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Background Methods Results Conclusions Parental acceptance of HPV vaccination remains low. This study investigates the influence of different message framing on Chinese parental intentions to vaccinate their daughters against HPV.A 2 (appeal framing: gain vs. loss) × 2 (cultural value: individualism vs. collectivism) × 2 (evidence type: narrative vs. non‐narrative) factorial design was used in an online experiment. Parents of unvaccinated junior high school girls were recruited and included in the experiment. The primary outcome assessed was the reduction in HPV vaccine hesitancy (VH). The analysis of variance tests (ANOVAs) and hierarchical regression analyses were conducted to test the hypotheses.Of 4012 participants, the majority were women with low VH. Only loss‐framing exerted a direct effect on advocacy (p = .036). Initial VH negatively moderated this effect (p = .027). Except for narrative evidence (p = .068), message framings showed significant small effects in low‐hesitant participants (p = .032). An incentive policy negatively moderated the initial VH's effect on advocacy (p = .042). Persuasion was evident only among low‐hesitant participants not receiving incentives (p = .002). In contrast, for highly hesitant individuals without incentive policies, loss‐framing (p = .024) and collectivism perspective (p = .033) produced counterintuitive effects.Message framing is effective among low‐hesitant parents of female adolescents in improving HPV vaccination decisions without economic incentives. Non‐narrative evidence and loss‐framing messages should be prioritized over narrative evidence and gain‐framing messages. Nonetheless, caution is warranted when engaging with highly hesitant parents. [ABSTRACT FROM AUTHOR]

• We provide quantitative evidence on the association between vaccine hesitancy and adverse vaccination behaviors. • We explore the association between vaccine hesitancy and adverse vaccination behaviors within various population characteristics. • The association between vaccine hesitancy and vaccination behaviors may be influenced by geographic regions, age, and health status. • Parents of children without high-risk health conditions may exhibit higher rates of vaccine hesitancy. Vaccination is crucial for prevention of infectious diseases, and identification of the impact of vaccine hesitancy on vaccination programs is crucial for early intervention and formulation of policies to alleviate vaccine hesitancy. The aim of this systematic review was to explore the relationship between vaccine hesitancy and negative vaccination behavior globally. We searched for observational studies in various databases. We conducted a meta-analysis using pooled odds ratios (OR) and 95 % confidence intervals (CI), performed meta regression and subgroup analysis to explore the role factors such as location and individual characteristics on the association between vaccine hesitancy and vaccination behavior. A total of 46 articles were included in systematic analysis and 34 articles were included in the meta-analysis. The systematic analysis comprised 162,601 samples, whereas the meta-analysis included 147,554 samples. The meta-analysis showed that a higher rate of vaccine hesitancy was associated with an increased likelihood of adverse vaccination behaviors (all adverse behaviors: OR = 1.50, 95 % CI, 1.33–1.70, P < 0.001; unvaccinated: OR = 1.48, 95 % CI, 1.29–1.70, P < 0.001; vaccine delay: OR = 2.61, 95 % CI, 1.97–3.44, P < 0.001). The meta-regression results indicated that the heterogeneity observed was mainly from sample selection methods, age of vaccinees and the health status of participants. The results showed that parents of minor vaccinees or without high-risk health status had a higher association between vaccine hesitancy and vaccine uptake compared with populations exposed to higher health risks or adult vaccinees. The findings provide evidence on the association between vaccine hesitancy and adverse vaccination behaviors. The results showed that these population-specific factors should be considered in future research, and during formulation of interventions and implementation of policies to improve vaccination uptake. [ABSTRACT FROM AUTHOR]