Determinants of HPV vaccination decision-making in adolescents and young adults in the Netherlands

Background Human papillomavirus (HPV) vaccination coverage remains suboptimal globally. To address this, several countries, including the Netherlands, have launched HPV catch-up campaigns. This study examined determinants influencing HPV vaccination decisions among adolescents and young adults during the 2023 Dutch HPV catch-up campaign targeting individuals aged 19–26 years. Methods Several months after the campaign was launched, a health survey was conducted among individuals aged 19–25 years in the Northern North Holland region in the Netherlands, including questions regarding HPV vaccination. Participants reported whether they had been vaccinated during the campaign, intended, hesitated or refused, and provided reasons for their decision. HPV knowledge was assessed using nine true/false statements. Associations of HPV knowledge and refusal, hesitancy and intention compared to uptake were analysed using multinomial logistic regression, adjusted for age, education, exposure to the information campaign, and, for women, previous vaccination in preadolescence. Results Among the 1795 included participants (57.5% women) self-protection was the predominant motivation for vaccination uptake and intention, while hesitancy and refusal were mainly driven by perceived insufficient information and concerns about long-term side effects. Median HPV knowledge score was 3 (IQR 1–6; range − 9 to +9). Multinomial analyses showed that lower HPV knowledge among men was associated with higher relative risk of refusing (Adjusted Relative Risk Ratio [aRRR] 3.43, 95%CI 1.93–6.07), hesitating (aRRR 2.73, 95%CI 1.51–4.95), or intending vaccination (aRRR 2.11, 95%CI 1.18–3.79); similar associations were observed for refusal and hesitancy among women. Conclusion Our findings highlight the importance of addressing safety concerns and knowledge gaps in HPV vaccination campaigns, particularly for men and individuals with lower health literacy.