Unmet needs for stroke patients based on the social ecological model: protocol for a mixed-methods systematic review.

Human papillomavirus (HPV) causes cervical cancer in women and oropharyngeal cancer, anal cancer, and condyloma acuminatum in both genders. In Japan, the incidence and mortality of cervical cancer continue to increase, particularly among women in their 20s and 30s; the incidence of oropharyngeal cancer in both genders, as well as the mortality of anal cancer and incidence of condyloma acuminatum among men, have also increased. Globally, approximately one in three men aged over 15 years is infected with genital HPV. In Japan, among men aged 20–95 years visiting urology clinics, 25% had any HPV infection and 13% had high-risk HPV. Therefore, preventing HPV-related diseases has become increasingly important regardless of gender. HPV is a sexually transmitted infection, and vaccination during adolescence is an effective preventive measure against HPV-related diseases. In Japan, HPV vaccination is implemented as a routine, publicly funded immunization for girls in school grades corresponding to the last year of elementary school through the first year of senior high school, using a standard three‑dose schedule at medical institutions; a two‑dose schedule permitted for younger age groups under current recommendations. Thus, HPV vaccination for girls began in December 2009 and became a national routine vaccination program in April 2013. However, active government recommendations were suspended in June 2013 following reports of adverse events, leading to a sharp decline in the vaccination rate to below 1%. Following reassessments confirming the vaccine’s effectiveness and safety, active government recommendations resumed in April 2022 after a nine-year suspension. Nevertheless, the cumulative first-dose vaccination rate among girls born during fiscal years (FYs) 2008–2012 remained low (4.4–49.9%) as of early 2024, far below the international standards of 90%. Meanwhile, HPV vaccination has been approved for males aged 9 years and older since December 2020. In contrast to the routine, publicly funded program for girls, HPV vaccination for boys has not been included in the national routine schedule and is provided as an optional vaccination; it generally follows the same three‑dose (or age‑dependent two‑dose) regimen at medical institutions, with out‑of‑pocket payment required. As of October 2024, 45 municipalities offered full or partial subsidies for boys’ vaccination, typically targeting those around 11–16 years of age. Therefore, no national data are yet available on HPV vaccination rates among boys. Promoting HPV vaccination among men is essential to prevent HPV-related diseases and strengthen herd immunity, considering the current low vaccination rate among women. In fact, many Western countries have achieved HPV vaccination rates of 60–80% in both genders. In Japan, parental or guardian consent is required for HPV vaccination in individuals under 16 years. Parents significantly contribute to decision-making regarding HPV vaccination. Mothers often play a central role in the decision-making process, reflecting traditional gender roles in household responsibilities. Previous domestic studies have identified psychosocial factors influencing mothers’ intentions to vaccinate their adolescent daughters, including perceived vaccine benefits, recommendations from healthcare professionals (HCPs), best-friend effect, and municipal notifications. The “best-friend effect” refers to the phenomenon through which vaccination uptake or recommendation by a daughter’s close friend positively shapes the mother’s perception of HPV vaccination and increases willingness to vaccinate, reflecting trusted peer influence rather than negative peer pressure. Previous domestic studies have identified that interventions targeting mothers can increase vaccination rates among daughters. Previous foreign studies have also identified various psychosocial factors of parents’ or guardians’ intentions to vaccinate their adolescent sons against HPV, including mothers’ perceived susceptibility, perceived vaccine benefits, recommendations from HCPs, and concerns about safety and cost; this generally indicates that many of these correlates are similar to those reported for mothers’ intentions to vaccinate their daughters. However, these findings may not be directly generalizable to Japan. In Japan, the HPV vaccination is implemented as a routine, publicly funded program only for girls, whereas boys receive HPV vaccination as a voluntary, self-paid service, and both girls and boys are vaccinated individually in clinic-based instead of school-based settings. Moreover, the suspension of active governmental recommendations for girls in 2013, following intensive media coverage of alleged adverse events, has led to a prolonged loss of public trust in HPV vaccination. In addition, public and policy discourse has focused mainly on cervical cancer prevention among girls, so the benefits of HPV vaccination for boys and their own cancer risk have been much less