Cross-country analysis on HPV vaccination behaviors among health workers and parents: a qualitative report from seven middle-income countries.

Purpose: This article presents a cross-country analysis of qualitative research reports on the barriers and drivers of HPV vaccination-related behavior among parents and health workers in seven middle-income countries using the COM-B theoretical framework. Four reports are from countries that had already introduced the HPV vaccine - Georgia, Moldova, Turkmenistan, and Uzbekistan, while the other three reports are from Kazakhstan, Kosovo, and Tajikistan which were preparing for HPV vaccine introduction in 2023 and 2024. Results: The cross-country analysis revealed that health workers (HWs), especially specialists like gynecologists and oncologists, were viewed as trusted sources of vaccination information by both parents and HWs. However, HWs faced gaps in HPV vaccine knowledge and communication skills, and these gaps persisted in some form even after training was conducted in countries that had already introduced the HPV vaccine. In addition, these specialists were not always included when training sessions were conducted with family doctors and nurses in preparation for the vaccine's introduction. Parents also experience knowledge gaps, safety concerns, and lack of trust. Parents across countries shared concerns related to HPV vaccine safety and effectiveness and were often exposed to misconceptions or misinformation through media and social networks. This was compounded by the lack of a strong and confident recommendation from HWs and poor patient-provider communication. Conclusions: The analyzed reports highlighted the need for tailored, multi-faceted interventions that account for locally specific issues, influencers, and target groups. Two prominent recommendations posited in the reports were: 1) engaging parents and addressing their concerns at the community level, and 2) ensuring HPV vaccine confidence through HW training and engagement, especially for specialists, and providing access to evidence-based information for HWs and others who influence vaccine acceptance.