Key Social Norms Take-aways The study highlights that social norms—particularly subjective norms shaped by influential actors such as health professionals, religious leaders, peers, and family—play a critical role in shaping parents’ acceptance of HPV vaccination for their daughters in Ethiopia. Norms operate through perceived expectations and social pressure, where approval or endorsement from trusted community figures increases acceptance, while misinformation, stigma, and fear (e.g., beliefs that the vaccine causes infertility or promotes sexual activity) reinforce resistance. The discussion emphasizes that social norms interact with knowledge, attitudes, and safety concerns, meaning that even when awareness exists, normative beliefs and community narratives can either enable or constrain vaccine uptake. Addressing these norms through trusted social networks and community engagement is essential for improving vaccination acceptance.

Objectives The study aimed to assess parents’ acceptance of HPV vaccination for their daughters and identify associated factors in Adet town, Northwest Ethiopia.

Methods A community-based concurrent mixed-methods cross-sectional study was conducted with 319 parents of daughters aged 9–14 years, supplemented by in-depth interviews and key informant interviews. Quantitative data were collected באמצעות structured questionnaires and analyzed using descriptive statistics and logistic regression. Social norms were measured quantitatively through subjective norms using Likert-scale items capturing perceived expectations from significant others. Qualitative data were analyzed thematically to explore community beliefs, norms, and contextual influences on vaccine acceptance.

Results Overall, 78.1% of parents accepted HPV vaccination for their daughters. Key factors significantly associated with acceptance included knowledge (AOR=2.96), positive attitudes (AOR=3.47), positive subjective norms (AOR=3.19), and low safety concerns (AOR=8.20). Qualitative findings revealed that misconceptions (e.g., vaccine causes infertility or acts as contraception), lack of knowledge, and distrust were major barriers. In contrast, endorsement from health professionals, religious leaders, and peers, along with perceived benefits of preventing cervical cancer, facilitated acceptance. Social norms—especially peer and authority influence—were consistently identified as shaping parental decision-making.

Conclusions While HPV vaccine acceptance is relatively high, persistent misconceptions, safety concerns, and negative normative beliefs remain barriers. The study concludes that improving acceptance requires multi-level interventions that enhance knowledge, address safety concerns, and leverage influential community actors to shift social norms. Without addressing the broader normative environment, efforts to increase vaccination uptake may be limited, underscoring the importance of integrating social norms change into public health strategies for cervical cancer prevention.