Gender-Neutral vs. Gender-Specific Strategies in School-Based HPV Vaccination Programs: A Systematic Review and Meta-Analysis

Nutthaporn Chandeying ¹ Puttichart Khantee ² Sirada Puetpaiboon ² Therdpong Thongseiratch ^2*

• ¹ Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
• ² Prince of Songkla University, Songkhla, Thailand

This systematic review and meta-analysis aimed to evaluate the effectiveness of genderneutral (GN) versus gender-specific (GS) strategies in improving knowledge, intention, and uptake of HPV vaccination among students in educational settings. A comprehensive literature search was conducted using PubMed, Scopus, Web of Science, and Cochrane Library, resulting in 17 randomized controlled trials being included. These trials encompassed a total of 22,435 participants, including 14,665 females and 7,770 males. Effect sizes were calculated using random-effects models, with risk difference for vaccination uptake and standardized mean differences (SMDs) for knowledge and intention outcomes. The results indicated that GN strategies significantly improved HPV-related knowledge (SMD = 0.95) and vaccination intention (SMD = 0.59), compared to GS strategies (SMD = 0.68 for knowledge and SMD = 0.14 for intention). GN strategies also showed a higher increase in vaccination uptake (5.7%) compared to GS strategies (2.5%). Heterogeneity varied, being higher in knowledge outcomes and moderate in vaccination uptake for GS strategies. While GN strategies appeared more impactful on HPV-related knowledge and intention, the observed higher uptake rate did not reach statistical significance compared with GS strategies. These findings underscore the need for further research with robust designs and extended follow-up to definitively ascertain whether GN approaches confer a superior advantage in increasing vaccination uptake.