Awareness and acceptability of HPV vaccination among parents of young girls in northern Morocco: a mixed-methods study

Abstract

BACKGROUND: Morocco implemented a national HPV vaccination program in 2022 as part of its primary cervical cancer prevention strategy. The program faces several challenges, with very low vaccination coverage, likely due to parental hesitancy. This study aimed to assess the acceptability of HPV vaccination among parents of young girls. METHODS: A mixed-methods study was conducted between 2024 and 2025 among parents of young girls in northern Morocco. We combined quantitative method with face-to-face questionnaire, analyzed using descriptive, univariate and multivariate statistics; and qualitative data from a focus group analyzed thematically. RESULTS: A total of 300 parents were recruited, with a mean age of 37.96 ± 8.0 years and a sex ratio F/M of 2.33. Only 10% of participants knew that cervical cancer is caused by persistent HPV infection. Awareness of the national HPV vaccination program was low (8.7%). Overall, 60% of parents reported good acceptability of HPV vaccination. Older age and formal education were independently associated with HPV vaccination hesitancy (OR = 1.046; 95% CI: (1.013-1.081; p < 0.006 and OR = 2.404; 95% CI: 1.334-4.331; p < 0.004). Qualitative findings indicated excellent acceptability of HPV vaccination, with lack of uptake primarily due to insufficient awareness of the disease, its vaccine, and the Moroccan HPV vaccination program. CONCLUSION: Our study found no evidence of an association between the low HPV vaccination rate in Morocco and parental acceptability. Nevertheless, limited awareness of the national HPV vaccination program remains a major concern. Barriers to HPV vaccination should be further explored through implementation research.