Iranian women's psychological responses to positive HPV test result: a qualitative study

Translation and psychometrics of the HPV impact profile in Iranian women

INTRODUCTION

The human papillomavirus (HPV) significantly impacts women's physical and psychological health, and there is a notable absence of specialized tools to assess its psychosocial effects comprehensively. The HPV Impact Profile (HIP) was developed to address this need. This study focuses on the translation and validation of the HIP for use among Iranian women.

METHODS

This methodological study was conducted among women diagnosed with HPV from May 2022 to July 2023. A total of 300 women participated by completing an online self-administered questionnaire. The HIP was translated into Persian following standardized procedures. The psychometric properties of the Persian version were evaluated through multiple validation methods: face validity (qualitative and quantitative), content validity (qualitative and quantitative), construct validity (exploratory factor analysis and confirmatory factor analysis), convergent and divergent validity, and reliability (Cronbach's alpha and McDonald's omega).

RESULTS

The original HIP consisted of 29 items. Following the translation process, the Persian version underwent rigorous psychometric validation. During the face validity assessment, no items were removed. However, during the content validity evaluation, 2 items were deleted, resulting in 27 items for further analysis. Exploratory factor analysis led to the removal of an additional 2 items, reducing the number to 25 items. Three factors were extracted, which collectively explained 81.65% of the total variance. Confirmatory factor analysis confirmed a good model fit, with all indices meeting the recommended thresholds. Reliability assessments demonstrated high internal consistency and stability, with Cronbach's alpha calculated at 0.932 and McDonald's omega at 0.996.

CONCLUSION

The Persian version of the HIP-25 exhibits strong psychometric properties, including high validity and reliability. It is a robust tool for assessing the quality of life among Iranian women with HPV, and it can be effectively utilized in clinical and research settings to better understand and address the psychosocial impacts of HPV.

Impact of HPV test results and emotional responses on psychosocial burden among Taiwanese women: a cross-sectional study

BACKGROUND

HPV is a sexually transmitted virus and is the cause of virtually all cervical cancers. Women undergoing HPV testing may experience significant psychosocial burdens, particularly those with a higher negative affect who test positive for the virus. This study investigates the relationships among test results, anxiety/depression, positive affect (PA), negative affect (NA), and psychosocial burden in women receiving their HPV test reports.

METHODS

This was a cross-sectional, observational study design. The data were collected after women received their HPV test reports. A total of 273 women were recruited for this survey study from June 2018 to April 2020 in a medical center in North Taiwan. Data were collected on an author-designed demographic-disease survey, the European Quality of Life Index Version 5D 5-Level-Anxiety/Depression, the International Positive and Negative Affect Schedule-Short Form, and the HPV Impact Profile questionnaire. Data were analyzed by descriptive statistics, independent-sample t-tests, analysis of variance, Pearson correlations, and hierarchical multiple linear regression models.

RESULTS

Among 273 women, 171 (62.6%) received HPV-positive results. Women with positive HPV test results reported significantly higher levels of anxiety/depression and NA compared to those with negative results. Additionally, those with positive results experienced greater psychosocial burden and worse sexual impact. Furthermore, age, NA, and PA were significant predictors of psychosocial burden in women who tested positive for HPV. Specifically, younger age, higher NA, and lower PA were significantly associated with increased psychosocial burden in women who received positive test results.

CONCLUSION

Health-care providers should pay attention to the test results and women's emotional status, especially for women who have positive results and exhibit negative moods. To alleviate the psychosocial burden in women who have positive test results and high negative moods, professionals could provide timely HPV information and reserve time for women to ask questions, which could decrease their distress after receiving the report.

Maternal human papillomavirus infection and offspring neurodevelopmental disorders

BACKGROUND

Human papillomavirus (HPV) infection can lead to multiple comorbidities in women, including mental health problems. However, few studies have examined the association between maternal HPV infection and the risk of neurodevelopmental disorders in their offspring.

AIM

We aimed to investigate the association between maternal HPV infection and risk of attention-deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) among their offspring.

DESIGN AND METHODS

Data from the Taiwan National Health Insurance Research Database were used for analysis. Offspring of mothers with HPV infection were identified as the index group, and a demographic-matched group (offspring of mothers without HPV infection) was selected as the controls. The primary outcome was the risk of ADHD or ASD. Cox regression models with multiple adjustments were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).

RESULTS

We included 7762 individuals in the index group and 31 048 in the control group. After adjusting for potential confounding factors, the index group had a higher risk of ADHD (HR: 1.39, 95% CI: 1.15-1.67) than the controls. Importantly, the risk remained significant when HPV infection was diagnosed either before (HR: 1.29, 95% CI: 1.05-1.59) or during pregnancy (HR: 1.79, 95% CI: 1.28-2.51). No increased risk of ASD was identified in the index group compared to the control group.

CONCLUSIONS

This study highlights the importance of preventing and treating HPV infection during and before pregnancy. Clinicians should be aware of the association between maternal HPV infection and ADHD in their offspring.

Prevalence of HPV genotypes and their association with reproductive tract inflammation and pregnancy outcomes among reproductive-age women in Ningbo, China: a retrospective cohort study (2016-2020)

BACKGROUND

The comprehensive impact of human papillomavirus (HPV) infection on reproductive tract inflammation and adverse pregnancy outcomes among women of reproductive age has not been fully investigated.

METHODS

A retrospective cohort study was conducted among women presenting to the gynecological departments of specialized women's hospitals in Ningbo, China, between 2016 and 2020. A total of 6506 women, with an average age of 28.7 years, who had undergone HPV testing and genotyping were included in the study.

RESULTS

Overall, the most prevalent HPV types were HPV 52 (25.8%), HPV 16 (17.9%), and HPV 58 (7.7%). Vaginitis and cervicitis were significantly more prevalent in women with high-risk HPV (HR-HPV) compared to those with low-risk HPV(LR-HPV) (9.0% vs. 4.7%; 10.8% vs.7.1%; P < 0.05). Moreover, the incidence of cervicitis in patients with persistent HPV infection for more than two years was significantly higher than in those with HPV infection for one year (21.8% vs. 11.8%; P < 0.05). Pregnant women with HR-HPV infection had a significantly increased risk of miscarriage (9.7% vs. 6.1%; P < 0.05). Our cross-sectional analysis of potential risk factors for HPV infection during pregnancy revealed that higher pregnancy glucose levels (prevalence, 4.23%; OR, 1.10; 95% CI, 1.10-1.20; P < 0.05) significantly increased the risk of HPV infection. Women with persistent HR-HPV infection had a significantly higher risk of reproductive tract inflammation and adverse pregnancy outcomes. The analysis revealed significant associations between HPV infection and several pregnancy outcomes, including an increased risk of miscarriage, reduced live birth rate, and a higher cesarean section rate.

CONCLUSIONS

This highlights the need to monitor gestational glucose levels, reproductive tract inflammation, and HPV infection to reduce the risk of adverse pregnancy outcomes among pregnant women.

Validity of Mehrviru® and Sacace® in molecular detection of HPV: a latent class analysis

BACKGROUND

Valid diagnostic tests for human papillomavirus (HPV) detection are crucial to identify individuals at high risk of cervical cancer. We assessed and compared the validity of Mehrviru HPV genotyping and Sacace (HPV Genotypes 14 Real-TM Quant) for molecular detection of 14 high-risk human papillomaviruses.

METHODS

We used three HPV test results to identify HPV-positive individuals (14 high-risk genotypes) in a specialist gynecology clinic. The HPV test results were collected using Mehrviru®, Sacace®, and a third kit from the clinical diagnostic laboratory. We used Latent class analysis to determine the actual status of HPV infection in study participants. The sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, Youden, and area under the ROC curve indices of each diagnostic kit and their 95% confidence intervals were calculated. The agreement between the Mehrviru and Sacace kits was determined using the Kappa statistic.

RESULTS

We examined 117 women at high risk of HPV infection. The mean age (SD) was 37.2 (9.1). According to LCA, 28.6% of participants had an HPV infection. The sensitivity and specificity (95% CI) of the Mehrviru were 90.8% (73.7-97.2%) and 90.9% (82.1-95.6%), and corresponding figures for Sacace were 92.0% (72.3-98.1%) and 97.4% (90.2-99.3%). The kappa index between the Mehrviru and Sacace kits was 69.7% (55.6-83.9%). The area under the ROC curve for Mehrviru and Sacace test were 91.4% (85.7-97.1%) and 94.4% (89.3-99.5%).

CONCLUSIONS

There is an excellent agreement between Mehrviru and Sacace test results, and the diagnostic accuracy indices were similar.

Attitudes and awareness related to cervical cancer vaccine

INTRODUCTION

Cervical cancer causes major morbidity and mortality around the world. This makes prophylactic vaccines a significant tool for preventing the disease. As these vaccines become more widely available, they have the potential to drastically lower the cancer's prevalence and burden in the future.

Investigating the psychometric properties of the Persian version of the Quality of Life Questionnaire for Women Infected with HPV (EQUALI-HPV)

INTRODUCTION

People with human papiloma virus (HPV) struggle with numerous challenges and needs in physical, and psychological aspects of quality of life related to this virus. Several studies have recommended counseling interventions to improve the quality of life for these individuals. There is also a need for standardized and normalized instruments in Iran to evaluate the effect of educational and therapeutic interventions on the quality of life of these patients. Therefore, this study was conducted in gynecological cancer clinics in Kerman and Mashhad to investigate the psychometric properties of the Persian version of the "Quality of Life Questionnaire for Women Infected with HPV".

METHODS

This study cross-sectional study included 580 women infected with HPV referred to Kerman and Mashhad's gynecologic cancer clinics. The samples were selected using convenience sampling method in 2023. Content validity, face validity, and construct validity were assessed using explanatory factor analysis (EFA) and confirmatory factor analysis (CFA).

RESULTS

The results of the content validity assessment, which included the Content Validity Index (CVI) and the Content Validity Ratio (CVR), indicated strong content validity. Additionally, qualitatively confirmed face validity, further supports these findings. The results of the EFA revealed that the Persian version of the EQUALI-HPV questionnaire has a 6-factor structure, with 34 items remaining from the 54 items. These 6 factors accounted for 48.9% of the variance and were confirmed by confirmatory factor analysis and using robust root mean square error of approximation (RMSEA = 0.054), comparative fit index (CFI = 0.928), and Tucker-Lewis index (TLI = 0.920). The content validity results showed that all the items had a good validity ratio and index. Cronbach's alpha and Raykov's rho were greater than 0.7 for all dimensions.

CONCLUSION

The results showed that the Persian version of the "Quality of Life Questionnaire for Women Infected with HPV" had acceptable validity and reliability and can be utilized to measure the quality of life of these people and conduct psychological studies.

Knowledge and perceptions regarding Human Papillomavirus (HPV) and willingness to receive HPV vaccination among university students in a north-eastern city in Turkey

BACKGROUND

For a HPV vaccination program to be successful, it is important that the target population has sufficient knowledge about HPV and HPV vaccines. The aim of this study was to evaluate HPV-related knowledge levels among students at a university in northern Turkey, to assess vaccination willingness, and to determine factors associated with HPV-related knowledge.

METHODS

This cross-sectional study was conducted on 824 (93.1%) students studying at 16 different faculties. The study population was identified through the proportional stratified sampling method. Data were collected through a questionnaire including socio-demographic characteristics and the HPV Knowledge Scale. Multiple linear regression analysis was performed to identify factors that may be associated with knowledge scores.

RESULTS

43.6% of the students had never heard of HPV, 50.6% of them had never heard of HPV screening tests or HPV vaccination. Only 2.7% of the students were vaccinated against HPV and 15.7% were willing to receive HPV vaccination. Awareness of HPV and willingness to receive vaccination were found to be higher among women, while previous experience with sexual intercourse was higher in men (p < 0.05). The mean HPV knowledge score was quite low (6.74 ± 7.13 out of 29 points). The studying in a field related to health sciences, being a senior student, intending to be vaccinated, being a woman, having had sex were found to be associated with high knowledge levels (p < 0.05).

CONCLUSIONS

Educational programmes should be developed to increase university students' knowledge about HPV and the HPV vaccine.

Knowledge on human papilloma virus and experience of getting positive results: a qualitative study among women in Kilimanjaro, Tanzania

BACKGROUND

Human papilloma virus (HPV) is a sexually transmitted infection causing more than 80% of cervical cancers. WHO recommends using of sensitive screening methods like HPV-testing to timely prevent future morbidity and mortality from cervical cancer. Pilot studies have shown that HPV-testing is feasible and can be scaled in developing country like Tanzania. However, there is limited information on women understanding, reactions and psychological challenges following diagnosis of high risk HPV (HR-HPV). This study explored the knowledge of women on HPV and their experience after HPV positive results in Kilimanjaro, Tanzania.

METHODS

The study was part of a larger study that assessed incidence and persistence of HR-HPV among women aged 18 years and above in Kilimanjaro. This was a cross sectional study conducted in Moshi municipal council among women who had HR-HPV positive results at enrollment. In-depth interviews were conducted with 13 randomly selected women who were attending for follow-up after enrollment. Interviews were conducted at the health facility and Atlas.ti.8 was used to analyze the data using thematic framework analysis.

RESULTS

Women had knowledge on HPV infection but they had different reactions following receiving positive HPV results. Reaction toward the positive HPV results had two extremes; some women had psychological effect (hopeless, death sentence, having cancer, being shocked, failure to disclose and psychosexual effects) while others women explained positive results is good as they are identified earlier, will be followed up and it has made them plan to continue with cervical cancer screening in future.

CONCLUSION

Women had knowledge on HPV, but positive results lead to negative and positive experiences by women. Clinicians and programs need to develop interventions and good strategies to minimize the psychological and social burden of testing positive for HPV.

Non-adherence to cervical cancer screening recommendations among women in Eswatini: a cross-sectional study

BACKGROUND

In 2018, Eswatini had the world's highest age-standardised cervical cancer incidence rate. Cervical cancer screening reduces women's risk of invasive cervical cancer. Data on adherence to cervical cancer screening recommendations in Eswatini are scarce. The purpose of the current study was to determine Eswatini women's self-reported adherence to cervical cancer screening recommendations, attitudes toward screening, and factors associated with non-adherence.

METHODS

A cross-sectional survey of women (n = 377) aged 25 to 59 accessing primary healthcare clinics (n = 4) in Eswatini assessed screening participation, attitudes and knowledge regarding cervical cancer screening, and socio-demographic variables. Adjusted logistic regression was used to assess factors associated with non-adherence to Eswatini cervical cancer screening recommendations.

RESULTS

One hundred and sixty-six (44%) women were classified as adherent to cervical cancer screening recommendations. Attitudinal barriers endorsed by over one-third of participants included a perceived low risk of cervical cancer (n = 161, 43%) and a view that screening is likely to be painful (n = 146, 38%). Participants had higher odds of being classified as non-adherent if they: were single compared with married (OR = 1.78, 95% CI: 1.05, 3.01, p = 0.03), perceived screening as likely painful (OR = 4.43, 95% CI: 2.62, 7.46, p < 0.001); and had not been advised by a doctor/ nurse to screen (OR = 2.82, 95% CI: 1.71, 4.64, p < 0.001). Also, a 1-year increase in age was associated with an increase in the odds of being classified as non-adherent (OR = 1.42, 95% CI: 1.39, 1.45, p = 0.01).

CONCLUSIONS

Self-reported adherence was moderate among this group of women. Tailored interventions are needed to increase participation in cervical cancer screening, especially for those women with characteristics associated with being classified as non-adherent. Primary healthcare clinic nurses (and other health providers) may contribute toward improving participation in cervical cancer screening by advising eligible women to screen and providing health education addressing negative attitudes toward screening.

A predictive model of genital warts preventive behaviors among women in the south of Iran: application of health belief model

BACKGROUND

Genital wart (GW) is known as an infectious disease. Besides the infection, it is associated with a higher risk of cervical neoplasia and cancer in the infected population. The present research aimed to explore the predictors of GW preventive behaviors based on the health belief model (HBM).

METHODS

The present analytical and cross-sectional research was conducted in 2019 among 720 women between 15 and 49 years of age in Bandar Abbas in the south of Iran. The sample was selected in a multi-stratified clustering method. The participants responded to a reliable and valid researcher-made questionnaire which explored demographic information, knowledge-related items and the model constructs. A multivariate linear regression analysis was run to determine the predictors of adopting GW preventive behaviors. A path analysis was also run to test the direct and indirect effects of the model constructs on the dependent variable.

RESULTS

The mean and standard deviation of participants' age was 30.43 ± 8.697 years. As Pearson's correlation coefficients showed, knowledge (r = 0.197, p < 0.001), perceived susceptibility (r = 0.434, p < 0.001), severity (r = 0.463, p < 0.001) and self-efficacy (r = 0.434, p < 0.001) were significantly correlated with the adoption of GWs preventive behaviors. Multiple linear regression analysis showed that self-efficacy (B = - 0.010, p < 0.001), perceived susceptibility (B = 0.070, p < 0.001) and severity (B = 0.078, p < 0.001) were the predictors of GW preventive behaviors. Path analysis showed that perceived susceptibility, severity and self-efficacy directly affected healthy behaviors while perceived benefits and barriers indirectly affected the preventive behaviors.

CONCLUSIONS

The present findings help to promote knowledge of the predictors of GW preventive behaviors. HBM can be a useful theoretical framework to evaluate the preventive behavior of the disease and help to reduce the rate of sexually-transmitted infections including GW.

The effectiveness of a model-based health education program on genital warts preventive behaviors: a quasi-experimental study

BACKGROUND

Genital warts (GWs) are highly prevalent among Iranian women. GWs are not only highly infectious but are also followed by severe adverse effects, including the development of cervical cancer. Therefore, the present study aimed to explore the effect of an educational intervention based on the health belief model (HBM) on the adoption of GWs preventive behaviors by married women in Bandar Abbas, a city in the south of Iran.

METHODS

A quasi-experimental intervention was conducted between 2019 and 2020 among 150 women participants (75 as the intervention and 75 as the control group). The sampling method was multi-stage clustering. The required data was collected using a reliable and valid tripartite questionnaire which explored demographic information, awareness, and HBM constructs. A total number of 15 educational sessions were held, each 90 min long. The control group received only one 90-min session. The final follow-up was completed three months after the intervention in November 2020.

RESULTS

The two research groups had no statistically significant differences in terms of awareness, perceived susceptibility, severity, benefits, barriers, and self-efficacy before the intervention (in the pre-test) (p > .05). After the educational intervention, the two groups showed statistically significant differences in all constructs except for the perceived benefits (p < .001). In the intervention group, in the pretest (before the intervention), the behavior score was 2.77 ± 2.59, which was increased to 3.73 ± .52 after the intervention (p < .001). In the control group, however, the difference was not statistically significant (p = 0.227).

CONCLUSION

The present findings showed that the educational intervention based on the HBM can improve the prevalence of GWs preventive behaviors in women. This education should be provided by experts at regular intervals in all healthcare centers.

Adaptation of patients diagnosed with human papillomavirus: a grounded theory study

Background

Human papillomavirus is the most common cause of sexually transmitted diseases. Various studies report that positive human papillomavirus diagnosis results in psychosexual issues for the infected and reduces their quality of life. However, the adaptation of the infected has not been addressed yet. The present study aims to identify the process by which individuals infected with human papillomavirus adapt to their disease.

Method

This is a qualitative work of research with a grounded theory design. The setting of the study was the skin clinic of Shahid Faghihi Hospital in Shiraz. The participants consisted of 27 individuals: 18 patients, 3 doctors, 2 counselors, and 4 spouses of patients. The subjects were selected via purposeful and theoretical sampling method until data saturation was reached. Data were collected through face-to-face, in-depth, semi-structured interviews from April 2019 to December 2020. The collected data were analyzed using Corbin and Strauss’s method (2015) and MAXQDA 2018.

Results

The theory which emerged from the data was “trying to maintain resilience in the absence of psychological security.” Analysis of data showed the main concern of participants in adapting to their diagnosis with human papillomavirus was “life stress”. “Stigma and ignorance” was found to be a contextual condition and “paradox in support” was an intervening condition in the patients’ adaptation. The patients’ action/interaction responses to their main concern in the context in question were “emotional confrontation” and “maintaining resilience.” The outcome was “oscillation between tension and tranquility.”

Conclusion

The present study explains the process by which patients with human papillomavirus adapt to their condition. Identification of the concerns of patients with human papillomavirus and the factors which affect their adaptation can help healthcare policy-makers and providers develop effective support plans in order to increase patients’ quality of life. Early interventions, e.g. counseling care providers to modify their behaviors toward alleviating the psychosexual tension of the infected, can facilitate the adaptation of the infected and decrease the consequences of the infection for them.

Graphical Abstract

Human papillomavirus (HPV) is the most common cause of sexually transmitted diseases. Almost all men and women get the infection at least once throughout their lives. The high-risk types of HPV account for about 5% of cancer cases globally. HPV can cause anogenital cancers and warts in both genders. In this grounded theory study, we conducted 27 in-depth interviews with Iranian patients, their spouses, and health care providers from April 2019 to December 2020. The collected data were analyzed using Corbin and Strauss’s method (2015) and MAXQDA 2018. The participants were concerned about tension in family relationships, being stigmatized, getting cancer, recurrence of warts, transferring their disease to others, and changes in the appearance of their genitalia. They stated that HPV is regarded as a shameful disease in society. Most of the participants said they had never heard anything about HPV. The patients’ action/interaction responses to their concerns were “emotional confrontation” and “maintaining resilience.” These strategies helped the patients recover some of their tranquility. However, some of patients’ concerns were persistent and kept them oscillating between tension and tranquility. An understanding of the patients’ perception of their disease is essential to development of effective educational interventions to change patients’ perspective on their situation and improve their recovery. Furthermore, because of the low level of public awareness about HPV and sexual health and the flow of misinformation to the infected, it is recommended that educational interventions focus on the patients’ concerns.