Adherence to Human Papillomavirus Vaccination in the Province of Oujda‐Angad, Morocco

Abstract

BACKGROUND: In a global context, where millions of women have died from cervical cancer, hesitancy toward the human papillomavirus (HPV) vaccine remains high, and this reluctance continues to contribute to preventable mortality. OBJECTIVE: This study aimed to examine the determinants of human papillomavirus vaccination adherence in the province of Oujda-Angad, eastern Morocco. METHODS: A cross-sectional community-based study was conducted between December 2024 and May 2025 and included 434 participants stratified into two distinct categories (girls aged 11-26 years and parents of minor girls). Participants were recruited from urban and rural areas. Data were collected using a structured questionnaire in Moroccan Arabic dialect covering sociodemographic characteristics, awareness of the HPV infection, cervical cancer, HPV vaccine, and decision-making processes. Associations were tested using chi-square, with p < 0.05 considered statistically significant. RESULTS: The study findings revealed an overall low vaccination coverage (6.7%) and a low level of knowledge about HPV infection (39.3%). While a high proportion of participants demonstrated awareness of cervical cancer severity (92.3%), fewer correctly identified the link between HPV infection and cervical cancer (25.5%) or were aware of existence of the HPV vaccine (31.7%). Only 16.4% of young adult women reported being solely responsible for the vaccination decision-making. Religious and cultural beliefs were identified as barriers to vaccine acceptance. HPV vaccination status was significantly associated with monthly income (p = 0.049), knowledge of HPV infection (p < 0.0001), knowledge of HPV transmission, and awareness of its link to cervical cancer (p < 0.001). In turn, awareness of HPV vaccination was significantly associated with educational level, occupation, and monthly income (p < 0.001). CONCLUSIONS: Persistent structural and sociocultural barriers were revealed by our study, including distrust in the healthcare system, deficits in communication and information, social circle influences, and religious and moral beliefs. These findings underscore the need to strengthen the role of healthcare professionals and to implement coordinated, targeted educational outreach strategies to improve vaccine perception and increase HPV vaccination coverage in Morocco.