• Heather M Brandt, Robin C Vanderpool, Meagan Pilar, Maria Zubizarreta, and Lindsay R Stradtman.
• University of South Carolina Arnold School of Public Health, Department of Health Promotion, Education, Behavior, Rural and Minority Health Research Center, 915 Greene Street, Columbia, SC 29208, United States. Electronic address: hbrandt@sc.edu.
• Prev Med. 2021 Apr 1; 145: 106407106407.

AbstractUptake of human papillomavirus (HPV) vaccine in the United States (U.S.) is far below the Healthy People 2020 goal of 80% coverage among adolescents. In rural communities, HPV vaccination coverage is low, yet incidence and mortality rates of HPV-associated cancer are high. Much of the research focused on HPV vaccination in rural U.S. communities has involved qualitative investigations, observations, survey research, and secondary data analysis with limited implementation of interventional study designs. The purpose of this narrative review was to examine intervention studies to increase HPV vaccination in rural settings and to summarize study characteristics and associated outcomes. PubMed, PsycINFO, CINAHL, and Web of Science were searched utilizing systematic narrative review methodology for studies describing implementation of HPV vaccination interventions in rural U.S. settings from January 2006-December 2019. Using specific search criteria, 991 studies were identified. After abstract review, 30 full-text articles were assessed for eligibility, and 15 met the inclusion criteria. The 15 articles - published from 2011 to 2019 - described HPV vaccination interventions in rural settings of six states, including communities, health clinics, and schools. A range of primary and secondary outcomes were reported, including HPV vaccine receipt (series initiation, continuation, and/or completion); HPV vaccine knowledge; and/or cervical cancer knowledge. Across the studies, there was an absence of the description of rural context. As compared to the broader HPV vaccination intervention literature, interventions in rural settings were limited. More interventional research is needed in rural communities given the elevated rates of HPV-related cancer and low rates of HPV vaccine uptake.Copyright © 2020 Elsevier Inc. All rights reserved.

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