An exploratory study of Japanese fathers' knowledge of and attitudes towards HPV and HPV vaccination: does marital status matter?

Effect of information awareness on attitudes toward human papillomavirus vaccination intentions in Japan

Background

The Human Papillomavirus (HPV) vaccination rate among Japanese high school girls remains critically low, reflecting ongoing public apprehension and misinformation. This study explores the relationship between information presentation and attitudes toward HPV vaccination in Japan.

Methods

We conducted a web-based survey of female high school students aged 15 to 16 and mothers of daughters of similar age across Japan. The first screening questionnaire investigated the vaccine uptake among eligible students. The detailed questions assessing awareness of HPV vaccination information, including vaccine eligibility and its cost, effectiveness, lifetime prevalence of HPV infection, and vaccine safety, were asked to the respondents. After presenting each piece of information, we investigated how the information influenced the vaccination attitudes of unvaccinated students and mothers of unvaccinated girls.

Results

Data collection occurred from August 20 to August 24, 2021. Of 473 students, 68 (14.4 %) had already been vaccinated before the study. Over half of the 245 participating students were aware of vaccine eligibility and cost (68.7 %) and effectiveness (63.6 %), but fewer understood lifetime prevalence (28.7 %) and safety (45.3 %). In contrast, awareness of the same questions in 245 mothers was higher than that in the students: 90.2 %, 92.5 %, 55.4 %, and 61.1 %, respectively. Among unvaccinated students and mothers of unvaccinated girls, the intention to get vaccinated increased the most after being informed about the lifetime risks of HPV infection; 50.5 % of students and 38.8 % of mothers showed a positive attitude toward the HPV vaccination.

Conclusions

Bridging the awareness gap between students and mothers is crucial for improving HPV vaccination rates. The findings underscore the potential of specific, targeted information to influence vaccination intentions, particularly regarding the HPV infection rate.

A Review of Parental Vaccine Hesitancy for Human Papillomavirus in Japan

Globally, Japan has the lowest rate of vaccine confidence. The persistent parental vaccine hesitancy has been attributed to safety and efficacy concerns and is primarily driven by the negative experience with human papillomavirus (HPV) vaccines. This literature review aimed to identify factors associated with HPV vaccine uptake and potential strategies to reduce vaccine hesitancy among Japanese parents. Articles published in English or Japanese between January 1998 and October 2022 that examined Japanese parental factors for HPV vaccine uptake were identified from PubMed, Web of Science, and Ichushi-Web. In total, 17 articles met the inclusion criteria. Four key themes which affected HPV vaccine hesitancy and acceptance were identified: perceptions of risk and benefits, trust and recommendation, information and knowledge, and sociodemographic characteristics. While governmental and healthcare provider recommendations are important factors, efforts to improve parental confidence in the HPV vaccine are required. Future interventions to counteract HPV vaccine hesitancy should actively disseminate information on vaccine safety and effectiveness, along with information on the severity and susceptibility of HPV infection.

Importance of human papillomavirus vaccination leaflets focusing on the safety profile targeted pediatricians in Japan

OBJECTIVES

To investigate the association between providing leaflets to support pediatricians in explaining the safety of the human papillomavirus (HPV) vaccine and mother's decision to vaccinate their daughters in Japan.

METHODS

In this cross-sectional study, we conducted a survey of mothers to evaluate the effect of leaflets that were created to support pediatricians in explaining the safety profile of the HPV vaccine. Mothers who provided consent for vaccination before receiving an explanation were excluded from the study. The primary outcome was the mother's decision to vaccinatetheir daughters with the HPV vaccine after receiving an explanation from pediatricians using our leaflets.

RESULTS

Among 161 eligible mothers, 101 decided on HPV vaccination (decided group) and 60 did not (decided against group). There was no difference in the maternal background between the 2 groups. The decided group had a significantly more positive impression of the leaflets than the undecided group. In multivariable logistic regression analysis, a detailed explanation for possible adverse events and specific solutions to them was associated with the mother's decision to have their daughters vaccinated (odds ratio 2.35, 95% confidence interval 1.02-5.44), but not the pathology of cervical cancer and the HPV vaccination process.

CONCLUSION

Leaflets emphasizing an explanation of adverse events may contribute to mothers' decision making for HPV vaccination.

Effect of a Brief Web-Based Educational Intervention on Willingness to Consider Human Papillomavirus Vaccination for Children in Japan: Randomized Controlled Trial

Background

The human papillomavirus (HPV) vaccination rate in Japan has fallen to nearly zero since the suspension of governmental proactive recommendations in 2013, owing to the development of purported adverse events.

Objective

This study aimed to evaluate the effects of a brief web-based educational intervention using the theory of behavioral insights on the willingness of adults to consider the HPV vaccine for their daughters and sons.

Methods

We recruited 1660 participants aged 20 years or older in March 2018 via a webpage and provided them with a 10-item questionnaire related to the following aspects: awareness regarding HPV infection and vaccination, willingness for immunization, and actions for prevention. We randomly stratified participants based on sex and age with or without a brief educational intervention involving scientific information presented in an easy-to-read format.

Results

Only 484 (29.2%) of the respondents were aware of the benefits of HPV vaccination. Although only 352 (21.2%) of the respondents displayed a willingness for immunization of their daughters, there were 40 (4.8%) more respondents in the intervention group with this willingness (adjusted odds ratio [aOR] 1.32, 95% CI 1.04-1.69). In a subanalysis, the willingness toward vaccination for daughters in men was significantly higher in the intervention group (aOR 1.46, 95% CI 1.05-2.02). However, such a difference was not observed among women (aOR 1.20, 95% CI 0.83-1.73).

Conclusions

This study suggests that a brief web-based educational intervention increases the willingness of adults to consider the HPV vaccine for their children, especially among men. Thus, providing adequate information to men may be a useful strategy to improve the currently low rates of HPV vaccination.

Trial Registration

UMIN Clinical Trials Registry UMIN000049745 (UMIN-CTR); https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000049745

Knowledge, Attitude, and Behavior of Teachers Regarding HPV (Human Papillomavirus) and Vaccination

This study aims to determine the knowledge, attitude, and behaviors of teachers regarding human papillomavirus (HPV) and its vaccination. This cross-sectional study included teachers from 30 schools of the Kahramanmaraş city between 01 March 2015 and 09 June 2015. The teachers were informed prior to the study, and 804 teachers giving written consents were enrolled. Nine questions (9 points) to ascertain the knowledge of teachers regarding HPV and 5 questions to detect the knowledge level about HPV vaccination were prepared from the literature. Of the participants, 448 (55.7%) were men and 356 (44.3%) were women with a mean age of 38.32 ± 8.36 (min = 23, max = 65) years. Of the teachers, 309 (38.4%) reported having heard about HPV before while 207 (25.7%) stated hearing about the HPV vaccine. The knowledge about HPV was mostly gained from the internet (n = 183, 22.8%). The mean knowledge score of HPV was 1.29 ± 1.57 in men and 1.76 ± 1.70 in women. The mean knowledge score about the HPV vaccination was 0.86 ± 1.06 in men and 1.14 ± 1.29 in women. The knowledge scores of female teachers regarding HPV and its vaccination were significantly higher compared with male teachers (p < 0.001, p = 0.001). We found that teachers' level of knowledge regarding HPV and its vaccination is lacking. Furthermore, we observed deficiency and mistakes in teachers' attitude and behaviors towards HPV and its vaccine. The knowledge deficiency of male teachers about HPV and vaccination compared with female teachers is remarkable.

Resources for assessing parents' vaccine hesitancy: a systematic review of the literature

The concept of Vaccine Hesitancy has begun to appear in the scientific landscape, referring to the reluctance of a growing proportion of people to accept the vaccination offer. A variety of factors were identified as being associated with vaccine hesitancy but there was no universal algorithm and currently there aren’t any established metrics to assess either the presence or impact of vaccine hesitancy. The aim of this study was to systematically review the published questionnaires evaluating parental vaccine hesitancy, to highlight the differences among these surveys and offer a general overview on this matter. This study offers a deeper perspective on the available questionnaires, helping future researches to identify the most suitable one according to their own aim and study setting.

Japanese physicians' attitudes and intentions regarding human papillomavirus vaccine compared with other adolescent vaccines

INTRODUCTION

Japan has experienced extremely low human papillomavirus vaccine (HPVV) coverage following the suspension of proactive governmental recommendations in 2013. Several studies have reported that recommendations from physicians increase adolescents' vaccine acceptance. In this survey, we evaluated the attitudes and intentions of Japanese physicians related to adolescent immunizations, particularly HPVV.

METHODS

We conducted a cross-sectional study using a mailed questionnaire targeting 330 Japanese physicians including 78 pediatricians, 225 internists and 27 obstetricians and gynecologists (OB/GYNs) in Kawasaki City, Japan in 2016. The survey measured physicians' reported frequency of educating adolescents about vaccines as well as their own perceptions and intentions related to adolescent immunizations.

RESULTS

Valid responses were obtained from 148 (45%) physicians. Though 53% agreed that the HPVV should be recommended, only 21% reported educating about HPVV. The majority of respondents (90%) agreed that they would restart HPVV for adolescents if the government reinstated its recommendation.

CONCLUSIONS

Although Japanese physicians reported support for adolescent immunizations, they were less likely to recommend or discuss HPVV compared with other adolescent vaccines. Responses indicated this was, at least in part, due to the lack of governmental support for HPVV, indicating that their recommendations would improve with government endorsement of the vaccine.

HPV VACCINE ADHERENCE AMONG ADOLESCENTS: INTEGRATIVE REVIEW

ABSTRACT Objective: to identify what factors are connected to adolescent adherence to the vaccination against Human Papillomavirus. Method: integrative developed using the following data base: Medical Literature Analysis and Retrieval System Online and Web of Science, Cumulative Index to Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Latin-American and Caribbean Literature in Health Sciences), and Base de dados de Enfermagem (Nursing Database); using the descriptors and keywords: Papillomaviridae, immunization, vaccines. The final sample had 31 original articles. Result: Vaccine adherence predictors were identified as: knowledge about virus infection risk, vaccination and its benefits; cervical cancer and genital warts prevention; sexual activity; being over 14 years old; mothers’ intention to adhere to vaccination; mother-child communication about sexually transmitted infections, contraception and condoms; vaccination offered in school; recommendation by teachers and health professionals; vaccine safety and effectiveness. Conclusion: Evidence points towards the necessity to redesign the presentation strategy of the vaccine, because despite the cultural differences among the countries where the studies were carried out, it is noticeable that society shelters adolescents aged from 10 to 14 years old, considering it early for sexual initiation and presenting difficulties to broach sexuality-related topics with children.

Knowledge and Attitudes of Postpartum Mothers towards Immunization of Their Children in a Lithuanian Tertiary Teaching Hospital

Background: Sufficient vaccination coverage among children depends on parents' knowledge and attitudes towards immunization and their intention to have their children vaccinated. The objective of the study was to evaluate postpartum mothers' knowledge and attitudes towards children's immunization. Methods: It was a cross-sectional survey. The anonymous questionnaire was handed out to postpartum mothers selected at random in the Hospital of Lithuanian University of Health Sciences Kauno Klinikos from March to July of 2014. In total, 300 women were surveyed. Results: The majority (63%) of respondents had higher education. The child was the first one for 49.7% of the mothers. The women indicated that their main sources of information about children's vaccination were the doctor, the Internet and mass media. Most respondents (87.3%) considered vaccine-preventable diseases to be dangerous but only 57.3% of them knew that vaccines provided efficient protection. Only 57% of the respondents considered vaccines to be safe but 75.3% thought that the benefits of vaccines were greater than the risks. We evaluated the knowledge as good in 36.3%, average in 41.3% and poor in 22.3% of mothers. Most of the respondents (81.3%) planned to immunize their child in the future with all the vaccines included in the national immunization program, however, 72.7% were worried about possible adverse events following vaccination. Of the mothers whose knowledge was evaluated as good, 74.8% had never refused or had doubts about having their child immunized (τ = -0.198, p < 0.001). The mothers with better knowledge were also less likely to be concerned (τ = 0.211, p < 0.001). Conclusions: Evaluation of postpartum mothers' knowledge and attitudes towards children's immunization could be the tool for better communication between health professionals and parents leading to increased vaccination rates.

Expression of Toll-like receptor 9 increases with progression of cervical neoplasia in Tunisian women--a comparative analysis of condyloma, cervical intraepithelial neoplasia and invasive carcinoma

Toll-like receptors (TLRs) are expressed in immune and tumor cells and recognize pathogen-associated molecular patterns. Cervical cancer (CC) is directly linked to a persistent infection with high risk human papillomaviruses (HR-HPVs) and could be associated with alteration of TLRs expression. TLR9 plays a key role in the recognition of DNA viruses and better understanding of this signaling pathway in CC could lead to the development of novel immunotherapeutic approaches. The present study was undertaken to determine the level of TLR9 expression in cervical neoplasias from Tunisian women with 53 formalin-fixed and paraffin-embedded specimens, including 22 samples of invasive cervical carcinoma (ICC), 18 of cervical intraepithelial neoplasia (CIN), 7 of condyloma and 6 normal cervical tissues as control cases. Quantification of TLR9 expression was based on scoring four degrees of extent and intensity of immunostaining in squamous epithelial cells. TLR9 expression gradually increased from CIN1 (80% weak intensity) to CIN2 (83.3% moderate), CIN3 (57.1% strong) and ICC (100% very strong). It was absent in normal cervical tissue and weak in 71.4% of condyloma. The mean scores of TLR9 expression were compared using the Kruskall-Wallis test and there was a statistical significance between normal tissue and condyloma as well as between condyloma, CINs and ICC. These results suggest that TLR9 may play a role in progression of cervical neoplasia in Tunisian patients and could represent a useful biomarker for malignant transformation of cervical squamous cells.

Knowledge, attitudes and behaviors of the Italian population towards Neisseria meningitidis, Streptococcus pneumoniae and HPV diseases and vaccinations: A cross-sectional multicentre study

OBJECTIVES

This study addressed knowledge of Streptococcus pneumoniae, Neisseria meningitidis and human papillomavirus (HPV), and attitudes and behaviours towards vaccines against them.

STUDY DESIGN

This is a cross-sectional, multicentre study.

METHODS

Data were collected through a questionnaire administered to 530 adults who accessed four Departments of Prevention of the Italian National Health Service in 2013.

RESULTS

Less than 50% of people gave the right answer to all the questions concerning the three diseases, but 96.2%, 94% and 92.7% agreed with the importance of vaccination against N. meningitidis, S. pneumoniae and HPV, respectively, and 58.4% expressed own willingness to have their children vaccinated with N. meningitidis B vaccine. The attitude towards vaccination was more positive in women for N. meningitidis and in people having children for HPV. Furthermore, individuals giving correct answers to all knowledge items were more in favour of both HPV and S. pneumoniae vaccination. A total of 68.8%, 82.6% and 84.5% of respondents vaccinated their own children against N. meningitidis C, S. pneumoniae and HPV, respectively. About 50% of the respondents reported paediatricians' or other health professionals' recommendations as the main reason for vaccination.

CONCLUSIONS

Vaccinations may be promoted through actions aimed at increasing citizens' knowledge. Health professionals should be educated to actively provide information on vaccinations in a clear, comprehensive and effective way.

Personal and socio-cultural barriers to cervical cancer screening in Iran, patient and provider perceptions: a qualitative study

BACKGROUND

Although cervical cancer is preventable and early screening might decrease the associated mortality, challenges faced by the women and health care providers can postpone early detection. This qualitative study aimed to establish patient and provider perceptions about personal and socio-cultural barriers for cervical cancer screening in Mashhad, Iran.

MATERIALS AND METHODS

In the present study, which was conducted in 2012, eighteen participants, who were selected purposefully, participated in individual in-depth, semi-structured interviews, which were recorded, transcribed verbatim, and analyzed using conventional content analysis and Atlas-Ti software.

RESULTS

One theme and two categories were derived from data including: cognitive/behavioral factors (lack of a community-based approach to cervical cancer, lack of awareness, wrong attitude and lack of health seeking behaviors) and socio/cultural issues (socio-cultural invasion, mismatch between tradition, modernity and religious, extra marital relationships and cultural taboos).

CONCLUSIONS

Providing community based approach education programs and employing social policy are needed for preventing of cervical cancer in Iran.

Awareness of female malignancies among women and their partners in Southern Sri Lanka and implications for screening: a cross sectional study

BACKGROUND

The incidences of breast, cervical and uterine malignancies continue to increase in Sri Lanka. It is important to explore the awareness of both women and their male partners regarding these malignancies and available screening services as it would determine the health seeking behaviours of females.

METHODS

This was a cross sectional survey of couples residing in the Galle District of the Southern province of Sri Lanka. The sample was selected from all 17 health administrative divisions of the district. An interviewer administered questionnaire was used to collect data on demography and level of awareness (risk factors, symptoms, signs, screening services) of breast, cervical and uterine cancers. Same questionnaire was used for both sexes except for gender specific questions.

RESULTS

A total of 282 (n-282, 564 individuals) couples were interviewed. The level of awareness regarding all malignancies was low. More than 50% of participants in both sexes scored less than half the points on a questionnaire testing awareness. Better family income, better education and permanent employment showed a significant association with better awareness in both sexes (univariate analysis). Encouragement by male partner was associated with better participation in some instances.

CONCLUSIONS

Community based health education on female malignancies needs to target both sexes. Educating males is important as, i) male partners can encourage females to utilize screening services and ii) some screening and preventive measures are relevant to males also. Better awareness of males may increase the uptake of screening services by females in societies with male dominant gender roles.

Parents' preferences and willingness-to-pay for human papilloma virus vaccines in Thailand

Objective

To examine parents’ preferences and willingness-to-pay (WTP) for HPV vaccines.

Methods

A discrete choice experiment (DCE) was used. Parents with at least one daughter aged 9–13 years residing in Songkhla province were asked to choose one alternative from each DCE choice set describing HPV vaccines by four attributes, including cervical cancer risk reduction, genital warts risk reduction, common side effects, and cost. Multinomial logit model was used for data analyses.

Results

Parents preferred higher risk reductions for cervical cancer and genital warts, and lower common side effects. They valued the quadrivalent and bivalent HPV vaccines at 21,189.9 and 10,479.9 Baht, respectively. Results also showed that mothers valued both vaccines more than fathers did.

Conclusions

Parents valued net benefits for both quadrivalent and bivalent HPV vaccines, but they were willing to pay for the quadrivalent vaccine more than for the bivalent vaccine.

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.

Challenges of providing cervical cancer prevention programs in Iran: a qualitative study

BACKGROUND

Cervical cancer has become a major public health problem worldwide. Iran, like other developing countries, is facing a number of challenges in managing the disease. This qualitative study documents challenges encountered in cervical cancer preventing programs in Iran.

MATERIALS AND METHODS

In-depth interviews were conducted with 28 participants including eleven patients with cervical cancer, three gynecologic oncologists, five specialists in Obstetrics and Gynecology, five midwives, three health care managers and one epidemiologist in Mashhad Iran, between May and December of 2012. The sample was selected purposively until data saturation was achieved. Data credibility verified via allocated sufficient time for data collection, using member checking and peer debriefing. Data analysis was carried out using conventional content analysis approach with ATLAS. ti software.

RESULTS

Findings from data analysis demonstrated 2 major themes and 6 categories about challenges of providing cervical cancer prevention programs including: individual and social challenges (cognitive/behavioral challenges and socio/cultural challenges) and health system challenges (stewardship, financing, competency of health care providers and access to services). Each category included some subcategories.

CONCLUSIONS

Managing the cervical cancer prevention programs need to include the consideration of individuals, health care providers and health system challenges. Addressing the low level of knowledge, negative attitudes, socio cultural challenges, Poor intersectional collaboration and coordination and intra-sectional management, financing and competency of health care providers are essential steps toward significantly reducing the burdens of cervical cancer.