The impact of exposure to HPV related information and injunctive norms on young women's intentions to receive the HPV vaccine in China: A structural equation model based on KAP theory

The impact of vaccine access difficulties on HPV vaccine intention and uptake among female university students in China

BACKGROUND

Ensuring vaccine access is a prerequisite for promoting human papilloma virus (HPV) vaccination. Although HPV vaccination efforts in China have primarily focused on young females, little research has examined the difficulties they face in accessing the HPV vaccine and its impact on vaccine uptake and intention. This study analyzed the overall perception of access difficulties to HPV vaccines, as well as three specific vaccine access difficulties, and examined their influencing factors among female university students in China. We also examined the associations between overall and specific vaccine access difficulties and HPV vaccination intention and uptake.

METHODS

A cross-sectional study was conducted among female university students from eight universities or colleges in Zhejiang Province, China, from December 2020 to January 2021. Logistic regressions were used to identify factors associated with both overall and specific perceptions of vaccine access difficulties. A multivariable logistic regression model and a multiple linear regression model were used to explore factors influencing HPV vaccine uptake and vaccine intention by controlling for potential confounding factors, respectively.

RESULTS

A total of 3176 female university students were included in this study. The proportion of female students perceiving overall difficulty in obtaining HPV vaccine, as well as difficulties in accessing the desired type of HPV vaccine, HPV vaccination centers, and HPV vaccination information, were 60.6%, 57.7%, 60.7%, and 54.0%, respectively. Perceived overall difficulty in obtaining HPV vaccine, as well as difficulties in accessing the desired type of HPV vaccine, HPV vaccination centers, and HPV vaccination information were associated with HPV vaccine uptake and intention.

CONCLUSIONS

Chinese female university students generally perceived various difficulties in accessing HPV vaccine. It is crucial to improve access to HPV vaccine, optimize the layout and service quality of HPV vaccination centers, and enhance the dissemination and transparency of HPV vaccine information. More efforts are needed to provide a strong guarantee for HPV vaccination uptake among female university students.

Factors influencing HPV vaccine hesitancy among university students in China: A cross-sectional survey utilizing the 3Cs model

The HPV vaccine, which has been demonstrated to be an effective method of reducing the risk of developing cervical cancer, is still being underutilized among college students in China. To assess the current status of HPV vaccine hesitancy among college students in Guangdong Province after the COVID-19 outbreak, and to systematically analyze the influencing factors of HPV vaccine hesitancy and construct a prediction model based on the WHO 3Cs model. A cross-sectional web-based survey was conducted in June 2023 among female college students in four cities in Guangdong Province. The data were analyzed using binary logistic regression with a focus on the 3Cs model: Complacency, Convenience, and Confidence. LASSO regression was employed to analyze the variables deemed to be of significance and to construct predictive models. Out of 1399 participants, 86.5% expressed no hesitancy toward HPV vaccination. However, 11.9% exhibited hesitancy, and 1.6% refused vaccination altogether. Factors such as trust in vaccine efficacy, perception of HPV infection risk, price considerations, and constraints like distance or time were significant contributors to hesitancy. Knowledge of the HPV vaccine, socio-demographic characteristics, and the educational level of participants' mothers also played a role in vaccine hesitancy. It is recommended that targeted interventions be implemented within educational institutions with the aim of raising awareness of cervical cancer and HPV vaccines, simplifying the scheduling of vaccination appointments, and increasing affordability through the implementation of strategic purchasing measures or subsidy schemes.

Knowledge, attitudes, and practices in adult patients and parents of pediatric atopic dermatitis patients: a cross-sectional study

Objective

To investigate the knowledge, attitude, and practice (KAP) of adult Atopic Dermatitis patients and parents of pediatric atopic dermatitis patients toward the disease.

Methods

A cross-sectional study was conducted from January to February 2022, involving 1,193 Asian Atopic Dermatitis patients from the Atopic Dermatitis patient organization "Atopic Dermatitis Home." The study included 594 adult patients and 599 parents of pediatric atopic dermatitis patients, with self-designed questionnaires assessing general demographics and continuous variables KAP.

Results

Adult patients demonstrated higher knowledge scores, particularly in areas of bathing and skincare (3.64 ± 0.68 vs. 3.35 ± 0.93, p < 0.01), and treatment precautions (3.35 ± 0.93 vs. 3.81 ± 0.51, p < 0.01), compared to parents of pediatric patients. In terms of practices, adult patients scored higher in treatment adherence (0.69 ± 0.96 vs. 3.33 ± 1.19, p < 0.01) and lifestyle management (1.85 ± 0.39 vs. 1.69 ± 0.59, p < 0.01), while parents scored higher in risk avoidance (1.58 ± 0.79 vs. 1.62 ± 0.88, p < 0.01). Regression analysis revealed that knowledge and attitudes significantly positively affected practices. Treatment adherence was positively associated with knowledge of treatment precautions (B = 0.323, 95% CI 0.175, 0.471, p < 0.001) and negatively with disease characteristics (B = -0.112, 95% CI -0.216, -0.008, p = 0.035). Self-treatment was positively associated with knowledge of disease characteristics (B = 0.154, 95% CI 0.036, 0.272, p = 0.011) and medication attitudes (B = 0.282, 95% CI 0.208, 0.356, p < 0.001). Lifestyle management was positively associated with knowledge of skincare (B = 0.071, 95% CI 0.036, 0.106, p < 0.001) and treatment precautions (B = 0.160, 95% CI 0.096, 0.224, p < 0.001), but negatively with patient type (B = -0.127, 95% CI -0.184, -0.070, p < 0.001). Risk avoidance was positively associated with knowledge of skincare (B = 0.128, 95% CI 0.067, 0.189, p < 0.001) and treatment precautions (B = 0.163, 95% CI 0.053, 0.273, p = 0.004).

Conclusion

The study concluded that knowledge and attitudes significantly affect health practices among Atopic Dermatitis patients. Enhancing patient education on treatment precautions and skincare can improve adherence and management behaviors, highlighting the need for targeted educational interventions.

Understanding hepatitis E vaccination intention among women of childbearing-age: A theory-based cross-sectional study

OBJECTIVES

The purpose of this study was to investigate the HEV vaccination intention, its determinants, and overall influence mechanisms among childbearing-age women.

METHOD

The current study was cross-sectional and conducted online from June 25, 2023 to September 25, 2023 in Nanjing, China. Logistic regression models were constructed to identify the intention-associated background factors. Technology Acceptance Model (TAM) and Theory of Planned Behavior (TPB) were integrated and expanded as TAM-TPB model to further investigate the determinants and overall influence mechanism of HEV vaccination intention among this population using structural equation modeling.

RESULTS

A total of 423 eligible participants were included in this study. High general HEV knowledge was independently associated with an increased intention to get HEV vaccination (OR = 1.97, 95 % CI: 1.11-3.58, P = 0.023). All the hypotheses proposed in the theoretical TAM-TPB model were supported, with perceived ease of use, perceived usefulness, attitude, subjective norm, and perceived behavioral control positively affecting the intention of HEV vaccination (all P values <0.05), while perceived risk (P = 0.003) exhibited an inverse association with HEV vaccination intention. The model achieved an acceptable fit, and the total explained variance of HEV vaccination intention was as high as 86.20 %. Moreover, no significant common method bias was observed.

CONCLUSION

This is the first theory-based study that explored the HEV vaccination intention, its determinants, and overall influence mechanism among childbearing-age women. The results of the current study are of great importance for improving the understanding of the HEV vaccination intention among females of childbearing age.

The Impact of Short-Form Video and Optimistic Bias on Engagement in Oral Health Prevention: Integrating a KAP Model

College students are recognized as a demographic particularly susceptible to higher oral health risks due to irregular and unhealthy habits. While previous research has underscored these risks through descriptive studies within this group, a significant gap persists in the literature regarding the impact of contemporary media, specifically oral-health-related content, on the engagement in oral health prevention among Chinese college students. To address this gap, this study, guided by the extended knowledge-attitude-practice (KAP) theory model, explores the direct, mediated, and serially mediated mechanisms through which exposure to oral health short-form videos on Douyin influences their participation in oral health prevention. An empirical cross-sectional online survey was conducted, with valid data (N = 421) analyzed using descriptive statistics and hierarchical regression. Mediation and serial mediation analyses were also performed using SPSS version 25.0. The analysis revealed that exposure to oral health short-form videos had a positive direct effect on both oral health knowledge and the reduction of optimistic bias among Chinese college students. Furthermore, a significant serial mediation effect of oral health knowledge and oral health attitude was identified. The findings underscore the substantial applicability and explanatory power of the extended KAP theory model in understanding engagement in oral health prevention.

Women's knowledge, attitude, and practice regarding cervical precancerous lesions: a cross-sectional study in Beijing, China

Background

This study aimed to examine the knowledge, attitude, and practice (KAP) of women in Beijing regarding cervical precancerous lesions.

Methods

This web-based, cross-sectional study included women at Dongzhimen Hospital of Beijing University of Chinese Medicine between March 13, 2024 and April 9, 2024. A self-administered questionnaire was developed to collect participants' demographic information and KAP scores toward cervical precancerous lesions.

Results

The study included 951 valid questionnaires, with a mean age of 40.0 years. The mean knowledge, attitude, and practice scores were 12.55 ± 6.23 (possible range: 0-26), 50.66 ± 7.48 (possible range: 13-65), and 26.13 ± 4.98 (possible range: 7-35), respectively. The knowledge score (OR = 1.071, 95%CI: 1.040-1.103, p < 0.001), currently married (OR = 0.548, 95%CI: 0.304-0.985, p = 0.045), and with a history of HPV infection (OR = 2.302, 95%CI: 1.062-4.990, p = 0.035) were independently associated with the attitude score. The knowledge score (OR = 1.155, 95%CI: 1.119-1.192, p < 0.001), monthly income >20,000 (OR = 2.793, 95%CI: 1.249-6.248, p = 0.012), a history of HPV infection (OR = 0.380, 95%CI: 0.222-0.650, p < 0.001), unknown HPV infection status (OR = 0.289, OR = 0.177-0.473, p < 0.001), vaccinated against HPV (OR = 1.752, 95%CI: 1.221-2.514, p = 0.002), giving birth to one child (OR = 1.991, 95%CI: 1.186-3.341, p = 0.009), and giving birth to two or more children (OR = 2.160, 95%CI: 1.240-3.763, p = 0.007) were independently associated with the practice score. The structured equation model showed that knowledge directly influenced attitude (β = 0.237, p = 0.004) and practice (β = 0.490, p = 0.010). Attitude directly influenced practice (β = 0.193, p = 0.009).

Conclusion

This study revealed inadequate knowledge, moderate attitude, and practice toward cervical precancerous lesions among women in Beijing. Educational interventions should be developed to enhance knowledge in this regard.

Risk perception and trust in the relationship between knowledge and HPV vaccine hesitancy among female university students in China: a cross-sectional study

BACKGROUND

Cervical cancer poses a heavy health burden in China, with the second highest incidence and mortality rate among female tumors, yet human papillomavirus (HPV) vaccination rate among female university students remain remains low. This study conducted a cross-sectional survey to assess the degree of HPV vaccine hesitancy among female university students and to explore the potential association between knowledge, risk perception, trust, and HPV vaccine hesitancy.

METHODS

A total of 1,438 female university students from four Chinese cities were recruited through stratified, multistage, cluster sampling method. The mediation model was constructed using the Bootstrap method, introducing trust and risk perception as mediating variables to examine the effect of knowledge on HPV vaccine hesitancy.

RESULTS

The study found that 8.9% (95%CI:7.4%∼10.4%) of the female university students exhibited HPV vaccine hesitancy. Pearson's correlation analysis revealed a negative association between vaccine hesitancy and knowledge, risk perception, and trust. The mediation model showed that knowledge had significant indirect effects on HPV vaccine hesitancy through trust (indirect effect: -0.224, 95% CI: -0.293 ∼ -0.167) and risk perception (indirect effect: -0.013, 95% CI: -0.033 ∼ -0.002).

CONCLUSION

HPV vaccine hesitancy among female university students has mitigated, but still needs to be addressed. In addition, trust and risk perception are mediators mediating the relationship between knowledge with HPV vaccine hesitancy. Therefore, there is a need to strengthen public health education to improve knowledge, with a particular focus on providing information about trust and risk perception to reduce HPV vaccine hesitancy.