Knowledge, attitudes, and perceptions associated with HPV vaccination among female Korean and Chinese university students

Effectiveness of a pre-test/post-test model in HPV health education among undergraduate medical students

BACKGROUND

The HPV vaccination rate of Chinese college students remains low. Therefore, there is an urgent need to provide health education regarding HPV vaccination among college students in China. We used a pre-test/post-test model to implement a health education intervention for the HPV vaccine among undergraduate medical students and subsequently evaluated its effectiveness.

METHODS

A total of 180 undergraduate medical students who were attending classes at the gynaecological department of the Third Affiliated Hospital of Sun Yat-sen University from October 2022 to March 2023 were selected for inclusion in the study. Before class, all students completed a questionnaire and a pre-class quiz to obtain key points in the course. The class regarding HPV and the HPV vaccine was taught by senior teachers. After the course, all students completed a post-class quiz consisting of the same questions as the pre-class quiz. The pre-class and post-class scores were compared to evaluate the effectiveness of this teaching model.

RESULTS

After the HPV health education intervention in the pre-test/post-test model, the post-class scores were significantly higher than the pre-class scores for different gender, years of study, clinical majors, different willingness of vaccine to receive the vaccine(p < 0.05).

CONCLUSION

A pre-test/post-test model may be an effective approach for HPV health education interventions.

Comparison of Self-Efficacy and Knowledge of Human Papillomavirus Vaccination among Various Types of Decision Makers in Indonesia: A Cross-Sectional Study

Background

Self-efficacy and knowledge of various types of decision-makers concerning the Human Papillomavirus (HPV) vaccine can play an essential role in the acceptance of the vaccine in women. This study sought to investigate the self-efficacy and knowledge regarding the HPV vaccine among different decision-makers, encompassing self-decision makers (SDM), assisted-decision makers (ADM), and helping-decision makers (HDM).

Methods

This cross-sectional survey was conducted in Jakarta, Indonesia, from May 13th to June 15th, 2023, involving 441 females distributed among three decision-making groups, each comprising 147 participants. Inclusion criteria were not receiving an HPV vaccination and being proficient in Bahasa Indonesia. Specific criteria were women aged 18-26 for SDM, sexually inexperienced female adolescents aged 9-17 for ADM, and mothers of eligible female adolescents for HDM. Participants completed questionnaires on self-efficacy and knowledge of HPV and cervical cancer. The Kruskal-Wallis test and Dunn's post hoc test (P<0.05) were used to analyze the data performed in SPSS 26 software.

Results

Most respondents were employed (224, 50.8%), were of low socioeconomic status (271, 61.5%), and had medium knowledge (278, 63%) and medium self-efficacy (190, 43.1%). The HDM and SDM groups demonstrated the lowest and highest knowledge scores, respectively, across all domains compared to the other groups, encompassing knowledge about HPV infection, cervical cancer, and HPV vaccination. The median score for self-efficacy in the SDM and HDM groups was the highest and lowest among the different types, respectively. The median of self-efficacy and knowledge showed statistically significant differences among decision-making groups (P<0.001).

Conclusion

This study revealed a significant difference between diverse decision-making groups and knowledge and self-efficacy. Educational interventions focusing on various types of decision-maker groups are recommended.

Knowledge, attitudes, and practices towards Human Papilloma Virus and uptake of HPV vaccine: A protocol for a systematic review

BACKGROUND

Despite a high burden of Human Papilloma Virus (HPV)-associated diseases, HPV vaccine uptake is disparate globally. The objective of this systematic review is to summarize the existing evidence on knowledge, attitudes, and practices (KAP) regarding HPV and the uptake of the HPV vaccine.

METHODS AND ANALYSIS

We will conduct a systematic review of observational studies that report data on HPV KAP and vaccine uptake among people aged 16 and above. We will search MEDLINE, CINAHL, Embase, Emcare, Web of Science, Cochrane Library, Global Health, and PsycInfo. We will conduct screening, data extraction, and assessment of the methodological quality of the included studies in duplicate. A random-effects model will be used to pool data. Subgroup analysis will be done for age younger adults (≤ 26 years old) and older adults (> 26 years old), sex (men and women), income level (as per World Bank), and WHO region. This systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PROSPERO registration number for the review is CRD42024532230.

ETHICS AND DISSEMINATION

Ethical approval is not necessary as this study will review secondary published data. Our findings will be disseminated as part of a doctoral thesis and through peer-reviewed journal publications and conferences.

Attitude Towards Vaccination Among University Students at a Spanish University: Relationships with Sociodemographic and Academic Variables

OBJECTIVES

This descriptive, cross-sectional study examines the attitude towards vaccination of students at the Complutense University of Madrid (Spain) and explores its relationship with sociodemographic and academic variables using a bivariate analysis and linear and logistic regression.

METHODS

The attitude towards vaccination of 3577 students of different disciplines was assessed using an online version of the Questionnaire on Attitudes and Behaviours towards Vaccination. In addition, all students were asked if they sought information produced by anti-vaccination groups and whether they identified as "anti-vaccine".

RESULTS

In general, the students showed a favourable attitude towards vaccination. Older students, those in paid employment, and those undertaking non-health-related studies had less favourable attitudes. Spanish-born and female students showed more positive attitudes than foreign-born and non-binary/male students, respectively. Only a small proportion of students identified as anti-vaccine.

CONCLUSIONS

Despite these positive results, the need for interventions targeting specific groups with less favourable attitudes, such as older students, employed students, and those in non-health-related fields, is clear.

Knowledge and Awareness of Dental Students Regarding Human Papillomavirus and Oral Cancer in Saudi Arabia

OBJECTIVE

This study aimed to evaluate the knowledge and awareness of dental students and interns in Saudi Arabia regarding human papillomavirus and oral cancer using a cross-sectional web-based survey.

MATERIALS AND METHODS

A cross-sectional survey was undertaken to assess the knowledge of dental students and dental interns regarding oral cancer and awareness of human papillomavirus (HPV) in public and private dental schools in Saudi Arabia. The survey included 18 questions grouped into three sections. The responses were analyzed for variations between dental students and interns, among males and females, and those attending private or public colleges. The Chai-square test assessed the correlation between participants' demographic data and their knowledge/awareness of oral cancer and HPV.

RESULTS

A total of 451 dental students and dental interns responded. The results show that dental students at private and public dental schools in Saudi Arabia are generally knowledgeable regarding knowledge of oral cancer and awareness of human papillomavirus. The dental interns exhibited significantly superior knowledge compared to the undergraduate dental students (p<0.05), particularly in the areas of identifying the most common location of oral cancer and recognizing the signs and symptoms of oral cancer (76.5% versus 65.1% correct answers). The dental interns showed a significant difference and better awareness (p<0.05) than dental students regarding HPV having a relationship with AIDS and HPV causing common warts.

CONCLUSION

Dental students and interns in this study presented a good but less than optimal knowledge and awareness regarding HPV and its prevention. Improving education courses and training for dental students in Saudi Arabia is crucial for improving their knowledge and awareness regarding oral cancer and HPV infection.

A Cross-Sectional Observational Study Analyzing the Knowledge, Attitude, and Practice of Young Female Nursing Officers and Female Doctors About the Human Papillomavirus Vaccine

Background Cervical cancer (CC) is the second most common cancer among Indian women and is caused by a human papillomavirus (HPV) infection. To achieve its global commitment to the elimination of CC, India is planning to include the HPV vaccine in its national immunization program. The success of the prevention of CC mostly depends on the level of awareness and knowledge among healthcare providers about different aspects of the disease and the vaccine. We aimed to evaluate the knowledge, attitudes, and practices (KAP) regarding CC, HPV, and the HPV vaccine in first-contact young female doctors and nursing officers. Methodology This cross-sectional study was conducted at the All India Institute of Medical Sciences, Kalyani, between February and June 2024 among young female health workers aged between 20 and 35 years. To evaluate KAP we used a validated, self-administered questionnaire. Results There were a total of 204 participants, whose median age was 26 (interquartile range = 25 to 29) years; among them, 114 (55.9%) were nursing officers and 90 (44.1%) were junior doctors. Good knowledge was found among 85.5% of doctors and 70.2% of nursing officers (p < 0.01). A positive attitude was found in 81.1% of doctors and 67.5% of nursing officers (p < 0.01). The overall good practice score was low (31.3%). A higher level of education was associated with good knowledge (β = -1.16, 95% confidence interval (CI) = -1.76, -0.55, p < 0.01) and positive attitude (β = -0.53, 95% CI = -0.9, 0.16, p = 0.005) toward HPV, CC, and the HPV vaccine. Conclusions Our cohort showed good knowledge and attitude toward CC, HPV, and the HPV vaccine, but poor HPV vaccine uptake and practice. Therefore, health education programs focused on increasing awareness and uplifting confidence are needed to accept and recommend the HPV vaccine in developing countries like India.

Coverage with the First Dose of Human Papillomavirus Vaccination among Females Aged 9-50 Years in Shenzhen, China: A Surveillance Based on Administrative Health Records in 2023

China started to offer human papillomavirus (HPV) vaccines to females aged 9-45 years in 2016. However, there was a lack of reports about HPV vaccination coverage in a representative sample of females in China. Therefore, this study aimed to examine the current HPV coverage and associated factors among females aged 9-50 years in Shenzhen, China, based on administrative health records kept by community health centers. A multistage random sampling approach was used. The research team randomly selected 18 community health centers in Shenzhen, and 3118 health records of females aged 9-50 years were then randomly selected from these health centers. Among all participants, 18.7% received at least one dose of HPV vaccination. The highest coverage was observed among females aged 18-26 years (23.4%), followed by those aged 27-35 years (22.0%) and 36-45 years (20.2%). Such coverage was very low among females aged 9-17 years (4.6%) and those aged 46-50 years (3.2%). Among females aged 18 years or above, higher education level, having a family doctor, and permanent residency in Shenzhen were associated with higher HPV vaccination coverage, while older age and being married/divorced were negatively associated with coverage. The HPV vaccination coverage in Shenzhen was 18.7% and there is a strong need for improvement.

Precision and correlation of ED50 and endpoint titer method in measuring HPV vaccine immunogenicity

Cervical cancer, the second leading cause of cancer-related deaths among women, is caused by human papillomavirus (HPV), a sexually transmitted virus. Vaccination is an effective preventive measure against viral infections and subsequent development of cervical cancer. Enzyme-linked immunosorbent assay (ELISA) is commonly used to measure specific binding antibody titers and assess the immunogenicity of test vaccines in preclinical models or clinical volunteers. Two methods of deriving titers, the endpoint titer (ET) and the effective dilution producing a median maximal effective fold of dilution (ED50) with a cut-off value, are widely used. For HPV, a pseudovirion-based neutralization assay (PBNA) is used to measure functional antibody titers. The ELISA binding titers and functional PBNA titers were found to be well-correlated for all nine HPV types tested in the vaccine, consistent with previous studies on HPV 16/18. Comparing the PBNA results with the two titration methods, the ED50 method showed higher precision and a closer correlation with PBNA results, both for individual types and pooled data analysis for all nine types. When comparing the titration results of the ET method based on a cut-off value with the ED50 method using all the data points across the dilution series, the ED50 method demonstrated better precision and a stronger correlation with PBNA results.

Relationship of Exposure to Contradictory Information and Information Insufficiency to Decision-Making About HPV Vaccination Among South Korean College Women

In this study, we investigated how exposure to contradictory messages about the human papillomavirus (HPV) vaccine affects female South Korean college students' vaccination decisions. Specifically, we focused on the relationship between exposure to contradictory messages, current knowledge, and information insufficiency that may affect participants' confusion and decision-making about vaccination. A percentile bootstrap method and pairwise comparison tests in structural equation modeling were employed. Exposure to contradictory messages significantly and negatively affected current knowledge of the HPV vaccine. Although current knowledge significantly and negatively affected confusion around the vaccine, information insufficiency failed to predict it. The vaccine confusion significantly and positively affected decisional conflicts, which, in turn, decreased the behavioral intentions to vaccinate. Additionally, the results showed how the participants' altruistic orientations and perceived stigma moderated the associations among the variables. The findings have theoretical and practical implications for future research investigating the effects of vaccine-related information on young adult women's decision-making about vaccination, particularly in cultural contexts where the HPV vaccine uptake rates are low.

Knowledge, attitude, and perception regarding HPV-related diseases and vaccination among the general public in Guizhou Province of China

BACKGROUND

The rising prevalence of high-risk human papillomavirus (HR-HPV) type-related diseases pose an ongoing health challenge in China. In this study, we assessed the current views of the general public of the Guizhou Province on HPV and HPV vaccinations to provide recommendations for future directions regarding the rollout of HPV vaccination in the area.

METHODS

An online questionnaire survey was conducted that included 3412 (2532 females and 880 males) native adult residents of the Guizhou Province. Data on the socio-demographic characteristics, knowledge of HPV, and perceptions of HPV vaccinations were collected. Data comparisons were made between students and non-students and between participants with and without medical backgrounds. All statistical analyses were performed using SPSS 26.0.

RESULTS

The self-reported HPV infection rates were 5.85% in women and 0.86% in men. A total of 46.29% of women and 34.43% of men achieved acceptable knowledge levels of HPV and 47.54% of women possessed an acceptable knowledge level of HPV vaccines. Non-students and medical participants performed significantly better in the knowledge tests than their respective opposing groups. Online media was the most popular HPV information source for all the participants. A total of 93.58% of women and 87.88% of men expressed willingness toward HPV vaccination. The major facilitators of vaccination acceptance were females (OR = 1.932, 95% CI: 1.390-2.685, p < 0.001) or students (OR = 2.276, 95% CI: 1.207-4.291, p = 0.011), and participants with higher HPV knowledge level (OR = 1.796, 95% CI: 1.300-2.481, p < 0.001). Ages 41-50 (OR = 0.255, 95% CI: 0.121-0.538, p = 0.001) or > 50 (OR = 0.141, 95% CI: 0.059-0.337, p < 0.001) were significant predictors of a negative attitude towards HPV vaccination.

CONCLUSION

Guizhou residents had poor knowledge of HPV-related issues. The percentage of healthcare workers who achieved acceptable knowledge levels was one-half or less. The increasing HPV prevalence and cervical cancer incidence can be contained if more affordable vaccines are developed and the low knowledge levels pervading young adults and medical staff is eliminated.

What Factors Are Associated with Attitudes towards HPV Vaccination among Kazakhstani Women? Exploratory Analysis of Cross-Sectional Survey Data

Background. The high prevalence of HPV infection among Kazakhstani women and the absence of an HPV vaccination program are directly reflected in increasing rates of cervical cancer incidence and mortality. Kazakhstan made its first attempt at introducing the HPV vaccine in 2013, but was unsuccessful due to complications and low public acceptance. The attitudes of Kazakhstani women towards the vaccine were never measured. Therefore, this study aims to investigate the attitudes of women towards the HPV vaccine and determine factors associated with positive, negative, or neutral attitudes. Methods. A 29-item survey consisting of 21 demographic and contextual questions and 8 Likert-scale questions was distributed among women attending gynecological offices in four major cities of Kazakhstan from December 2021 until February 2022. Attitudes of women were measured based on their answers to the eight Likert-scale questions. Ordinal logistic regression was built to find associations between demographic characteristics and attitudes of women. Results. Two hundred thirty-three women were included in the final analysis. A total of 54% of women had positive attitudes towards the vaccine. The majority of women did not trust or had a neutral attitude towards the government, pharmaceutical industry, and traditional and alternative media. However, the trust of women was high in medical workers and scientific researchers. Women's age, education, number of children, effect of the 2013 HPV program, and trust in alternative medicine were included in the ordinal logistic model. Women with a low level of education, a high number of children, who believe in alternative medicine, and who were affected by the failed 2013 vaccination program were less likely to have a positive attitude towards the vaccine. Conclusions. Contrary attitudes towards HPV vaccination exist among Kazakhstani women, with approximately half having positive and almost half having negative or neutral attitudes towards the vaccine. An informational campaign that takes into consideration women's levels of trust in different agencies, as well as targets those who are the most uninformed, might help in a successful relaunch of the HPV vaccination program. However, more studies that cover a higher number of women are required.

Parents' intention for their children to receive COVID-19 vaccine: Implications for vaccination program in Macao

INTRODUCTION

The decision about vaccinating children is subject to their parents' decision. To inform strategies that support full vaccination coverage, it is important to understand the parents' vaccination attitude and tendency to act. This study aims to investigate the intention and the factors affecting parents' decision-making about vaccinating their children.

METHODS

A cross-sectional, self-administered online questionnaire was completed by parents of children aged 3-12 yeas in Macao between 7 March and 17 April 2022. The survey tool was informed by the Theory of Planned Behavior (TPB) which composes of the variable "intention" and three TPB constructs (Attitude, Subjective Norm, and Perceived Behavioral Control). Respondents rated their level of agreement on the construct statements using a 5-point Likert scale. Multiple linear regression analysis was used to determine if the TPB constructs were predictors of parents' intention.

RESULTS

A total of 1,217 parents completed the questionnaire. The majority of participants were mothers (83.2%), aged 31-40 years (62.7%), having two or more children (74.1%), had at least one dose of COVID-19 vaccine (84.4%) and considered themselves knowledgeable about the vaccine (62.1%), all of which were significantly associated with the intention to vaccinate their children (all p < 0.05). Their intention varied from negative (19.1%), neutral (38.4%) to positive (42.5%). Respondents were mostly concerned about the serious side effects that the COVID-19 vaccine (mean = 3.96 ± 1.23), highly acknowledged the expectation by the school (mean = 3.94 ± 1.15) and the community (mean = 3.90 ± 1.19) of children vaccination, and rated highly the ease of making necessary arrangement (mean = 3.93 ± 1.25). In the multiple linear regression model which explained 63.5% of the variance in the intention-to-vaccinate their children, only Attitude (B = 0.52, p < 0.001) and Subjective Norm (B = 0.39, p < 0.001) were identified as strong predictors. The major reasons for not having intention were safety concerns (n = 646/699, 92.4%). Participants' most trusted local information sources were doctors (n = 682), government (n = 426) and healthcare professional organizations (n = 416).

CONCLUSIONS

Vaccinating children with COVID-19 vaccine is a complex decision-making for parents. A key to a successful COVID-19 vaccination program is effective communication about the safety profile and the usage experiences warranting the integration of reliable information sources across different healthcare sectors.