Vaccination coverage against HPV in a national representative sample of schoolgirls aged 12-18 years in Greece and core knowledge factors in parents' decision to vaccinate their daughters.

Background: HPV vaccination coverage is important to prevent cervical cancer and other HPV-related diseases. This study estimated the vaccination coverage rate among adolescent schoolgirls aged 12-18 in Greece and identified factors affecting parental vaccination decisions. Design and Methods: A cross-sectional study was conducted from September 2021 to March 2022. A nationwide representative sample of 3205 parents/guardians of schoolgirls from 48 schools was selected through a probabilistic multistage sampling. Besides descriptive statistics, estimation, exploration and inferential methods were used, including 95% CI to estimate the vaccine rate, exploratory factor analysis to emerge the factors of HPV knowledge and multiple logistic regression analysis to identify the crucial parameters associated with vaccination, after adjusting for mutual confounding. Results: About 62.5% [95% CI: 61.1-63.9] of the girls were fully vaccinated. Mother's HPV vaccination (OR [95% CI] = 2.90 [1.77, 4.73]), parental education level (OR [95% CI] = 2.50 [1.65, 3.79]), child's attendance at the Upper secondary school (OR [95% CI] = 2.36 [1.83, 3.03]) and the level of HPV vaccine knowledge (OR [95% CI] = 1.59 [1.37, 1.84]) influenced parents' decision to vaccinate their daughters. Conclusions: A significant increase in HPV vaccination coverage was recorded in Greece, compared to previous estimations. The identified determinants of parents' vaccination decisions, especially HPV vaccine knowledge, can feed into targeted public health policies, to achieve the WHO's goal to vaccinate 90% of adolescent girls by 2030. Policies may include the implementation of school-based awareness programmes for students and parents, state incentives for parents and expert recommendations for vaccination.