HPV Vaccination Intentions of Female Students in Chinese Universities: A Systematic Literature Review and Meta-Analysis

Gender-neutral vs. gender-specific strategies in school-based HPV vaccination programs: a systematic review and meta-analysis

Introduction

This systematic review and meta-analysis evaluated whether gender-neutral (GN) or gender-specific (GS) strategies more effectively enhanced knowledge, intention, and uptake of HPV vaccination among students in educational settings.

Methods

A comprehensive literature search of PubMed, Scopus, Web of Science, and Cochrane Library identified 17 randomized controlled trials encompassing 22,435 participants (14,665 females, 7,770 males). Random-effects models were used to calculate standardized mean differences (SMDs) for knowledge and intention, and risk differences for vaccination uptake.

Results

GN strategies achieved higher improvements in knowledge (SMD = 0.95) and intention (SMD = 0.59) compared with GS (SMD = 0.68 for knowledge, SMD = 0.14 for intention), and displayed a greater increase in uptake (5.7% versus 2.5% in GS), although this uptake difference was not statistically significant. Heterogeneity was more pronounced for knowledge outcomes and moderate for GS uptake results.

Discussion

Despite GN approaches seemingly offering more robust enhancements in HPV-related knowledge and vaccination intention, additional research with robust designs and longer follow-up is required to determine whether GN interventions definitively outperform GS strategies in achieving statistically significant increases in actual vaccination uptake.

Parental willingness of HPV vaccination in Mainland China: A meta-analysis

This meta-analysis aimed to systematically review and analyze parental awareness of human papillomavirus (HPV) and its vaccine, as well as parental willingness of the HPV vaccine in China. The literature search selected studies that met the following criteria: study published between 2009 and 2023, study design involving parents with at least one child aged ≤ 18 years, sample sizes exceeding 300, availability of data on parental willingness of the HPV vaccine or sufficient information to calculate effect sizes, and studies published in either English or Chinese. Studies that did not meet one of the above points were excluded. From an initial pool of 660 papers, 33 studies were included, encompassing a total sample size of 92,802. The analysis revealed that the pooled awareness rates of HPV and the HPV vaccine among Chinese parents were 45.0% (95% CI: 36.1-54.0%) and 41.4% (95%CI: 30.7-52.5%), respectively. The overall parental willingness for vaccinating children against HPV was 61.0% (95% CI: 53.5-68.3%). Both parental awareness and willingness of the HPV vaccine in China were found to remain low when compared to other countries.

Awareness and acceptance of human papillomavirus vaccine in the Middle East: A systematic review, meta-analysis, and meta-regression of 159 studies

Cervical cancer, closely linked to human papillomavirus (HPV) infection, is a major global health concern. Our study aims to fill the gap in understanding HPV vaccine awareness and acceptance in the Middle East, where national immunization programs are often lacking and cultural perceptions hinder acceptance. This systematic review and meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search across several databases was conducted on 5 September 2023. We included quantitative studies on HPV vaccine awareness and acceptance in Middle Eastern countries. Data extraction and quality assessment were conducted independently by multiple reviewers to ensure accuracy. Statistical analyses, including subgroup analyses, were performed using R to calculate pooled estimates, assess heterogeneity, and publication bias. We reviewed 159 articles from 15 Middle Eastern countries, focusing on 93,730 participants, predominantly female and healthcare workers. HPV vaccine awareness was found to be 41.7% (95% CI 37.4%-46.1%), with higher awareness among healthcare workers. The pooled acceptance rate was 45.6% (95% CI 41.3%-50.1%), with similar rates between healthcare and non-healthcare workers. Our study highlights the critical need for increased HPV vaccine awareness and acceptance in the Middle East, emphasizing the importance of integrating the vaccine into national immunization programs and addressing cultural and religious factors to improve public health outcomes.

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.

Effects of Message Framing on Human Papillomavirus Vaccination: Systematic Review

BACKGROUND

With the advancement of cervical cancer elimination strategies, promoting human papillomavirus (HPV) vaccination is essential to achieving this goal. The issue of how to structure and develop message content to promote HPV vaccination is a debatable issue.

OBJECTIVE

The efficacy of gain-loss framing in vaccination contexts is disputed. Our study aimed to elucidate the consequences of message framing on attitudes, intentions, and behavioral tendencies toward HPV vaccination, with the objective of refining message framing strategies and their elements.

METHODS

This systematic review adhered strictly to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guideline reporting standards to comprehensively retrieve, extract, and integrate data. We searched databases, including PubMed, Embase, Scopus, and Web of Science, for literature published from database construction to August 15, 2023. Literature screening, data extraction, and quality evaluation were performed by 2 researchers. Intervention studies published in English, conducted with populations with children eligible for HPV vaccination, and involving message framing were included. Attitudes, intentions, and behaviors served as outcome evaluation criteria.

RESULTS

A total of 19 intervention studies were included. Gain-loss framing had no clear effect on vaccination attitudes nor intentions. Loss framing showed a weak advantage at improving HPV vaccination attitudes or intentions, but the evidence was not strong enough to draw definitive conclusions. The impact of gain-loss framing on HPV vaccination behaviors could not be determined due to the limited number of studies and the qualitative nature of the analysis.

CONCLUSIONS

Combining gain-loss framing with other message framing approaches may be an effective way to enhance the effect of message framing. More high-quality message framing content and exploring alternative moderator or mediator variables are required to support the conclusion.

TRIAL REGISTRATION

CRD42023451612; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=451612.

Human papillomavirus vaccination intention and its associated factors among female medical college students in Hubei, China: A cross-sectional study

BACKGROUND

The uptake rate of human papillomavirus (HPV) vaccination in China is low, including among college students. In addition, medical students are the target population for the HPV vaccine, but they have poor uptake of the HPV vaccine. This study aimed to investigate factors related to HPV vaccination intention among female medical college students in Hubei Province.

MATERIALS AND METHODS

This cross-sectional study was conducted on 988 female medical college students from six colleges in Hubei Province with a multistage sampling method. The data were collected by web-based online software. Multiple logistic regression was applied to explore the factors associated with the intention of HPV vaccination.

RESULTS

The majority of students (85.5%) reported a high level of intention to receive HPV vaccine, about 82.3% have a willingness to pay (WTP) for HPV vaccine, and 51.5% reported that family members had never received the HPV vaccine. The students who had higher scores of knowledge of HPV, HPV infection prevention awareness, the protection motivation theory (PMT)-related factors including perceived severity, perceived response efficacy, perceived self-efficacy, and WTP for the HPV vaccine had higher intention to receive HPV vaccine.

CONCLUSION

HPV vaccination intention was high in medical students. Also, it was influenced by knowledge of HPV, PMT-related factors, and WTP for HPV vaccine. Thus, consideration of these factors is important to design the HPV vaccination campaign that can increase the intention to receive HPV vaccine, which in turn may increase the HPV vaccination.

Knowledge, Attitude, and Uptake of Human Papillomavirus (HPV) Vaccination among Chinese Female Adults: A National Cross-sectional Web-Based Survey Based on a Large E-commerce Platform

BACKGROUND

Human papillomavirus (HPV) vaccination is a promising step toward cervical cancer elimination. This study was conducted to investigate the knowledge, attitude, and HPV vaccine uptake among female adults in mainland China based on a large e-commerce platform.

METHODS

We conducted a cross-sectional online survey of female adults between March 4 to April 20, 2022. The survey consisted of sociodemographic information, related knowledge, vaccination uptake, and attitudes toward vaccination. We included women aged 18-45 years in the final analysis. Logistic regressions were conducted to explore influencing factors associated with related knowledge, HPV vaccination uptake, and willingness to be vaccinated.

RESULTS

In total, 3,572 female adults (34 years, IQR 30-39) were included in the analysis. The majority of the participants were highly educated (78.7%) with a high monthly family income (79.0%). The median HPV knowledge score was 8.25 out of 11. More than 75% of respondents were unvaccinated, while 95.8% of unvaccinated female adults are willing to be vaccinated. Variables such as age, insurance, vaccination history, and whether one had heard of the HPV vaccine influence HPV vaccination practice (all p-values < 0.05). The main barriers to vaccination were vaccine inaccessibility and the high cost of the vaccine.

CONCLUSION

The findings of our study highlight a moderate knowledge level, poor vaccination rate, and strong willingness to be vaccinated among Chinese female adults who were better educated and wealthier. Targeted health education and practical support should be provided in the future, to reduce gaps between vaccine uptake and vaccine acceptance.

Determinants of HPV vaccine uptake intentions in Chinese clinical interns: an extended theory of planned behavior approach

Background

This study aims to utilize the extended Theory of Planned Behavior (TPB) model to examine the intentions of clinical interns in China towards Human papillomaviruses (HPV) vaccination. It also fills a significant gap in the literature concerning vaccine acceptance in this specific population.

Methods

This cross-sectional study was carried out with clinical interns in Shandong Province, China, with a total of 1,619 participants. Data were collected through self-reported questionnaires, including demographic characteristics, TPB variables, and HPV-related health knowledge. Hierarchical regression analysis was employed to identify key factors influencing vaccination intentions, and Structural Equation Modeling (SEM) was used to analyze the interrelationships between these factors.

Results

This study initially identified key predictors affecting clinical interns' intentions to receive the HPV vaccine through hierarchical regression analysis. The preliminary model, which accounted for demographic factors, revealed foundational impacts of household income and HPV-related clinical experience on intentions. After integrating TPB variables-attitude, subjective norm, perceived behavioral control, and HPV-related health knowledge-the model's explanatory power was enhanced to 37.30%. SEM analysis focused on the interplay among TPB constructs and extended variables, confirming their significance in forming vaccination intentions, with subjective norm having the most substantial impact (β = 0.375, p < 0.001). The extended TPB model explained over half of the variance in vaccination intentions, substantiating the hypotheses and revealing the psychological determinants behind clinical interns' decision-making for HPV vaccination.

Conclusion

The extended TPB model from this study effectively explains the vaccination intentions among clinical interns for HPV, offering theoretical support for public health strategies and educational interventions targeting this group. These findings are of significant importance for public health practice and future health promotion strategies.