From non-uptake during early adolescence to acceptance during a catch-up campaign: a qualitative study of changing HPV vaccination decisions across two life stages among young women in Amsterdam, the Netherlands

Background: Human Papillomavirus (HPV) vaccination effectively prevents HPV-related disease, but its population-level impact depends on sufficient coverage. In 2023-2024, the Netherlands offered free HPV vaccination to individuals aged 19-27 years through a national catch-up campaign. For women, this was a second opportunity, as they had been offered vaccination at ages 9-13 through the National Immunisation Programme (NIP). Back then, uptake was relatively low (46-57% in these birth cohorts), but uptake increased to 55-63% following the catch-up vaccination. This campaign provided an apt opportunity to explore the factors underlying previous and current HPV vaccination decisions among the same women across two life stages. Methods: Between May 2023 and May 2024, 16 semi-structured interviews were conducted in Amsterdam with women who accepted HPV vaccination during the catch-up after non-uptake during early adolescence. Interviews explored factors influencing non-uptake and later acceptance, guided by the Health Belief Model and additional sociocultural constructs. Data were analysed using thematic analysis with open and theory-guided coding in MAXQDA. Results: Non-uptake during early adolescence was primarily shaped by parental decision-making, cultural and religious norms, fear of side effects, low perceived susceptibility to HPV and limited self-efficacy. Acceptance in young adulthood was driven by greater autonomy, higher perceived susceptibility, increased trust in accumulated vaccine evidence and accessible vaccination infrastructure. Peer influence replaced parental influence as the dominant social factor. Conclusion: HPV vaccine decision-making is a dynamic process rather than fixed. Permanent catch-up HPV vaccination opportunities would enable young adults to make autonomous vaccination decisions as their circumstances change.