Understanding and Addressing HPV Vaccine Hesitancy in Muslim Mother-Daughter Dyads: A Mixed-Methods Study of Religious Fatalism, Modesty, and Intervention Preferences

Human papillomavirus (HPV) vaccination is a cornerstone of primary prevention for cervical and other HPV-related cancers; however, uptake remains consistently lower among Muslim communities in Western contexts. The behavioral, religio-cultural, and relational dynamics shaping vaccine decision-making—particularly within the mother–daughter dyad—remain insufficiently explored. This sequential explanatory mixed-methods study examined how Islamic religio-cultural constructs, including religious fatalism and modesty concerns, intersect with general vaccine hesitancy to influence HPV vaccination intentions, while also exploring lived experiences and intervention preferences to inform a culturally congruent behavioral model. Phase 1 consisted of a cross-sectional survey of 300 Muslim mother–adolescent daughter dyads (N = 600), assessing religiosity, HPV knowledge, religious fatalism, modesty concerns, vaccine hesitancy, and vaccination intentions. Dyadic associations were analyzed using Actor–Partner Interdependence Models. Phase 2 involved separate in-depth interviews with 20 purposively selected hesitant dyads, analyzed through reflexive thematic analysis. Quantitative findings indicated that mothers’ higher religious fatalism and modesty concerns were significantly associated with lower vaccination intentions and exerted negative partner effects on daughters’ intentions, while daughters’ modesty concerns independently predicted their own hesitancy. Qualitative analysis revealed tensions between divine decree and preventive responsibility, the framing of the female body as a sacred trust (amānah), the circulation of misinformation within trusted community networks, and the central role of faith-informed, gender-concordant counsel. These findings underscore that HPV vaccine decision-making in Muslim families is a relational process embedded in religious worldview and gendered ethics, highlighting the need for dyadic, family-centered interventions that integrate Islamic principles of health preservation and trusted healthcare–religious partnerships.