Knowledge and attitudes about human papillomaviruses and immunization among Turkish pediatricians

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.

Knowledge, attitudes and behaviors of family physicians about childhood vaccinations that are not in the routine vaccination schedule: a cross-sectional study

AIM

In our country, there are childhood vaccinations that are not included in the routine vaccination schedule and that families have to buy and have for a fee. In addition to income level, family physicians' recommendations also play a major role in getting these vaccines.Our study was planned to determine the level of knowledge, attitudes and behaviors of family physicians about rotavirus, HPV and meningococcal vaccines, which are not included in the routine vaccination scheme of the Ministry of Health.

MATERIALS AND METHODS

Our cross-sectional and descriptive study was carried out between May and July 2019. The population of our study consists of approximately 30 000 family physicians working as Family Physicians in Turkey. When the sample size is calculated with 5% margin of error and 95% confidence interval, it turns out to be 381. A 15-question questionnaire prepared by scanning the literature and including socio-demographic characteristics was presented to the participants. The Likert scale, which includes 12 questions about rotavirus, meningococcus, HPV and vaccines developed for these microorganisms, was administered to physicians either face-to-face or via the internet. In our study, the statistical significance level was accepted as P < 0.05, and the SPSS statistical package program was used in the calculations.

RESULTS

81 Research Assistants, 62 Family Medicine Specialists and 234 Family Physicians participated in our study, and the participants were determined by simple random sampling method. The mean age of the participating physicians was 37.96 ± 9.3 (min: 25 and max: 68). 50.9% of the physicians were women, 79.8% were married, 85.1% were in the city center, and 62.1% were practicing family medicine as general practitioners. 74.82% of the participating physicians recommend rotavirus and 56.2% HPV vaccines to their patients. 10.6% (40 people) of the physicians participating in our study did not recommend any of the rotavirus, HPV, meningococcal, influenza and adult pertussis vaccines to their patients. In the evaluation of the reason for this, 58.7% (27 people) of physicians who did not recommend special vaccines state that they did not recommend vaccines because they are not included in the routine vaccination schedule of the Ministry of Health. Another important reason was that the vaccines are paid (30.4%, 14 people). To the question of having sufficient information about special vaccines that are not included in the routine vaccination schedule, 26% of the participants stated that they have sufficient knowledge, and 56.5% stated that they have partial knowledge. The Likert knowledge questions total score of those who recommended at least one vaccine to their patients was significantly higher than those who did not recommend it at all. Likert knowledge questions total score of those who had at least one vaccination was significantly higher than those who never had it (P = 0.001).

CONCLUSION

In general, as the level of knowledge about private vaccines decreases, the rates of self-vaccination, recommending it to their patients, and asking it to be included in the national vaccine schedule decrease. For this reason, increasing the knowledge of physicians about vaccines not included in the national vaccination schedule will contribute to the dissemination of vaccines, thus increasing immunity and reducing mortality and morbidity.

A Survey on Parents' Health Literacy on Childhood Human Papilloma Virus Vaccination

Objective The aim of this study is to determine parents' knowledge levels and attitudes about childhood human papillomavirus (HPV) vaccination and reveal the differences between parents who are health care workers and nonhealth care workers. The HPV vaccine can potentially prevent initial HPV infection and HPV-related genital and anal precancerous disorders and cancers.

Methods Questions and attitudes toward childhood HPV vaccination were asked to 564 parents who agreed to participate in the study.

Results In our study, the rate of health care worker parents considering having their children vaccinated against HPV (63.1%) was higher than that of nonhealth care worker parents (11.4%). Only 5% of parents had their children previously vaccinated against HPV; however, there was no difference between parents who were health care workers and those who were not. In addition, this rate was relatively low compared to other paid vaccines (49.8, 35.3, and 18.8%, respectively). Parents who had not previously vaccinated their children against HPV were considering getting their children vaccinated, especially if a pediatrician recommended it.

Conclusion The parents' high level of health literacy may not be effective in deciding to vaccinate their children against HPV. Therefore, adequate information and awareness should be provided to all parents about HPV vaccination as early as possible for all children of appropriate age. Pediatricians should be given important roles in raising the awareness of parents about childhood HPV vaccination by health authorities.

Knowledge, attitudes, and perception toward human papillomavirus among health profession students: A cross-sectional study in King Saud Bin Abdulaziz University for Health Sciences

BACKGROUND

Human papillomavirus (HPV) infection is the major risk factor for cervical cancer (CC) in women of reproductive age. Despite advances in treatment and prevention of CC by HPV vaccination, very few women utilize them because of a lack of awareness about HPV.

MATERIALS AND METHODS

We conducted this cross-sectional study among Health Professions Students (HPS) at King Saud Bin Abdul Aziz University for Health Sciences, Jeddah. Data were collected using a predesigned and validated study questionnaire to assess the knowledge, attitude, and perception of HPS toward HPV.

RESULTS

A total of 580 HPS responded to the survey; 128 (22.1%) were male, while 452 (77.9%) were female with the mean age ± standard deviation 20.36 ± 1.74 years. There was no significant difference between males and females related to screening of HPV and CC (82.8%; 82.3%). A minority (30.3%) of participants thought that HPV infection leads to CC, while 38.3% did not know about it. Furthermore, knowledge about HPV screening and vaccination was poor.

CONCLUSIONS

Students from the college of medicine had more knowledge and awareness about HPV (34.9%, P < 0.001). Thus, it is important to implement effective education programs, curricular activities, and awareness campaigns for health professions to augment the learning process effectively.

Identification Level of Awareness and Knowledge of Emirati Men about HPV

One of the most frequent cancers that affects males globally is cervical cancer (CC) that kills hundreds or even thousands of women each year, particularly in underdeveloped nations. The study focuses on human papillomavirus (HPV) that contributes to cervical cancer (CC) development. In the majority of Arab nations, there seems to be no public education or vaccination programs. In research, methodological rigor is employed to find solutions to both theoretical and practical difficulties. This research aims to assess the knowledge and awareness of the HPV vaccination among Emirati men. Results of the research showed that Emirati males had a poor understanding of HPV and its vaccination. According to the findings of this research, Emirati males lack a basic understanding of HPV, which necessitates the implementation of national HPV education initiatives. We have identified several critical knowledge gaps that can be filled in the future regarding HPV infection and vaccination.

A systematic review of the barriers to implementing human papillomavirus vaccination programs in low- and middle-income countries in the Asia-Pacific

AIM

The increasing burden of human papillomavirus (HPV)-related diseases in low- and middle-income countries (LMICs) could be alleviated by effective HPV vaccination programs. In this systematic review, we examined barriers to introduction, implementation, and/or sustainability of HPV vaccination programs in LMICs in the Asia-Pacific region (AP-LMICs).

METHODS

A systematic search of literature from the past 10 years (2010-2019) was performed through PubMed, Cochrane CENTRAL, and Google Scholar. Studies were included if they reported barriers to HPV vaccination in AP-LMICs. All study designs were included except commentaries and editorials. The journal articles were assessed using the Joanna Briggs Institute critical appraisal checklists.

RESULTS

A total of 46 eligible articles were included. An increase in publications was noted from 2010 to 2019. Barriers were diverse and were classified into four levels--government, healthcare providers (HCPs), society, and individual. The top specific barriers that were identified across AP-LMICs are lack of funding and political support at the government level, lack of awareness among HCP and lack of vaccination programs at the level of health providers, and the perceived cost/benefit ratio for the individual level.

CONCLUSION

Barriers to successful implementation of HPV vaccination programs differ among Asia-Pacific LMICs. Policymakers will need to evaluate the relative importance of these barriers in their target areas and population in order to draft an effective dissemination and implementation strategy.

Assessment of the State of Knowledge about HPV Infection and HPV Vaccination among Polish Resident Doctors

HPV (human papillomavirus) vaccinations have been introduced into the population of many countries through vaccination programs, although their acceptance varies from country to country, largely dependent on the state of knowledge about diseases caused by genital HPV types as well as cultural, social, and religious factors. The aim of the study was to analyze the state of knowledge about HPV and HPV vaccines among doctors during their specialization in gynecology and obstetrics, dermatology and venereology, and pediatrics. Another objective of the study was to analyze the impact of the state of knowledge about HPV vaccination on their attitude to primary prevention, i.e., vaccinations. A questionnaire was used to collect the data and 639 doctors took part in the study. The analysis was carried out mainly using descriptive statistical methods. In Poland, doctors' knowledge about HPV is low, independent of gender, age, and subject of specialization. Doctors' knowledge about the HPV vaccine is very low and independent of sex, age, and subject of specialization. However, doctors' knowledge about HPV and the HPV vaccine influences the attitude to HPV vaccination and does not affect pro-active behaviors.

Recommending immunizations to adolescents in Turkey: a study of the knowledge, attitude, and practices of physicians

Introduction: The aim of this study was to determine the knowledge, attitudes, and practices of family physicians and pediatricians in regard to adolescent immunization.Methods: The study was conducted from March to May 2017. A total of 665 physicians participated. Participants were asked 31 questions about their personal sociodemographic characteristics and their knowledge, attitudes, and practices around adolescent immunization.Results: The study sample consisted of 348 family physicians (52.3% of the sample) and 317 pediatricians (47.7%). The results showed that 5.4% of family physicians and 10.4% of pediatricians thought that they had enough knowledge about adolescent immunization (p < .01). Overall, 15.8% of family physicians and 12.7% of pediatricians provided adolescents with information about vaccines 'always/most of the time'. A variety of reasons for not providing information about adolescent vaccines was provided, including 'inability to allocate time' (50.2% of family physicians, 69.3% of pediatricians); 'forgetfulness' (34.8% of family physicians, 28.5% of pediatricians); 'lack of knowledge about vaccines' (34.1% of family physicians, 27.4% of pediatricians); and 'no need to immunize adolescents' (15.7% of family physicians, 6.5% of pediatricians) (p < .01). HPV immunization was recommended only to girls by 30.5% of family physicians and 38.8% of pediatricians (p < .01). The percentages of family physicians and pediatricians not recommending that adolescents be immunized with the Tdap vaccine were 53.4% and 42.6%, respectively (p = .016). Meningococcal immunization was not recommended by 20.7% of family physicians and 11.4% of pediatricians (p < .01), and influenza immunization was not recommended by 10.3% of family physicians and 8.2% of pediatricians (p < .01).Conclusion: Family physicians and pediatricians in Turkey have low rates of recommendation of immunization to adolescents. Reasons for not recommending immunization include an inability to allocate time, forgetfulness, and lack of knowledge about vaccines. We conclude that educational programs should be used to improve knowledge of adolescent immunization among family physicians and pediatricians.

Physician's knowledge and opinions on human papillomavirus vaccination: a cross-sectional study, Saudi Arabia

BACKGROUND

In a transition period of prevention strategy against HPV infection and cervical cancer in Saudi Arabia, it becomes necessary to appraise physicians' preparedness to undertake the inherent actions and responsibilities, by evaluating their knowledge and opinions regarding HPV infection and vaccine.

METHODS

A cross-sectional study carried out between Jan 2017 and Nov 2018, included 2000 physicians working in 21 public centers from the five regions of Saudi Arabia. A self-administered questionnaire was used to assess physicians' perception about HPV infection prevalence (1 item), knowledge about HPV infection and vaccine (9 items), and opinions and attitudes toward vaccine (4 items). A knowledge score (range 0-9) was calculated and adequate knowledge was assumed for a score ≥ median. Factors associated with opinions and attitudes were explored and multivariate regression was used to analyze independent factors of inadequate knowledge (score < median).

RESULTS

Majority of the participants replied correctly to all knowledge questions, and 63.0% perceived HPV infection as a frequently encountered infection. Median knowledge score was 8 and 62.0% had adequate knowledge (score ≥ 8). Inadequate knowledge was independently associated with Saudi nationality (OR = 1.51, p = 0.003), practice level (resident: OR = 3.53, p < 0.001; junior OR = 1.67, p = 0.002), and non Ob-Gyne specialty (OR = 5.40, p < 0.001); in addition to disparities across region and age. Among the participants, 7.6% were immunized and 41.2% accepted to receive the vaccine, while majority were favorable to have their children vaccinated (77.6%) and to include HPV vaccine in the local immunization program (69.6%). Self-perceived underexposure to HPV infection (58.5%), lack of knowledge about the vaccine (21.1%) and being sexually inactive (14.7%) were the most frequently reported reasons for refusing the vaccine. Overall negative attitude regarding vaccine was typically associated with male, older, Saudi, senior consultant in other than Ob/Gyn specialty. Inadequate knowledge level as well as lowly perceived prevalence of HPV infection were associated with less favorable attitude to vaccination.

CONCLUSIONS

More specific educational interventions are warranted to trigger physicians' active engagement in the fight against HPV infection and cervical cancer. Such interventions should demystify the HPV vaccine by exposing its efficacy, availability and safety, along with providing practical information about the vaccination procedure and goals to achieve successful prevention strategy.

Knowledge, attitudes, and practices of Saudi physicians regarding cervical cancer and the human papilloma virus vaccine

BACKGROUND

Cervical cancer is considered the second most common type of cancer in women worldwide, with a reported 570,000 incident cases documented each year. Infection with certain types of the Human Papillomavirus (HPV) has been found to be associated with more than 99% of cervical cancers. The HPV vaccine can prevent HPV infection and most cases of cervical cancers; however the uptake of this vaccine remains low in Saudi Arabia. Physicians can play a vital role in providing their patients with objective information regarding the HPV vaccine, yet little is known about their knowledge, attitudes, and practices in this area.

MATERIALS AND METHODS

We conducted a cross-sectional study in King Abdul-Aziz Medical City (KAMC), Central Region, Saudi Arabia where data were collected through an online questionnaire to assess the knowledge, attitudes, and practices of physicians.

RESULTS

Most physicians (61%) displayed a good level of knowledge about cervical cancer; 94% were knowledgeable of the causative link between (HPV) infection and cervical cancer. Family medicine physicians had better knowledge regarding cervical cancer, HPV, and HPV vaccination than pediatricians (p=0.023). Physicians with >10 years of practice had better knowledge of cervical cancer than other respondents (p=0.041). 80% of the sample thought it was important for women to receive the HPV vaccine and 82% stated they would allow their daughters to be given the HPV vaccine. Lack of parental knowledge of the vaccine was significantly (p=0.034) associated with a lack of knowledge about HPV, and this was one of the most common barriers preventing recommendation of the HPV vaccine.

CONCLUSION

With the increasing prevalence of HPV infections, better knowledge of HPV infection, HPV-related diseases, and the availability of HPV vaccinations from health professionals will assist with the implementation of effective prevention and treatment programmes.

Practice patterns and knowledge among California pediatricians regarding human papillomavirus and its relation to head and neck cancer

OBJECTIVE

To identify practice patterns regarding human papillomavirus (HPV) vaccination efforts and vaccination rates in context of head and neck cancer prevention, identify barriers to vaccination, and identify gaps in knowledge regarding the link between HPV and head and neck cancer in the pediatrician population.

STUDY DESIGN/METHODS

A 27-question cross-sectional survey was distributed to members of the four California chapters of the American Academy of Pediatrics.

RESULTS

Of the completed responses, 89.4% identified as "always" recommending the HPV vaccine to patients, but only 19.5% of pediatricians estimated that >75% of their eligible patients had completed the HPV vaccination series. 71.5% of respondents felt that further education about HPV's link to head and neck cancer them more comfortable discussing vaccination. Physicians who were in practice longer were less likely to respond that additional education about HPV and its link to head and neck cancer would make them more comfortable discussing vaccination with patients (p = 0.043). Physicians who were in practice longer were more likely to correctly respond that HPV type 16 is the most common strain linked to head and neck cancer (p = 0.021).

CONCLUSION

There is need to improve both the knowledge base and comfort level of pediatricians in counseling their patients during vaccine recommendations. Otolaryngologists have a critical role in providing education to physicians, trainees, and the general public in the effort to combat the epidemic of HPV-associated head and neck cancer.

Awareness of primary health care physicians about human papilloma virus infection and its vaccination: a cross-sectional survey from multiple clinics in Saudi Arabia

Background

The incidence of human papilloma virus (HPV) infections in conservative populations is increasing, yet vaccination is not routinely recommended by primary health care (PHC) physicians. The aim of this study is to evaluate PHC physicians’ awareness of HPV infections and vaccination in Saudi Arabia.

Materials and methods

A self-administered survey was conducted in 2017 at eleven PHC clinics in Saudi Arabia. Their knowledge on HPV infections (six statements) and HPV vaccines (ten statements), their perceived importance of HPV vaccine, and if they recommended this vaccine to their patients was evaluated. Knowledge scores were summated and commuted into percentage mean scores (PMS). Analyses were conducted to identify factors associated with these outcomes.

Results

Almost 80% of physicians perceived HPV vaccine as necessary and important, while 33 (16.5%) actually recommend HPV vaccine to their patients. Overall PMS± standard deviation of knowledge on HPV infections and vaccine was 61.8±10.4 and 91.3±11.4, respectively. Female physicians had a better perception of the importance of the vaccine (94; 84.7%), compared to male physicians (65; 73.0%), P=0.043. Younger physicians (<38 years) had better perception of the importance of HPV vaccine (75; 88.2%), compared to older physicians (≥38 years) (84; 73%), P=0.009. Family medicine physicians were more knowledgeable about both HPV infections (62.1±9.7) and HPV vaccine (91.2±12.0), compared to physicians of other specialties (56.3±13.7 and 85.8±10.2), P=0.03 and P=0.007, respectively. PHC physicians who routinely recommended HPV vaccine were also more knowledgeable (96.7±5.4), P=0.005. Compared to males, females were 3.1 times more likely to recommend HPV vaccines, adjusted P=0.015. Physicians who had better perception of the importance of vaccine were 4.8 times more likely to recommend vaccination, adjusted P=0.042.

Conclusion

Enhancing PHC physicians’ knowledge about HPV infections and the efficiency of its vaccine boosts the physicians’ confidence to recommend HPV vaccination. Special consideration should be paid to male PHC physicians and older physicians, who had poorer perception of the importance of HPV vaccines in comparison to their counter groups.

A Survey of Wisconsin Pediatricians’ Knowledge and Practices Regarding the Human Papillomavirus Vaccine

Objective

The human papillomavirus (HPV) is common and carries a significant burden of disease. This is increasingly apparent in males with the rising incidence of HPV-related oropharyngeal cancer. Unfortunately, vaccination rates remain poor and are lowest in males. It is unclear if pediatricians are aware of the alarming rise of HPV-mediated head and neck cancers and the disproportionate effect on males.

Study Design

This investigation used a cross-sectional descriptive survey research design.

Setting

The survey was developed by investigators in the University of Wisconsin Division of Otolaryngology.

Subjects and Methods

The survey was distributed to 831 members of the Wisconsin Chapter of the American Academy of Pediatrics.

Results

A total response rate of 49.6% was achieved. Most supported routine vaccination in both sexes. Females are regarded as being at higher risk of an HPV-related cancer and are more often recommended vaccination. Most providers are unaware of the magnitude of HPV-related oropharyngeal cancer and the greater affliction in males.

Conclusions

Male vaccination is overwhelmingly supported by Wisconsin pediatricians, yet there is a preponderance toward vaccinating females, who are perceived as having greater risk for HPV-associated disease. This is likely because providers are unaware of the magnitude of HPV-driven oropharyngeal cancer and its predilection for males. A lack of provider awareness, in combination with out-of-date education material for parents, likely contributes to poor vaccination rates in males.

Knowledge and attitudes of women regarding gynaecological cancer prevention in an urban area of Greece in financial crisis

INTRODUCTION

Preventive gynaecological examinations (PGEs) are the main means of monitoring gynaecological cancers across the developed world. The purpose of this study was to investigate the perceptions and attitudes of women of a regional municipality of Greece, regarding preventive gynaecological examinations amid economic crisis.

MATERIAL AND METHODS

The study included 360 women aged 20-70 years, who lived in an urban area of Greece. A specialised, valid and anonymous questionnaire that included questions about perceptions and attitudes regarding preventive gynaecological examinations was used. The data analysis was performed using the statistical package spss 21.

RESULTS

It was found that women who lived in less developed areas had had lower educational levels and higher abstinence rates from medical examinations. The main source of information about sexually transmitted diseases was their social circle (48%), but the gynaecologist is the one preferred (54.8) to inform about preventive gynaecological examinations. Thirty per cent of the participants had never have a mammogram, while 33.9% of the sample did not show the same result, although considered the Pap test necessary. The main cause of women's abstention of preventive gynaecological examinations is the financial crisis.

CONCLUSIONS

The current financial crisis has negatively affected the women's ability to afford gynaecological examinations. Therefore, it is necessary to inform the population about the necessity of preventive gynaecological examinations starting from school age and at the same time, health information and promotion campaigns should be launched at a national level.

A brief educational intervention increases providers' human papillomavirus vaccine knowledge

Recommendation by a healthcare provider is critical to increase human papillomavirus (HPV) vaccine uptake in the US. However, current deficits in providers' knowledge of HPV and its vaccine are not fully understood and interventions to amend knowledge gaps are untested. To determine whether attending a structured presentation could increase provider knowledge of the HPV vaccine, we assessed knowledge levels of physicians, non-physician healthcare workers, and medical students before and after attending a 30-minute lecture held between October 2012 and June 2014. Paired t-test and McNemar's test were used to compare knowledge scores and the proportion of correct responses for each question, respectively. Multiple linear regression analyses were performed to examine correlates of baseline knowledge and change in knowledge scores post-intervention. A total of 427 participants, including 75 physicians, 208 medical students, and 144 nurses or other healthcare workers, attended one of 16 presentations and responded to both pre-test and post-test surveys. Baseline knowledge was low among all groups, with scores higher among older participants and physicians/medical students. On average, knowledge scores significantly improved from 8 to 15 after the presentation (maximum possible score 16) (P < .001), irrespective of specialty, race/ethnicity, gender, and age. Although lower at baseline, knowledge scores of younger participants and non-physician healthcare workers (e.g., nurses, physician assistants (PAs), nursing students) improved the most of all groups. We conclude that a brief, structured presentation increased HPV knowledge among a variety of healthcare workers, even when their baseline knowledge was low.

Knowledge, attitudes and beliefs about cervical cancer and human papilloma virus vaccination with related factors in Turkish university students

BACKGROUND

This study aimed to determine knowledge, attitudes and believes about cervical cancer and human papilloma virus (HPV) vaccination with related factors in Turkish university students.

MATERIALS AND METHODS

This descriptive and cross sectional study was conducted between June-July 2013 in Hitit University located in Corum, a rural area to the East of Ankara. The population consisted of 550 university students who were training in first and last year from Faculties of Economics, Theology and Health. We reached 463 volunteer students without selection. The study of data was collected with a 44 item questionaire covering socio-demographic features, knowledge, attitudes and beliefs about cervical cancer, HPV and vaccination. Also for this study ethic committee report was taken from Bozok University. Data were evaluated with the SPSS 17.0 programme using the Ki kare test with P<0.05 accepted as statistically significant.

RESULTS

It was seen that there was a statistically significant variation between classrooms and departments of students with knowledge about cervical cancer and human papilloma virus and vaccine (p<0.001; p<0.01; p<0.05). Also we found low attitudes to thinking about taking HPV vaccination of girls and their children in the future.

CONCLUSIONS

In light of the study findings; it was concluded that knowledge levels, beliefs and attitudes of the university students about cervical cancer, HPV infection and HPV vaccination were low.