Parental acceptance of human papillomavirus (HPV) vaccination in Indonesia: a cross-sectional study

Background

Cervical cancer ranks the second most frequent cancer in Indonesian women. In Indonesia, human papillomavirus (HPV) vaccine acceptance has not been studied before.

Objective

To determine parental HPV vaccine acceptance in Indonesia, and factors that influence their decision. Factors include sociodemographic factors, knowledge of HPV, HPV vaccination and cervical cancer, health beliefs about cervical cancer, and attitudes towards vaccination in general.

Methods

746 parents, with at least 1 daughter aged 0-14, were interviewed using questionnaires based on published and adjusted interviews. Interviews were done in sub district public health centers, general governmental hospitals, and via house-visits, in 5 Indonesian provinces.

Results

Parental HPV vaccine acceptance was 96.1%. Logistic regression revealed that age, beliefs regarding cervical cancer, and attitudes towards vaccination in general were significantly associated with HPV vaccine acceptance. Of the participants, 66.0%, 16.6%, and 15.8% had heard about cervical cancer, HPV, and HPV vaccination respectively. The mean total knowledge score was 1.91(Standard Deviation 2.31) on a 0-8 scale. Health beliefs about cervical cancer and attitudes towards vaccination in general were positive. Participants named the high cost of the vaccine, fear for side-effects, and chosen vaccination locations as possible barriers towards HPV vaccine implementation.

Discussion

Parental HPV vaccine acceptance is high, but knowledge about HPV and cervical cancer is low. During HPV vaccination programs, focus should not only be on providing information, but also on existing beliefs and attitudes towards cervical cancer and vaccination in general. If HPV vaccination programs were to be implemented in Indonesia, the indicated barriers should be taken into account.     

Barriers to receiving human papillomavirus vaccination among female students in a university in Hong Kong

This paper investigates, using a qualitative approach, barriers to receiving Human Papillomavirus (HPV) vaccine among female undergraduate students in a Hong Kong university. By conducting individual semi-structured interviews with 35 young women aged 19 to 23, seven intertwining perceptual, social and cultural, healthcare provider and financial barriers were identified. These barriers included the perception as being low-risk due to an absence of sexual contact, lack of confidence in the safety of the vaccine, suspicion of parents concerning the intention to get vaccinated, lack of positive discussion among peers, insufficient information from primary-care doctors, difficulty in choosing a suitable HPV vaccine and cost of the vaccine. Future HPV-vaccination promotion therefore not only needs to enhance risk perception and needs awareness of young women, but also educate parents and correct their misconceptions. As primary care doctors are the first line of contact with patients, providing more support to enhance their knowledge of the HPV vaccine and to encourage their enthusiasm in providing responsive disease-prevention education can motivate young women to get vaccinated.     

Human papillomavirus knowledge,attitudes, and vaccination among Chinese college students in the United States

Human papilloma virus (HPV) is the most common sexually transmitted infection in the USA with some strains increasing the risk of certain cancers. The HPV vaccine, introduced in 2006, has reduced the infection rate, although racial/ethnic disparities in vaccination exist. Asian college students are among those with the lowest vaccination rates, however there has been little exploration as to why. The purposes of this study were to assess (a) knowledge and attitudes regarding HPV and its vaccine, (b) HPV vaccination practices, and (c) factors associated with HPV-related knowledge and attitudes, and vaccination among Chinese college students in the USA. This cross-sectional quantitative survey collected data face-to-face and online from 449 participants. The mean scores for HPV knowledge and attitudes were 40.87 and 2.36 indicating a low-to-moderate level of knowledge but a moderately positive attitude regrading HPV transmission and vaccination. Only half (50.8%) knew that the vaccination could be received after the age of 18 years. Only 38.3% reported having receiving at least one dose of the vaccine, with 92.4% receiving their first HPV vaccines in the USA. Multiple logistic regression showed that men and non-health sciences majors had lower knowledge about HPV. Older students, those without a primary care provider, and those who completed the survey in English had more negative attitudes about the HPV and vaccine. Participants who were younger, female, had a higher level of knowledge, had more positive attitudes, and completed the survey online were associated with better vaccination status. Findings from this study provide insight into Chinese college students’ knowledge and attitudes about HPV and HPV vaccination and may be used to develop culturally sensitive programs that address the risk of HPV and the benefits of HPV vaccine.     

Human papillomavirus vaccination: Assessing knowledge,attitudes, and intentions of college female students in Lebanon,a developing country

Human papillomavirus (HPV) infection is a common cause for genital warts and cervical cancer. Developing countries in the Middle East such as Lebanon are traditionally considered to be conservative societies with low incidence of sexually transmitted infections. However, nowadays, there is an unexpected increase in the incidence of HPV infections among Middle Eastern females. Thus, the objective of this study is to assess the behavioral perceptions of HPV vaccination among female students attending an academic institution in Lebanon. This cross-sectional study invited 512 students to complete a self-administered questionnaire that assessed the knowledge, attitudes, and intentions towards HPV vaccination. Data analysis included the calculation of knowledge scores ranging from 0 to 100, attitude scores ranging from most positive (1) to most negative (5), and intention scores ranging from lowest intention (0) to highest intention (10). With a response rate of n = 215 (42%), 36.5% never heard of the vaccine before, and only 16.5% were already HPV vaccinated. The median knowledge score of 52.7% ± 1.71 reflects poor to moderate knowledge. Still, the median attitude score of 2.47 ± 0.05 shows a general positive attitude towards HPV vaccination where most of the participants agreed that female college students in Lebanon have a good chance of contracting HPV (62.1%) and that all gynecologists should recommend the vaccine (76.0%). Students in graduate programs, health related majors, and those who are vaccinated had significantly higher knowledge scores compared with students in undergraduate programs, non-health related majors, and HPV non-vaccinated students, respectively. Finally, the survey helped in increasing the intention to obtain HPV vaccine as the intention score increased significantly from 5.24 ± 0.27 before the students went through the survey to 6.98 ± 0.22 after the students completed the survey. Our study highlights the importance of offering guidance to female college students about HPV and its vaccination in developing countries where the incidence of sexually transmitted infections is on the rise.     

Female students receiving post-secondary education in Greece: the results of a collaborative human papillomavirus knowledge survey

ObjectivesContrary to the optimistic forecasts, existing until 2008 and despite the incorporation of the vaccine into the Greek National Immunization Program, six years later, the percentage of HPV vaccination coverage in Greece remains disappointingly low. The aim of this extended study was to investigate the knowledge, behaviour and attitude of a representative sample of the initial target group; young female students of Greek higher education institutions to Pap cervical screening, biology of HPV infection and principles of HPV vaccination.Study designCross-sectional study.MethodsOne thousand two hundred ten (1210) questionnaires were completed by young female students aged 17–24 years. The survey questionnaire sought data relating to sociodemographic characteristics, health behaviour and knowledge about HPV, as well as vaccination status.Results79.6% of the sample reported at least one annual gynaecologic examination and 92.6% were familiar with the rationale of cervical screening; however only 52.9% had undergone a Pap smear. 69.7% reported adequate knowledge about HPV and 89.3% were aware of the possible course of HPV infection. Despite most (95.9%) were aware of vaccine availability, vaccinated students represented only 33.1%. According to the multivariate analysis, vaccination status was associated with university studies (OR 1.96; 95% CI: 1.19–3.20), parental area of expertise (OR 2.77; 95% CI: 1.18–6.53, OR 2.03; 95% CI: 1.05–3.94), and adequate knowledge of the reasons for which women should undergo regular cervical screening (OR 4.23; 85% CI: 1.55–11.55). Fear of side-effects and equivocal information were the main reasons of non-vaccination (52.2% and 33.1% respectively). Finally, the majority of unvaccinated individuals showed a positive attitude towards prospective HPV vaccination, providing they received well-documented advising.ConclusionsYoung women attending Greek higher education exhibit a good level of knowledge about HPV and its correlation with cervical cancer. These data highlight the need for further sensitization of the general population.     

Human papillomavirus vaccine motivators and barriers among community college students: Considerations for development of a successful vaccination program

BackgroundPrevious interventions in colleges to improve human papillomavirus (HPV) vaccination have not been highly successful. Although barriers have been assessed in traditional colleges, less is known about vaccination barriers in community colleges.MethodsWe approached students aged 18–26 years old enrolled at a community college for an in-person semi-structured qualitative interview on HPV vaccination and health, with questions guided by the Theory of Planned Behavior. Data collection took place between April 2015 and December 2015. Thematic analysis techniques were used to analyze the data.ResultsDuring interviews with 19 students, 4 themes emerged, including: general vaccine attitudes, barriers to HPV vaccination, motivators to HPV vaccination, and social influences. Participants felt that vaccines were beneficial, but were concerned about side effects. They felt that getting the HPV vaccine would be inconvenient, and they did not know enough about it to decide. Most would not trust their friends’ opinions, but would want to know about side effects that their vaccinated friends experienced.ConclusionsSuccessful interventions at community colleges should include several components to increase convenience as well as utilize interactive methods to promote HPV vaccine awareness.     

Knowledge differences between male and female university students about human papillomavirus (HPV) and cervical cancer: Implications for health strategies and vaccination

Knowledge about HPV and cervical cancer (CC) depends on several factors such as gender and education, which brings implications for health strategies and vaccination. A survey was conducted in Portugal with a representative sample of 1706 university students. Only 55.4% (n = 945) had already heard of HPV, although 88.3% (n = 834) from that know that is a risk factor for CC. 89% students (n = 841) wants to be vaccinated against it, but only 13.8% stated as main reason to be vaccinated “prevention of the disease”. Mean scores of knowledge were calculated. Statistical differences were found, regarding “CC knowledge”, in gender (p < 0.001) and between health sciences schools and non-health sciences schools (p < 0.001). Differences regarding the study area in “knowledge and beliefs of HPV” (p < 0.001) and in “relation between HPV and CC” (p < 0.001) were found. Therefore, these differences may help to develop effective strategies that lead to decline CC incidence and mortality.     

A qualitative study investigating knowledge and attitudes regarding human papillomavirus (HPV) and the HPV vaccine among parents of immunosuppressed children

Barriers influencing the willingness of parents to vaccinate immunocompetent children include a lack of knowledge about human papillomavirus (HPV) and low perception of risk regarding their child's acquisition of HPV infection. However, it cannot be assumed that the facilitators and barriers of HPV vaccination are the same for parents/guardians of children who are immunocompromised, or who have chronic medical conditions. This study aimed to document the knowledge and attitudes of parents/guardians of immunosuppressed children and adolescents towards HPV infection and the vaccine.     

西安非医学专业女大学生对HPV和HPV疫苗的认知

目的 了解西安市高校非医学专业女大学生对人乳头瘤病毒(HPV)的认知情况及其对接种HPV疫苗的态度,为制定针对非医学专业大学生健康教育模式,推广HPV疫苗的接种提供依据.方法 采用整群随机抽样的方法,在西安市6所非医学类本科高校中抽取16个专业的大学二、三年级女大学生共2 131名,用自行设计的问卷进行调查,获有效问卷2 096份,有效回收率为98.4％.结果 仅11.3％被调查者知晓HPV,有性生活组大学生对HPV知晓率显著高于无性生活组(x2=20.182,P＜0.05),来自单亲或重组家庭的女大学生对HPV知晓率显著高于来自原生家庭组(x2=4.329,P＜0.05).不同年级间(x2=0.921),来自城市或农村(x2=0.891),是否独生子女(x2 =0.330)组间对HPV知晓率差异无统计学意义(P＞0.05).仅9.7％被调查者知晓HPV疫苗.79.9％的被调查者表示愿意接种HPV疫苗;担心会感染HPV (44.1％)或患宫颈癌(19.3％)的被调查者有较强的接种意愿;公众健康教育(42.2％)及医务人员推荐(34.7％)是女大学生们更愿意接受的疫苗推荐方式.超过半数被调查者(50.1％)能够接受的疫苗价格在50～ 100元.结论 西安非医学专业大学生对HPV及HPV疫苗的知晓率低,但接种意愿强.应加强科普健康教育,普及宫颈癌一级预防、HPV及HPV疫苗相关知识.     

Relationship status impacts primary reasons for interest in the HPV vaccine among young adult women

IntroductionThe HPV vaccine prevents HPV-related cancers and genital warts, which cause significant morbidity and mortality in the US. The vaccine is targeted toward 11–12 year old males and females, but is recommended for “catch-up” vaccination until age 26 for females. Young adult females (18–26 years) represent a unique group that may face distinct barriers to HPV vaccination, one of which is relationship status. The purpose of this study was to assess how relationship status impacts interest in HPV vaccination and primary reasons for non-vaccination among 18–26 year old young adult women.MethodsThe National Health Interview Survey 2010 was examined among unvaccinated females, 18–26 years (N = 1457). A survey-weighted logistic regression analysis with conversion to prevalence ratios assessed how interest in the HPV vaccine (yes/no) was influenced by relationship status (married, living with a partner, other, single) among young adult women. A Rao-Scott chi-square test examined differences between primary reasons for non-vaccination and relationship status among HPV vaccine uninterested women.ResultsAmong unvaccinated women, 31.4% were interested in the HPV vaccine. Women who were living with a partner (PR = 1.45, 95%CI 1.06–1.90) and single (PR = 1.42, 95%CI 1.11–1.76) were significantly more likely than married women to be interested in the HPV vaccine, while controlling for socio-demographic and other known risk factors. Additionally, primary reasons for non-vaccination differed based on relationship status among uninterested women (p < 0.01). Women who were married were more likely to cite not needing the vaccine compared to never married women (p < 0.05).ConclusionRelationship status in young adulthood impacts HPV vaccine interest and decision-making among a national sample of women. Primary reasons for non-interest in the vaccine may be shaped by attitudes and knowledge about the HPV vaccine that differ by relationship status. Future research is needed to elucidate ways to overcome relationship status as a barrier to HPV vaccination.     

某大学本科生对HPV及疫苗认知及接种意愿的分析

目的 调查广州某大学本科学生对 HPV 疫苗认知情况及 HPV 疫苗接种意愿,分析其影响因素,为日后 HPV 疫苗在国内推广提供建议。方法 调查方式采用自行设计调查问卷,进行现场调查,研究对象问卷自填式,并做好质量监控,获得某大学本科学生共 579 名。内容包括基本情况及人口统计学特征、对 HPV 疫苗和相关疾病的认知情况以及 HPV 疫苗接种的意愿。结果 共获得 579 有效问卷,有效率为 96.5%,有 42.3%的人听说过 HPV 疫苗,有 21.7%的人愿意自己接种疫苗。性别差异对 HPV 的了解有统计学意义(P<0.05),年级方面,除了大三、大四及以上2组之外,其余各组对 HPV 认知差异有统计学意义(P<0.05),而生源地方面除了大陆-澳门和澳门-台湾之外,各生源地包括香港-澳门、香港-台湾、香港-大陆和大陆-台湾组对 HPV 认知差异有统计学意义(P<0.05)。是否听说HPV 相关疾病、是否担心患 HPV 相关疾病、疫苗的可接受价格和是否有过妇科病史对 HPV 疫苗的接种意愿存在差异(P<0.05),而性别、民族、生源地、年级等对于 HPV 疫苗的接种意愿的差异无统计学意义(P>0.05)。结论 大陆的高年级女性对 HPV 疫苗了解的程度较高。对于 HPV 疫苗接种,女性以及亲戚或朋友有过妇科病史的人更愿意接种 HPV 疫苗,对国产疫苗可接受价格在 1 000～3 000 元的人具有注射疫苗的倾向,不担心患宫颈癌的人更多地倾向于不接种HPV 疫苗。     

Disparities in parental human papillomavirus (HPV) vaccine awareness and uptake among adolescents

Trends in HPV vaccine awareness among parents of adolescent girls and boys (ages 13–17) and HPV vaccine uptake (≥1 dose) among girls (ages 13–17) were evaluated in Los Angeles County, California. Between 2007 and 2011, parental HPV vaccine awareness increased from 72% to 77% overall, with significant increases among mothers, Latinos, and respondents with daughters and Medi-Cal insured children. In 2011, parents who were male, older, less educated, Asian/Pacific Islander, and had sons remained significantly less likely to be aware. HPV vaccine initiation among daughters nearly doubled from 25% in 2007 to 48% in 2011, and girls who were older, uninsured, and had access-related barriers showed the largest improvements. In 2011, daughters who were younger and who had older and African American parents were at risk for low uptake. Thus, initiatives targeting male and younger adolescents, culturally-relevant information, and access to vaccination may help to reduce identified disparities.     

Awareness of HPV and drivers of HPV vaccine uptake among university students: A quantitative,cross‐sectional study

HPV vaccination is a milestone in primary prevention. However in Italy, vaccine coverage is still nowhere near the target of 95%. We investigated factors associated with inclination to get vaccinated in university students, as they are likely to have just assumed a central role in their healthcare decision‐making. University students aged 18–25 were asked to fill in a questionnaire. The effect of socio‐demographic and behavioural characteristics on HPV awareness was assessed with a logistic regression adjusting for age, gender, nationality, degree course, relationship, age at first intercourse, number of sexual partners, smoking, sexual orientation, past diagnosis of STDs and knowledge of people who had received HPV vaccine. A second regression adjusting also for information sources, awareness and knowledge investigated factors associated with inclination to receive vaccine. Nine thousand nine hundred and eighty‐eight questionnaires were included (response rate 91.3%); awareness of HPV and vaccine was 83.3% and 69.9% respectively. Awareness (AOR: 3.3; 95% CI: 2.3–4.6) and a good knowledge positively affected acceptability, as well as a previous diagnosis of STDs and knowledge of vaccinated people. Healthcare workers (AOR: 1.6; 95% CI: 1.4–1.9) and family members (AOR: 1.7; 95% CI: 1.4–2.1) were the most influencing information sources, even if knowledge of vaccinated people was by far more persuasive (AOR: 2.7; 95% CI: 2.2–3.3). Only 12% of participants were acquainted with skin to skin HPV transmission, while 75% believed in a full effectiveness of condom; less than 22% associated HPV with cancer (other than cervical cancer). Efforts to increase awareness are likely to be worth considering that: awareness is the main determinant of vaccine acceptance; only 50% of individuals not interested in receiving vaccine were aware of it; males are much less aware (AOR: 0.09; 95% CI: 0.07–0.11). Moreover, this study spotlights some misconceptions around HPV and acknowledges a pivotal role of healthcare workers, family and peer influence.     

Considerations for human papillomavirus (HPV) vaccination of mid-adult women in the United States

In the United States, human papillomavirus (HPV) vaccination is recommended for 11 or 12 year old girls, with catch-up vaccination through age 26 years. Data are available for women over the age of 26 years on immunogenicity for both quadrivalent and bivalent HPV vaccines and on efficacy for the quadrivalent HPV vaccine. If HPV vaccines are licensed for use in women over 26 years of age (mid-adult women), recommendations for this age group will need to be considered. This review summarizes vaccine efficacy and immunogenicity data in mid-adult women, and addresses epidemiologic data related to key questions for consideration of vaccine recommendations for women over age 26 years.     

Acceptability of vaccination against human papillomavirus among women aged 20 to 45 in rural Hunan Province,China: A cross-sectional study

ObjectiveThis study aimed to examine the intentions of and barriers to vaccination against human papillomavirus (HPV) among women aged 20 to 45 in rural areas, and to determine the popular sources to getting information about HPV vaccine and vaccination.MethodsThis cross-sectional study was conducted in 2018 with a sample of women aged 20 to 45 from rural areas of Hunan Province in China. Anonymous self-administered questionnaires were used to collect sociodemographic information and characteristics related to reproductive health of participants, and intentions of and barriers to HPV vaccination. All statistical analysis methods were performed with SPSS 18.0.ResultsA total of 2101 women participated in the study, with 58.55% intended to vaccinate against HPV. Increased intention of HPV vaccination was associated with higher age (adjusted odds ratio [AOR] = 1.35 and 1.50, respectively) and education level (AOR = 1.13 and 1.47, respectively). Women who have heard of HPV vaccine (AOR = 2.67, 95% confidence interval [CI]: 1.20–5.98) and have been aware of that cervical cancer could be prevented (AOR = 2.01, 95%CI: 1.44–2.82) were more willing to vaccinate. Having never heard of HPV vaccine and worry about efficacy and safety of vaccines were the most commonly cited reasons to refuse vaccination. The preferred source to get the knowledge was medical personnel (58.45%), followed by WeChat or Microblog, TV programs, and Internet.ConclusionWe found the intention of HPV vaccination among women aged 20 to 45 in rural China is low. Findings highlighted the importance of knowledge and trust in HPV vaccine, and suggested strengthening educational interventions on HPV vaccine and vaccination through multiple sources, including HPV vaccine coverage in health insurance to increase access.     

年轻女性流动人口生殖健康知识及态度调查

目的 了解年轻女性流动人口避孕/性病、艾滋病知识及其态度.方法 采用流行病学现况调查方法,于2008年7-8月对山东省青岛市6个行政区10家工厂年轻女性流动人口3521人进行问卷调查.结果 知识问卷得分≥10分的占40.4%,<10分的占59.6%;Logistic回归(LR法)筛选分析发现,文化程度低(OR=2.01),过去6个月没有得到过(RH)信息(OR=1.45)是得分低的危险因素;首次性行为年龄大、与丈夫住在一起、有生育史的人得分高;相关态度分析结果表明,29.9%的人拒绝与患性病的同事交往,15.9%的人要求将患性病的同事赶出工厂;37%的人拒绝与感染人类免疫缺陷病毒(HIV)的同事交往,22.4%的人要求将感染HIV的同事赶出工厂.结论 年轻女性流动人口生殖健康知识水平较低,对性病、艾滋病患者的歧视现象很严重.     

Effect of a school-based educational intervention on HPV and HPV vaccine knowledge and willingness to be vaccinated among Chinese adolescents : a multi-center intervention follow-up study

BackgroundMiddle school students are recommended as the primary target population for human papillomavirus (HPV) vaccination. This study aimed to assess HPV and HPV vaccine knowledge, and to evaluate the effect of a school-based educational intervention, immediately and one year later, on HPV knowledge and vaccine acceptability among adolescents in mainland China.MethodsA school-based interventional follow-up study was conducted in seven representative cities in mainland China from May 2015 to May 2017. “Train-the-trainer” strategy was employed to educate school teachers in this study. Students aged 13 to 14 years old were assigned to intervention classes and control classes. All students were required to complete the baseline questionnaire. Students in the intervention classes were given a 45-minute lecture regarding HPV and HPV vaccine knowledge and were then asked to complete a post-education questionnaire. One year later, all students were asked to complete the post-education questionnaire again.ResultsBaseline HPV knowledge was low among Chinese adolescents, with only 12.6% and 15.7% of students having heard of HPV and HPV vaccines, respectively. After the intervention, the level of HPV-related knowledge increased immediately, and students with higher knowledge levels of HPV and HPV vaccines were more willing to get vaccinated. One year after the intervention, the knowledge of HPV and HPV vaccines was dramatically diminished. However, knowledge was significantly higher in intervention classes compared to control classes.ConclusionsKnowledge and awareness of HPV and vaccination are generally deficient among Chinese adolescents. School-based health education was very effective in improving awareness and positive attitudes about HPV and HPV vaccines within a short time. Integrating health education on HPV into the existing school-based sexual health curriculum could be an effective way to increase HPV vaccination coverage and help to eliminate preventable HPV-associated cancers in China.     

Cervical cancer prevention-related knowledge and attitudes among female undergraduate students from different ethnic groups within China,a survey-based study

ABSTRACT

The purpose of this study was to understand cervical cancer prevention-related knowledge and attitudes among female undergraduate students from different ethnic groups within China. We conducted a survey among ethnically diverse female students from the Minzu University of China, in Beijing in October, 2014. Results: Questionnaires from 493 participants aged from 16 to 26 years were included in the final database. The seven ethnic groups included in the final analysis were Han, Korean, Mongolian, Uyghur, Tibetan, Hui, and Tujia. Compared to the Han Chinese, the members of the other six ethnic groups had lower cervical cancer knowledge levels. The knowledge scores of Mongolian and Korean students were significantly lower than those of the Han Chinese. The willingness to accept cervical cancer prevention efforts also differed across different ethnic groups. After adjusting for age and place of residence, the acceptance of cervical cancer screening among the Tibetan, Uyghur, and Korean groups was significantly lower than among the Han Chinese, with different related decision-making factors in each group. Cervical cancer prevention-related public education is an urgent need in China. Extra consideration of ethnic differences should be taken into account when designing and improving new current cervical cancer prevention programs.