Parental Knowledge, Attitudes and Hesitancy Towards Human Papillomavirus Vaccination in Saudi Arabia: An Online Cross-Sectional Study

Mohammed Shaikhomer¹Houriah Y. Nukaly^2*Razan A. Dalloul²Jumanah Y. Nassar²Amal M. Kayali²Shayma Al-Rubaki²Asim M. Alshanberi²Safaa M. Alsanosi³Ehab Abo-Ali²

• ¹King Abdulaziz University, Jeddah, Saudi Arabia
• ²Batterjee Medical College, Jeddah, Saudi Arabia
• ³Umm Al-Qura University, Mecca, Saudi Arabia

Word count: 324 Background: Cervical cancer incidence is rising in Saudi Arabia, leading to the integration of the human papillomavirus (HPV) vaccine into the national immunization program. Parental awareness and acceptance play a critical role in the vaccine's uptake. Methods: A cross-sectional study was conducted among 675 parents of daughters aged 11–15 years across various regions in Saudi Arabia. Data were collected using a self-administered questionnaire assessing sociodemographic factors, knowledge levels, and attitudes regarding the mandatory HPV vaccination. Results: Only 43.5% of parents (n = 294) were aware of the mandatory HPV vaccination for adolescent girls; 24.1% had learned about it through media sources, while only 11.7% cited healthcare providers, reflecting a missed opportunity for clinical education. Fathers were significantly less knowledgeable than mothers (adjusted odds ratio [AOR] = 0.29; 95% confidence interval [CI]: 0.14–0.60, p = 0.001), indicating a notable gender disparity in health engagement. Parents in health-related occupations had a higher knowledge level than those in non-health-related jobs or who were unemployed (AOR = 2.15, 95% CI: 1.02–4.50, p = 0.043). Mothers who had never undergone a Pap smear were less likely to have knowledge than those who had (AOR = 0.33, 95% CI: 0.24–0.65, p = 0.000). Older parents showed less favorable attitudes than younger ones (AOR = 0.45, 95% CI: 0.22–0.91, p = 0.025), and parents living in urban areas had more positive attitudes compared to those in rural areas (AOR = 2.30, 95% CI: 1.12–4.74, p = 0.024). A negative family history of cervical cancer was also associated with a less positive attitude (AOR = 0.35, 95% CI: 0.23–0.56, p = 0.030). Key concerns contributing to hesitancy included potential side effects (53.4%) and vaccine safety (42.5%). Conclusions: Despite national policy support, parental awareness and knowledge of the HPV vaccination in Saudi Arabia remain limited. Strengthening the role of healthcare providers and addressing gender-based engagement disparities are essential components of targeted educational strategies aimed at improving vaccine uptake and reducing cervical cancer risk.