providers and mothers. Mothers generally accepted the reduced schedule, however requested further information from a trusted source.


Adolescent vaccination providers and mothers preferred the 2-dose over 3-dose HPV vaccination schedule. Acceptability of a 2-dose HPV vaccination could be improved with additional information to providers and mothers on HPV vaccination safety and efficacy.


Adolescent vaccination Acceptability Human papillomavirus Dose Adolescent Providers Parents Focus groups 



Human immunodeficiency virus


Human  papillomavirus


Low- and middle-income country


Strategic Advisory Group of Experts


Sexually transmitted infections


World Health Organization



The authors gratefully acknowledge the participants of this study. The authors thank Suzanne Landi, Shoshana Goldberg, and Sara Smith for their assistance in developing this manuscript. JYI was supported by a NIH NRSA individual predoctoral fellowship (F31-CA210474-01A1). Cervarix is a trademark owned by or licensed to the GSK group of companies.


This study was funded by GlaxoSmithKline Biologicals SA (Study ID: 117339); all data collection, analysis, and interpretation was conducted by study co-authors, and GSK had the opportunity to review this paper. GSK did not have input into the research data collection, analysis, or interpretation of results.

Compliance with ethical standards

Conflict of interest

Jennifer S. Smith has received research grants, served on paid advisory boards, and/or been a paid speaker for GSK group of companies and Merck & Co., Inc. over the past 5 years. The remaining authors have no conflicts of interest to disclose.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Jessica Yasmine Islam
    • 1
  • Alexis M. Hoyt
    • 2
  • Silvina Ramos
    • 3
  • Karen Morgan
    • 4
    • 5
  • Chan Joo Kim
    • 6
  • Sylvia de Sanjose
    • 7
  • Nicole Butera
    • 8
  • Virginia Senkomago
    • 2
  • Karin L. Richter
    • 9
  • Mary Anne McDonald
    • 10
  • Nadja A. Vielot
    • 11
  • Jennifer S. Smith
    • 2
    • 12
    • 13
    Email author
  1. 1.Department of Epidemiology, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA
  2. 2.Department of Health Behavior, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA
  3. 3.Centro de Estudios de Estado y SociedadBuenos AiresArgentina
  4. 4.Perdana University School of MedicineSeri KembanganMalaysia
  5. 5.Royal College of SurgeonsDublinIreland
  6. 6.Department of Obstetrics and Gynecology, The Catholic University of Korea College of MedicineSt. Paul’s HospitalSeoulSouth Korea
  7. 7.Infections and Cancer, Cancer Epidemiology Research ProgrammeInstitut Català d’OncologiaBarcelonaSpain
  8. 8.Department of Biostatistics, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA
  9. 9.Department of Medical Virology, University of PretoriaNational Health Laboratory ServicePretoriaSouth Africa
  10. 10.Center on Genomics, Race, Identity, DifferenceDuke UniversityDurhamUSA
  11. 11.Department of Family Medicine, School of MedicineUniversity of North CarolinaChapel HillUSA
  12. 12.UNC Lineberger Comprehensive Cancer CenterUniversity of North CarolinaChapel HillUSA
  13. 13.Department of EpidemiologyUNC Gillings School of Global Public HealthChapel HillUSA

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