HPV knowledge among HPV+ women

OBJECTIVE: To assess knowledge and information seeking among women recently receiving an HPV+ diagnosis. METHODS: A 2-phase mixed methods design was used. In both phase I (qualitative) and phase II (quantitative), women with scheduled gynecological exams and Pap smears at clinic sites were approached to participate. RESULTS: Women expressed confusion about HPV, and most could not correctly articulate the meaning of their diagnosis. Women do engage in further information seeking, especially through the Internet. CONCLUSION: Identifying gaps in knowledge among HPV+ women who need clear messages to facilitate their comprehension of the diagnosis is an important public health activity.     

Human papillomavirus and the value of screening: young women's knowledge of cervical cancer

The study reports a questionnaire survey of female university students intended (1) to delineate their knowledge of cervical cancer and screening, and (2) to impute their valuation of the introduction of human papillomavirus (HPV) testing. It was found that almost 80% of respondents thought cervical cancer was a leading cause of cancer death amongst women. Most subjects consistently over-estimated the incidence of cervical cancer, consistent with the social amplification hypothesis. The major risk factors were accurately identified by the majority, although family history was emphasized to a degree unwarranted by epidemiological evidence. Subjects' knowledge of the screening programme was accurate in some respects, but not in others, e.g. the majority under-estimated the abnormality rate and over-estimated the age at which abnormalities typically occurred. Subjects placed a premium on the increased accuracy which HPV testing might potentially offer, predictable from their beliefs about the performance of the existing screening programme. Policy makers can be reassured that female university students appear unconcerned about undergoing a test for a sexually transmitted disease, although their beliefs about cervical cancer and the power of screening are distorted, and their enthusiasm for HPV testing relates to an, as yet, unconfirmed belief in its accuracy.     

Application of a Health Literacy Framework to Explore Patients’ Knowledge of the Link between HPV and Cancer

Abstract

The human papillomavirus (HPV) is a sexually transmitted infection and causes most oropharyngeal (e.g., throat) and anogenital (e.g., anal, cervical) cancers. Research indicates low knowledge about the link between HPV and cancer among the general population, and similar low knowledge of HPV among individuals diagnosed with HPV-associated cancers. This is important because HPV status can have implications for treatment, prognosis, and future sexual decisions. Using a health literacy framework, this study explored how patients diagnosed with HPV-associated cancers accessed, understood, appraised, and applied HPV information. We conducted 27 in-depth interviews with patients seeking care at a comprehensive cancer center; and data were analyzed using applied thematic analysis. Findings revealed that patients’ primary source of HPV information was medical providers (access); and many patients exhibited limited understanding of HPV and its role in their cancer diagnosis (understand). Most patients (17 of 27) did not mention HPV as the cause of their cancer. Many patients displayed difficulty connecting HPV with their lifestyles (appraise); and few discussed plans to engage in HPV prevention practices going forward (apply). Future research should focus on strategies to improve understanding of HPV which could increase vaccine uptake, reduce stigma, and enhance informed decision-making among HPV-associated cancer patients.     

The contribution of a negative colorectal screening test result to symptom appraisal and help‐seeking behaviour among patients subsequently diagnosed with an interval colorectal cancer

Background

Colorectal cancer (CRC) screening programmes using a guaiac faecal occult blood test (gFOBt) reduce CRC mortality. Interval cancers are diagnosed between screening rounds: reassurance from a negative gFOBt has the potential to influence the pathway to diagnosis of an interval colorectal cancer.

Methods

Twenty‐six semi‐structured face‐to‐face interviews were carried out in Scotland and England, with individuals diagnosed with an interval colorectal cancer following a negative gFOBt result.

Results

Participants reported they were reassured by a negative gFOBt, interpreting their result as an “all clear”. Therefore, most did not suspect cancer as a possible cause of symptoms and many did not recall their screening result during symptom appraisal. Among those who did consider cancer, and did think about their screening test result, reassurance from a negative gFOBt led some to “downplay” the seriousness of their symptoms with some interviewees explicitly stating that their negative test result contributed to a delayed decision to seek help.

Conclusion

Screening participants need to be informed of the limitations of screening and the ongoing risk of developing colorectal cancer even when in receipt of a negative result: the importance of minimizing delay in seeking medical advice for colorectal symptoms should be emphasized.     

Cervical Cancer Screening: Exploring Appalachian Patients’ Barriers to Follow-Up Care

This article describes a community-based Patient Navigation (PN) project conducted to identify potential barriers to seeking follow-up cervical cancer care in southeastern Kentucky. Patient navigators (PNs) were placed in cervical cancer programs within county public health departments where they interviewed patients about their perceived barriers to seeking follow-up care after receiving a positive Pap test result. Participants identified various potential barriers at three levels: the individual/personal level, the health care system level and the community/environmental level. One identified barrier that was unique to this study was a lack of consistency between follow-up recommendations and follow-up guidelines for patients under age 21. Implications are discussed.     

Knowledge of HPV and HPV Vaccine among Women Ages 19 to 26

ObjectiveTo describe knowledge about human papillomavirus (HPV) and HPV vaccination among women ages 19 to 26 seeking a variety of services at reproductive health centers. A secondary objective was to identify common sources of HPV information.MethodsTen reproductive health centers enrolled 365 women ages 19 to 26 in a randomized, controlled trial to determine the effect of automated reminder messages on HPV vaccine completion. Using responses from a 61-item self-administered baseline questionnaire completed before initiating the HPV vaccine, this subanalysis assessed participants' knowledge regarding HPV and the HPV vaccine.ResultsKnowledge of HPV prevention, transmission, and disease outcomes among the study population was highly variable. The mean HPV knowledge score was 11.0 of a possible 19 (SD = 3.8). Most participants (77%) had heard of the HPV vaccine before completing the questionnaire and indicated that their primary sources of information about the vaccine were television ads (61%), health care providers (52%), and friends (45%).ConclusionsDespite a relatively high awareness of the vaccine, specific knowledge regarding HPV and the HPV vaccine varied substantially and participant scores highlighted knowledge gaps among vaccine-eligible young women. Media, health care providers, and friends were identified by participants as sources of information and may influence their knowledge of HPV and the HPV vaccine.     

Knowledge, attitude and practice in primary and secondary cervical cancer prevention among young adult Italian women

In Italy since 2007 vaccination against human papillomavirus (HPV) is offered to 11-year-old females, whereas vaccination for older age groups is still a matter of debate. To assess Italian young women's knowledge, attitudes and practice regarding primary and secondary cervical cancer prevention a cross-sectional study among young women aged 18-26 years was conducted in 2008. The survey collected information on in-depth awareness and knowledge regarding Pap testing, HPV infection, HPV vaccine and cervical cancer. The response rate was 57.7% with a wide range of variability (34-84%) amongst local health units. Among 667 women who participated in the survey poor awareness and various misconceptions regarding HPV and cervical cancer prevention were detected. Overall women were found to be more knowledgeable about Pap smears and cervical cancer than about HPV infection and the HPV vaccine. Respondents pointed to their healthcare providers as their most trusted source for medical information. Understanding women's knowledge on cervical cancer prevention, as well as related factors is important in helping to achieve and maintain adherence to cervical cancer preventive strategies. Moreover in order to minimize cervical cancer risk by improving women's adherence to preventive strategies, appropriate and adequate information dissemination, and guidance from health professionals appear to be crucial elements.     

HPV vaccine acceptability among Kenyan women

As human papillomavirus (HPV) vaccines become available in less-developed countries, understanding women's attitudes towards HPV vaccines can help guide approaches to immunization programs. We assessed knowledge and interest in prophylactic HPV vaccines among Kenyan women seeking women's health services (N = 147). They knew little about cervical cancer or HPV vaccine. Most women (95%, 95% confidence interval [CI]: 92%, 99%), however, were willing to have their daughters vaccinated with a vaccine that would prevent cervical cancer, with preference for an inexpensive vaccine requiring fewer doses.     

Media coverage of cervical cancer and the HPV vaccine: implications for geographic health inequities

Objective To describe the content of newspaper articles about cervical cancer and the human papillomavirus (HPV) vaccine published in Appalachia and identify potential differences in coverage as compared to the content of newspaper articles published in non‐Appalachia Ohio. Background Individuals rely on media as an important source of health information. Inadequate coverage of health issues may reinforce health inequities such as the elevated cervical cancer incidence and mortality rates in Appalachia Ohio. Methods A content analysis was conducted of all newspaper articles about cervical cancer and the HPV vaccine published in Appalachia and non‐Appalachia Ohio during 2006. Findings A total of 121 published newspaper articles (42 in Appalachia and 79 in non‐Appalachia) about cervical cancer and the HPV vaccine were identified. Articles published in Appalachia Ohio were significantly less likely than articles published in non‐Appalachia Ohio to provide information about the threat of cervical cancer and the efficacy of the HPV vaccine. Specifically, few articles published in Appalachia included information about the ability of the vaccine to prevent cervical cancer, the cost of the vaccine and the availability of assistance programmes for the un‐ and underinsured. Conclusions Newspaper articles printed in the Appalachia region lacked vital information that could help promote uptake of the HPV vaccine. Health educators and healthcare providers should be aware that women from underserved geographic regions like Appalachia may have greater information needs regarding their risk of cervical cancer and the potential benefits of the HPV vaccine as compared to the general patient population.     

Knowledge of Human Papillomavirus Infection Among Young Adult Men and Women: Implications for Health Education and Research

Human papillomavirus (HPV) infection of the genital tract is one of the most common sexually transmitted diseases (STDs), and a subset of genital tract HPVs are etiologically associated with cervical cancer. The prevalence of HPV infection is highest among adolescents and young adults. This study was undertaken to explore first year college students' knowledge about HPVs and to determine whether there were gender differences in this knowledge. An anonymous survey was distributed to all first year students at a private university. The results were analyzed by gender. We found that 96.2% of males and 95.4% of females had heard of genital warts, although only 4.2% of males and 11.6% of females knew that HPV caused genital warts. Although there was a greater awareness of genital warts than HPV in this population, students were uncertain about modes of transmission of both genital warts and HPVs, and unclear about the importance of HPV infection relative to other STDs. For both men and women (87% and 87.4%, respectively), health education classes were the major source of information about STDs. We conclude that health education should be reconceptualized to incorporate a better understanding of STDs, including HPV infection, by engaging adolescents and young adults in exploring the biological and social context of STDs, their public health importance, strategies for prevention, and the uncertainty of our scientific knowledge.     

Epidemiology and genotype distribution of human papillomavirus (HPV) in women of Sardinia (Italy)

The human papillomavirus (HPV) infection is necessary for the development of cervical cancer. Our study aims to evaluate the rate of HPV circulation in our population, to identify the prevalent genotypes and to establish correlation with cervical abnormalities. Furthermore, the awareness of women about HPV issues was investigated.This study included 864 women attending the Oncologic Prevention Service for their routine Pap test screening or the Health Promotion Mother-Child Service for counselling about sexual activity, from July 2006 to September 2007. All the participants gave their informed consent to be enrolled in the study and were invited to fill in a questionnaire about the socio-cultural state, sexual activity and awareness about HPV. The women samples were tested for HPV-DNA and HPV genotypes: any type of HPV-DNA was detected in 31.0% of the women; single or multiple infections sustained by HPV-16 or HPV-18 represented 43.5% of all HPV infections, accounting for infections in 11.8% of the recruited women. The HPV and high-risk HPV (HR-HPV) prevalence significantly declined in women older than 46 years. The Pap test result was available in 490 women; 48.1% of the Pap test positive women had also an HPV infection and among these 22.7% were infected by HPV-16 and/or HPV-18 genotype, while 51.9% (94/181) were HPV negative. The analysis by binary logistic regression showed that genotype 16 and/or 18 is a risk factor for the Pap positive test with a odds ratio (OR) of 2.9 (95% C.I. 1.4–5.9) and 3.6 (95% C.I. 1.58–8.42) respectively, while age is a protective factor (OR 0.97, C.I. 95% 0.96–0.99); furthermore, the mean age at the first sexual intercourse and the mean number of partners since the beginning of sexual activity, were statistically associated with the risk of HPV infection. More than half of women were aware about HPV, its sexual transmission and of its correlation with cervix cancer.Our findings evidenced that HPV infection is frequent in women aged 18–46 years in Sardinia and particularly that 16 and 18 HPV genotypes are detectable in more than 40% of the infected women. The proportion of women informed about HPV issues is sufficient to guarantee an aware approach to HPV vaccination.     

Understanding HPV Vaccine Uptake Among Cambodian American Girls

Cervical cancer incidence rates vary substantially among racial/ethnic groups in the United States (US) with women of Southeast Asian descent having the highest rates. Up to 70 % of cervical cancers could be prevented by widespread use of the human papillomavirus (HPV) vaccine. However, there is a lack of information about HPV vaccine uptake among Southeast Asian girls in the US. We conducted a telephone survey of Cambodian women with daughters who were age-eligible for HPV vaccination. Survey items addressed HPV vaccination barriers, facilitators and uptake. Our study group included 86 Cambodian mothers who lived in the Seattle metropolitan area. The proportions of survey participants who reported their daughter had initiated and completed the HPV vaccine series were only 29 and 14 %, respectively. Higher levels of vaccine uptake were significantly associated with mothers having heard about the HPV vaccine from a health professional and having received a recent Pap test. Commonly cited barriers to HPV vaccination included lack of knowledge about the HPV vaccine, not having received a physician recommendation for HPV vaccination and thinking the HPV vaccine is unnecessary in the absence of health problems. Linguistically and culturally appropriate HPV educational programs should be developed and implemented in Cambodian American communities. These programs should aim to enhance understanding of disease prevention measures, increase knowledge about the HPV vaccine and empower women to ask their daughter’s doctors for HPV vaccination.     

The Information Management Processes of Women Living with HPV

The human papillomavirus (HPV) represents a significant public health burden because of its widespread prevalence, its links to genital warts and cancers, and the negative psychosocial impact of HPV infection and diagnosis. Scholars have attributed some of these negative effects to insufficient knowledge and information about HPV, prompting research on women's HPV information preferences; however, little is known about how women obtain, avoid, and use this information. To address this lacuna, we designed a study to trace the information management processes of women with HPV. Our analysis of interviews with 25 women living with HPV revealed a common sequence of emotional, cognitive, and behavioral responses to the HPV diagnosis. The authors review these findings and articulate their relevance and importance to research, theory, and practice in the discussion.     

两种细胞学检查联合HPV检测筛查宫颈癌及癌前病变的临床对比分析

目的:对比分析液基薄层细胞学检查(TCT)联合HPV检测和巴氏涂片检查联合HPV检测筛查早期宫颈癌和癌前病变的效果。方法:选择妇科体检的1 012例女性随机分成两组:TCT组500例实施液基薄层联合HPV检测;巴氏涂片检查组512例进行巴氏涂片检查联合HPV检测,比较两种方法对于宫颈异常的检出率,两种方法都以病理检查为标准。结果:TCT组特异性为79.22%、敏感性为92.87%、假阴性率为0.20%;巴氏涂片组特异性为98.24%、敏感性为56.24%、假阴性率为1.97%,两组比较差异有统计学意义(P<0.05)。阳性检出率TCT组为3.40%,巴氏涂片组为2.73%,两组比较差异无统计学意义(P>0.05)。结论:在宫颈癌和癌前病变诊断中,TCT检查联合HPV检测优于巴氏涂片检查联合HPV检测,其筛查的假阴性率较低,敏感性较高,可以作为一种先进的筛查方法。     

Risk,choice and the ‘girl vaccine’: Unpacking human papillomavirus (HPV) immunisation

The marketing of Gardasil® and Cervarix? vaccines for the prevention of human papillomavirus (HPV) targeted pre-sexual girls and cervical cancer, representing young women as practicing ‘decision autonomy’ in acquiring the ‘facts‘ about HPV and cancer. We challenge this overly simple explanatory model of vaccine choice. Through interviews with vaccine scientists and public health nurses in Canada, we illustrate the clinical, political and practical complexities of introducing a new and controversial vaccine. The omission of provocative sexual themes in the marketing of the vaccine strategically created an object marked for ‘women only’. The public acceptability of the vaccine was promoted by neglecting the clinical and sexual facts of the spread and prevalence of HPV infection and related cancers across genders and sexual orientations. This strategic omission generated a blockbuster vaccine embedded in a discourse of individualised risk and pharmaceutical control centred on female bodies.     

Challenges to accepting a human papilloma virus (HPV) vaccine: a qualitative study of Australian women

A vaccine that protects women against the two most frequent high-risk genotypes of human papilloma virus (HPV) and the two types that cause 90 percent of genital warts was licensed in June 2006 in the USA and Australia. It is important to understand whether a vaccine delivered to young women before the onset of sexual activity would be acceptable. The goal of this project was to investigate the knowledge and awareness of Victorian women about cervical cancer and HPV infections, and their beliefs about, and possible barriers to, a potential vaccine. We report on findings from five focus groups, held between August and October 2005, which targeted 34 women, aged 22 to 71, from diverse backgrounds. High levels of acceptance of vaccines in general were expressed, particularly if the vaccine is recommended by health professionals and supported by the government. Reservations emerged about the proposed HPV vaccine when the link between HPV and sexual activity was understood. We offer suggestions concerning the nature of information required prior to the introduction of a vaccination program and the mechanisms by which the information can be delivered to ensure its availability to all women.     

Parental Decisional Strategies Regarding HPV Vaccination Before Media Debates: A Focus Group Study

Before the introduction of the human papillomavirus (HPV) vaccine, decisional strategies and factors that could guide HPV vaccination intentions were explored. The authors conducted 4 focus group discussions with 36 parents of children 8–15 years of age. Three groups consisted primarily of Dutch parents and 1 group of only Turkish parents. Discussions followed a semi-structured question route. Results showed that some parents used an approach of systematically seeking information as a way to prepare a decision, whereas others merely relied on trust in the message source. In general, parents believed that it was important to protect their child against negative outcomes that could result from vaccinating or not, and they felt that it is their responsibility to decide about uptake. Perceived susceptibility, vaccine effectiveness, and possibility of serious side effects were most important in the HPV vaccination decision-making process. In conclusion, parents perceived a lack of information and felt insecure about the vaccine's safety and effectiveness. This may result in ambivalent feelings toward HPV vaccination, which, in turn, may lead to postponing decisions about uptake. To facilitate informed decision making, which requires central processing, personally relevant messages about the knowns and unknowns regarding the effects of HPV vaccination should be provided.     

A qualitative analysis of South African women's knowledge, attitudes, and beliefs about HPV and cervical cancer prevention, vaccine awareness and acceptance, and maternal-child communication about sexual health

In South Africa, cervical cancer is the second leading cause of death among women. Black South Africa women are disproportionately affected by cervical cancer and have one of the highest mortality rates from this disease. Although the body of literature that examines HPV and cervical cancer prevention is growing in the developing world; there is still a need for a better understanding of women's knowledge and beliefs around HPV and cervical cancer prevention. Therefore, this formative study sought to examine women's attitudes, beliefs and knowledge of HPV and cervical cancer, HPV vaccine acceptance, maternal-child communication about sexuality, and healthcare decision-making and gender roles within an urban community in South Africa.Women ages 18-44 were recruited from an antenatal clinic in a Black township outside of Johannesburg during the fall of 2008. Twenty-four women participated in three focus groups. Findings indicated that the women talked to their children about a variety of sexual health issues; had limited knowledge about HPV, cervical cancer, and the HPV vaccine. Women were interested in learning more about the vaccine although they had reservations about the long-term affect; they reinforced that grandmothers played a key role in a mother's decisions’ about her child's health, and supported the idea that government should provide the HPV vaccine as part of the country's immunization program.Our findings indicate the need to develop primary prevention strategies and materials that will provide women with basic cervical cancer prevention messages, including information about HPV, cervical cancer, the HPV vaccine, screening, and how to talk to their children about these topics. Prevention strategies should also consider the cultural context and the role that grandmothers play in the family unit.     

HPV and cervical cancer testing and prevention: knowledge, beliefs, and attitudes among Hispanic women

Cervical cancer is a preventable disease resulting from infection with high-risk types of sexually transmitted human papillomaviruses (HPVs). Public knowledge of HPVs and their link to cervical cancer is limited. Participation in cervical cancer prevention programs, including Pap and HPV screening and HPV vaccine acceptance, is crucial for limiting the incidence of cervical cancer. Hispanic women suffer the highest cervical cancer incidence rates in the United States. In this study, we conducted community-based focus groups with Hispanic women to explore knowledge and attitudes relating to cervical cancer, HPV, HPV testing, and HPV vaccination. Study findings suggest a need to increase public health literacy in relation to HPV, the link between HPV and cervical cancer, and HPV primary and secondary prevention options. Health care providers should be prepared to share information with patients that supports and promotes informed decision making about HPV testing and vaccines and their complementary roles in cervical cancer screening and prevention.