Table 1.

Summary of included studies

Studies	Participants and Design	Facilitators/ Barriers	HPV Vaccine Outcome	Type of Study/ Risk of Bias
Agénor et al. (2020)	Heterosexual, bisexual, and lesbian women Sample size n = 7033 Age: 15-25 years Computer-assisted personal interview and audio computer-assisted self-interview questionnaires	Facilitators Health insurance	Initiation	Type of Study: Quantitative Risk of Bias: Low
Gerend et al. (2019)	Men who identified as gay, bisexual, or queer Sample size n = 29 Age: 18–26 years Semi-structured interview	Facilitators Preventing HPV and reducing risk of HPV-related diseases; (2) Peace of mind; (3) Protecting sexual partners; (4) People in their lives would be supportive of them receiving the HPV vaccine; (5) Descriptive norms for HPV vaccination; (6) Recommendation from a health care provider Barriers Perceived only women could receive the vaccine; (2) Whether the HPV vaccine is effective for men who have already been sexually active; (3) The recommended number and timing of doses; (4) Typical age for receiving the HPV vaccine; (5) Common side effects; (6) Sexual disinhibition; (7) Stigma; (8) Vaccine cost; (9) Did not know where they could receive the vaccine; (10) The inconvenience of being offered the vaccine while at the clinic	Acceptance Initiation Completion	Type of Study: Qualitative Risk of Bias: Low
Loretan et al. (2019)	Men who have sex with men (MSM) Sample size n = 2,381 (2014); n = 4,143 (2015); n = 3,926 (2016); n = 3,407 (2017) Mean age: 23.5 years Online survey	Facilitators (1) Younger; (2) Had health insurance; (3) Visited a healthcare provider in the past 12 months; (4) Resided in the Northeast; (5) Resided in metropolitan areas; (6) Had higher household income; (7) Disclosed their sexual identity to health care provider; (8) Had gonorrhea/chlamydia diagnosis in the past 12 months	Initiation	Type of Study: Quantitative Risk of Bias: Low
Koskan & Fernández- Pineda, (2018)	HIV-positive gay and bisexual men Sample size n = 15 Age: 18–30 years In-depth interviews	Facilitators Prevent infection Barriers (1) Never heard of the HPV vaccine; (2) Perceived it as a resource for women only; (3) Lack of provider recommendation to complete the vaccine series; (4) Vaccine cost; (5) Lack of insurance coverage	Acceptance Completion	Type of Study: Qualitative Risk of Bias: Low
Bednarczyk et al. (2017)	Lesbian, gay, bisexual, and trans Sample size n = 660 Age: 18–34 years Self-administered, anonymous online cross-sectional survey	Facilitators (1) Received a health care provider's recommendation for HPV vaccination; (2) Having health insurance	Initiation	Type of Study: Quantitative Risk of Bias: Low
Gorbach et al. (2017)	Young men who have sex with men (MSM) & trans women Sample size n = 808 Age: 18–26 years Self-administered computerized questionnaire	Facilitators (1) History of self-reported sexually transmitted disease (STD); (2) College degree or higher; (3) Health care provider recommendation	Initiation	Type of Study: Quantitative Risk of Bias: Low
Oliver et al. (2017)	Men who have sex with men (MSM) Sample size n = 2892 Age: 18–26 years National HIV Behavioral Surveillance (NHBS), a multicity surveillance system conducted in 20 metropolitan statistical areas (MSAs) with a high HIV/AIDS burden in the U.S.	Facilitators (1) Self-reported HIV infection; (2) Having a health care visit within 12 months; (3) Health insurance; (4) A usual place of care; (5) Disclosing MSM attraction or behavior to a health care provider.	Initiation	Type of Study: Quantitative Risk of Bias: Low
Polek & Hardie. (2017)	Lesbian, bisexual & heterosexual women Sample size n = 5695 Age: 18–26 years The Centers for Disease Control and Prevention's National Health Interview Survey 2013–2014	Facilitators Having sex with different genders of partners	Initiation	Type of Study: Quantitative Risk of Bias: Moderate
Wheldon et al. (2017)	Men who have sex with men (MSM) Sample size n = 22 Age: 18–26 years Semi-structured interview	Facilitators (1) Physical and psychological benefits; (2) Health care provider recommendation; (3) The support of friends or family; (4) Convenience of vaccine uptake; (5) Perceived self-efficacy; (6) Perceived threat of HPV infection and disease; (7) Anogenital warts Barriers (1) Perceived HPV as a women's health issue; (2) The risks of vaccination; (3) Negative responses from family or friends; (4) Vaccine cost; (5) Vaccine access; (6) Disclosing their sexuality to healthcare providers; (7) HPV knowledge and information	Initiation	Type of Study: Qualitative Risk of Bias: Low
Fontenot et al. (2016)	Young men who have sex with men (MSM) Sample size n = 34 Mean age: 20.8 years Qualitative, descriptive study that utilized a focus group design	Facilitators (1) Positive vaccine beliefs; (2) Creative use of mobile technology; (3) Bundling vaccination with other health services Barriers (1) Low HPV knowledge and awareness; (4) Perceived stigmas	Initiation Completion	Type of Study: Qualitative Risk of Bias: Low
Gerend et al. (2016)	Men who have sex with men (MSM) Sample size n = 336 Age: 18–26 years Online survey	Facilitators Worry about becoming infected with HPV; (2) Developing an HPV-related cancer; (3) Contracting genital warts; (4) General prevention or precaution Barriers (1) Lack of a provider recommendation; (2) Lack of knowledge about HPV or the vaccine; (3) Health care provider was unaware of their sexual identity; (4) Not feeling at risk for HPV; (5) Having concerns about vaccine safety; (6) Already infected with HPV; (7) Not sexually active; (8) Vaccine cost; (9) Not having enough information; (10) Not shared their sexual identity with their provider	Initiation	Type of Study: Quantitative Risk of Bias: Low
Jones et al. (2016)	Self-identified men who have sex with men (MSM) Sample size n = 199 Age: 18–26 years Online survey	Facilitators (1) Read the information webpage Barriers (1) Lack of insurance	Acceptance	Type of Study: Quantitative Risk of Bias: Moderate
Makris et al. (2016)	Women who have sex with women (WSW) Sample size n = 1105 Age: 18–25 years & 26 and older Cross‐sectional descriptive study	Facilitators (1) Health insurance; (2) More education	Initiation	Type of Study: Quantitative Risk of Bias: Moderate
Agénor et al., (2015)	U.S. women and girls Sample size n = 3253 Age: 15–25 years 2006–2010 National Survey of Family Growth (NSFG)	Facilitators Ever heard of the HPV vaccine	Acceptance Initiation	Type of Study: Quantitative Risk of Bias: Low
Cummings et al. (2015)	Men who have sex with men (MSM) Sample size n = 1457 Age: 18–26 years Online survey	Facilitators (1) Higher HPV knowledge scores; (2) Disclosure to a doctor they were gay or bisexual; (3) Being tested for a sexually transmitted infections in the past year	Acceptance Initiation	Type of Study: Quantitative Risk of Bias: Moderate
Onyeabor et al. (2015)	African American male adolescents who self-identify as MSMs Sample size n = 24 Age: 16–18 years Focus group interviews	Barriers (1) Very little knowledge of the HPV vaccine; (2) Not aware of the complications of HPV virus infection	Acceptance	Type of Study: Qualitative Risk of Bias: Low
Reiter et al. (2015)	Gay and bisexual men Sample size n = 428 Age: 18–26 years Online survey	Facilitators (1) Had received a health care provider recommendation; (2) Higher levels of worry about getting HPV-related disease; (3) Perceived positive social norms of HPV vaccination Barriers (1) Perceived greater barriers to getting vaccinated	Acceptance Initiation	Type of Study: Quantitative Risk of Bias: Low
McRee et al. (2014)	Lesbian and bisexual women Sample size n = 543 Age: 18–26 years Online survey	Facilitators (1) Had a college degree; (2) Had received a healthcare provider's recommendation; (3) Perceived positive LGBT community vaccination norms; (4) Anticipated greater regret if they did not get vaccinated and later got HPV Barriers (1) Perceived greater HPV vaccine harms; (2) Perceived greater barriers to getting the vaccine; (3) Perceived a greater likelihood of acquiring HPV; (4) Anticipated greater regret if they got the vaccine and fainted; (5) Perceived a greater likelihood of getting HPV-related disease	Initiation Completion	Type of Study: Quantitative Risk of Bias: Low
Meites et al. (2014)	Men who have sex with men (MSM) Sample size n = 3221 Age: 18–26 years The 2011 National HIV Behavioral Surveillance System	Facilitators (1) Visited a healthcare provider; (2) Disclosed same-sex sexual attraction/behavior to a provider; (3) Reported a positive HIV test; (4) Received hepatitis vaccine	Initiation	Type of Study: Quantitative Risk of Bias: Moderate
Ong et al. (2013)	Lesbian, gay, bisexual, trans & queer individuals Sample size n = 323 Age: 16–74 years The 2010 National Health Interview Survey (NHIS) Cancer Supplement survey	Facilitators (1) Had heard about HPV and its vaccine	Acceptance	Type of Study: Quantitative Risk of Bias: Moderate
Gilbert et al. (2011)	Gay and bisexual men Sample size n = 312 Age: 19–59 years Online survey	Facilitators (1) Think HPV vaccine worked in males; (2) A physician would recommend the vaccine Barriers (1) Health care provider who would not give the vaccine to males; (2) Being unable to afford the cost of the vaccine.	Acceptance	Type of Study: Quantitative Risk of Bias: Low
Gilbert et al. (2011)	Gay Sample size HIV-negative n = 188 Mean age: 47 years HIV-positive n = 59 Mean age: 51 years Interview	Facilitators (1) Anticipated regret over developing HPV-related disease after declining vaccination; (2) Higher perceived likelihood of HPV-related diseases; (3) A physician would recommend the vaccine; (4) Higher perceived effectiveness of the vaccine; (5) Higher perceived severity of HPV-related disease; (6) Lower perceived barriers to getting HPV vaccine	Acceptance	Type of Study: Quantitative Risk of Bias: Moderate
Thomas & Goldstone, (2011)	Men who have sex with men (MSM) Sample size n = 191 Mean age: 36.57 years Written or telephone survey	Facilitators (1) Acknowledge prevention of future HPV infections; (2) Healthcare provider recommendation; (3) Advertisements; (4) Friend’s recommendation; (5) A desire to cure HPV infection; (6) Prevent more HPV problems; (7) Don’t want HPV again Barriers (1) Vaccine cost; (2) Not FDA approved; (3) Already infected with HPV; (4) Did not know enough about the vaccine; (5) Fear of side effects; (6) too old to benefit; (7) Did not feel the vaccine was necessary	Acceptance	Type of Study: Quantitative Risk of Bias: Low
Wheldon et al. (2011)	Gay and bisexual men Sample size n = 179 Age: 18–29 years Internet-based questionnaire	Facilitators (1) Providing basic information about HPV and HPV vaccine; (2) Positive attitudes toward HPV vaccination; (3) Perceived moderate physical and psychological benefits of vaccination; (4) Self-efficacy; (5) Subjective norms in favor of getting vaccinated Barriers (1) Financial cost of vaccination; (2) Concern about side effects	Acceptance	Type of Study: Quantitative Risk of Bias: Low
Hollander (2010)	Gay and bisexual men Sample size n = 306 Age: 18–59 years Online survey	Facilitators (1) Number of sex partners; (2) Recommendations from the health care providers; (3) Knowledge of HPV; (4) Knowledge of HPV vaccine	Acceptance	Type of Study: Quantitative Risk of Bias: Moderate
Reiter et al. (2010)	Gay and bisexual men Sample size n = 306 Age: 18–59 years Online survey	Facilitators (1) Doctor would recommend they get HPV vaccine; (2) Reported 5 or more lifetime sexual partners; (3) Perceived HPV-related disease to be more severe; (4) Perceived HPV vaccine to be more effective; (5) Reported greater anticipated regret if they did not get vaccinated and an HPV infection later developed.	Acceptance	Type of Study: Quantitative Risk of Bias: Low