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Cited by 6Cervical Cancer and HPV ResearchVaccine Coverage and HesitancyWomen's cancer prevention and management

Barriers to HPV vaccination among adolescent girls in India: A scoping review

Open access
Josten, Kripa, Rose Dhar, Redolen, Reshmi, Bhageerathy, Natti Krishna, Veena, Vennila, J.·2026·The Indian Journal of Medical Research
DOI 10.25259/ijmr_1834_2025PMC PMC12883130
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Abstract

Background & objectives: The aim of this scoping review is to systematically map the existing research on human papillomavirus (HPV) vaccination uptake among adolescent girls in India, with a focus on ( i ) identifying the current trends, and ( ii ) examining the challenges and facilitators of vaccine uptake. Methods: The review adheres to the scoping review framework developed by Arksey and O'Malley. A thorough search of peer-reviewed literature was carried out utilizing databases such as PubMed, Scopus, and Web of Science. Studies published between 2008 and 2025 were assessed for relevance. The socio-ecological model was used to chart and synthesize data, categorizing barriers and enablers at the individual, interpersonal, community, institutional, and policy levels. Results: A total of 37 studies were included. Lack of awareness, sociocultural stigma, economic constraints, and insufficient assistance from the health system were highlighted as some of the main barriers. Government awareness initiatives, healthcare provider recommendations, and school-based interventions were found to facilitate HPV vaccination. Interpretation & conclusions: Improving HPV vaccine uptake in India requires addressing multi-level barriers with integrated public health initiatives and policy interventions.

AI snapshot

Written from the paper’s full text.

TL;DR

This scoping review maps 37 studies on HPV vaccination among adolescent girls in India and finds uptake remains very low, driven by multilevel barriers including poor awareness, stigma, cost, and weak health-system support. It concludes that improving coverage requires integrated, culturally tailored, multilevel public health and policy interventions.

Key findings

  • The review included 37 studies published between 2009 and 2025; most were cross-sectional surveys (n=24), followed by cohort studies (n=5), interventional/quasi-experimental studies (n=4), randomized controlled trials (n=2), and model-based projections (n=2).
  • Major barriers were lack of awareness, sociocultural stigma, economic constraints, and insufficient health-system assistance. Reported awareness levels were as low as 5.7% and 2.2% in cited studies, while NFHS-5 data noted <1% of girls in India already vaccinated and about 2% of Indian women ever tested.
  • Facilitators included government awareness initiatives, healthcare provider recommendations, and school-based interventions. One school-linked community project reported 98% vaccination completion, and educational interventions produced post-intervention knowledge gains exceeding 50% in some groups; one quasi-experimental study reported acceptance rising from 61% to 88.6% after education.
  • Policy-level barriers included high vaccine cost and exclusion from India’s national immunization schedule, while the low-cost domestic vaccine Cervavac was noted at approximately INR 200–400 per dose.

Methods

  • Scoping review using Arksey and O’Malley’s framework, reported per PRISMA-ScR, with a protocol prospectively registered on the Open Science Framework.
  • Searches covered PubMed, Scopus, Embase, CINAHL, and Web of Science for studies published between January 2008 and January 2025, with the search conducted in October 2024; two reviewers independently screened records on Rayyan, consulting a third reviewer for consensus.
  • Data were charted and synthesized using the socio-ecological model across individual, interpersonal, community, institutional, and policy levels; quality appraisal was not conducted.

Limitations

  • The paper states that variability in study design, locations, and population coverage among included sources limits generalized conclusions, and that empirical studies evaluating implementation and effectiveness of targeted strategies remain scarce.
  • The paper also states that evidence on long-term effectiveness, scalability, and cultural adaptability in the Indian context—especially among marginalized and out-of-school adolescent girls—remains limited.
  • Evident from the text: quality appraisal was not performed and studies were included regardless of quality; the abstract and methods also differ in the databases listed, and the search date precedes the stated inclusion end date.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.25259/ijmr_1834_2025

Cites

57 of 57 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

49 of 141 cited sources checked · 2 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    The vaccination programme in India started in 2008.

    “Only Studies published between January 2008 and January 2025 were included, since the vaccination programme in India started in that year7 (Annexure A included in the Supplementary Material).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [7] Lahariya C A brief history of vaccines & vaccination in India Indian J Med Res 2014 139 491 511 24927336 PMC4078488 source

      The Abstract and the 'How to use PRISMA 2020' section discuss reporting guidelines for systematic reviews, not vaccination in India. Searches for the Indian vaccination programme and 2008 found no passage addressing when that programme started. Page numbers were not available in our copy. (LLM, conf=0.77)

      Experimental — accuracy not yet measured
  • Findingcitation

    Targeted educational programs demonstrated significant gains in vaccine intent and knowledge.

    “Targeted educational programs demonstrated significant gains in vaccine intent and knowledge38,43.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [38] Apurva UT Muralidhar PT Malangori AP Poonam VS Pradip SB Effect of health education on the knowledge and attitude regarding the human papillomavirus vaccine among adolescent school girls of a city in Western Maharashtra Indian J Community Health 2024 36 549 55

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [43] Dhinu K Fernandez S Gupta A Elangbam V Effect of health education on acceptance of human papilloma virus vaccine among parents of adolescent girls of Bishnupur, Manipur: A quasi-experimental study Indian J Med Res 2024 160 346 53 39632632 PMC11619045 source

      The Results (page unavailable) report a statistically significant association between mothers’ educational attainment and knowledge of cervical-cancer risk factors. The Methods mention a health education package, but the paper does not report measured gains after that program or gains in vaccine intent. Thus, the significant knowledge finding offers only partial support for the claim. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Findingcitation

    Recent developments include the introduction of low-cost vaccines like Cervavac.

    “At the policy level, high vaccine costs, lack of integration into national immunisation programmes, and limited public funding restricted access, although there were recent developments such as the introduction of low-cost vaccines like Cervavac11,17,21.”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [11] Sharma H Parekh S Pujari P Shewale S Desai S Bhatla N et al Immunogenicity and safety of a new quadrivalent HPV vaccine in girls and boys aged 9–14 years versus an established quadrivalent HPV vaccine in women aged 15–26 years in India: A randomised, active-controlled, multicentre, phase 2/3 trial Lancet Oncol 2023 24 1321 33 37949086 source

      The Discussion (page not supplied) anticipates an affordable Indian HPV vaccine, but says it was still undergoing a Phase III clinical trial. It does not name Cervavac or report the introduction of a low-cost vaccine, so it supports the affordability prospect but not the claimed development. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [17] Madhivanan P Krupp K Yashodha MN Marlow L Klausner JD Reingold AL Attitudes toward HPV vaccination among parents of adolescent girls in Mysore, India Vaccine 2009 27 5203 8 19596420 source
    • cites [21] Prinja S Bahuguna P Faujdar DS Jyani G Srinivasan R Ghoshal S et al Cost‐effectiveness of human papillomavirus vaccination for adolescent girls in Punjab state: Implications for India's universal immunization program Cancer 2017 123 3253 60 28472550 source
    • Rests on an assumption: The findings of the included studies are reliable enough to support the review's synthesis, despite the absence of quality appraisal.
  • Findingcitation

    These misconceptions were especially prevalent in conservative or rural settings, where this was considered a stigma.

    “These misconceptions were especially prevalent in conservative or rural settings, where this was considered a stigma36,37.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [36] Degarege A Krupp K Fennie K Srinivas V Li T Stephens DP et al An integrative behavior theory derived model to assess factors affecting HPV vaccine acceptance using structural equation modeling Vaccine 2019 37 945 5 30655176 PMC6351189 source

      The Introduction discusses misconceptions about HPV and its vaccine, and the Discussion reports that urban–rural residence moderated some parental beliefs. It does not say misconceptions were especially prevalent in rural or conservative settings or describe them as a stigma. The Discussion instead reports higher vaccination intention among rural than urban parents; page numbers were not available in our copy. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [37] Krupp K Srinivas V Marlow L Li T Albetini A Gowda S et al O19.4 Acceptability of HPV vaccination among parents of adolescent school going girls in Mysore city, India Sex Transm Infect 2013 89 3 A64

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Findingcitation

    Religion was another factor, with some communities expressing stronger resistance due to their religious norms or misinformation within their social circles.

    “Religion was also found to be another factor, with some communities expressing stronger resistance due to their religious norms or misinformation within their social circles36,42.”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [36] Degarege A Krupp K Fennie K Srinivas V Li T Stephens DP et al An integrative behavior theory derived model to assess factors affecting HPV vaccine acceptance using structural equation modeling Vaccine 2019 37 945 5 30655176 PMC6351189 source

      The Results section (page unavailable) finds that religion was associated with vaccination-related norms: Muslim parents were less likely than non-Muslim parents to expect others to recommend HPV vaccination. It does not establish that religious norms caused stronger resistance, or that misinformation within social circles did so; Muslim parents were also less likely to hold negative beliefs about vaccination. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [42] Paul P Tanner AE Gravitt PE Vijayaraghavan K Shah KV Zimet GD et al Acceptability of HPV vaccine implementation among parents in India Health Care Women Int 2014 35 1148 61 23611111 PMC4503242 source

      The Discussion (page unavailable) says potential religious differences in vaccine acceptance need further study; it does not report that particular communities showed stronger resistance because of religious norms. It also suggests that concerns about side effects could become misinformation and lead to negative attitudes, but does not locate that misinformation within social circles. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 20
  • May combine two claims. 39

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    HPV vaccines were introduced in India in 2008.

    “Despite the introduction of human papillomavirus (HPV) vaccines in 2008 and recent policy moves toward the introduction of a national programme for the prevention and control of noncommunicable illnesses1, uptake remains extremely low.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [7] Lahariya C A brief history of vaccines & vaccination in India Indian J Med Res 2014 139 491 511 24927336 PMC4078488 source

      The Abstract and Scope of the guideline sections discuss reporting systematic reviews, not HPV vaccination. Searches for HPV vaccine introduction in India in 2008 and for India’s vaccination programme found no passage addressing the claim. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The socio-ecological model (SEM) was used as the theoretical framework to map and interpret influences on HPV vaccination awareness and uptake among adolescent girls in India.

    “The theoretical framework used for the review is the socio-ecological model (SEM) to map and interpret the various influences on HPV vaccination awareness and uptake among adolescent girls in India47,48.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [47] McLeroy KR Bibeau D Steckler A Glanz K An ecological perspective on health promotion programs Health Educ Q 1988 15 351 77 3068205 source
    • cites [48] Shah P Shetty V Ganesh M Shetty AK Challenges to human papillomavirus vaccine acceptability among women in south India: an exploratory study Am J Trop Med Hyg 2021 105 966 73 34370698 PMC8592141 source

      The Introduction and Results describe family, community, cost, and information-related influences on HPV vaccine awareness and acceptability in India. But this source studied women aged 18–45, not adolescent girls, and its Discussion says it did not use a theory-driven methodology. It therefore supports the relevance of several influences, not the attribution of an SEM framework to this study. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Titles and abstracts of all retrieved records were independently screened by two reviewers using pre-defined inclusion and exclusion criteria.

    “The titles and abstracts of all retrieved records were independently screened by two reviewers (KJ and RRD) using pre-defined inclusion and exclusion criteria on the Rayyan web-based systematic review platform8.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] Ouzzani M Hammady H Fedorowicz Z Elmagarmid A Rayyan-a web and mobile app for systematic reviews Syst Rev 2016 5 210 27919275 PMC5139140 source

      The Methods sections describe recruitment, HPV testing, and cervical cancer screening in a prospective cohort, not screening titles and abstracts of retrieved records. Searches for independent reviewer screening, inclusion and exclusion criteria, and Rayyan found no supporting passage in our copy. (LLM, conf=0.77)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Both Jacob et al and Joshi et al demonstrated notable improvements in awareness scores, with post-intervention knowledge gains exceeding 50 per cent in some groups.

    “Both studies demonstrated notable improvements in awareness scores, with post-intervention knowledge gains exceeding 50 per cent in some groups.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [33] Jacob RA Abraham PS Thomas FR Navya V Sebastian J Ravi MD et al Impact of indirect education on knowledge and perception on cervical cancer and its prevention among the parents of adolescent girls: An interventional school-based study Ther Adv Vaccines Immunother 2021 9 2515135521990268 33629029 PMC7882753 source
    • cites [32] Joshi SV Chaudhari HR Chaudhari NA Effect of education on awareness, knowledge, and willingness to be vaccinated in females of Western India J Cancer Educ 2020 35 61 8 30460493 source

  • May combine two claims.

    Findingcitation

    At the policy level, high vaccine costs, lack of integration into national immunisation programmes, and limited public funding restricted access.

    “At the policy level, high vaccine costs, lack of integration into national immunisation programmes, and limited public funding restricted access, although there were recent developments such as the introduction of low-cost vaccines like Cervavac11,17,21.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [11] Sharma H Parekh S Pujari P Shewale S Desai S Bhatla N et al Immunogenicity and safety of a new quadrivalent HPV vaccine in girls and boys aged 9–14 years versus an established quadrivalent HPV vaccine in women aged 15–26 years in India: A randomised, active-controlled, multicentre, phase 2/3 trial Lancet Oncol 2023 24 1321 33 37949086 source

      The Discussion (page unavailable) says vaccine cost raises affordability concerns in India and recommends inclusion in the national immunisation programme, noting that states could fund distribution until then. It does not establish that limited public funding itself restricted access. Its discussion of national integration is also specific to India, not national programmes generally. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [17] Madhivanan P Krupp K Yashodha MN Marlow L Klausner JD Reingold AL Attitudes toward HPV vaccination among parents of adolescent girls in Mysore, India Vaccine 2009 27 5203 8 19596420 source
    • cites [21] Prinja S Bahuguna P Faujdar DS Jyani G Srinivasan R Ghoshal S et al Cost‐effectiveness of human papillomavirus vaccination for adolescent girls in Punjab state: Implications for India's universal immunization program Cancer 2017 123 3253 60 28472550 source
    • Rests on an assumption: The findings of the included studies are reliable enough to support the review's synthesis, despite the absence of quality appraisal.

  • May combine two claims.

    Findingcitation

    At the individual level, limited knowledge, cultural misconceptions, and attitudinal barriers such as fear of side effects or concerns about morality were key problems, especially among less educated or rural populations.

    “At the individual level, limited knowledge, cultural misconceptions, and attitudinal barriers, such as fear of side effects or concerns about morality were key problems, especially among less educated or rural populations12,14,17,19,28,37,38.”
    Quote in the paperSubstantial claim3 of 7 sources checked
    • cites [12] Hussain S Nasare V Kumari M Sharma S Khan MA Das BC et al Perception of human papillomavirus infection, cervical cancer and HPV vaccination in North Indian population PLoS One 2014 9 e112861 25386964 PMC4227878 source
    • cites [14] Hussain S Bharadwaj M Nasare V Kumari M Sharma S Hedau S et al Human papillomavirus infection among young adolescents in India: Impact of vaccination J Med Virol 2012 84 298 305 22170551 source

      The Discussion (page unavailable) says HPV vaccination depends on public acceptance, which broadly supports the relevance of attitudes. It does not identify limited knowledge, cultural misconceptions, fear of side effects, or morality concerns as key problems, nor does it say these barriers are especially prevalent among less educated or rural populations. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [17] Madhivanan P Krupp K Yashodha MN Marlow L Klausner JD Reingold AL Attitudes toward HPV vaccination among parents of adolescent girls in Mysore, India Vaccine 2009 27 5203 8 19596420 source
    • cites [19] Madhivanan P Li T Srinivas V Marlow L Mukherjee S Krupp K Human papillomavirus vaccine acceptability among parents of adolescent girls: Obstacles and challenges in Mysore, India Prev Med 2014 64 69 74 24732716 source

      The Introduction discusses evidence needed for HPV-vaccine policy decisions, and the Limitations discuss what the cost-effectiveness model did not include. Neither addresses individual-level barriers such as limited knowledge, misconceptions, fear of side effects, or morality concerns, including among less educated or rural populations. Searches for those barriers and for “side effects” found no supporting passage in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [28] Degarege A Krupp K Srinivas V Ibrahimou B Marlow LAV Arun A et al Determinants of attitudes and beliefs toward human papillomavirus infection, cervical cancer and human papillomavirus vaccine among parents of adolescent girls in Mysore, India J Obstet Gynaecol Res 2018 44 2091 100 30117218 PMC6996479 source

      The Discussion (page unavailable) reports that 71.6% of surveyed parents had never heard of HPV, and the Results > Beliefs about HPV vaccine describe concerns that vaccination might make girls more sexually active. The paper does not establish fear of side effects as a key problem. Its sample was urban, so it cannot support the claim about rural populations; its education finding also does not show greater concern among less-educated parents. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [37] Krupp K Srinivas V Marlow L Li T Albetini A Gowda S et al O19.4 Acceptability of HPV vaccination among parents of adolescent school going girls in Mysore city, India Sex Transm Infect 2013 89 3 A64

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [38] Apurva UT Muralidhar PT Malangori AP Poonam VS Pradip SB Effect of health education on the knowledge and attitude regarding the human papillomavirus vaccine among adolescent school girls of a city in Western Maharashtra Indian J Community Health 2024 36 549 55

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • Rests on an assumption: The findings of the included studies are reliable enough to support the review's synthesis, despite the absence of quality appraisal.

  • May combine two claims.

    Findingcitation

    Many respondents, especially mothers, were uncomfortable with their daughters receiving a vaccine against a sexually transmitted disease, frequently attributing this to ethical issues and the belief that it encourages immorality.

    “Many respondents, especially mothers, said they were uncomfortable with their daughters receiving a vaccine against a sexually transmitted disease, frequently attributing this to ethical issues and the belief that it encourages immorality36,37,45.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [36] Degarege A Krupp K Fennie K Srinivas V Li T Stephens DP et al An integrative behavior theory derived model to assess factors affecting HPV vaccine acceptance using structural equation modeling Vaccine 2019 37 945 5 30655176 PMC6351189 source

      The Introduction (page unavailable) reports that parental beliefs that HPV vaccination could promote sexual promiscuity were associated with lower intention to vaccinate daughters. It does not establish that many respondents—especially mothers—said they were uncomfortable because the vaccine targets a sexually transmitted disease, or that they frequently cited ethical issues. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [37] Krupp K Srinivas V Marlow L Li T Albetini A Gowda S et al O19.4 Acceptability of HPV vaccination among parents of adolescent school going girls in Mysore city, India Sex Transm Infect 2013 89 3 A64

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [45] Ahlawat P Batra N Sharma P Kumar S Kumar A Knowledge and attitude of adolescent girls and their mothers regarding cervical cancer: A community-based cross-sectional study J Midlife Health 2018 9 145 9 30294187 PMC6166420 source

  • May combine two claims.

    Findingcitation

    Limited knowledge is often accompanied by misinformation and myths, including the belief that HPV vaccines lead to infertility.

    “The limited knowledge is often accompanied by misinformation and myths, including the belief that HPV vaccines lead to infertility hence, they prefer vaccinating their daughters at an older age46.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [46] Madhivanan P Srinivas V Marlow L Mukherjee S Narayanappa D Mysore S et al Indian parents prefer vaccinating their daughters against HPV at older ages Asian Pac J Cancer Prev 2014 15 107 10 24528008 source

      The Results report limited HPV knowledge and misconceptions about vaccination age. They do not report a belief that HPV vaccines cause infertility; the older-age preference is discussed in relation to perceived sexual activity and cancer risk, not infertility. No page numbers are available in our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    The SEM recognizes that health behaviors are shaped by interactions across multiple levels: individual, interpersonal, organizational/institutional, community, and policy.

    “The SEM recognizes that health behaviors are shaped by interactions across multiple levels: individual, interpersonal, organizational/institutional, community, and policy.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [47] McLeroy KR Bibeau D Steckler A Glanz K An ecological perspective on health promotion programs Health Educ Q 1988 15 351 77 3068205 source
    • cites [48] Shah P Shetty V Ganesh M Shetty AK Challenges to human papillomavirus vaccine acceptability among women in south India: an exploratory study Am J Trop Med Hyg 2021 105 966 73 34370698 PMC8592141 source

      The Introduction discusses family, school, and community influences on HPV vaccination decisions, and the Results describe how information can spread through schools and health care settings. But our copy does not define the SEM or identify the five levels in the claim; searches for “SEM,” “socioecological model,” and the listed levels found no such passage. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Institutional settings, particularly schools and health centres, proved effective for vaccine delivery when adequately supported, yet out-of-school girls remained underserved.

    “Institutional settings, particularly schools and health centres, proved effective for vaccine delivery when adequately supported, yet out-of-school girls remained underserved33,35,40.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [33] Jacob RA Abraham PS Thomas FR Navya V Sebastian J Ravi MD et al Impact of indirect education on knowledge and perception on cervical cancer and its prevention among the parents of adolescent girls: An interventional school-based study Ther Adv Vaccines Immunother 2021 9 2515135521990268 33629029 PMC7882753 source

      The Conclusion (page unavailable) says schools may be effective for communicating and educating adolescent girls about HPV vaccination. It does not establish that schools or health centres effectively delivered vaccines when adequately supported, or that out-of-school girls remained underserved. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [35] Holroyd TA Yan SD Srivastava V Srivastava A Wahl B Morgan C et al Designing a pro-equity HPV vaccine delivery program for girls who have dropped out of school: community perspectives from Uttar Pradesh, India Health Promot Pract 2022 23 1039 4 34636268 source
    • cites [40] Jacob M Mawar N Menezes L Kaipilyawar S Gandhi S Khan I et al Assessing the environment for introduction of human papillomavirus vaccine in India Open Vaccine J 2010 3 96 107 source

      The Discussion (page unavailable) says adolescents have fewer formal interactions with the healthcare system and that reaching them for vaccination will be a challenge. It mentions opportunistic boosters at primary health centres, but does not show that schools or health centres proved effective for HPV vaccine delivery, or specifically identify out-of-school girls as underserved. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • Rests on an assumption: The findings of the included studies are reliable enough to support the review's synthesis, despite the absence of quality appraisal.

  • May combine two claims.

    Findingcitation

    Community-level factors, including stigma, cultural norms, and religious beliefs, often reinforced vaccine hesitancy, though engagement with local leaders and culturally tailored interventions showed promise.

    “Community-level factors, including stigma, cultural norms, and religious beliefs, often reinforced vaccine hesitancy, though engagement with local leaders and culturally tailored interventions showed promise 28,30,34,36.”
    Quote in the paperSubstantial claim3 of 4 sources checked
    • cites [28] Degarege A Krupp K Srinivas V Ibrahimou B Marlow LAV Arun A et al Determinants of attitudes and beliefs toward human papillomavirus infection, cervical cancer and human papillomavirus vaccine among parents of adolescent girls in Mysore, India J Obstet Gynaecol Res 2018 44 2091 100 30117218 PMC6996479 source

      The Results (Beliefs about HPV vaccine; page unavailable) link parents’ religion with differing beliefs about vaccine safety, effectiveness, and sexual activity. The Discussion recommends education directed particularly toward older parents and some religious minorities. It does not report stigma as a factor or show that engagement with local leaders or culturally tailored interventions improved vaccine acceptance. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [30] Degarege A Krupp K Srinivas V Ibrahimou B Madhivanan P Structural equation modeling to detect correlates of childhood vaccination: A moderated mediation analysis PLoS One 2020 15 e0240749 33057426 PMC7561155 source
    • cites [34] Raychaudhuri S Mandal S Socio-demographic and behavioural risk factors for cervical cancer and knowledge, attitude and practice in rural and urban areas of North Bengal, India Asian Pac J Cancer Prev 2012 13 1093 6 22799287 source

      The Abstract reports low HPV-vaccination awareness and recommends reorienting awareness campaigns, especially in rural areas. Searches for stigma, cultural or religious beliefs, vaccine hesitancy, local leaders, and culturally tailored interventions found no passage addressing the claimed barriers or approaches. (LLM, conf=0.74)

      Experimental — accuracy not yet measured
    • cites [36] Degarege A Krupp K Fennie K Srinivas V Li T Stephens DP et al An integrative behavior theory derived model to assess factors affecting HPV vaccine acceptance using structural equation modeling Vaccine 2019 37 945 5 30655176 PMC6351189 source

      The Results and Discussion (page numbers unavailable) link religion and cultural practices to parental beliefs about HPV vaccination. The Introduction recommends adapting education programs to local culture and religion, but the paper does not report that such interventions were tested or showed promise. It does not address stigma or engagement with local leaders. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • Rests on an assumption: The findings of the included studies are reliable enough to support the review's synthesis, despite the absence of quality appraisal.

  • May combine two claims.

    Findingcitation

    Interpersonal factors like parental influence, peer support, and healthcare provider recommendations shaped decisions, though outreach was inconsistent in underserved areas.

    “Interpersonal factors like parental influence, peer support, and healthcare provider recommendations also shaped decisions, though outreach was inconsistent in underserved areas31,39,45.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [31] Ray S Mulchandani R Patel P Demand and willingness to pay for human papilloma virus vaccine for their daughters among mothers in Haryana, India: A contingent valuation study J Health Serv Res Policy 2024 29 76 83 37994804 source
    • cites [39] Swain D Parida SP Preparedness of young girls for prevention of cervical cancer and strategy to introduce the HPV vaccine Indian J Community Med 2018 43 S38 41 30686873 PMC6324042 source

      The Results report that some participants learned about cervical cancer and HPV vaccination from parents, friends, or relatives, while the Discussion identifies parental consent as a reason for declining vaccination and reports uptake after expert recommendations. The paper does not establish that peer support shaped decisions, or that outreach was inconsistent in underserved areas; its participants were nursing students, some from rural backgrounds. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [45] Ahlawat P Batra N Sharma P Kumar S Kumar A Knowledge and attitude of adolescent girls and their mothers regarding cervical cancer: A community-based cross-sectional study J Midlife Health 2018 9 145 9 30294187 PMC6166420 source
    • Rests on an assumption: The findings of the included studies are reliable enough to support the review's synthesis, despite the absence of quality appraisal.

  • May combine two claims.

    Findingcitation

    Despite educational interventions, a subset of participants remained hesitant, often citing concerns about vaccine cost, availability, or insufficient information from healthcare providers.

    “Despite this, a subset of participants remained hesitant, often citing concerns about vaccine cost, availability, or insufficient information from healthcare providers31,32,38,43.”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [31] Ray S Mulchandani R Patel P Demand and willingness to pay for human papilloma virus vaccine for their daughters among mothers in Haryana, India: A contingent valuation study J Health Serv Res Policy 2024 29 76 83 37994804 source
    • cites [32] Joshi SV Chaudhari HR Chaudhari NA Effect of education on awareness, knowledge, and willingness to be vaccinated in females of Western India J Cancer Educ 2020 35 61 8 30460493 source
    • cites [38] Apurva UT Muralidhar PT Malangori AP Poonam VS Pradip SB Effect of health education on the knowledge and attitude regarding the human papillomavirus vaccine among adolescent school girls of a city in Western Maharashtra Indian J Community Health 2024 36 549 55

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [43] Dhinu K Fernandez S Gupta A Elangbam V Effect of health education on acceptance of human papilloma virus vaccine among parents of adolescent girls of Bishnupur, Manipur: A quasi-experimental study Indian J Med Res 2024 160 346 53 39632632 PMC11619045 source

      The Ethical considerations section (page unavailable) says participants received a health education package, but reports no post-intervention vaccine hesitancy. The Results and Discussion passages (page unavailable) address cervical-cancer knowledge, not concerns about vaccine cost, availability, or information from healthcare providers. Searches for those barriers and for vaccination attitudes after the intervention found no supporting passage in our copy. (LLM, conf=0.74)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    School-based HPV vaccination programs demonstrated high efficiency and coverage.

    “Programs implemented through schools demonstrated high efficiency and coverage35,40.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [35] Holroyd TA Yan SD Srivastava V Srivastava A Wahl B Morgan C et al Designing a pro-equity HPV vaccine delivery program for girls who have dropped out of school: community perspectives from Uttar Pradesh, India Health Promot Pract 2022 23 1039 4 34636268 source
    • cites [40] Jacob M Mawar N Menezes L Kaipilyawar S Gandhi S Khan I et al Assessing the environment for introduction of human papillomavirus vaccine in India Open Vaccine J 2010 3 96 107 source

      The Results describe parents’ access to village-based childhood immunization, and the Discussion reports coverage of existing vaccines among children under two. Our copy does not report the efficiency or coverage of a school-based HPV vaccination program (searched for school-based programs, efficiency, coverage, and school). (LLM, conf=0.75)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Girls from urban and higher socioeconomic backgrounds were more likely to have heard of HPV and the vaccine, whereas those from rural or tribal areas had lower awareness and greater scepticism.

    “Girls from urban and higher socioeconomic backgrounds were more likely to have heard of HPV and the vaccine, whereas those from rural or tribal areas were found to have lower awareness and greater scepticism31,32,36.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [31] Ray S Mulchandani R Patel P Demand and willingness to pay for human papilloma virus vaccine for their daughters among mothers in Haryana, India: A contingent valuation study J Health Serv Res Policy 2024 29 76 83 37994804 source
    • cites [32] Joshi SV Chaudhari HR Chaudhari NA Effect of education on awareness, knowledge, and willingness to be vaccinated in females of Western India J Cancer Educ 2020 35 61 8 30460493 source
    • cites [36] Degarege A Krupp K Fennie K Srinivas V Li T Stephens DP et al An integrative behavior theory derived model to assess factors affecting HPV vaccine acceptance using structural equation modeling Vaccine 2019 37 945 5 30655176 PMC6351189 source

      The Discussion reports that urban–rural residence moderated the relationship between parents’ HPV awareness and their vaccination beliefs. It does not establish that urban or higher-socioeconomic-status girls were more aware, or that rural or tribal girls were less aware and more sceptical. The Methods identify parents, not girls, as the survey respondents; page numbers are unavailable in our copy. (LLM, conf=0.72)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Exclusion of the HPV vaccine from India's national immunization schedule has stymied uptake, especially among marginalized groups.

    “Multiple studies emphasized that the exclusion of the HPV vaccine from India’s national immunization schedule had stymied uptake, especially among marginalized groups15,21,25,26.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [15] Rehman A Srivastava S Garg PR Garg R Kurian K Shumayla S et al Awareness about human papillomavirus vaccine and its uptake among women from North India: Evidence from a cross-sectional study Asian Pac J Cancer Prev 2022 23 4307 13 36580014 PMC9971470 source
    • cites [21] Prinja S Bahuguna P Faujdar DS Jyani G Srinivasan R Ghoshal S et al Cost‐effectiveness of human papillomavirus vaccination for adolescent girls in Punjab state: Implications for India's universal immunization program Cancer 2017 123 3253 60 28472550 source
    • cites [25] Sankaranarayanan R Joshi S Muwonge R Esmy PO Basu P Prabhu P et al Can a single dose of human papillomavirus (HPV) vaccine prevent cervical cancer? Early findings from an Indian study Vaccine 2018 36 4783 91 29551226 source

      The Introduction (page unavailable) discusses national HPV immunization programs generally, and the Discussion (page unavailable) describes potential coverage benefits of a one-dose schedule. Neither says that exclusion from India’s national schedule stymied uptake, particularly among marginalized groups. Searches for India’s immunization schedule, uptake, and socioeconomic disadvantage found no passage establishing that link. (LLM, conf=0.72)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Education-led interventions increase intent to vaccinate, but hesitancy remains.

    “Although awareness using education-led interventions showed promise in increasing intent to vaccinate, there existed a hesitancy13,32,33.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [13] Mandal R Banerjee D Gupta K Chatterjee P Vernekar M Ray C Experience of human papillomavirus vaccination project in a community set up-an Indian study Asian Pac J Cancer Prev 2021 22 699 704 33773531 PMC8286678 source

      The Discussion reports increased vaccine acceptance after parents received educational factsheets and concludes that awareness and education can help community implementation. The Methods note that five girls refused a second dose, but the paper did not measure how many parents initially refused and did not establish that hesitancy persisted after education. It also did not measure a change in intent to vaccinate in its own project. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [32] Joshi SV Chaudhari HR Chaudhari NA Effect of education on awareness, knowledge, and willingness to be vaccinated in females of Western India J Cancer Educ 2020 35 61 8 30460493 source
    • cites [33] Jacob RA Abraham PS Thomas FR Navya V Sebastian J Ravi MD et al Impact of indirect education on knowledge and perception on cervical cancer and its prevention among the parents of adolescent girls: An interventional school-based study Ther Adv Vaccines Immunother 2021 9 2515135521990268 33629029 PMC7882753 source

  • May combine two claims.

    Premisecitation

    Kenya and Uganda deployed mobile vaccination camps to reach remote and rural populations, ensuring greater coverage among out-of-school adolescents.

    “In Kenya and Uganda, mobile vaccination camps have been deployed to reach remote and rural populations, ensuring greater coverage among out-of-school adolescents58,59.”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [58] Sadoh AE Okonkwobo C Nwaneri DU Ogboghodo BC Eregiea C Oviawe O et al Effect of peer education on knowledge of human papilloma virus and cervical cancer among female adolescent students in Benin city, Nigeria Ann Glob Health 2018 84 121 8 30873785 PMC6748253 source

      The Introduction discusses HPV vaccine access in Nigeria, and the Discussion reports peer education among students in Benin City; page numbers are unavailable in our copy. Searches for Kenya, Uganda, mobile vaccination camps, and out-of-school coverage found no passage addressing the claimed deployments or their effects. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [59] Watson-Jones D Mugo N Lees S Mathai M Vusha S Ndirangu G et al Access and attitudes to HPV vaccination amongst hard-to-reach populations in Kenya PLoS One 2015 10 e0123701 26115523 PMC4482601 source

      The Results (Context for providing HPV vaccines) report that Kenya used mobile clinics for a tetanus vaccination programme. The Discussion recommends considering mobile outreach to reach out-of-school girls in a future HPV programme. The paper does not report that Kenya or Uganda deployed mobile HPV vaccination camps or that such camps increased coverage among out-of-school adolescents. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    International research shows that even with increased awareness, factors such as vaccine cost, perceived necessity, and cultural sensitivity influence HPV vaccination decision-making.

    “These findings are consistent with international research, which has shown that even with increased awareness, factors such as vaccine cost, perceived necessity, and cultural sensitivity influence decision-making51.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [51] Xu MA Choi J Capasso A DiClemente RJ Improving HPV vaccination uptake among adolescents in low resource settings: Sociocultural and socioeconomic barriers and facilitators Adolesc Health Med Ther 2024 15 73 82 39100520 PMC11296371 source

      The Results (page unavailable) show that only 28% of Senegalese adolescents who had heard of HPV were willing to be vaccinated. The Introduction and Conclusions (pages unavailable) discuss social and cultural factors affecting vaccine uptake. Our copy does not establish vaccine cost or perceived necessity as influences on decisions, and it does not show that awareness had increased over time. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Out-of-school girls often come from marginalized or tribal populations and remain underrepresented in HPV vaccination, echoing equity challenges across LMICs.

    “Out-of-school girls often come from marginalized or tribal populations, which remain underrepresented, echoing equity challenges seen across LMICs56.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [56] Ahmed D Vander Ende K Harvey P Bhatnagar P Kaur N Roy S et al Human papillomavirus (HPV) vaccine introduction in Sikkim state: Best practices from the first statewide multiple-age cohort HPV vaccine introduction in India-2018-2019 Vaccine 2022 40 A17 25 34429233 PMC10874777 source

      The Results (Vaccine delivery and coverage; page unavailable) report that tracking out-of-school girls at sub-district level was lacking, supporting a concern about reaching them. The paper does not say that these girls often come from marginalized or tribal populations, establish that they were underrepresented in vaccination, or document the claimed equity pattern across LMICs. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Physicians in rural and semi-urban India remain under-utilized for HPV vaccination, a challenge echoed in other LMICs.

    “However, physicians in rural and semi-urban India remain under-utilized, a challenge echoed in other LMICs49,53.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [49] Xie H Zhu HY Jiang NJ Yin YN Awareness of HPV and HPV vaccines, acceptance to vaccination and its influence factors among parents of adolescents 9 to 18 years of age in China: A cross-sectional study J Pediatr Nurs 2023 71 73 8 37028228 source

      The Results (Cost-Benefit Perception and Attitudes; page unavailable) say that adolescents use health services minimally in most LMICs and often lack a primary care doctor or nurse. This supports a broader LMIC access challenge, but the paper does not establish that physicians are under-utilized for HPV vaccination in rural or semi-urban India. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [53] Massey PM Boansi RK Gipson JD Adams RM Riess H Dieng T et al Human papillomavirus (HPV) awareness and vaccine receptivity among Senegalese adolescents Trop Med Int Health 2017 22 113 21 27754581 PMC5205573 source

      In the paper’s main text (page unavailable), the authors describe sociocultural, health-system, and financial barriers to HPV vaccine rollout in LMICs. The paper does not say that physicians in rural or semi-urban India are under-utilized for vaccination, or that this specific challenge occurs in other LMICs. (LLM, conf=0.79)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    State-level HPV vaccination programmes in Punjab and Sikkim provide practical models for effective implementation among school-going girls, supported by mandatory school enrolment, integration of health and education departments, comprehensive training, and strong community engagement.

    “In India, the state-level HPV vaccination programmes, particularly from Punjab and Sikkim, provide practical models for effective implementation, among the school-going girls55, supported by mandatory school enrolment, integration of health and education departments, comprehensive training, and strong community engagement56.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [55] Mehrotra R Hariprasad R Rajaraman P Mahajan V Grover R Kaur P et al Stemming the wave of cervical cancer: Human papillomavirus vaccine introduction in India J Glob Oncol 2018 4 1 4 PMC6180758 30241163 source

      Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [56] Ahmed D Vander Ende K Harvey P Bhatnagar P Kaur N Roy S et al Human papillomavirus (HPV) vaccine introduction in Sikkim state: Best practices from the first statewide multiple-age cohort HPV vaccine introduction in India-2018-2019 Vaccine 2022 40 A17 25 34429233 PMC10874777 source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Some studies also included healthcare providers, reproductive-age women, and community members.

    “Some studies also included healthcare providers, reproductive-age women, and community members to provide a broader context on knowledge, attitudes, and barriers surrounding HPV vaccination.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The majority of included studies employed cross-sectional survey designs (n=24), followed by cohort studies (n=5), interventional studies including quasi-experimental designs (n=4), randomized controlled trials (n=2), and model-based projections (n=2).

    “The majority of studies included employed cross-sectional survey designs (n=24), followed by cohort studies (n=5), interventional studies including quasi-experimental designs (n=4), randomized controlled trials (n=2), and model-based projections (n=2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    Data collection involved structured questionnaires, focus group discussions, in-depth interviews, and in selected scenarios, biological testing such as PCR-based assays to detect HPV prevalence.

    “Data collection involved structured questionnaires, focus group discussions, in-depth interviews, and in selected scenarios, biological testing such as polymerase chain reaction (PCR) based assays to detect HPV prevalence.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Study settings spanned both urban and rural areas, with school- and community-based recruitment strategies in various states of India.

    “The study settings spanned both in urban and rural areas, with both school- and community-based recruitment strategies in various states of India.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Sample populations ranged from adolescent girls (typically aged 9-19 yr) to their parents or caregivers.

    “Sample populations ranged from adolescent girls (typically aged 9–19 yr), their parents or caregivers (Table 1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Sampling methods included random, stratified, cluster, convenience, and probability proportionate-to-size sampling techniques.

    “Sampling methods included in these articles were random, stratified, cluster, convenience, and probability proportionate-to-size sampling techniques.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The included studies were published between 2009 and 2025.

    “A total of 37 studies published between 2009 and 2025 were included in this scoping review10-46.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Lack of awareness, sociocultural stigma, economic constraints, and insufficient assistance from the health system are main barriers that prevent HPV vaccine uptake in India.

    “Lack of awareness, sociocultural stigma, economic constraints, and insufficient assistance from the health system were highlighted as some of the main barriers.”
    • Also stated in: § Interpretation & conclusions · plain
      “However, obstacles like low awareness, social stigma, budgetary limitations, and problems with the health system still prevent uptake.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The findings of the included studies are reliable enough to support the review's synthesis, despite the absence of quality appraisal.

  • May combine two claims.

    Findingnone given

    These attitudes were more prevalent among populations with lower education levels or those influenced by traditional gender roles.

    “These attitudes were more prevalent among populations with lower education levels or those influenced by traditional gender roles.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Many interventions were short-term or evaluated only immediate knowledge outcomes, not the participants' long-term change towards the intake of vaccines.

    “Many interventions were short-term or evaluated only immediate knowledge outcomes, not the participants ‘long-term change towards the intake of vaccines.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Government awareness initiatives, healthcare provider recommendations, and school-based interventions facilitate HPV vaccination.

    “Government awareness initiatives, healthcare provider recommendations, and school-based interventions were found to facilitate HPV vaccination.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The findings of the included studies are reliable enough to support the review's synthesis, despite the absence of quality appraisal.

  • May combine two claims.

    Findingreasoning

    Cost, availability, programmatic support, and integration into public health infrastructure are central themes in HPV vaccine adoption.

    “Issues of cost, availability, programmatic support, and integration into public health infrastructure were central themes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    School-based interventions generate community-level awareness, but broader social barriers due to stigma and conservative norms remain unaddressed.

    “School-based interventions were often successful in generating community-level awareness, but broader social barriers due to stigma and conservative norms remained unaddressed.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    High cost of the HPV vaccine is a major policy-level barrier in India, particularly as the HPV vaccine remains outside the national immunization program.

    “The high cost of the HPV vaccine was a major policy-level barrier in India, particularly as the HPV vaccine remains outside the national immunization program.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Reference lists of all included articles were manually searched for additional relevant studies.

    “To ensure a comprehensive review, the reference lists of all included articles were manually searched for additional relevant studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    In cases of uncertainty, a third reviewer was consulted to reach consensus.

    “In cases of uncertainty, a third reviewer was consulted to reach a consensus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Full-text articles of potentially eligible studies were assessed independently.

    “Full-text articles of potentially eligible studies were subsequently retrieved and assessed independently.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Quality appraisal was not conducted in this review.

    “Quality appraisal was not conducted, as the focus of this research was to identify and describe the nature of studies on HPV research in this area, not to assess their quality.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The review was conducted and reported in accordance with PRISMA-ScR guidelines.

    “This review was conducted and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines to ensure methodological transparency and rigor (Supplementary material).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The review used Arksey and O'Malley's methodological guidance for scoping reviews.

    “The framework used for this scoping review was Arksey and O'Malley's methodological guidance for scoping reviews5.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Arksey H O'Malley L Scoping studies: Towards a methodological framework Int J Soc Res Methodology 2005 8 19 32

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Peer-led education and school-based peer counselling showed promise for HPV vaccination, although less studied.

    “Peer-led education and school-based peer counselling showed promise, although less studied.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The school setting allows for mass outreach, consistent communication, and practical convenience for HPV vaccination.

    “The school setting allowed for mass outreach, consistent communication, and practical convenience.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The influence of community leaders, religious beliefs, and stigma surrounding HPV as an STI is pivotal.

    “The influence of community leaders, religious beliefs, and stigma surrounding HPV as a sexually transmitted infection (STI) was pivotal.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Organizational success of HPV vaccination programs depends heavily on coordination of communication, adequate training of staff, and inclusive strategies to reach all adolescent groups.

    “Organizational success depended heavily on the coordination of communication, adequate training of staff, and inclusive strategies to reach all adolescent groups.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Single-dose HPV vaccine strategies align with WHO's updated guidance and hold promise for broader, more cost-effective coverage.

    “These findings are aligned with WHO’s updated guidance and hold promise for broader, more cost-effective coverage.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Cervavac is a low-cost, domestically produced HPV vaccine priced at approximately INR 200-INR 400 per dose.

    “The recent approval and rollout of Cervavac, a low-cost, domestically produced HPV vaccine priced at ∼ INR 200–INR 400 per dose, marks a critical policy milestone, as reported by Sharma et al11.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Sharma et al11

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationcitation

    Out-of-school girls, often from marginalized backgrounds, lack access to structured health communication, reinforcing disparities in awareness and vaccination.

    “These girls, often from marginalized backgrounds, lacked access to structured health communication, reinforcing disparities in awareness and vaccination.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Holroyd et al35

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    Teachers need awareness about structured health education programs to amplify message delivery and dispel myths among students and parents.

    “Jacob et al33 pointed to the absence of structured health education programs and the need for awareness about the same for the teachers, which could otherwise amplify message delivery and dispel myths among students and parents.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Jacob et al33

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    HPV is perceived as a sexually transmitted disease, leading to denial, shame, and parental resistance.

    “Degarege et al28 and Raychaudhuri et al 34 reported that HPV was perceived as a sexually transmitted disease linked leaded by denial, shame, and parental resistance.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Degarege et al28

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Raychaudhuri et al 34

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Out-of-school girls are excluded from school-based HPV vaccination programs, which is a major equity issue.

    “Holroyd et al35 highlighted the exclusion of out-of-school girls from school-based programs as a major equity issue.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Holroyd et al35

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    In Senegal, China, and Nigeria, culturally sensitive messaging and involvement of community health workers and peer educators are effective in increasing HPV vaccination acceptance.

    “In settings like Senegal, China, and Nigeria, the integration of culturally sensitive messaging and the involvement of community health workers and peer educators have proven effective in increasing vaccination acceptance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Myanmar integrated HPV vaccination into its national immunization programme, financed through GAVI.

    “Similarly, countries such as Myanmar integrated HPV vaccination into their national immunization programme, financed through GAVI57.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] Basa JE Clemens R Clemens SAC Nicholson M Landscaping analysis of immunization progress and program structures in selected middle income Southeast Asian countries Vaccine 2024 42 2326 3 38448324 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Introduction of India's low-cost vaccine like Cervavac and WHO's endorsement of a single-dose schedule are major milestones with potential to reduce cost and logistical hurdles.

    “However, the introduction of India’s low-cost vaccine, like Cervavac, and WHO's endorsement of a single-dose schedule are major milestones with the potential to reduce cost and logistical hurdles.”
    Quote in the paperNot a substantial claim
55 of 55

  • The paper relies on this without support.

    In India, cervical cancer is the second leading cause of cancer mortality among women.

    “In India, cervical cancer is the second leading cause of mortality related cancer among women.”

  • The paper relies on this without support.

    The findings of the included studies are reliable enough to support the review's synthesis, despite the absence of quality appraisal.

    “Quality appraisal was not conducted, as the focus of this research was to identify and describe the nature of studies on HPV research in this area, not to assess their quality.”
2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Exhaustive study-design counts omit qualitative studies

    Minor

    The five reported design counts total all 37 included studies, leaving no place for the qualitative policy review explicitly listed in the summary table.

  • Shah is attributed to the wrong reference number

    Minor

    The text cites Shah et al. as reference 49, but reference 49 is by Xie et al.; Shah et al. is reference 48.

  • Madhivanan study has conflicting publication years

    Minor

    The table dates the study cited as reference 46 to 2009, but the reference lists it as published in 2014.

  • Prinja study has conflicting publication years

    Minor

    The summary table dates Prinja et al. to 2014, but reference 21 dates the same study to 2017.

  • Joshi study has conflicting publication years

    Minor

    The summary table gives 2018 for Joshi et al., while reference 32 gives 2020.

  • Ahlawat table entry carries another study's title

    Minor

    The title assigned to Ahlawat et al. in the summary table is the title of the Apurva et al. study listed as reference 38. Reference 45 gives Ahlawat et al. a different title.

6 of 6

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Authors
Josten, K., Rose Dhar, R., Reshmi, B., Natti Krishna, V., & Vennila, J.
Affiliations
  • Manipal Academy of Higher Education (IN)
  • Department of Health Information Management, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
  • Renal Replacement Therapy and Dialysis Technology Program, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
ORCID
Venue
The Indian Journal of Medical Research
Publisher
Scientific Scholar
Published
2026-01-31
Volume
162
Issue
6
Pages
743-753
ISSN
0971-5916 (ISSN-L)
DOI
10.25259/ijmr_1834_2025
PMC
PMC12883130
OpenAlex
W7126375914
Semantic Scholar
43cf36ca27968862c7bbb99bc4e3ab0e4637bbc2
Cited by
6
References
52
Citations by year
2026: 6
FWCI
25.84
Type
journal article
Language
en
Open access
Licence
cc-by-nc-sa
Locations
  • The Indian Journal of Medical Research (publishedVersion, cc-by-nc-sa)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion, cc-by-nc-sa)
  • PubMed Central (submittedVersion, cc-by-nc-sa)
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Social Sciences › Health › Vaccine Coverage and Hesitancy
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
Keywords
HPV vaccination, adolescent girls, barriers to vaccination, sociocultural stigma, vaccine awareness, economic constraints, provider recommendation, school-based intervention, socio-ecological model, India
MeSH terms
Human Papillomavirus Viruses, Adolescent, Uterine Cervical Neoplasms, Female, Humans, India, Health Knowledge, Attitudes, Practice, Vaccination, Papillomavirus Infections, Papillomavirus Vaccines

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-16.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-16.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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