Knowledge and attitudes about human papillomavirus (HPV) and HPV vaccines among women living in metropolitan and rural regions of China

Insufficient knowledge of Human Papillomavirus among reproductive-aged women from Arak, Iran

BACKGROUND

The Human Papillomavirus (HPV) is the most common sexually transmitted infection worldwide. Knowledge about this virus and its vaccine is still limited among women in developing countries. Therefore, this study aimed at evaluation of women's knowledge about HPV and vaccination to identify the related factors conducting on reproductive-aged women referred to health care centers in Arak, Iran.

METHODS

In this cross-sectional study, a researcher-made questionnaire was applied to assess the participants' knowledge about HPV and its vaccination among Iranian reproductive-aged women. Mann Whitney U test, and Kruskal Wallis test were used to analyze the data. Quantile regression was employed to account for potential confounding factors.

RESULTS

Totally, 400 women with a mean age of 32.5 years were investigated. The vast majority of the participants (82%) were married, 32.2% graduated from high school, 64.0% had 1-2 children, 93% lived in the urban area. The associated HPV and vaccine knowledge was evaluated to be "insufficient" in 86.5% and 79% of the participants, respectively. Out of 400, 37.5% and 34.5% of participants were aware of HPV vaccine protection against cervical cancer and genital warts, respectively. Multifactorial quantile regression models revealed that women with higher levels of education demonstrated significantly greater awareness of HPV. Additionally, employed women and those with higher education exhibited notably increased awareness of the HPV vaccine.

CONCLUSIONS

The level of understanding in terms of the incidence and prevention was evaluated "insufficient" in our study. The findings highlight the importance of further campaigns to improve the awareness of HPV among Iranian women. Vaccination programs should be seriously considered to prevent HPV infection and its complications like cervical cancer.

Cervical Cancer and HPV vaccination: Insights into knowledge, attitudes, and practices among Albanian women

Introduction

Human papillomavirus (HPV) infection is a widespread skin-to-skin transmitted infection that poses a global health concern. Although Albania faced prior challenges, it has recently introduced a quadrivalent recombinant HPV vaccine, a critical step in preventing cervical cancer among young women. This study aims to identify potential gaps in knowledge and attitudes among Albanian women regarding cervical cancer and HPV infection, as well as provide insights into the effectiveness of the national primary prevention program.

Methods

We conducted a cross-sectional study among 473 Albanian women using an anonymous online questionnaire to collect sociodemographic information, awareness on HPV infection and cervical cancer, and HPV vaccination practices. The association between sociodemographic variables and outcome measures was explored using descriptive statistics and Chi-square tests in SPSS.

Results

Most of the participants fell within the age range of 18 to 30 years old (42.1 %). 71.7 % of the respondents lived in urban areas. According to the study findings, a considerable proportion of the participants demonstrated knowledge of cervical cancer, with 66.6 % correctly identifying HPV infection as a major cause of this disease. Additionally, the study uncovered that a substantial number of participants had an acceptable awareness (59.6 %) about the HPV vaccine. Nevertheless, 48.4 % of the participants expressed concerns about the vaccine's efficacy and safety.

Conclusions

The study reveals knowledge gaps and misconceptions about HPV transmission, hereditary aspects, and its connection to various cancers. While a positive attitude towards preventive measures exists, concerns about HPV vaccination safety and efficacy underscore the need for targeted education campaigns to enhance awareness and accessibility, addressing misconceptions and promoting informed decision-making for effective cervical cancer prevention.

Trends in the Disease Burden and Risk Factors of Women's Cancers in China From 1990 to 2019

Objectives

To examine age-specific trends and risk factors in the burden of women's cancers (WCs) in China from 1990 to 2019 to inform strategies.

Methods

Data were sourced from the Global Burden of Disease 2019 and World Population Prospects 2019. Time trends, age differences, and key factors for breast, cervical, and ovarian cancers (BC, CC, and OC) were analyzed based on age-standardized incidence rate (ASIR) and disability-adjusted life years (DALYs) rate.

Results

ASIRs for BC and CC increased over the study period, with a slower growth rate for CC after 2005, likely due to targeted HPV prevention. OC showed the highest ASIR and DALY increases, indicating a growing concern. Peak ASIR for BC and CC was in women aged 50-55, while OC showed a higher burden in women aged 70-79. Lower DALYs in women born after 1985 suggest improved healthcare access.

Conclusion

This study highlights significant trends in cancer burden among Chinese women, driven by age and reproductive health policies. Future efforts should enhance screening, health literacy, and age-targeted risk reduction for specific cancer types.

Awareness of HPV vaccine and its socio-demographic determinants among the parents of eligible daughters in Bangladesh: A nationwide study

Background

Vaccination against Human papillomavirus (HPV) is recommended to avoid HPV infections and its associated diseases, including cervical cancer. However, there is no awareness study among Bangladeshi population. Hence, this nationwide study was conducted to explore HPV vaccine awareness and its determinants among parents of eligible adolescent girls.

Methods

This study was conducted among the parents of daughters aged 9-15 years from 42 out of 64 randomly selected districts of Bangladesh between June 28 to August 2, 2023. A multistage sampling method was used to enroll 2151 study participants from all eight divisions of Bangladesh. A semi-structured questionnaire was used for face-to-face interviews in this study. The statistical software Stata (Version 17) was used for statistical analyses.

Results

The average age of the participants was 38.18 (±5.86) years. Only 22.32 % of the participants were aware of the HPV vaccine. Every additional year of age increased the likelihood of being aware of the HPV vaccine by 3 % (AOR: 1.03; 95%CI: 1.00-1.06). Participants residing in the urban area had 3.56 times higher odds of awareness than rural and semi-urban people. Businessmen and housewives had 60 % (AOR: 0.40; 95 % CI: 0.22-0.69) and 77 % (AOR: 0.23; 95 % CI: 0.16-0.33) lower odds in comparison to job holders. The lower-income group exhibited significantly higher odds of awareness (AOR: 0.25, 95%CI: 0.16-0.39) compared to the middle and the higher-income group. Participants who never went through routine health check-ups had 77 % lower odds of being aware than those who availed of regular routine check-ups (AOR: 0.23; 95%CI: 0.16-0.34).

Conclusion

Awareness of the HPV vaccine among the general population of Bangladesh is very low. Age, residence, occupation, monthly income, and routine medical check-ups were associated with HPV vaccine awareness. A nationwide awareness campaign would increase this awareness level among the Bangladeshi population, especially among the parents of daughters.

Prevalence and Correlates of Cervical Cancer Prevention Knowledge Among High School Students in Ghana

INTRODUCTION

Cervical cancer is a preventable yet highly prevalent disease in Africa. Despite female adolescents and young women being a target group for cervical cancer prevention strategies, little research has examined their knowledge of how to prevent the disease. The study aimed to describe: (a) knowledge about cervical cancer prevention and (b) sociodemographic, social, and systemic factors associated with and interacting with knowledge among female senior high school students in Ghana.

METHODS

A cross-sectional survey assessed knowledge about (a) risk factors and (b) primary and secondary prevention of cervical cancer among 2,400 female students from 17 public senior high schools in the Ashanti region, Ghana. Descriptive statistics were used to describe knowledge. Linear mixed-effects regression models were used to examine factors associated with knowledge scores.

RESULTS

Knowledge gaps were observed for at least two-thirds (>65%) of students. Most students (mean age = 17) did not know that early sexual debut (before 18 years) is a risk factor for cervical cancer (72%) and that a blood test cannot detect cervical cancer (71%). Students in later stages of senior high school education and those who received sexual health education from teachers and parents had significantly greater cervical cancer knowledge scores than their counterparts. Interactive effects showed that school-based sexual health education was associated with higher knowledge scores than home-based education among students.

CONCLUSIONS

Most female senior high school students had gaps in knowledge about cervical cancer prevention. Finding new ways to strengthen the capacity of schools and parents to deliver accurate cervical cancer prevention information is warranted.

Acceptability of and barriers to human papillomavirus vaccination in China: A systematic review of the Chinese and English scientific literature

INTRODUCTION

Widespread adoption of the human papillomavirus (HPV) vaccine will require population acceptance and tailoring of immunisation services to community needs and preferences. We examined peer-reviewed publications on the acceptability of and barriers to the HPV vaccine across China.

METHODS

We searched English (MEDLINE, Embase, and Web of Science) and Chinese (CNKI, VIP, Wanfang data) databases between 1 January 2006 and 31 December 2017. We adopted a narrative approach for data synthesis.

RESULTS

We identified 73 studies. The overall median acceptability of HPV vaccine was 71.8% (Q1-Q3: 58.6%-81%). Low levels of acceptability (<40%) of HPV vaccine were found in eastern regions of China. The largest differences of acceptability were observed between rural western regions (all >90%) and urban eastern regions (all <35%). Despite these regional variations, common barriers to HPV vaccine acceptance were concerns about vaccine safety, uncertainty over vaccine effectiveness, low perceived risk of cervical cancer and the price of the vaccine. The level of willingness to pay for the HPV vaccine (over 153 US dollars) was very low (<7%).

CONCLUSION

The acceptability of and attitudes towards HPV vaccine vary by regions and populations across China. HPV vaccination programmes will need to tailor service delivery as well as information materials to take account of regional concerns.

Effect of an IMB Model-Based Education on the Acceptability of HPV Vaccination Among College Girls in Mainland China: A Cluster RCT

Objective

Despite the fact that the human papillomavirus vaccine (HPVV) has been approved in mainland China since 2016, there is a lack of inoculation among Chinese college women. This multi-center, online interventional RCT based on the information-motivation-behavioral skills (IMB) model intended to investigate if the intervention may improve human papillomavirus vaccine acceptance and awareness among target women.

Methods

Participants were selected from comprehensive universities and allocated to 1 of 2 groups: intervention or control. After the baseline survey, participants in the intervention group were given 10-minute online IMB model-based education every day for 7 days. Self-administered questionnaire surveys on Human papillomavirus knowledge, HPVV acceptability, and IMB construct toward HPV vaccination were performed at pre- and post-intervention.

Results

The baseline survey was completed by 3739 female university students from the intervention (n = 1936) and control groups (n = 1803) between February and April 2020. The average score of students on 11 HPV-related questions was 5.225 ± 2.739, and only 32.07% (1199/3739) of them showed a willingness to be vaccinated against HPV. After the intervention, the intervention group had a higher willingness to vaccinate themselves and encourage their friends to get the HPVV compared to the control group (40.39% vs 31.56%, 82.67 vs 73.18%, P < .001), and the difference in knowledge scores between the 2 groups was significant (7.917 ± 1.840 vs 5.590 ± 2.859, P < .001). In addition, 8 students in the intervention group self-reported receiving HPVV during the research period.

Conclusions

This IMB model-based intervention showed positive effects on the participants’ knowledge, motivation, and perceived objective skills toward HPV vaccination and has the potential to improve the vaccination among Chinese college women.

Reasons and influential recommendations associated with HPV vaccination among Chinese college students in the USA

OBJECTIVES

To evaluate (a) reasons for not receiving recommended doses of the human papillomavirus (HPV) vaccine, (b) the most influential recommending source in getting the HPV vaccine, and (c) associated factors among Chinese college students in the United States.

METHODS

A cross-sectional design utilizing a structured self-report questionnaire was used.

PARTICIPANTS

A network sample of 449 participants aged 18 or older completed the survey between March and May of 2018.

RESULTS

Only 172 participants (38.3%) had received the HPV vaccine. The most common reason was that participants had never received recommendations from healthcare providers regarding HPV vaccines. Recommendations from doctors were the most cited source in deciding HPV vaccine uptake. Factors associated with reasons and recommendation sources included attitudes toward HPV, gender, school year, age, major, and health insurance.

CONCLUSIONS

Healthcare providers play an important role in promoting HPV vaccination among Chinese college students. More research is needed for this understudied population.

Human papillomavirus vaccination coverage and knowledge, perceptions and influencing factors among university students in Guangzhou, China

Introduction: HPV vaccines were administered in mainland China from July 2017 at a gradual rate. We aimed to assess the vaccination rate and vaccination influencing factors among college students in mainland China.Methods: From October to December 2018, we conducted face-to-face questionnaires including 5 sections and 22 questions to collect demographic information, HPV infection and transmission knowledge, HPV vaccine knowledge and attitudes among college students in Guangzhou, China. HPV vaccine vaccination status and cervical screening behaviors were self-reported. Knowledge and attitudes differences between the vaccinate and non-vaccinate groups were analyzed using univariable logistic regression. Vaccination-related influencing factors were estimated using multivariable logistic regression.Results: 5307 of 5414 valid questionnaires were collected. The self-reported cervical screening rate and HPV vaccine coverage were 11.82% (9.03%-14.61%) and 3.09% (2.62%-3.56%). In total, 55.57% of the participants were hesitant about vaccination. Urban residence (OR = 2.1, 95%CI: 1.4-3.3), high monthly consumption (OR = 2.6, 95%CI: 1.9-3.6), awareness of vaccination adaptive population (OR = 3.1, 95%CI: 1.9-5.0), awareness of infection-related risk factors (OR = 2.5, 95%CI: 1.1-5.7), and awareness of HPV vaccine effectiveness (OR = 3.2, 95%CI: 2.0-5.2) were significant in multivariable logistic regression.Conclusion: HPV vaccine coverage is quite low among college students in China Guangzhou. Economic affordability, awareness of HPV infection, and belief in the effectiveness of HPV vaccine are influencing factors for vaccination. In the future, establishing a national financial subsidy and strengthening health education is needed to increase the vaccination rate in China.

HPV vaccine acceptability and willingness-related factors among Chinese adolescents: a nation-wide study

BACKGROUND

Adolescents are the primary target population for human papillomavirus (HPV) vaccination. The objective of this study is to explore the acceptability of HPV vaccines and evaluate factors related to willingness to be vaccinated among Chinese adolescents.

METHODS

A nation-wide survey was conducted across 14 schools in mainland China. The questionnaire consisted of questions relating to socio-demographic characteristics, knowledge of adolescent sexual health, cervical cancer, HPV and HPV-related disease, and students' willingness to be vaccinated. Chi-square tests and multivariable logistic regression were conducted in the data analysis.

RESULTS

A total of 4,062 students participated in this study. Among them, only 17.1% of students reported having heard of HPV vaccines; however, 67.3% were willing to receive the HPV vaccine. Multivariable regression analysis showed that students who were from rural areas, have received sexual health education, have heard of cervical cancer or HPV vaccine, have a positive attitude toward vaccination, reported they were at the risk of developing cervical cancer, and those who value their parents' and teachers' opinions were more willing to receive HPV vaccination.

CONCLUSIONS

Awareness about the HPV vaccine is low among Chinese adolescents. The factors that most related to willingness to vaccinate among Chinese adolescents were school location, education about vaccination, HPV, and HPV vaccines. Integrating health education on HPV vaccination into existing school-based sexual health curricula may be an effective way to increase HPV vaccination coverage in mainland China.

Inequalities in Cervical Cancer Screening Uptake Between Chinese Migrant Women and Local Women: A Cross-Sectional Study

INTRODUCTION

Uptake of cervical cancer screening services in Chinese migrant workers is unknown and may be lower than non-migrant workers in China.

METHODS

We conducted a cross-sectional study among migrant and non-migrant women aged 21-65 at 7 provinces across China and administered a questionnaire investigating knowledge and attitudes regarding cervical cancer, human papillomavirus (HPV), and HPV vaccine. We used multivariable logistic regression to evaluate odds of previous cervical cancer screening in migrant workers.

RESULTS

737 women participated in the study. Mean age was 41.9 ± 7.2 years. 50.2% of the participants were migrant workers. 27.6% of the migrant workers reported previous cervical cancer screening compared to 33.2% of local participants. 36.6% migrant workers reported awareness of HPV compared to 40.2% of local participants. In adjusted analysis migrant status was not associated with increased odds of previous cervical cancer screening (aOR = 1.11 95%CI: 0.76-1.60). High school or higher education compared to less than high school education and employer-sponsored insurance compared to uninsured were associated with increased odds of previous cervical cancer screening (aOR = 2.15 95%CI: 1.41-3.27 and aOR = 1.67 95% CI: 1.14-2.45, respectively). Having heard of HPV compared to no awareness of HPV was associated with increased odds of cervical cancer screening (aOR = 2.02 95%CI: 1.41-2.91). Awareness of HPV among migrant workers was associated with increased odds of cervical cancer screening compared to migrant and local participants without awareness (aOR = 2.82 95% CI: 1.70-4.69 and 2.97 95%CI: 1.51-5.83, respectively).

CONCLUSIONS

Efforts to increase education opportunities, provide insurance, and promote HPV awareness could increase cervical cancer screening uptake in migrant women in China.

Concerns for others increases the likelihood of vaccination against influenza and COVID-19 more in sparsely rather than densely populated areas

Vaccination yields the direct individual benefit of protecting recipients from infectious diseases and also the indirect social benefit of reducing the transmission of infections to others, often referred to as herd immunity This research examines how prosocial concern for vaccination, defined as people's preoccupation with infecting others if they do not vaccinate themselves, motivates vaccination in more and less populated regions of the United States. A nationally representative, longitudinal survey of 2,490 Americans showed that prosocial concern had a larger positive influence on vaccination against influenza in sparser regions, as judged by a region's nonmetropolitan status, lesser population density, and lower proportion of urban land area. Two experiments (total n = 800), one preregistered, provide causal evidence that drawing attention to prosocial (vs. individual) concerns interacted with social density to affect vaccination intentions. Specifically, prosocial concern led to stronger intentions to vaccinate against influenza and COVID-19 but only when social density was low (vs. high). Moderated mediation analyses show that, in low-density conditions, the benefits of inducing prosocial concern were due to greater perceived impact of one's vaccination on others. In this light, public health communications may reap more benefits from emphasizing the prosocial aspects of vaccination in sparser environments.

Caught in the Crossfire: How Contradictory Information and Norms on Social Media Influence Young Women's Intentions to Receive HPV Vaccination in the United States and China

This study uses online survey data from the United States and China to examine how contradictory information and social norms regarding HPV vaccines obtained through social media are related to young women’s attitudes and intentions surrounding HPV vaccination. The results show that exposure to contradictory information on social media had a greater negative association with intentions to receive HPV vaccination among the United States participants than among the Chinese participants, while social norms supporting HPV vaccines had a stronger positive association with intentions to receive HPV vaccination among the Chinese participants than among the United States participants. These findings extend the literature on social media communication regarding HPV vaccination and contribute to our knowledge of cultural contexts that influence intentions to receive HPV vaccination.

A nationwide post-marketing survey of knowledge, attitude and practice toward human papillomavirus vaccine in general population: Implications for vaccine roll-out in mainland China

BACKGROUND

Human papillomavirus (HPV) vaccine has been increasingly discussed in mainland China since its first approval in 2016. To date, nearly all studies assessing HPV vaccine perceptions and attitudes were implemented during pre-licensure period. Therefore, the nationwide post-marketing survey was conducted to update knowledge, attitudes and practice on HPV vaccine among general population in mainland China.

METHODS

Participants aged 18-45 years living in mainland China were recruited in April 2019 by multi-stage non-randomized sampling. Sociodemographic factors, HPV and HPV vaccine related awareness, knowledge, attitudes, vaccine uptake and potential obstacles were assessed in questionnaires. Bivariate analysis and multivariate regression were used to identify disparity among subgroups with different sociodemographic characteristics.

RESULTS

4,000 women (32.1 ± 7.81y) and 1,000 men (31.8 ± 7.96y) were included in final analysis. Less than one third of participants had heard of HPV (female: 31%; male: 22%) and HPV vaccine (female: 34%; male: 23%). Knowledge score was also unfavorable on HPV (female: 3 out of 13; male: 1.8 out of 13) and HPV vaccine (female: 3 out of 6; male: 2 out of 5). Only 3% females had been vaccinated three years after HPV licensure in China, although willingness to get vaccinated among those unvaccinated were high (mean willingness score ± SD: female: 3.3 ± 0.97; male: 3.0 ± 0.98). Industry of employment and household income were the major factors related to awareness and knowledge of vaccine, whereas HPV and HPV vaccine awareness were key influential factors for willingness. The main obstacles of vaccination were safety concerns, lack of knowledge, and high price of HPV vaccines.

CONCLUSIONS

Findings highlight a lack of vaccine awareness, knowledge, and poor uptake in mainland China and underscore the necessity of health education campaigns. The identified priority groups, contents to be delivered and practical obstacles could furthermore provide insight into health education to reduce disparities and accelerate HPV vaccine roll-out in China.

Factors impacting self-pay pediatric vaccine utilization in China: a large-scale maternal survey

OBJECTIVES

Utilization of self-pay vaccines worldwide is very low, especially in China; the reasons for this are unclear. We aimed to identify factors that impact the decision among Chinese mothers to utilize self-pay vaccines for their children.

METHODS

Mothers who were hospitalized at two hospitals in Zhanjiang City and who agreed to participate by completing the required questionnaire were eligible for this study.

RESULTS

In total, 7518 respondents (n = 7592) completed the questionnaire and were included in this survey. The self-pay option was largely elected by mothers with one child, compared with those who had two or more children. Similarly, utilization by workers at government agencies and organizations was higher than that among factory workers or unemployed respondents. Mothers with a college degree or above had higher utilization than those with a high school level education or lower. The main issues affecting maternal decisions to utilize self-pay pediatric vaccines were safety, the protective effect, and the high cost.

CONCLUSION

Mothers with higher socioeconomic status were more inclined to self-pay for pediatric vaccines. Steps taken to enhance public awareness about the safety and protective benefits of self-pay vaccines, as well as lowering their cost will likely encourage broader utilization of these vaccines.

Evaluation of Knowledge and Attitude Toward HPV and Vaccination Among Medical Staff, Medical Students, and Community Members in Fujian Province

Purpose

To evaluate the level of human papilloma virus (HPV)-related knowledge and vaccination willingness of people in Fujian Province, and to explore the factors influencing doctors’ recommendation of HPV vaccine.

Methods

We conducted two cross-sectional surveys in Fujian Province. The study cohort included 248 medical staff and medical students and 1001 community members. Descriptive statistics were used to identify the general demographics of the participants, along with their knowledge and attitudes regarding HPV and vaccination. Analyses were conducted to identify factors associated with willingness to vaccinate and willingness to recommend vaccination.

Results

The level of HPV knowledge in Fujian province was found to be low, but more than 80% of participants would like to accept HPV vaccine. Medical staff had a higher willingness to recommend HPV vaccine than students (OR= 4.696, CI: 2.698-8.175), which may be related to work experience and acceptance of vaccine price but not to knowledge level.

Conclusion

Knowledge of HPV in our community population appears to be lower than that in other regions in China. We suggest that a lack of knowledge may not be the main factor affecting the willingness to vaccinate, but we still needed to raise the level of knowledge about HPV to prevent misunderstandings. When the level of knowledge is high, education and per capita household income are not important factors influencing the willingness to vaccinate; only acceptance of vaccine prices significantly affects the willingness to vaccinate. Inclusion of the HPV vaccine in the national immunization program could help to alleviate public concerns regarding the vaccine to change present situation.

Effect of an educational intervention on human papillomavirus (HPV) knowledge and attitudes towards HPV vaccines among healthcare workers (HCWs) in Western China

BACKGROUND

Healthcare workers (HCWs) play a key role in the recommendation of HPV vaccination. Our study aimed to understand to what extent a structured health intervention could change the knowledge and attitudes toward HPV and its vaccines among HCWs in Western China.

METHODS

This was a multi-center, questionnaire-based interventional study conducted across 12 cities of seven provinces in Western China, from November 2018 to July 2019. Participants were recruited from local health systems by e-invitation. Questionnaires were administered to participants before and after the intervention.

RESULTS

A total of 1448 HCWs attended the educational lectures and 1354 participants completed both pre- and post-study questionnaires. In general, HCWs had satisfactory baseline knowledge regarding HPV and its vaccines compared with other populations, and a significantly higher knowledge level was observed after the intervention. However, some more specific knowledge on the vaccination procedures, other HPV-related diseases and whether HPV testing was required before vaccination was relatively poor. Following the educational intervention, the correct responses to the above questions increased (P < .001). However, it was still lower compared with answers to other questions. Change was also detected regarding HCWs' willingness to recommend HPV vaccines to the appropriate population (P < .001).

CONCLUSION

Educational intervention on HPV and its vaccines is effective in improving HCWs' knowledge levels and willingness to recommend HPV vaccines. Future educational interventions should focus more on knowledge regarding HPV-related diseases and HPV vaccination. Education campaigns targeting rural HCWs are urgently needed in the near future.

Factors affecting young Chinese women's intentions to uptake human papillomavirus vaccination: an extension of the theory of planned behavior model

BACKGROUND

Aside from personal beliefs, women's intention to uptake human papillomavirus vaccination can be influenced by their perceived risks of developing cervical cancer and daily communication.

OBJECTIVES

This study incorporated perceived risks and communication factors (i.e., media attention and interpersonal discussion) with theory of planned behavioral factors (i.e., attitude, subjective norm, and perceived behavioral control) to predict women's intentions to uptake human papillomavirus vaccination in China.

METHODS

A quantitative survey was conducted with 417 female university students in China. The Structural Equation Modeling analysis was applied to test the proposed extended TPB model and to examine the hypotheses in Mplus software.

RESULTS

The results showed that the original theory of planned behavior factors and the perceived risk toward cervical cancer were positively related to their intention to uptake human papillomavirus vaccination. Moreover, media attention and interpersonal discussion positively affected people's attitudes toward human papillomavirus vaccination and subjective norm, which further influenced their intentions to uptake human papillomavirus vaccination.

CONCLUSION

This study can help better understand unvaccinated eligible vaccine recipients and identify the differences between individuals who are likely and unlikely to get vaccinated.

Intention to Pay for HPV Vaccination among Women of Childbearing Age in Vietnam

The intention to pay for human papillomavirus (HPV) vaccination among women of childbearing age in Vietnam, where cervical cancer remains a significant public health concern, has been mostly lacking. To examine this issue, we conducted a cross-sectional study of 807 pregnant women in an urban and a rural district (Dong Da and Ba Vi) of Hanoi, Vietnam. The vast percentage of our respondents expressed a firm intention to vaccinate, especially women in rural areas (over 90.0%). However, on being informed of the current price of the HPV vaccine, their intention to vaccinate dropped to about one-fifth of overall respondents, i.e., only 4.4% of women in rural areas. It was also observed that the initial intention to get the HPV vaccination among women in the rural district was about ten times higher than that of women living in the metropolitan district. Those participants who had greater knowledge of cervical cancer and HPV vaccinations also had a significantly higher intention to vaccinate. Our findings underscore the need to develop a well-designed vaccination program in Vietnam and other countries in a similar situation to increase the adoption of HPV vaccination.

Cost-effectiveness of 2-dose human papillomavirus vaccination for 12-year-old girls in Zhejiang Province: implications for China's expanded program on immunization

BACKGROUND

The high cost and insufficient supply of HPV vaccines have substantially slowed their implementation in lower-income countries. This study aimed to assess the incremental cost-effectiveness of two doses of human papillomavirus (HPV) vaccination (bivalent 16/18 vaccine; 2vHPV) compared to a no-vaccination scenario and a three-dose scenario in one province in China.

METHODS

A static Markov model was used to model a lifetime cohort of 100,000 girls aged 12 years at the start of vaccination. A two-dose vaccination schedule was assumed to be non-inferior to a three-dose schedule in terms of vaccine efficacy, and both vaccination schemes were assumed to provide lifelong protection. Incremental costs, health effects and incremental cost-effectiveness ratios were used to measure the outcomes when comparing the different strategies.

RESULTS

Compared to no vaccination, the incremental cost-effectiveness ratio (Chinese yuan per quality-adjusted life year) of the two-dose vaccination strategy is 12,472, and the 2-dose strategy is calculated to be cost saving relative to the 3-dose vaccination strategy.

CONCLUSIONS

Introducing the 2vHPV vaccine would be highly cost effective at a per-dose vaccine price of CNY 500, which has implications for cervical cancer control in China and other resource-limited countries.

Awareness and knowledge of human papillomavirus vaccination and their influential factors among Chinese women: a systematic review

Objectives

To systematically review the knowledge attitudes and the influential factors on human papillomavirus (HPV) vaccination among Chinese women.

Methods

Published studies on knowledge and attitudes of HPV vaccination for preventing cervical cancer among Chinese female population were retrieved using the major Chinese and English databases. Meanwhile, handwork retrieval was also conducted and the references including in the literature were retrieved. The quality of the literature was rigorously evaluated and extracted independently by two researchers and the data were analyzed and described by review manager 5.3 (RevMan5.3) software.

Results

In all, 19 articles including 8 articles in Chinese and 11 in English were chosen. A total of 30,176 participants were included and the sample size ranged from 64 to 6,024. The overall awareness of HPV and HPV vaccine among Chinese women was at a low level. Chinese women generally showed poor knowledge about HPV and HPV vaccine. Acceptance of HPV vaccination among Chinese women was at a high level. Vaccination intentions were influenced by the theory of planned behavior (TPB) and measured by attitudes subjective norms and perceived behavioral control.

Conclusions

The health authorities may evaluate and develop TPB-based interventions to increase HPV vaccination intentions of Chinese women. HPV vaccination programs should focus on carrying out multi-level and targeted health education and developing effective public health strategies after balancing the cost and benefit of HPV vaccine program. Medical staff should play the positive role in promoting the use of HPV vaccines in China. Integration of policy and community perspectives and multi-level interventions are essential to maximize the public health benefits of HPV vaccination.

Knowledge, Attitude, and Barriers Towards Human Papillomavirus (HPV) Vaccination Among Youths of Karachi, Pakistan

Introduction Human papillomavirus (HPV) is the most common infection of the reproductive tract. The introduction of HPV vaccines by WHO aims to reduce the incidence of cervical cancer. Pakistan lacks an effective nationwide HPV vaccination program, thereby making HPV a major threat. In this study, we aimed to assess the knowledge of HPV vaccination in Pakistan and to determine the barriers against it. Methods A cross-sectional study was conducted in Karachi, Pakistan, between April and May 2019. A convenience sampling technique was implemented using a self-administered questionnaire, which was filled by individuals aged 18-26. The questionnaire assessed the knowledge regarding HPV and also evaluated the attitude and acceptability amongst these individuals towards the vaccine. Data were analyzed using Statistical Package for Social Sciences (SPSS), version 20.0. Results The majority of the participants belonged to the monthly household income range of 200,000 rupees and above, which was labeled as the high-income category (n=158, 39.5%). Out of the 18 people who were vaccinated, eight belonged to the aforementioned category. Of these 18, nearly two-thirds (n=11, 61.1%) had gotten vaccinated upon the recommendation of their doctor. A statistically significant difference was found only between those currently enrolled in universities and previously vaccinated for HPV (p=.047). Nearly half of the responders perceived the vaccine to be time-consuming (n=167, 41.8%) and overpriced (n=187, 46.8%). Conclusion The vaccination rate is low in Karachi, Pakistan. Concentrated efforts involving the healthcare system should be made to raise awareness regarding HPV and its vaccine thereby reducing barriers to HPV prevention.

Sociodemographic determinants of knowledge and attitude in the primary prevention of cervical cancer among University Tunku Abdul Rahman (UTAR) students in Malaysia: preliminary study of HPV vaccination

BACKGROUND

Cervical cancer is the third most common cancer affecting women around the world in which the Human Papillomavirus (HPV) is the one of the recognized causative agent affecting women health. In response to this health issue, the Malaysian government had officially implemented the HPV immunisation programme for secondary schoolchildren in 2010 at the age of 13 years old and above. The purpose of this study is to investigate the sociodemographic determinants of knowledge and attitude among students of Universiti Tunku Abdul Rahman (UTAR) towards the HPV vaccination programme.

METHODS

A cross-sectional study was conducted using self-administered questionnaires, recruiting 374 UTAR's students as the respondents by using convenience sampling method. Respondents were categorized as having good/poor level of knowledge and positive/negative attitude towards HPV vaccination.

RESULTS

Over half of the respondents were females (64.5%) and the majority were aged 20 years old and below (55.8%). Generally, 54.7% of the total respondents had a high level of knowledge towards HPV vaccine while 57.5% of the total respondents showed a negative attitude towards HPV vaccine. Female respondents aged 20 years old and below showed good knowledge (56.4%) and a more positive attitude (55.8%) towards HPV vaccine. Students from the Faculty of Medicine and Health Sciences (FMHS) exhibited higher knowledge (67.3%) and positive attitude (62.4%) as compared to the Faculty of Accountancy and Management (FAM) which showed only 32.7% of knowledge and 37.6% of positive attitude towards the HPV vaccination.

CONCLUSION

The majority of UTAR students possess good knowledge regarding HPV vaccination. Nonetheless, they demonstrated a negative attitude towards HPV vaccination, depicting the necessity to impart and further intensify the sense of health awareness among all students, especially among male students. The judicious use of social media apart from the conventional mass media should be an advantage as to enhance the practice of HPV vaccination among them and thereafter minimize the health and economic burdens of cervical cancer.

Awareness of women about cervical smear, human papilloma virus and human papilloma virus vaccine

Objective:

The aim of this study was to assess the awareness level of women about cervical smears, human papilloma virus (HPV), and HPV vaccine in a rural city in the central part of Anatolia.

Materials and Methods:

A total of 553 patients were included in the study. A 16 item questionnaire developed by our group was completed by all participants. The first part of the questionnaire collected the demographic and socioeconomic information of the participants. In the second part, it was questioned whether this information had a relationship with HPV, HPV vaccine awareness, and cervical screening tests. In the third part, the participants were asked questions related to the acceptance of an HPV vaccine for themselves and their willingness to give consent to have their children vaccinated.

Results:

In our study, it was found that HPV awareness significantly increased with the level of education, occupational status and total monthly family income (p<0.001). There was a significant increase in HPV vaccine awareness as the parity (p=0.016), level of education (p=0.025), and occupational status (p=0.001) increased. Having a Pap smear significantly increased with age, income, and number of parity (p<0.001).

Conclusion:

Our study revealed that only 9.8% of the women had knowledge about HPV, the majority of the women reported that they would accept vaccination for themselves and for their children. These results indicate that physicians should pay attention to increasing the awareness about HPV.

Awareness and attitude towards human papillomavirus and its vaccine among females with and without daughter(s) who participated in cervical cancer screening in Shenzhen, China

OBJECTIVES

To evaluate the awareness of HPV and HPV vaccine, and willingness to be vaccinated against HPV, among women with and without daughter(s) in Shenzhen, China.

METHODS

Cross-sectional survey in January and June 2015 by means of a self-administered questionnaire to collect information. Multivariate logistic regression was used to explore the factors associated with awareness of HPV and its vaccine and the willingness to be vaccinated.

RESULTS

A total of 9855 women (mean age 37.09 years, SD 7.48) were included in the analysis. Although only 42.3% had heard of HPV and 21.0% of HPV vaccine, 63.3% were willing to be vaccinated. 73.9% of the 5799 women with daughter(s) were willing have their daughter(s) vaccinated. Women with daughter(s) did not have a higher awareness of HPV (43.2% vs. 41.5%, P = 0.109) and HPV vaccine (21.1% vs. 20.9%, P = 0.854) than women without daughter(s), but did tend to be more willing to be vaccinated themselves (66.3% vs. 59.9%, P < 0.001). Women's awareness of HPV and specific knowledge of HPV vaccine were predictors of the willingness to have both themselves and their daughters vaccinated. These associations may be modified by residency status, education and monthly income.

CONCLUSIONS

Although awareness of HPV and HPV vaccine among women in Shenzhen was low, willingness to have themselves and their daughter(s) vaccinated was relatively high, especially among mothers. High awareness of HPV and its vaccine will help improve the acceptability of HPV vaccination according to residency status, education and monthly income.

Inequalities in Awareness and Attitude towards HPV and Its Vaccine between Local and Migrant Residents Who Participated in Cervical Cancer Screening in Shenzhen, China

PURPOSE

A cross-sectional survey was conducted to evaluate the differences on awareness and attitude towards human papillomavirus (HPV) and its vaccine between local and migrant residents who participated in cervical cancer screening in Shenzhen, China.

Materials and Methods

A total of 9,855 females sampled from healthcare institutions in 20 street blocks through the Cervical Cancer Prevention Network were surveyed in this study by a self-administered questionnaire. Multivariate logistic regression was conducted to explore the role of the hukou and resident status in the willingness to receive HPV vaccination.

RESULTS

Local residents had a relatively higher awareness of HPV (62.0% vs. 35.6% vs. 29.9%, p < 0.001) and its vaccine (35.3% vs. 15.4% vs. 14.8%, p < 0.001), as well as a higher willingness to receive HPV vaccination (68.5% vs. 62.5% vs. 56.2%, p < 0.001) than non-permanent residents and floating population. Except for age, education level, marital status, monthly income, having daughter(s), and heard of HPV and its vaccine, the hukou and resident status significantly associated with the willingness to receive HPV vaccination (local residents vs. floating population: odds ratio, 1.216; 95% confidence interval, 1.057 to 1.398). None significant difference on the associated factors was found between local residents and internal migrants (p for interactions > 0.05).

CONCLUSION

Inequalities in awareness and attitude towards HPV and its vaccine existed between local and migrant residents in Shenzhen. The hukou and resident status did impact on the willingness to receive HPV vaccination, therefore, it is critical to implement effective health education campaigns on HPV and its vaccine among internal migrants.

The feasibility of universal HPV vaccination program in Shenzhen of China: a health policy analysis

Background

HPV vaccination for the prioritized adolescent girls is well accepted and implemented in developed countries as an effective measure for cervical cancer prevention and control with increasing population-level effectiveness evidence accumulated. This study is to assess the feasibility of universal HPV vaccination among adolescent girls to inform strategies to manage political dimensions of policy-making process in Shenzhen, China, offering insights for other low- and middle-income countries undergoing HPV vaccine introduction.

Methods

Document review and in-depth interviews with identified stakeholders were conducted. The framework of Health Policy Triangle was adapted to guide data collection and analysis in terms of context, actors, process and content. Stakeholder analysis examining actors’ position, power, role and interest and thematic analysis focusing on data coding and theme development were used.

Results

Shenzhen’s contextual factors include legislative authority under a unitary political system, economic developments and cultural values on immunization and sexuality. Stakeholders’ position and power could be explained by their role and interest in the Top-down health administration. Mothers could be potential bystanders if having little knowledge on HPV vaccination. Themes in policy-making process were problem definition, advocacy activities to promote HPV vaccination, HPV vaccine demand and access, the role of media and political attention on evidence-informed policy-making in Shenzhen. These stakeholders also discussed different aspects of program planning prospectively.

Conclusions

Shenzhen witnesses a possibility of demonstration projects for local government’s horizontal accountability but no potential advocates were identified at local level for fragmented organization of public health facilities and health professionals’ lacking mobilization skills. A cervical cancer prevention expert could be a policy entrepreneur. Despite of these challenges, the recommendations to enhance the feasibility include multi-participation to engage non-governmental organizations, pharmaceuticals, target girls and their mothers, power enforcement along governing system, as well as better use of the media.

Effect of an educational intervention on HPV knowledge and attitudes towards HPV and its vaccines among junior middle school students in Chengdu, China

Background

Little is known about the knowledge and attitudes towards human papillomavirus (HPV) and its vaccines among adolescents in mainland China. Also, limited information has been available on how to improve their knowledge and willingness towards HPV and its vaccines to ensure a successful vaccination program in the future.

Methods

This was a school-based interventional follow-up study. One urban and one rural junior middle school in Chengdu were selected by convenience sampling. At baseline, half of the grade one students were randomly selected as controls and the rest were interventions. A set of self-administered questionnaires on HPV and its vaccines were completed by both groups at baseline. After that, only the intervention group received a PowerPoint-oriented health education and finished the post-education questionnaires. One year later, both groups completed the same questionnaires as the follow-up survey.

Results

In total, 1675 students finished the pre-intervention questionnaires; 751 were from the control group and 924 were from the intervention group. Among them, only 34.3% had heard of cervical cancer/genital warts, while only 15.1% of them had ever heard of HPV. However, 55.2% of students showed their willingness to be vaccinated even before any intervention. Seven variables were found to be associated with the willingness to be vaccinated at baseline. Immediately after the intervention, 88.4% of students were willing to vaccinate themselves. After 1 year, the effectiveness of intervention remained but decreased. Compared with the control group, the intervention group was more aware about cervical cancer, HPV and its vaccines with statistical significance. However, the level of HPV knowledge and willingness to be vaccinated among the intervention group had significantly decreased compared with that immediately after the intervention (P < 0.001).

Conclusions

The baseline level of knowledge on HPV, its vaccines, and cervical cancer was very low among junior middle school students in Chengdu, China. However, the willingness to be vaccinated seemed positive. School-based health education is effective and appropriate in increasing the awareness of HPV and willingness towards its vaccines. Regular health education on HPV and cervical cancer prevention at a shorter interval should be guaranteed to ensure continuous effectiveness.

A Nationwide Study Comparing Knowledge and Beliefs about HPV among Female Students before and after HPV Vaccination

STUDY OBJECTIVE

To assess the knowledge and beliefs regarding human papillomavirus (HPV) and the HPV vaccine among girls before and after vaccination in the Malaysian HPV Immunisation Programme.

DESIGN

A nationwide longitudinal survey.

SETTING

Thirty-two randomly selected schools from 13 states and 3 federal territories in Malaysia from February to March 2013, and October to November 2013.

PARTICIPANTS

Form One female students (13 years old).

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Mean knowledge score of HPV infection.

RESULTS

A total of 2644 students responded to the prevaccination survey, of whom 2005 (70%) completed the postvaccination survey. The mean knowledge score was 2.72 (SD ± 2.20) of a maximum score of 10 in the prevaccination survey, which increased significantly to 3.33 (SD ± 1.73) after the 3 doses of HPV vaccine (P = .001). Many answered incorrectly that, "Only girls can get HPV infection" (91.5%, n = 1841 prevaccination vs 96.1%, n = 1927 postvaccination), and only a few were aware that, "Vaccinating boys helps to protect girls against HPV infection" (11.4%, n = 229 for prevaccination vs 10.2%, n = 206 for postvaccination). The mean knowledge score was significantly higher postvaccination among higher-income families and those with parents of a higher occupational status. Regarding beliefs about the HPV vaccine, 89.4% in the prevaccination survey held the view that they would not get a HPV infection, and the percentage remained similar in the postvaccination survey. Perceived severity of HPV infection also remained low in the pre- and postintervention groups. Only 21.5% reported receiving health information about HPV along with the provision of the HPV vaccine; those who received health information showed higher levels of knowledge.

CONCLUSION

Findings revealed a general lack of knowledge and erroneous beliefs about HPV and the HPV vaccine even after receiving vaccination. This suggests that imparting accurate knowledge about HPV along with vaccine administration is essential. Specifically, girls from lower socioeconomic groups should be a target of educational intervention.

Awareness and Knowledge Levels of 18-Year-Old and Older Individuals Regarding Human Papillomavirus (HPV) and HPV Vaccine in Hatay, Turkey

The aim of this study was to evaluate the knowledge and awareness levels of 18-year-old and older women and men on HPV infection, HPV vaccine, and the potential risk factors in Hatay, Turkey. In our study, it was found that overall 27.0 and 23.2% of the participants reported having heard of HPV infection and HPV vaccine. The rate of participants who had heard of HPV infection and HPV vaccine was higher in women than in men (p < 0.000). Thirteen percent of the participants was aware of the fact that HPV triggers cervical cancer, 10.2% penile cancer, and 16.7% genital warts, respectively. The overall vaccination rate of the participants was 2.7%. When the total knowledge score of the participants about HPV infection and HPV vaccine was evaluated according to independent variables, it was found that being a woman, urbanization, and having a high level of education had a positive effect on knowledge score, while never having heard of HPV infection and HPV vaccine had a negative effect on knowledge score (p < 0.000). It was determined in the linear regression model that gender, educational status, residential area, and having heard of HPV infection before influenced knowledge levels. It was determined that the relation between these variables and the total knowledge scores of the participants was statistically significant (p < 0.05). It was also determined that women who had higher educational levels, those who were living in urban areas, and those who had heard HPV infection before had higher knowledge levels. The level of knowledge of the participants about HPV infection and HPV vaccine was found to be very low. Having adequate knowledge about HPV infection and increasing the acceptance of HPV vaccination in public will play an important role in decreasing the rate of mortality and morbidity of the different HPV-associated cancers in women and men.

Knowledge and Attitudes Regarding HPV and Vaccination Among Chinese Women Aged 20 to 35 Years in Fujian Province: A Cross-Sectional Study

The use of the human papillomavirus (HPV) vaccine was recently approved in Mainland China. This study determined the knowledge and attitudes of young women aged 20 to 35 years in Fujian Province, China, with regard to HPV and vaccination and explored the potential factors influencing their attitudes toward HPV vaccination. This was a cross-sectional study that collected data regarding the knowledge on and attitudes toward HPV and vaccination using questionnaires. Furthermore, the prevalence of HPV was determined from the sampled participants. A total of 1001 young women were included in the survey. This study demonstrated that the HPV prevalence rate was 15.7% (157/1001). Among all patients, 44.9% (n = 449) had heard of HPV; however, detailed knowledge about HPV was lacking. The majority (83.7%) expressed a willingness to be vaccinated. Specifically, knowledge of the dangers of HPV infection was significantly associated with the willingness to be vaccinated. In this study, women cited some concerns and expressed high expectations for the HPV vaccine, but the costs of vaccination reduced their willingness to be vaccinated. This study found that most patients did not have a detailed knowledge of HPV. Thus, there is a need for continued HPV promotion and education efforts, especially on the dangers of HPV infection, among young women aged 20 to 35 years in Fujian Province, China. Furthermore, it is important to subsidize the costs of vaccination for promoting vaccination campaigns in China.

Different Culture or Different Mind? Perception and Acceptance of HPV Vaccine in China and in the U.S

Unlike the United States, where human papillomavirus (HPV) vaccines have been available for decades, China recently approved its first HPV vaccines. Setting up a baseline comparison between these two countries, this study examines the influence of message framing, motivational orientation, cultural worldview, knowledge, and gender on young adults' intentions to get vaccinated. Compared to the U.S. participants, Chinese participants perceived HPV as a more severe risk and were more willing to get the vaccine. However, they were also more skeptical about vaccine safety. Inconsistencies with previous research emerged regarding the moderating effects of motivational orientation and cultural worldview. Findings from this study offer important implications for HPV vaccine promotion in China.

Urban-Rural Inequities in the Parental Attitudes and Beliefs Towards Human Papillomavirus Infection, Cervical Cancer, and Human Papillomavirus Vaccine in Mysore, India

STUDY OBJECTIVE

The aim of this study was to compare the parental attitudes and beliefs about human papillomavirus (HPV), cervical cancer, and HPV vaccine between urban and rural areas, India.

DESIGN

Cross-sectional.

SETTING

Mysore, India.

PARTICIPANTS

Parents of school-going adolescent girls.

INTERVENTIONS

Parents completed a self-administered questionnaire.

MAIN OUTCOME MEASURES

Attitudes and beliefs about HPV, cervical cancer, and HPV vaccine.

RESULTS

A total of 1609 parents from urban (n = 778) and rural (n = 831) areas participated in this study. Most of the parents had never heard about HPV (73.6%), did not know that their daughters could get an HPV infection (62.7%) or cervical cancer (64.1%) in the future, and believed that HPV vaccine was not effective (67.1%). Parents living in the urban area were more likely to believe that HPV infection (adjusted odds ratio [aOR], 2.69; 95% confidence interval [CI], 1.43-5.06) and cervical cancer (aOR, 2.68; 95% CI, 1.83-3.91) could cause serious health problems than those living in the rural area. The odds of agreeing that HPV vaccination will make girls sexually active was lower among urban than rural parents (aOR, 0.55; 95% CI, 0.33-0.94). There was no significant difference among parents in the urban and rural areas in their beliefs about susceptibility of their daughter to HPV infection or cervical cancer, and beliefs about the safety and ability of HPV vaccine to protect against cervical cancer.

CONCLUSION

Rural parents might be reluctant to recommend behaviors that can help prevent HPV infection and cervical cancer such as HPV vaccination for their daughters.

Inadequate and Incomplete: Chinese Newspapers' Coverage of the First Licensed Human Papillomavirus (HPV) Vaccine in China

Glaxo Smith Kline's Cervarix was the first human papillomavirus (HPV) vaccine licensed for use in China and officially launched there on 31 July 2017. Since news media content can influence people's vaccine-related knowledge, understanding, and intentions, a content analysis was used to examine Chinese newspapers' coverage of the HPV vaccine. A total of 253 articles published from 2000 to 2016 met the inclusion criteria and were coded. The results show that HPV and the HPV vaccine received very little newspaper coverage in China both before and after vaccine licensure. Most of the coverage came from China Party press newspapers, with the stories predominantly using thematic rather than episodic framing. Application of the Health Belief Model to the content analysis revealed that benefits, self-efficacy, and cues to action were found in most news stories. Overall, given the relative lack of Chinese newspaper coverage, public health officials and health-care providers in China should assume most people, including those for whom HPV vaccination is recommended, have little or no knowledge about HPV, HPV vaccine, and the reasons for the vaccination recommendation. If news media are to be a source of HPV information for the Chinese public, significant efforts will be needed to increase attention.

Factors influencing intention to obtain the HPV vaccine in South East Asian and Western Pacific regions: A systematic review and meta-analysis

Since licensing in 2006, there has been poor uptake of the HPV vaccine among the targeted population in the South East Asia Region (SEAR) and Western Pacific Region (WPR). A systematic review was conducted to identify the studies exploring the relationship between factors and intention for HPV vaccination among women in SEAR and WPR countries. Nineteen studies were identified as suitable for qualitative synthesis, and three as suitable for meta-analysis. Most women had a positive intention to have an HPV vaccine (range 57%-85%). Having a positive intention to vaccinate was significantly higher among women not aware of HPV infection (OR: 1.34, 95% CI: 1.02-1.76) and HPV vaccine (OR: 1.57, 95% CI: 1.26-1.96). Lower knowledge level and less confidence in safety and efficacy of the vaccine, negatively affected intention to vaccinate. Perceiving the vaccine to be expensive, low perception of contracting HPV infection and cervical cancer, and lack of concrete recommendations from healthcare providers also negatively affected intention to vaccinate. This review suggests the decision-making processes of women in SEAR and WPR is influenced by the cost of vaccination, perceived efficacy and safety of vaccine, provision of information on vaccination, and the awareness about HPV infection and the HPV vaccine.

Focus Group Study of Chinese International Students' Knowledge and Beliefs About HPV Vaccination, Before and After Reading an Informational Pamphlet About Gardasil(®)

An increasing need for Human Papillomavirus (HPV) vaccines in China remains unmet in the mainland and the knowledge and intentions of Chinese youth regarding vaccination is unknown. In the fall of 2013, 44 Chinese international students (CIS) attending a university in the United States Midwest participated in 10 focus group discussions (five female and five male). Result showed that participants have limited awareness and knowledge about HPV infection and vaccination, participants erroneously believed that the causes of cervical cancer are abortion and miscarriage. Participants rely heavily on informal sources such as Chinese-based social media platforms and personal social networks for information on sexually transmitted infections. Sexual cultures and behaviors are perceived differently between CIS born in the 1990s and 1980s. Interestingly, participants' perceived stigma about HPV infection decreased with improving knowledge level during group discussions. In conclusion, HPV vaccine should be further promoted alongside sex education among CIS.

Factors involved in human papillomavirus (HPV) vaccine hesitancy among women in the South-East Asian Region (SEAR) and Western Pacific Region (WPR): A scoping review

A scoping review was performed to identify factors that may lead to human papillomavirus (HPV) vaccine hesitancy among women in low- and middle-income countries in South East Asian Region (SEAR) and Western Pacific Region (WPR). A systematic search of English and non-English articles using Pubmed, EMBASE, PsycINFO, Cochrane, MEDLINE, and CINAHL plus was conducted. Only 63 studies conducted in SEAR and WPR were included from inception until December 2016. Results of these studies have shown that poor awareness and knowledge of practices on cervical cancer prevention was evident in both SEAR and WPR. Concerns on safety and efficacy of the vaccine, and costs in getting vaccinated were significant barriers. Most women stated that they needed more information, and strongly welcomed a physician's recommendation in both geographical regions. Women also felt they have a low risk of acquiring HPV infection and cervical cancer. Most women in SEAR and WPR were unable to decide on whether to accept HPV vaccination.

Cervical Cancer, Human Papillomavirus Infection, and Vaccine-Related Knowledge: Awareness in Chinese Women

Cervical cancer (CC) has a high incidence and mortality and is accompanied by lack of organized CC screening programs, lack of health-care facilities, and a lack of human papillomavirus (HPV) vaccination among female population in the world, particularly China. We recruited 487 females who visited the outpatient department of the First People's Hospital of Yunnan Province from November 2015 to January 2016 to complete a standardized-designed questionnaire. We found that only 39.6% of the females knew about the role of HPVs in the development of cervical cancer. Moreover, none of the females knew that HPV could cause penile carcinomas, perianal carcinomas, and head and neck carcinomas. The majority of the participants acquired information about cervical cancer, HPV, and the HPV vaccine from medical workers. Only 15.6% of the recruited females had heard about the HPV vaccine. The overall HPV vaccine acceptance rate was higher (91.2%) if the vaccine was available free of cost. In this study, we found high acceptability of the HPV vaccine in Chinese women and high awareness about cervical cancer. However, very low levels of knowledge about HPVs and their role in cancer development among the recruited women is alarming. Therefore, it is very important to initiate educational programs to raise awareness and knowledge about cervical cancer, HPV, and the HPV vaccine in this region.

Knowledge and Awareness of Cervical Cancer, Human Papillomavirus (HPV), and HPV Vaccine Among HPV-Infected Chinese Women

BACKGROUND It is important to understand the knowledge that various groups of a population have about cervical cancer and human papillomavirus (HPV) and their attitudes toward HPV vaccination, as it will ultimately influence their decision-making for or against the acceptability of vaccines and other preventive methods. This study was designed to determine the level of knowledge and awareness about cervical cancer, HPV, and the HPV vaccine among Chinese women in Yunnan province. MATERIAL AND METHODS A survey was conducted in Yunnan province by the Laboratory of Molecular Virology in collaboration with the Yunnan First People's Hospital in Feb 2015. A total of 388 women were recruited and asked to participate in a questionnaire-based interview that collected information related to their awareness and knowledge about: (1) cervical cancer, (2) HPV and HPV vaccine and willingness to have their children receive vaccination, and (3) demographic characteristics. RESULTS A total of 388 HPV-positive women were included; 300/388 (73.3%) were Han, and 88/388 (22.7%) were other ethnicities. Overall, 204/388 (52.6%) of the women were aware of cervical cancer, with a significant difference between Han women and women of other ethnic groups (168/388, 56.0% and 36/88, 40.9%; P=0.015). Overall, 26.5% of the women were aware of the role of HPV in cervical cancer; 29.0% of the Han women and 18.2% of women of other ethnic groups were aware of this role of HPV (P=0.05). The knowledge that HPV infection leads to cervical cancer was higher among Han women (29.0%) compared to women of other ethnicities (18.2%). Knowledge about the HPV vaccine was very low in all ethnic groups, but the Han women were more willing to allow their children to be vaccinated before they become sexually active. A similar difference has also been found in women from various regions. CONCLUSIONS Although level of awareness and knowledge about cervical cancer was moderate, knowledge and awareness of HPV and the HPV vaccine was very low. Targeted communication is very important among populations in which knowledge gaps exist in order to promote dialogue about the vaccine among patients and their healthcare providers.

Knowledge, perceptions and acceptability of HPV vaccination among medical students in Chongqing, China

OBJECTIVES

To evaluate medical students' knowledge of HPV and HPV related diseases and assess their attitudes towards HPV vaccination.

METHODS

A total of 605 medical undergraduates from Chongqing Medical University in China were surveyed using a structured and pretested questionnaire on HPV related knowledge.

RESULTS

Some 68.9% of the medical students were females, and mean age was 21.6 (±1.00) years. Only 10.6% correctly answered more than 11 out of 14 questions on HPV related knowledge, 71.8% being willing to receive/ advise on HPV vaccination. Female students (OR: 2.69; 95% CI: 1.53-4.72) and students desiring more HPV education (OR: 4.24; 95% CI: 1.67-10.8) were more willing to accept HPV vaccination. HPV vaccination acceptability was observed to show a positive association with HPV related knowledge.

CONCLUSIONS

Our survey found low levels of HPV related knowledge and HPV vaccination acceptability among participating medical students. HPV education should be systematically incorporated into medical education to increase awareness of HPV vaccination.

miRNA Expression Profiles of HPV-Infected Patients with Cervical Cancer in the Uyghur Population in China

The study aimed to investigate the state of human papillomavirus (HPV) infection in patients with cervical cancer in the Uyghur population in China and to identify miRNA as biomarker for cervical cancer and HPV infection. We also performed genotyping to determine the variation in the types of HPV. Using microRNA (miRNA) microarray technology, differential miRNA expression between HPV-infected cervical cancer and uninfected normal cervical tissues was determined; the microarray results were verified by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) using 20 samples of both the tissues. The infection rate of HPV in patients with cervical cancer was 96.7% (29 of 30), and the main subtype identified was HPV16 (29 of 29). HPV16 integration assay demonstrated that the majority of infectious cases were of the integrated form (26 of 29). Analysis of 140 miRNAs demonstrated greater than two-fold change in miRNA expression in HPV-infected cervical cancer tissue as compared to that in uninfected cervical tissue. The qRT-PCR analysis verified that the expression of miR-15a-5p, miR-17-5p, miR-20a-5p, miR-21-5p, miR-96, miR-106b-5p, and miR-3653 was higher, while the expression of miR-497-5p was lower in cancer tissues than in normal tissues. The results demonstrate significant changes in miRNA expression in cervical cancer tissues associated with HPV infection as compared to that in normal tissues. These molecular markers may be useful for an early diagnosis and prognosis of cervical cancer in specific human populations.

Knowledge and attitude of Iranian University students toward human papilloma virus

INTRODUCTION

Increasing prevalence of human papilloma virus (HPV) infection and its association with cervical cancer as a leading cause of death make it necessary to evaluate and improve the public knowledge, especially of university students, about this cause of disease.

METHODS

A cross-sectional study of knowledge and attitude of a total 669 students from Tabriz University of Medical Sciences was therefore performed with a modified validated questionnaire, arranged into 5 parts and containing 55 questions, in July 2011. Questions were directed to study socio-demographic characteristics of the participant, knowledge about HPV disease, transmission route, relationship with cervical cancer, predisposing factors, and participants attitude toward people with HPV infection.

RESULTS

All of the participants were Moslem with a mean age 25.6±5.33 years of age. All of the participants had heard of HPV, and acquired their knowledge through university courses (90.6%); the majority of them knew that HPV is a sexually transmitted disease and a potential cause for genital warts but general knowledge about details was not high. Mean knowledge score of residents and post graduate midwifery and nursing students was high as compared to other groups (P<0.001). Statements that indicated the presence of fear to communicate with people suffering HPV and people's avoidance to rely on babysitting of these patients were observed. Educational level (β=0.21, P<0.001), age (β=0.18, P=0.002,) and smoking (β=-0.11, P=0.006) were predicted to effect knowledge.

CONCLUSIONS

Moderate level of knowledge about HPV among medical university students makes it necessary to set effective national public health efforts on HPV education and prevention considering he excess of young population in Iran vulnerable to cervical cancer.

Parental knowledge and attitudes about human papilloma virus in Iran

Infection by human papillomavirus (HPV) is one of common sexually transmitted diseases leading to cervical cancer. Evaluation of parental knowledge and attitudes toward HPV were aims of present study to provide an appropriate method to decrease burden of this infection on society. During this study, 358 parents were assessed for knowledge about HPV and its related disorders. Some 76% of parents had no information about HPV infection and among the informed parents 36% had obtained their information via internet and others from studying medical resources. The average score of mothers information about HPV infection was higher than that of fathers, and also educational level and age had significant impact on knowledge of parents about HPV. Parent knowledge about the hazards of HPV was higher than their knowledge about modes of transmission. Lack of awareness about HPV infection was high in this study, underlining the urgency of education among all adult people in our society.

Knowledge, Attitude and Practice Concerning Human Papilloma Virus Infection and its Health Effects among Rural Women, Karnataka, South India

BACKGROUND

Cervical cancer is one of the commonest cancers among women all over the world. The association of cervical cancer with human papilloma virus (HPV) is well established. Knowledge about the causal relationship between HPV and cervical cancer is important to make appropriate, evidence-based health care choices. In this context we conducted a community based study among women about the knowledge, attitude and practice about HPV infections and their health effects.

MATERIALS AND METHODS

A cross sectional interview based house to house survey was conducted with a validated data collection tool covering sociodemographic factors, knowledge, attitude and practice about HPV and its health effects, among 1020 women from a rural village, Perdoor, in Udupi district, Karnataka, India in 2013-14.

RESULTS

The mean age of participants was 38.9 years (SD=12.6). Study participants showed a high literacy rate (85.7%). Only 2.4% of sexually exposed women had undergone Pap smear testing. Partners of 4.4%women had undergone circumcision and they belonged to the Muslim community. Male condom usage was reported by 26 women (2.6%). However, none of the participants had heard of HPV and its health effects.

CONCLUSIONS

This community based study found complete ignorance about HPV among rural South Indian women in spite of a high literacy level.

Awareness and knowledge about human papillomavirus vaccination and its acceptance in China: a meta-analysis of 58 observational studies

BACKGROUND

The human papillomavirus (HPV) vaccines have been widely introduced in immunization programs worldwide, however, it is not accepted in mainland China. We aimed to investigate the awareness and knowledge about HPV vaccines and explore the acceptability of vaccination among the Chinese population.

METHODS

A meta-analysis was conducted across two English (PubMed, EMBASE) and three Chinese (China National Knowledge Infrastructure, Wan Fang Database and VIP Database for Chinese Technical Periodicals) electronic databases in order to identify HPV vaccination studies conducted in mainland China. We conducted and reported the analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Fifty-eight unique studies representing 19 provinces and municipalities in mainland China were assessed. The pooled awareness and knowledge rates about HPV vaccination were 15.95 % (95 % CI: 12.87-19.29, I (2)  = 98.9 %) and 17.55 % (95 % CI: 12.38-24.88, I (2)  = 99.8 %), respectively. The female population (17.39 %; 95 % CI: 13.06-22.20, I (2) = 98.8 %) and mixed population (18.55 %; 95 % CI: 14.14-23.42, I (2) = 98.8 %) exhibited higher HPV vaccine awareness than the male population (1.82 %; 95 % CI: 0.50-11.20, I (2) = 98.5 %). Populations of mixed ethnicity had lower HPV vaccine awareness (9.61 %; 95 % CI: 5.95-14.03, I (2) = 99.0 %) than the Han population (20.17 %; 95 % CI: 16.42-24.20, I (2) = 98.3 %). Among different regions, the HPV vaccine awareness was higher in EDA (17.57 %; 95 % CI: 13.36-22.21, I (2) = 98.0 %) and CLDA (17.78 %; 95 % CI: 12.18-24.19, I (2) = 97.6 %) than in WUDA (1.80 %; 95 % CI: 0.02-6.33, I (2) = 98.9 %). Furthermore, 67.25 % (95 % CI: 58.75-75.21, I (2)  = 99.8 %) of participants were willing to be vaccinated, while this number was lower for their daughters (60.32 %; 95 % CI: 51.25-69.04, I (2)  = 99.2 %). The general adult population (64.72 %; 95 % CI: 55.57-73.36, I (2) = 99.2 %) was more willing to vaccinate their daughters than the parent population (33.78 %; 95 % CI: 26.26-41.74, I (2) = 88.3 %). Safety (50.46 %; 95 % CI: 40.00-60.89, I (2)  = 96.6 %) was the main concern about vaccination among the adult population whereas the safety and efficacy (68.19 %; 95 % CI: 53.13-81.52, I (2)  = 98.6 %) were the main concerns for unwillingness to vaccinate their daughters.

CONCLUSIONS

Low HPV vaccine awareness and knowledge was observed among the Chinese population. HPV vaccine awareness differed across sexes, ethnicities, and regions. Given the limited quality and number of studies included, further research with improved study designis necessary.

Awareness and acceptance of human papillomavirus vaccination among health sciences students in Malaysia

The major cause of cervical cancer is human papillomavirus (HPV) for which vaccination is available. The success HPV vaccination programme largely depend on the degree of knowledge of the healthcare providers who can recommend to the public. Health sciences students as future healthcare providers play a major role in HPV vaccination initiatives. The objective of this study was to evaluate the knowledge, attitude, practice and to find out the willingness to pay for HPV vaccination among the health sciences students in a private university. The cross-sectional study was conducted among the university students studying health sciences program using a validated questionnaire to measure their awareness and acceptance of HPV vaccination. The students demonstrated moderate knowledge about HPV infection and vaccination with mean knowledge scores of 9.3 out of 17. Students were showing positive attitude towards HPV vaccination with mean scores of 3.80 out of 5. However, low HPV vaccination uptake rate was reported among the students. Most of the students were willing to recommend HPV vaccine. The participants felt that the cost is the major barrier towards HPV vaccination and they felt the government should cover the cost of vaccination for all. The results of this study may be helpful in establishing educational policies on cervical cancer-related topics in the universities.

Effect of a group educational intervention on rural Chinese women's knowledge and attitudes about human papillomavirus (HPV) and HPV vaccines

Background

Statistics regarding HPV prevalence and cervical cancer rates in rural China are high, however, low levels of HPV awareness and HPV-related knowledge pose a great challenge for cervical cancer control.

Methods

The authors conducted an educational intervention study, which was embedded in a cervical cancer screening project in Yangcheng county, Shanxi Province, China from October to December, 2011 and was designed to assess the short-term effectiveness of a hospital-based, brief, HPV-focused session on rural Chinese women’s knowledge and attitudes. Student’s t-test was used when comparing quantitative variables. Chi-squared test or Fisher’s exact tests was used when comparing qualitative variables.

Results

We found that following the intervention, significant increases were detected in awareness regarding HPV (5.9 % vs. 59 %, p < 0.001) and cervical cancer (63.0 % vs. 89.2 %, p < 0.001). Changes were also observed regarding women’s intention to vaccinate themselves (82.0 % vs. 89.0 %, p = 0.001) and their daughters (82.9 % vs. 88.0 %, p = 0.011), although the impact was more modest compared with the impact on change of awareness. Among women who were aware of HPV, 60.3 % knew that cervical cancer is related to HPV, while only 5.0 % knew the relationship between HPV and genital warts after the educational intervention.

Conclusions

Educational campaigns, particularly those targeting women with limited education and poor access to public media or other educational channels are needed to improve knowledge regarding HPV in the general population.