Knowledge about human papillomavirus (HPV), and health beliefs and intention to recommend HPV vaccination for girls and boys among Korean health teachers

Web and theory-based motivational interviews in encouraging mothers for HPV vaccination of their daughters: A randomized controlled study

BACKGROUND

Mothers' intentions regarding the Human Papillomavirus (HPV) vaccination of their daughters are crucial, especially in societies that prioritize cultural and religious values.

OBJECTIVES

This study aimed to encourage mothers to vaccinate their daughters against HPV by enhancing their perceptions of the vaccine's benefits, susceptibility, severity, and knowledge levels, while reducing their barriers through web-based interventions and Health Belief Model-based motivational interviews.

METHODS

The study was designed as a pre-mid-post test randomized controlled experimental study. The sample included 63 mothers of female high school students (31 in the experimental group, 32 in the control group). Data were collected using a "Demographical and Descriptive Characteristics Information Form", "Health Belief Model Scale for Human Papillomavirus and Its Vaccination" and "Human Papillomavirus Knowledge Scale". Mothers in the experimental group received three HBM-based motivational interviews, web support, and follow-up.

CLINICALTRIALS

gov code is NCT04992741.

RESULTS

Following the interventions, the experimental group exhibited higher levels of knowledge, benefit, susceptibility, and severity perception of HPV vaccination, and lower perceptions of barriers compared to the control group. At the end of the study, 24 mothers from the experimental group and 5 mothers from the control group decided to vaccinate their daughters against HPV.

CONCLUSIONS

Motivational interviews, along with web support and monitoring, significantly enhanced mothers' knowledge and beliefs.

IMPLICATIONS FOR PRACTICES

This study provides evidence for the applicability of theory-based motivational interviewing in the acceptance of HPV vaccine by mothers. It enables the dissemination of HPV vaccination and encourages community health nurses to use theory-based motivational interviewing to recommend HPV vaccination.

Human Papilloma Virus Infection and Vaccine Knowledge Levels, Attitudes, Beliefs in University Students: Turkey and Ghana Comparison

Purpose: Studies reported that early diagnosis, treatment, and prevention of cervical cancer are influenced by knowledge, beliefs, and attitude toward screening. This descriptive-comparative study aimed to assess human papilloma virus (HPV) knowledge, attitudes, and beliefs in university students and the affecting factors and to compare between Turkish and Ghanaian students. Methods: The sample consists of 933 university students studying in 4 different faculties in 2 universities from Turkey and Ghana. The data were collected between November 2019 and February 2020. The study's data were analyzed using Analysis of Variance, Pearson Correlation test, t-test, and Mann-Whitney U test. Results: The findings of the study showed that none of the students in both countries had HPV vaccination. It was found that students have low level of knowledge about HPV infection and vaccine (3.28 ± 2.14) and positive attitudes (16.57 ± 3.28) and beliefs (36.74 ± 6.55) toward vaccine. The attitude score of the Ghanaian students (17.54 ± 3.23) was found to be significantly higher than the Turkish students (15.74 ± 3.09). The knowledge score of the Ghanaian students who had sexual intercourse was found to be significantly higher than others. The findings of the study revealed that the students of both countries had low level of knowledge about HPV infection and vaccine and positive attitudes and beliefs toward the vaccine. Conclusions: It is recommended to increase effective interventions to increase the knowledge level of university students about HPV infection and vaccine. In addition, the vaccine should be included in the immunization program in both countries.

Exploring HPV vaccine knowledge, attitudes, barriers and information sources among parents, health professionals and teachers in Kazakhstan: a mixed-methods study protocol

INTRODUCTION

Human papillomavirus (HPV) is a prevalent sexually transmitted infection linked to certain types of malignant neoplasms, notably cervical cancer (CC). In Kazakhstan, a high prevalence of high oncogenic HPV types (HR-HPV) has been observed, and CC ranks as the second most common malignancy among women with a crude incidence rate of 18.3 cases per 100 000 women. The HPV vaccine, developed as the primary prevention measure against HPV infection, including the most prevalent HR-HPV, received approval from the WHO in 2009. In 2014, Kazakhstan initiated HPV vaccination as a pilot project in four sub-national regions; however, it was later in 2017 discontinued due to widespread parental refusal influenced by negative media reports. This study aims to examine knowledge, attitudes, information sources, barriers to HPV vaccination and factors associated with HPV vaccination hesitancy among different target groups in Kazakhstan prior to the HPV vaccine re-launch announced by the Ministry of Health.

METHODS AND ANALYSIS

This mixed-method-designed research comprises quantitative and qualitative components. Data on HPV awareness, attitudes towards HPV vaccination and sources of information will be collected through an online survey administered by parents and legal guardians, health professionals, and schoolteachers in the Republic of Kazakhstan between January 2023 and January 2024. Additionally, qualitative data on Kazakhstani parental beliefs and attitudes toward HPV vaccination will be collected through online focus group discussions.

ETHICS AND DISSEMINATION OF RESULTS

The study has been approved by the local ethics committee at the Kazakhstan Medical University "Higher School of Public Health" (KMU "KSPH") (No. 138 of 31.05.2021). The results will be reported in publications, at conferences among researchers and healthcare and school education professionals in Kazakhstan, and internationally.

An Integrative Review of the Influence on Human Papillomavirus Vaccination Adherence among Adolescents

To enhance the vaccination rate of adolescents against HPV, understanding their current vaccination intentions and identifying the factors that influence their decision to vaccinate are imperative. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used to search for relative literature. Five electronic databases (CINAHL, PubMed, Web of science, Research Information Sharing Service (RISS) and Korea Citation Index (KCI)) were searched from 2007 to 2022, and 19 studies were selected for final review. The Mixed Methods Assessment Tool (MMAT) was used as a critical appraisal tool to evaluate the quality for various types of research designs. This integrative review revealed three themes, including facilitators (personal characteristics and environmental factors), barriers (lack of awareness and knowledge about HPV, concerns about side effects, and the burden of costs), and ways to increase vaccination uptake (knowledge promotion and HPV vaccines coverage by public insurance). To encourage HPV vaccine uptake, it is essential to enhance public knowledge, create compelling advertisements, and ensure that the vaccines are covered by public insurance. Moreover, providing educational programs that emphasize the effectiveness and significance of HPV vaccines to adults who can influence the vaccination decisions of adolescents is vital.

The Effect of University Students' Levels of Knowledge about HPV Infection and the HPV Vaccine on Their Health Beliefs: Health Sciences Students

The aim of this study was to determine health sciences students' levels of knowledge about HPV infection and the vaccine and their health beliefs, to compare them in terms of individual characteristics, and to examine the relationship between their knowledge of the HPV infection/vaccine and their health beliefs. The data of the study were collected from Health Sciences Faculty students through a face-to-face setting (n: 824). The data tools used in the study were the identification form, the health belief model scale for human papillomavirus infection and vaccination, and the human papillomavirus knowledge scale. The results showed that (1) although the students' levels of knowledge about HPV infection and the vaccine were low, (2) they did perceive HPV infection to be a severe problem. According to the multilinear regression analysis performed, the main predictor of the perceived severity (β = 0.29; 95% Cl: 0.04, 0.07), obstacle (β = 0.21; 95% Cl: 0.01, 0.04), and sensitivity (β = 0.22; 95% Cl: 0.02, 0.06) subscales of the HBMS-HPVV was general HPV knowledge. It was also determined that as the students' knowledge about HPV increased, their health belief levels regarding HPV infection and the vaccine increased as well (n: 824). In conclusion, for nurses and other healthcare professionals to be effective in informing individuals, they should have knowledge of HPV infection and the vaccine. In this context, the necessary education and advice about the importance of HPV infection and the vaccine should be provided to students receiving education in the field of healthcare.

Narrative versus statistical messages: The interplay of perceived susceptibility and misperceptions on vaccine intention

Although there is enough scientific evidence to show the benefits and safety of vaccines, vaccine rates are low, while misperceptions about vaccines are on the rise. The main purposes of the current study are to 1) examine the effects of narrative vs. statistical messages on vaccine intention, 2) test the mediating role of perceived expectancies, and 3) examine the moderating roles of perceived susceptibility and misperceptions on vaccine intention. Data were collected with an online experiment through Amazon Mturk. The online experiment was conducted via Qualtrics once the study was considered exempt by the Institutional Research Board of a large University in the U.S. A total of 300 participants aged 18 and above completed the survey. Findings show that perceived expectancies mediate the relationship between message manipulation and vaccine intention. Our findings also show a three-way interaction which indicates that among individuals with high misperceptions, statistical messages are more persuasive for individuals with high perceived susceptibility, while narrative messages are more influential for individuals with low perceived susceptibility.

Predictor of HPV Vaccination Uptake among Foreign-Born College Students in the U.S.: An Exploration of the Role of Acculturation and the Health Belief Model

OBJECTIVE

to measure the HPV vaccination rate and knowledge about HPV and its vaccine among foreign-born college students; additionally, to measure the effect of acculturation and HBM constructs on the HPV vaccination behavior among foreign-born college students.

METHODS

a cross-sectional design with a non-probability sample of foreign-born college students was collected via a web-based self-administered survey that measured the HPV vaccination rate, assessed knowledge about HPV and its vaccine, and evaluated the effect of acculturation and HBM constructs on HPV vaccination behavior among foreign-born college students.

RESULTS

Foreign-born college students had moderate knowledge about HPV and the HPV vaccine, and about 63% were HPV-vaccinated. Perceived susceptibility, perceived barriers, and cues to action were significantly associated with the HPV vaccination behavior, while knowledge levels about HPV and the HPV vaccine and acculturation levels were not significantly associated with the HPV vaccination behavior of foreign-born college students.

CONCLUSIONS

The current study shows a moderate vaccination rate and moderate knowledge about HPV and its vaccine among foreign-born college students. Additionally, vaccination campaigns need to increase awareness about the susceptibility to acquiring HPV and minimize the barriers to receiving the vaccine to increase the HPV vaccination rate among foreign-born college students.

Effect of Health Intervention via Web-Based Education on Improving Information-Motivation-Behavioral Skills Related to HPV Vaccination Among Chinese Female College Students

Objectives: The human papillomavirus (HPV) vaccination rate is generally low in China. This study aimed to assess the effect of web-based education on improving information-motivation-behavior skills related to HPV vaccination among Chinese female college students. Methods: From February to May 2020, female students were recruited from a university and divided into intervention and control groups. The intervention group received 7 days of HPV-related web-based education. Related information were collected using questionnaires in the baseline, 7 days, 1 month, and 3 months after the intervention. Chi-square test and repeated ANOVA were used to compare the differences between the two groups in the four surveys. Results: A total of 449 students (235 in the intervention and 214 in the control group) were included in the analysis. There were no statistical differences in demographic information between the two groups. Compared with the control group, students in the intervention group showed a richer knowledge and subjective norms of HPV vaccination (p < 0.05). Conclusion: The study provides preliminary support for a health intervention via web-based education in increasing HPV vaccination information among female college students.

Factors influencing Chinese female college students' willingness to receive human papillomavirus vaccine: A cross-sectional study based on information-motivation-behavioral skills model

China bears heavy disease burden of cervical cancer, but the willingness to receive human papillomavirus (HPV) vaccine is low. This study aimed to assess the factors affecting the willingness of Chinese female college students to receive HPV vaccine based on the information-motivation-behavior skills (IMB) model. A cross‑sectional study was carried out in Henan University of Engineering in February 2020. Demographic characteristics and IMB model variables were collected using an anonymous questionnaire. A structural equation model was constructed to assess influencing factors of HPV vaccination willingness in the IMB model variables using AMOS 24.0. A total of 449 participants completed the survey. Among them, 23.4% were willing to get the HPV vaccine in the next 6 months. The average scores of knowledge, motivation, and behavioral skills were 1.72 ± 1.07, 11.69 ± 1.71, and 10.14 ± 1.86, respectively. The final revised model indicated a good fit to the data (χ²/df = 1.684, goodness of fit index = 0.984, adjusted goodness of fit index = 0.959, root mean square error of approximation = 0.044). The results of the model showed that the behavioral skills (β = 0.318, P < .001) were positively related to the willingness of HPV vaccination uptake among female students. Moreover, motivation (β = 0.475, P < .001) positively affected students' behavioral skills toward HPV vaccination, which further influenced their willingness of HPV vaccination uptake. HPV-preventive interventions for female students should focus on enhancing motivation and strengthening behavioral skills to increase the willingness to receive HPV vaccine and reduce HPV infection.

An Internet-Based Education Program for Human Papillomavirus Vaccination Among Female College Students in Mainland China: Application of the Information-Motivation-Behavioral Skills Model in a Cluster Randomized Trial

Background

Patients diagnosed with cervical cancer in the last 2 decades were mainly young females. Human papillomavirus (HPV) vaccination is the most radical way to prevent HPV infection and cervical cancer. However, most female college students in mainland China have not yet been vaccinated, and their relevant knowledge is limited. Theory-based education delivered via the internet is a potentially accessible and useful way to promote HPV vaccination among this population.

Objective

This 3-month follow-up study intended to identify the feasibility and efficacy of an information-motivation-behavioral skills (IMB) model–based online intervention for promoting awareness and willingness regarding HPV vaccination among female college students.

Methods

A 7-day online HPV education program for female college students in mainland China was developed using a cluster randomized trial design. Recruitment and questionnaire surveys were performed online without face-to-face contact. SPSS 23.0 was used for statistical analysis. The chi-square test and t test were used to compare differences in qualitative and continuous variables between intervention and control groups. The generalized estimating equation was used to test the effectiveness of the intervention with a consideration of the time factor.

Results

Among 3867 participants, 102 had been vaccinated against HPV before the study (vaccination rate of 2.6%). A total of 3484 participants were followed up after the baseline survey, with no statistical difference in the loss rate between the intervention and control groups during the intervention and follow-up periods. At different follow-up time points, HPV-related knowledge, and the motivation, behavioral skills, and willingness regarding HPV vaccination were higher in the intervention group than in the control group. HPV-related knowledge was statistically different between the 2 groups, while the motivation, behavioral skills, and willingness regarding HPV vaccination only showed statistical differences right after the intervention, reaching a peak right after the intervention and then gradually reducing over time. Furthermore, there was no statistical difference in the HPV vaccination rate between the 2 groups.

Conclusions

IMB model–based online education could be a promising way to increase the HPV vaccination rate and reduce the burden of HPV infection and cervical cancer among high-risk female college students in China.

Trial Registration

Chinese Clinical Trial Registry ChiCTR1900025476; http://www.chictr.org.cn/showprojen.aspx? proj=42672

International Registered Report Identifier (IRRID)

RR2-DOI:10.1186/s12889-019-7903-x

Willingness to human papillomavirus (HPV) vaccination and influencing factors among male and female university students in China

This study compared the willingness to receive human papillomavirus (HPV) vaccination and the influencing factors between male and female university students who had never been vaccinated against HPV in China. University students were recruited from seven universities in China. A self-administered questionnaire was used to collect information about demographic characteristics, willingness to HPV vaccination, and possible influencing factors including demographics, knowledge, and attitude toward HPV vaccination. The χ2 test was used to test the difference between males and females' knowledge and attitudes to HPV vaccination. Multivariate logistic regression was employed to detect the factors associated with willingness to HPV vaccination. A total of 7335 university students participated in the survey (3570 males and 3765 females). Over 70% of the participants had previously received sex education and knowledge. The average age of sexual debut was 17.5 years old. More male students reported acceptance of premarital sex than female students did (χ2  = 708.458, p < 0.001). Female students had better knowledge and attitudes to HPV in general, while male students perceived a higher chance of being infected by HPV compared with female students (χ2  = 6.047, p =  0.014). The level of knowledge (male: adjusted odds ratio [AOR] = 1.935, 95% confidence interval [CI]:1.516-2.470; female: AOR = 1.227, 95% CI: 1.055-1.428) and receiving sex education (male: AOR = 1.414, 95% CI: 1.109-1.804; female: AOR = 1.289, 95% CI: 1.064-1.562) were indicators of the HPV vaccination willingness for both genders. For male students, those who had ever inoculated optional self-paid vaccines were more likely to receive the HPV vaccine than those who had not (AOR = 1.567, 95% CI: 1.242-1.977). Female students were more willing to be vaccinated against HPV, if they had higher living expenses (AOR = 1.395 and 3.717, 95% CI: 1.071-1.426 and 1.776-7.752), relatives or friends had certain cancer (AOR = 1.290, 95% CI: 1.095-1.518), ever had sexual experiences (AOR = 2.628, 95% CI: 1.788-3.863), and had ever consulted on HPV vaccination issues (AOR = 1.612, 95% CI: 1.367-1.901). In China, more active education should be provided to improve university students' knowledge and attitudes on HPV and HPV vaccination. Including HPV vaccine uptake for both males and females at recommended ages in National Immunization Program would be the most cost-effective way to prevent HPV infection.

Knowledge, attitudes, and perceptions associated with HPV vaccination among female Korean and Chinese university students

Background

Human papillomavirus (HPV) vaccination is a form of primary prevention for cervical cancer. The HPV vaccination rate of female university students is not high in Korea and China. Therefore, the purpose of this study was to identify and compare the factors associated with intention to receive HPV vaccination between Korean and Chinese female university students.

Methods

The participants were 273 Korean and 317 Chinese female university students who had not been vaccinated for HPV, and data were collected using a self-reported questionnaire about attitudes toward HPV vaccination, HPV knowledge, perceptions of HPV infection, and intention to receive HPV vaccine.

Results

There were no significant differences between the Korean and Chinese female university students in HPV knowledge, attitudes, perceptions, and vaccination intention. The factors influencing the intention of HPV vaccination in Korean students were a positive attitude toward the HPV vaccine and a high HPV knowledge score. For Chinese students, sexual experience, awareness of genital warts, a positive attitude toward the HPV vaccine, a high HPV knowledge scores, a perception of the seriousness of HPV infection, and negative emotions regarding HPV infection were significant factors.

Conclusions

It is important to improve attitudes and knowledge about HPV and the HPV vaccine in order to enhance HPV vaccination both in Korea and China. Perceived seriousness and negative emotions regarding HPV infection should be used as a framework to develop subject-tailored interventions in China.

Does Seeing What Others Do Through Social Media Influence Vaccine Uptake and Help in the Herd Immunity Through Vaccination? A Cross-Sectional Analysis

Widespread acceptance of COVID-19 vaccination is the next major step in fighting the pandemic. However, significant variations are observed in the willingness to take the vaccination by citizens across different countries. Arguably, differences in vaccination intentions will be influenced by beliefs around vaccines to influence health. Often perceptions of what others are doing and the information available guide individuals' behaviors for vaccination. This is more so in the digital age with the influence of the internet and media. This study aims to determine the factors that impact willingness to vaccinate for COVID-19. We examined factors associated with acceptance of vaccine based on (1) constructs of the Health Belief Model (HBM), (2) sources of information, (3) social media usage, (4) knowledge of COVID-19 treatment, and (5) perception of government's efforts for mitigation. Randomly sampled online survey data was collected by a global firm between December 2020 and January 2021 from 372 citizens (with a response rate of 96.6%) from multiple regions, including North America, the Middle East, Europe, and Asia. Ordered probit regression suggests that the health belief model constructs hold. Perceived severity of COVID-19 (P < 0.001) and action cues of others taking the vaccine positively influences a subject's vaccine intent (P < 0.001), perceived benefits and perceived efficacy of the vaccine positively influences a subject's vaccine intent (P < 0.001). Perceived barriers negatively influence vaccine intent (P < 0.001). Interestingly as for media usage, mainstream media (e.g., TV, newspaper) (P = 0.006) and social media (P = 0.013) both negatively influence a subject's vaccine intent. Social media platforms that are more entertainment and social-based, such as Whatsapp, Instagram, and YouTube, have a negative and significant influence on vaccine intent (P = 0.061), compared to other more information-based social media platforms (e.g., Twitter, LinkedIn). Knowledge of COVID-19 treatment positively influences vaccine intent (P = 0.023). Lastly, governmental efforts' perceived reliability in mitigation strategy (P = 0.028) and response efforts (P = 0.004) negatively influence vaccine intent. The study highlights the "wait-and-see" action cue from others and leaders in the community. It also informs the importance of shaping media information for vaccination through informative media and social media outlets to counteract any misinformation.

Does group education affect mothers' knowledge and attitudes towards the HPV vaccine?

In this study the authors' investigated the effect of group education on human papillomavirus (HPV) on level of knowledge and health beliefs for HPV infection and vaccine. The study was semi-experimental with a pre- and post-test education model. In total, 110 mothers of secondary school students, 55 in education group, and 55 in control group participated. The groups were educated on different content and three evaluations (pre-education, post-education, and six months following the education) were made. HPV knowledge and belief scores of the education group increased compared to pre-education and control group scores (p < 0.001). Perceived barriers to vaccination were similar in both groups (p > 0.05). Group education increases awareness about HPV infection and vaccine.

Willingness to Accept Human Papillomavirus Vaccination and its Influencing Factors Using Information-Motivation-Behavior Skills Model: A Cross-Sectional Study of Female College Freshmen in Mainland China

BACKGROUND

This study aimed to assess the awareness and attitudes toward human papillomavirus (HPV) vaccination among female college freshmen and explore their willingness and associated factors to receive the HPV vaccine based on the information-motivation-behavior skills (IMB) model.

METHODS

From February 21 to April 30, 2020, a cross-sectional survey was conducted among female freshmen in seven colleges in mainland China. Socio-demographic characteristics, health-related awareness, knowledge of HPV, motivation, and behavioral skills toward HPV vaccination were assessed using questionnaires. Univariate and multivariate logistic regression analyses were performed to identify the influencing factors of willingness to receive the HPV vaccine in the next 6 months.

RESULTS

Among the 3867 students invited to participate in this study, 102 (2.64%) reported having taken the HPV vaccine. Among the unvaccinated participants, 59.89% had previously heard of HPV, and 32.08% were willing to take the HPV vaccine in the next 6 months. Willingness to get the HPV vaccine was associated with sexual experience(s) (AOR = 1.96, 95% CI: 1.25-3.08), family or friends with cancer (AOR = 1.24, 95% CI: 1.04-1.48), having heard of HPV (AOR = 1.23, 95% CI: 1.03-1.47), and having actively searched for or having consulted on issues concerning HPV vaccine (AOR = 1.22, 95% CI: 1.02-1.45). In the dimensions of the IMB model, "perceived susceptibility" (AOR = 1.20, 95% CI: 1.09-1.31), "perceived severity" (AOR = 1.24, 95% CI: 1.11-1.39), "subjective norms" (AOR = 2.09, 95% CI: 1.75-2.49), and "self-efficacy" (AOR: 2.95, 95% CI: 2.44-3.58) were positively associated with HPV vaccination acceptance, while "perceived barriers" (AOR = .60, 95% CI: .52-.69) negatively affected intention to get HPV vaccination.

CONCLUSION

HPV vaccination rates and willingness to receive the HPV vaccine in the next 6 months were found to be poor among female college freshmen in mainland China. Having a positive attitude toward HPV vaccination, creating vaccine-friendly social norms, and removing related barriers are important measures to promote HPV immunization.

Barriers towards HPV Vaccinations for Boys and Young Men: A Narrative Review

Background: HPV vaccination of both girls and boys can protect against infection and eliminate the risk for HPV-associated cancer. Due to a common misconception that the virus only poses risks to women, vaccine coverage is suboptimal among men in many countries. It is urgent to identify barriers to vaccination of boys and men. Methods: We conducted a narrative review of publications examining attitudes and beliefs regarding HPV vaccination for boys and young men. The electronic databases searched were PubMed, PsychInfo and Scopus (December 2020; last update July 2021). A total of 103 original articles were included in the final analysis. Results: The central barriers against vaccination of boys and men are: (1) lack of knowledge, (2) vaccine hesitancy in general, (3) lack of recommendation from and/or discussions with healthcare providers, (4) cost and logistics, and (5) the idea that HPV vaccination may promote promiscuity. Men who have sex with men and families belonging to ethnic minorities express a need for information tailored to their situation. Conclusions: Boys should be included in national immunization programs and men should also be offered catch-up vaccinations. Future studies should focus on addressing vaccine hesitancy and developing interventions to promote pan-gender HPV vaccination.

Development and Psychometric Properties of the Health Belief Scales Toward COVID-19 Vaccine in Ho Chi Minh City, Vietnam

Background

Beliefs of an individual about health conditions can play an important role in contributing to their behavior concerning good and bad health practices. The aim of this study was to develop and assess a set of vaccination belief scales in relation to COVID-19 vaccines.

Methods

A cross-sectional study was conducted between July 2020 and January 2021 using a systematic random sampling of 425 adult outpatients at two hospitals in Ho Chi Minh City, Vietnam. An instrument was designed based on the dimensional structure and wording of the health belief model (HBM), which was followed by the assessment of the instrument’s internal consistency and the construct validity.

Results

The 15-item instrument showed the content validity index (CVI) of scales reached a value of 1.0. Exploratory factor analysis was performed on the first sample (n = 170) and extracted 12 out of 15 draft items in a four-factor model (threat of disease, perceived benefits, perceived barriers, and cues to action) that accounted for 68.3% of the total variance. Cronbach’s alpha coefficient of 0.765 showed as satisfactory. Following this, the confirmatory factor analysis in the remaining sample (n = 255) found a good fit between a four-factor model and a theoretical model of HBM with acceptable values of fit indices.

Conclusion

Beliefs scales for COVID-19 vaccination have been determined to be valid and reliable. They can be a helpful instrument for health educators to use for assessing immunization beliefs of individuals and the public where there is the need to implement new vaccines, such as the COVID-19 vaccine, before they are used more widely across the community.

Validity and Reliability Assessment of Attitude Scales for Hepatitis B Vaccination Among Parents in Ho Chi Minh City, Vietnam

Background

Attitudes and beliefs could be associated with the low number of vaccinations in low- to middle-income countries such as Vietnam. This study aims to describe ways to develop and assess the attitudes towards Hepatitis B vaccination.

Methods

A mixed-method study was carried out between April 2015 and July 2017. Qualitative data were gathered via semi-structured interviews and focus group discussions. The data were then analyzed thematically into four domains of the Health Belief Model (HBM) in order to design the structured questionnaire. The quantitative strand was followed by the evaluation of the reliability and the construct validity, for which data were obtained after interviewing 768 parents whose children aged from 12 to 24 months, who were receiving the vaccines as part of the Expanded Programme on Immunization (EPI) schedules at the Commune Health Centers.

Results

The findings showed the content validity index value of 13 items ranged from 0.86 to 1.00. The factor analyses showed that 11 items remained in the final questionnaire after deleting 2 problematic items due to no relation to the total scales and revealed four factors (perceived susceptibility, perceived severity, perceived benefits, perceived barriers) that jointly accounted for 62.1% of the observed variances. All four factors have good internal consistency with a total Cronbach’s alpha of 0.735. A confirmatory factor analysis demonstrated the proposed factor model which fits well in four domains of HBM.

Conclusion

Attitude scales for Hepatitis B vaccination based on HBM have been developed. This has confirmed to be a valid and reliable instrument that might be useful in assessing parents’ attitudes regarding Hepatitis B vaccination and may be used to promote interventions within the increasing vaccination coverage for Vietnamese children.

Effect of an educational intervention on human papillomavirus (HPV) knowledge and attitudes towards HPV vaccines among healthcare workers (HCWs) in Western China

BACKGROUND

Healthcare workers (HCWs) play a key role in the recommendation of HPV vaccination. Our study aimed to understand to what extent a structured health intervention could change the knowledge and attitudes toward HPV and its vaccines among HCWs in Western China.

METHODS

This was a multi-center, questionnaire-based interventional study conducted across 12 cities of seven provinces in Western China, from November 2018 to July 2019. Participants were recruited from local health systems by e-invitation. Questionnaires were administered to participants before and after the intervention.

RESULTS

A total of 1448 HCWs attended the educational lectures and 1354 participants completed both pre- and post-study questionnaires. In general, HCWs had satisfactory baseline knowledge regarding HPV and its vaccines compared with other populations, and a significantly higher knowledge level was observed after the intervention. However, some more specific knowledge on the vaccination procedures, other HPV-related diseases and whether HPV testing was required before vaccination was relatively poor. Following the educational intervention, the correct responses to the above questions increased (P < .001). However, it was still lower compared with answers to other questions. Change was also detected regarding HCWs' willingness to recommend HPV vaccines to the appropriate population (P < .001).

CONCLUSION

Educational intervention on HPV and its vaccines is effective in improving HCWs' knowledge levels and willingness to recommend HPV vaccines. Future educational interventions should focus more on knowledge regarding HPV-related diseases and HPV vaccination. Education campaigns targeting rural HCWs are urgently needed in the near future.

Interventions to improve human papillomavirus vaccination among Chinese female college students: study protocol for a randomized controlled trial

Background

While the HPV vaccines have been approved by the US FDA since 2006, in recent years an increasing number of women are living with cervical cancer globally. Among them, Chinese women have a higher cervical cancer incidence and mortality rate than the global average, with mortality rates being almost twice the global average. However, the current approach of HPV vaccination in China is not satisfactory given the high disease burden of cervical cancer. The current study is a randomized controlled trial designed to identify the barriers and facilitators of HPV vaccination among Chinese female students. This study will also test a health intervention measure via a popular form of new media in order to improve the HPV vaccine uptake under the framework of Information-Motivation-Behavioral skill Model (IMB).

Methods

This investigation is a multicenter, school-based, prospective, randomized, parallel group, double-blind, blank-controlled trial involving a 7-day education intervention with a further 6-month follow-up. We will enroll at least 3360 participants older than 18 years. The enrolled participants will be randomly divided into two groups (1:1 ratio). The intervention group will be offered a 7-day mobile health education, and participants in both groups will fill out 4 questionnaires at the baseline, 1 month, 3 months and 6 months after the intervention. The primary outcome is the difference in HPV vaccination or reservation for the HPV vaccine between the intervention and control groups. Secondary outcomes will include the comparison of (1) knowledge, attitudes, motivation, beliefs and behavioral skill about HPV and cervical cancer prevention, and (2) the willingness to uptake HPV vaccination.

Discussion

This study will examine the theory-based intervention in improving HPV vaccination among Chinese female college students. We will conduct the randomized controlled trial to provide scientific evidence on the potential effect of the IMB theory-based intervention. Findings from this study will contribute to a growing research field which assesses the effectiveness of mobile-based, school-targeted and theoretically guided interventions for promoting HPV vaccination in adolescents.

Trial registration

Chinese Clinical Trial Registry (ChiCTR), ChiCTR1900025476; Registered on 27 August 2019.

Analysis of factors influencing parents' willingness to accept the quadrivalent influenza vaccine for school-aged children in the Nanhai District, China

Recently, China has attached great importance to promoting immunization, prompting the media, scholars, and public to focus on its coverage and efficacy. This study aimed to understand the factors influencing parental willingness to have their school-aged children vaccinated with quadrivalent influenza vaccines (QIVs). A cross-sectional study through face-to-face interviews was conducted between September and December 2018. Forty-four kindergartens and primary and junior high schools were randomly selected via stratified three-stage cluster sampling. Of 4,430 participants, 24.6% reported having heard of QIV and 24.2% reported having previously received information on QIV. Of these, 42.8% expressed willingness to obtain the QIV for their children. A junior college degree (adjusted odds ratio [aOR] = 1.447; 95% confidence interval [95% CI]: 1.202-1.742), higher influenza knowledge level (medium level, aOR = 1.150, 95% CI, 1.006-1.314; high level, aOR = 1.332, 95% CI, 1.045-1.697), and previous influenza information (aOR = 2.241; 95% CI, 1.604-3.130) were positively correlated with vaccination willingness. In contrast, no previous QIV-related information (aOR = 0.490; 95% CI, 0.418-0.575), no perceived susceptibility of children to influenza (aOR = 0.576; 95% CI, 0.489-0.680), fear of side effects (aOR = 0.599; 95% CI, 0.488-0.735), concern that vaccines need to be carefully administered (aOR = 0.728; 95% CI, 0.593-0.894), and mistrust of new vaccines (aOR = 0.730; 95% CI, 0.628-0.849) were pivotal barriers hindering parents from having their children vaccinated. This study provides baseline information for future immunization programs and delivery, with the ultimate goal of increasing vaccine uptake and minimizing school-wide influenza outbreaks.

Effects of cervical cancer prevention education in middle-school girls in Korea: A mixed-method study

PURPOSE

The aim of this study was to determine the effects of cervical cancer prevention education (CCPE) among Korean middle-school girls in terms of whether it provided them with a positive perception of the Papanicolaou test (Pap test) and encouraged them to undergo Pap testing in adulthood.

METHODS

A mixed-method design was used to only one group of 15 people, which combined a one-group pretest-posttest design with a qualitative study and a focus group interview (FGI). The CCPE was provided to 15 girls, after which they participated in the FGI. The changes between pretest and posttest were analyzed using the Wilcoxon signed-rank test. The findings of the FGI were analyzed using content analysis.

RESULTS

After being provided CCPE, the girls showed a significant increase in their awareness of the importance of cervical cancer prevention (Z = -3.10, p = 0.002), but there were no significant changes in the perceived importance of their body, their emotional response to the Pap test, their confidence in cervical cancer prevention, or their intention to undergo Pap testing. In the FGI, the girls expressed negative emotions about the Pap test and were aware of the necessity of CCPE.

CONCLUSION

This is the first study to develop CCPE focused on the Pap test targeting Korean middle-school girls. We found that the CCPE was partially effective, in terms of increasing their awareness of the importance of cervical cancer prevention.

Cross-sectional study estimating the psychosocial impact of genital warts and other anogenital diseases in South Korea

OBJECTIVES

To estimate self-reported human papillomavirus (HPV) disease-related psychosocial impact among male and female patients in South Korea.

DESIGN

In this multicentre cross-sectional study, psychosocial impacts were estimated using a one-time survey capturing HPV Impact Profile (HIP) results, CuestionarioEspecifico en Condilomas Acuminados (CECA; in Spanish)-'Specific questionnaire for Condylomata Acuminata' and the EuroQol-5 Dimension (EQ-5D) surveys. Student's t-tests or Mann-Whitney U tests were used for continuous comparisons; χ² or Fisher's exact tests were applied for categorical comparisons.

SETTING

5098 clinics throughout Seoul, Busan, Daegu, Kwangju and Daejeon (South Korea).

PARTICIPANTS

Patients with and without genital warts (GW) (males) and selected HPV diseases (females) visiting primary care physicians, obstetricians/gynaecologists, urologists and dermatologists with 2-30 years experience.

RESULTS

Of 150 male and 250 female patients, HIP scores showed 85.3% of male patients with GW and 32.0% without reported moderate psychological impact (p<0.0001). In categorised total scores, 88.5% of female patients with and 66.0% without selected HPV-related diseases reported moderate or high psychological impacts (p=0.0004). In the CECA questionnaire, male patients had mean (SD) scores of 10.51 (3.79) in 'emotional health' and 15.90 (6.13) in 'sexual activity'. Female patients with GW reported lower scores in both dimensions with mean scores of 7.18 (4.17) in 'emotional health' and 10.97 (5.80) in 'sexual activity' (p<0.0001), indicating worse health-related quality of life (HRQoL). For the EQ-5D, male patients with GW reported lower mean Visual Analogue Scale (VAS) scores than those without (75.1 vs 81.13, p<0.0135). Mean VAS score and utility values were lower for females with HPV-related diseases than those without (72.18 vs 76.86 and 0.90 vs 0.94, respectively).

CONCLUSION

In South Korea, GW in men and HPV-related diseases in women negatively impact patient well-being and HRQoL scores. Among women, those with GW suffered a greater psychosocial impact than those with other selected HPV-related diseases.

Perceptions of nurses on human papillomavirus vaccinations in the Republic of Korea

BACKGROUND

In June 2016, the Republic of Korea included free human papillomavirus (HPV) vaccinations for all 12-year-old girls in its national immunization program.

PURPOSE

This study investigated perceptions of nurses on HPV vaccination and their intent to vaccinate preteens at the best ages.

METHODS

Recruited for the survey were 514 health teachers (181, 35.2%), public health nurses (168, 32.7%), and clinical nurses (165, 32.1%). Factor-analysis was conducted to validate the Vaccine-Hesitancy Scale for Korean nurses. Related variables associated with vaccine-acceptance were examined using the Kruskal-Wallis test and Spearman's rho coefficients, due to lack of normalization.

RESULTS

Factor-analysis results showed that two factors of positive acceptance (7 items) and negative acceptance (3 items) accounted for 67.46% of the total variance, and explained 47.4% and 20.1%, respectively. Nurses who positively accepted HPV vaccine differed significantly in agreement to vaccinate girls or boys. For the proper vaccination age, a significant difference emerged between answers for girls and vaccine-acceptance scores, whereas no difference emerged between answers for boys and the scores. The vaccinated status of respondents significantly related to higher HPV vaccine acceptance, although age, religion, marital status, education, and working duration did not.

CONCLUSIONS

This study showed that vaccine-acceptance levels reflect nurses' attitudes and opinions about HPV vaccination for girls and boys.

Prevalence of human papillomavirus by geographical regions, sexual orientation and HIV status in China: a systematic review and meta-analysis

OBJECTIVE

Human papillomavirus (HPV) infection causes multiple cancers in both women and men. In China, both HPV vaccination and cervical cancer screening coverages are low. We aim to investigate the temporal and geographical trends of HPV DNA prevalence in heterosexual men, women, men who have sex with men (MSM) and people living with HIV (PLHIV) in China.

METHODS

We conducted a systematic review, collecting publications in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang Data from January 2000 to May 2017. A total of 247 studies were selected for this meta-analysis to estimate pooled HPV prevalence, incidence of cervical cancer and risk of infection for subgroups. Meta-regression was applied to identify contributing factors to prevalence heterogeneities.

RESULTS

The national HPV prevalence was 15.6% (95% CI (14.4% to 16.9%)) in women with normal cervical cytology, and Central China had the highest prevalence (20.5% (15.2% to 25.8%)). HPV prevalence in heterosexual men (14.5% (11.3% to 17.7%)) was comparable with that of women (OR=1.09 (0.98 to 1.17)), but HPV prevalence in MSM (59.9% (52.2% to 67.6%)) was significantly higher than that in heterosexual men (OR=8.81 (8.01 to 9.69)). HIV-positive women (45.0% (38.4% to 51.6%)) and HIV-positive MSM (87.5% (82.3% to 90.9%)) had 4.67 (3.61 to 6.03) and 6.46 (5.20 to 8.02) times higher risk of HPV infection than their HIV negative counterparts.

CONCLUSION

HPV infection is prevalent in China, particularly in Central China, in comparison with the global level and neighbouring countries. Targeted HPV vaccination for women, MSM and PLHIV and scale-up of cervical screening for women are priorities in curbing the HPV epidemic in China.

Mothers' intentions to vaccinate their teenaged children against human papillomavirus, as predicted by sex in South Korea: An application of the theory of planned behavior

AIM

This study was conducted in order to examine the intention of mothers to vaccinate their teenaged children against human papillomavirus (HPV) infection, according to the children's sex. Based on the theory of planned behavior, the study identified the sex-specific predictors of mothers' intention to vaccinate their teenaged children against HPV.

METHODS

This was a descriptive survey study that included, as participants, 200 mothers whose teenaged children were not vaccinated against HPV.

RESULTS

The mothers' experience with HPV vaccination was a significant predictor of their childrens' HPV vaccination status. For the mothers of sons, subjective norms, attitudes, and perceived behavioral control were found to be significant predictors of intention of HPV vaccination, with an explanatory power of 69.5%. For those with daughters, only attitudes and subjective norms were significant predictors, with an explanatory power of 79.6%.

CONCLUSION

The application of the theory of planned behavior is an effective method to determine the predictors of children's HPV vaccination status. In order to improve the HPV vaccination rate of teenaged children, strategies for education and effective promotion that involve mothers should be developed.

A study on the predictors of Korean male students' intention to receive human papillomavirus vaccination

AIMS AND OBJECTIVES

The objective was to survey the current state of human papillomavirus (HPV) vaccination and the predictors of vaccination intention among Korean male students of high school (ages 15-19) and university (ages 17-27).

BACKGROUND

Human papillomavirus is a sexually transmitted infectious agent causing uterine cervical, anal, and/or penile cancer and genital warts in males and females. Infection rate of human papillomavirus increases from the age when sexual intercourse first occurs. Therefore, motivation to receive human papillomavirus vaccination is needed to protect infection.

DESIGN

Cross-sectional descriptive survey was performed only in male students. They are less aware of human papillomavirus than females, because human papillomavirus vaccination has been targeted on females for preventing cervical cancer in Korea.

METHODS

Data were collected using a self-reporting questionnaire for male high school and university students sampled from a city in Korea. Human papillomavirus vaccine-related knowledge, health beliefs, demographic, and sexual history information variables relating to intentions to vaccinate were assessed.

RESULTS

The human papillomavirus vaccination rate was very low and the levels of knowledge and health beliefs were low. The significant predictors that raised the intention of human papillomavirus vaccination were a university student, experience of sexual intercourse and perceiving the benefits of human papillomavirus vaccination.

CONCLUSIONS

To promote human papillomavirus vaccination, educational programming targeting males should include health beliefs and knowledge, emphasising that vaccination is important to prevent uterine cervical cancer and to role as a preventative measure against common male diseases.

RELEVANCE TO CLINICAL PRACTICE

Male high school students should be included as a major target population for school human papillomavirus education programmes, as they are at the age of commencing sexual intercourse. In addition, public health policies including human papillomavirus vaccination in the national immunisation programme are warranted.

Health Belief Model Scale for Human Papilloma Virus and its Vaccination: Adaptation and Psychometric Testing

STUDY OBJECTIVE

To adapt and psychometrically test the Health Belief Model Scale for Human Papilloma Virus (HPV) and Its Vaccination (HBMS-HPVV) for use in a Turkish population and to assess the Human Papilloma Virus Knowledge score (HPV-KS) among female college students.

DESIGN

Instrument adaptation and psychometric testing study.

SETTING AND PARTICIPANTS

The sample consisted of 302 nursing students at a nursing school in Turkey between April and May 2013.

INTERVENTIONS

Questionnaire-based data were collected from the participants.

MAIN OUTCOME MEASURES

Information regarding HBMS-HPVV and HPV knowledge and descriptive characteristic of participants was collected using translated HBMS-HPVV and HPV-KS. Test-retest reliability was evaluated and Cronbach α was used to assess internal consistency reliability, and exploratory factor analysis was used to assess construct validity of the HBMS-HPVV.

RESULTS

The scale consists of 4 subscales that measure 4 constructs of the Health Belief Model covering the perceived susceptibility and severity of HPV and the benefits and barriers. The final 14-item scale had satisfactory validity and internal consistency. Cronbach α values for the 4 subscales ranged from 0.71 to 0.78. Total HPV-KS ranged from 0 to 8 (scale range, 0-10; 3.80 ± 2.12).

CONCLUSION

The HBMS-HPVV is a valid and reliable instrument for measuring young Turkish women's beliefs and attitudes about HPV and its vaccination.

The health beliefs of mothers about preventing cervical cancer and their intention to recommend the Pap test to their daughters: a cross-sectional survey

BACKGROUND

Mothers have a primary role in the prevention of cervical cancer in Korea. This study aimed to determine the awareness and health beliefs of mothers about preventing cervical cancer in their daughters, their intention to recommend the Pap test to their daughters, and the factors influencing this intention.

METHODS

A cross-sectional survey design was employed, and the study enrolled mothers (n = 1,581) of pubescent girls aged 13 to 18 years who were living nationwide in Korea. The six health-beliefs variables related to preventing cervical cancer in their daughters, awareness of the importance of cervical cancer prevention methods, and the intention to recommend the Pap test to daughters were investigated. The impacts of these health beliefs of the mothers and the sociodemographic factors influencing their intention to recommend the Pap test to their daughters were assessed using multiple logistic regression analysis.

RESULTS

Almost one-quarter (23.7 %) of the mothers had talked about the Pap test, 69.2 % were intending to recommend the Pap test to their daughters, and 38.5 % considered that the Pap test could be necessary if their daughters became sexually active. The significant health beliefs influencing the intention to recommend the Pap test were the perceived barriers [odds ratio (OR) = 1.47, 95 % confidence interval (95 % CI) = 1.03-2.11] and benefits (OR = 2.25, 95 % CI = 1.55-3.25). The significant sociodemographic factors of mothers were their education (OR = 1.52, 95 % CI = 1.08-2.13), their experience of talking about the Pap test with their daughters (OR = 2.11, 95 % CI = 1.23-3.64), their regularity of undergoing the Pap test themselves (OR = 1.98, 95 % CI = 1.30-3.03), and their age when they first underwent the Pap test (OR = 1.60, 95 % CI = 1.43-0.82).

CONCLUSIONS

The mothers perceived HPV vaccination as the most important of the five methods for preventing cervical cancer in their daughters. Mothers perceived the importance of their daughters undergoing the Pap test regardless of the presence of HPV vaccination, and most of the mothers had an intention of recommending the Pap test to their daughters. Strategies for increasing the intention of mothers to recommend the Pap test to their adolescent daughters could be promoted by increasing their perceptions of the benefits while reducing their perceptions of barriers toward their daughters undergoing the Pap test, and by empowering active communication about the Pap test between mothers and daughters.

Awareness of cervical cancer prevention among mothers of adolescent daughters in Korea: qualitative research

OBJECTIVES

Korean adolescent girls are unprepared for cervical cancer prevention due to the lack of a mandatory policy regarding human papilloma virus (HPV) vaccination and school health education regarding cervical cancer. The aim of this study was to determine how aware mothers are about cervical cancer prevention in their adolescent daughters, with a view to developing strategies for expanding primary cervical cancer prevention for adolescent girls through the mothers' involvement.

DESIGN

A qualitative design was employed. Nine mothers with adolescent daughters participated in this study and were interviewed using open-ended questions. The themes were extracted by content analysis.

SETTING

A general living area in Seoul, South Korea.

PARTICIPANTS

The snowball method was used to select mothers.

RESULTS

Five themes emerged. In general, the mothers' awareness of cervical cancer was not clear, and they exhibited a lack of awareness of the importance of having a regular Papanicolaou screening test. The mothers recognised that they were role models for their daughters, and realised and accepted the necessity of educating their daughters regarding cervical cancer; however, they perceived barriers related to the prevention of cervical cancer in their daughters. The mothers recommended enforcing sex education in schools and the provision of financial support for HPV vaccination.

CONCLUSIONS

The mothers' awareness and preparedness with respect to the prevention of cervical cancer in their adolescent daughters were low and inadequate. Mothers should be informed and motivated to play a role in the education of their daughters regarding cervical cancer prevention. Strategies for disseminating information regarding early cervical cancer prevention for adolescent girls are recommended by communicating with both the girls and their mothers and providing them with education regarding cervical cancer prevention.

Awareness of human papillomavirus and factors associated with intention to obtain HPV vaccination among Korean youth: quasi experimental study

BACKGROUND

This study aimed to determine the awareness among fifth-grade girls and boys of sexually transmitted diseases (STDs), cancer, and human papillomavirus (HPV), and to determine the factors associated with intention to obtain the HPV vaccination.

METHODS

A quasi experimental design was employed with Korean fifth-grade students as the subjects for this study (n=117). Prior to providing HPV education, the awareness and health beliefs regarding STDs and cancer prevention were assessed according to gender. After 2 hours of HPV education, gender comparisons were made with respect to the awareness and health beliefs, HPV knowledge, and intention to obtain the HPV vaccination, and the factors associated with that intention.

RESULTS

Prior to the 2hours education session, only two boys knew that HPV is a virus. There were significant gender differences with respect to responses to the statements "STD is preventable" (χ(2)=8.76, p=0.013) and "cancer is preventable" (χ(2)=6.37, p=0.041), and concerns about the pain associated with vaccine injection (z=-2.44, p=0.015). After HPV education, there were no significant gender differences in HPV knowledge and intention to obtain the HPV vaccination. Awareness that "HPV vaccine can prevent cervical cancer" was significantly related to intention to obtain the HPV vaccine among both boys and girls.

CONCLUSIONS

Increased HPV knowledge could positively influence the intention to obtain the HPV vaccination among youth. Thus, HPV education at elementary school would be helpful to make students aware of HPV and the importance of HPV prevention.

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.

Equity in human papilloma virus vaccination uptake?: sexual behaviour, knowledge and demographics in a cross-sectional study in (un)vaccinated girls in the Netherlands

Background

In the Netherlands, human papillomavirus (HPV) vaccination is part of a national program equally accessible for all girls invited for vaccination. To assess possible inequalities in vaccine uptake, we investigated differences between vaccinated and unvaccinated girls with regard to various characteristics, including education and ethnicity, (both associated with non-attendance to the national cervical screening program), sexual behaviour and knowledge of HPV.

Methods

In 2010, 19,939 nationwide randomly-selected 16–17 year-old girls (2009 vaccination campaign) were invited to fill out an online questionnaire. A knowledge scale score and multivariable analyses identified variables associated with vaccination status.

Results

2989 (15%) of the selected girls participated (65% vaccinated, 35% unvaccinated). The participants were comparable with regard to education, ethnicity, most sexual risk behaviour and had similar knowledge scores on HPV transmission and vaccination. However, unvaccinated girls lived in more urbanised areas and were more likely to have a religious background. Irrespective of vaccination status, 81% of the girls were aware of the causal relationship between HPV and cervical cancer, but the awareness of the necessity of cervical screening despite being vaccinated was limited.

Conclusions

HPV vaccine uptake was not associated with knowledge of HPV and with factors that are known to be associated with non-attendance to the cervical cancer screening program in the Netherlands. Furthermore, most sexual behaviour was not related to vaccination status meaning that teenage unvaccinated girls were not at a disproportionally higher risk of being exposed to HPV. Routine HPV vaccination may reduce the social inequity of prevention of cervical cancer.

Factors associated with the intention to recommend human papillomavirus vaccination among Korean school health teachers

PURPOSE

The purposes were to examine Korean school health teachers' knowledge and attitudes toward human papillomavirus (HPV) and HPV vaccination, identify factors associated with their intention to recommend the HPV vaccine, and characterize school health teachers' communication with students or parents regarding the HPV vaccine.

DESIGN AND METHODS

The online survey involved 119 school health teachers in Korea.

RESULTS

Factors associated with an intention to recommend the HPV vaccine were perceived benefits, desiring more education regarding HPV and the HPV vaccine, and age of school health teachers.

PRACTICE IMPLICATIONS

Findings suggest a need for more education to promote a greater understanding of HPV and HPV vaccination among Korean school health teachers.

Associations between health communication behaviors, neighborhood social capital, vaccine knowledge, and parents' H1N1 vaccination of their children

During the H1N1 pandemic in 2009-10, the vaccination behavior of parents played a critical role in preventing and containing the spread of the disease and the subsequent health outcomes among children. Several studies have examined the relationship between parents' health communication behaviors and vaccinations for children in general. Little is known, however, about the link between parents' health communication behaviors and the vaccination of their children against the H1N1 virus, and their level of vaccine-related knowledge. We drew on a national survey among parents with at least one child less than 18 years of age (n=639) to investigate Parents' H1N1-related health communication behaviors including sources of information, media exposure, information-seeking behaviors, H1N1-related knowledge, and neighborhood social capital, as well as the H1N1 vaccination rates of their children. Findings showed that there is a significant association between the degree at which parents obtained H1N1 vaccination for their children and health communication variables: watching the national television news and actively seeking H1N1 information. And this association was moderated by the extent of the parents' H1N1-related knowledge. In addition, the parents' degree of neighborhood social capital mediated the association between H1N1 knowledge of the parents and H1N1 vaccination acceptance for their children. We found, compared to those with a low-level of neighborhood social capital, parents who have a high-level of neighborhood social capital are more likely to vaccinate their children. These findings suggest that it is necessary to design a strategic health communication campaign segmented by parent health communication behaviors.

Evaluation of Korean Version of the Beliefs about Papanicolau Test and Cervical Cancer in Unmarried University Students

PURPOSE

This study was conducted to evaluate Korean version of the beliefs about Papanicolau (Pap) test and cervical cancer [CPC-28] in unmarried university students.

METHODS

The Korean version of CPC-28 (K-CPC-28) was developed through forward-backward translation techniques. A reliability, confirmatory factor analysis and correlations coefficients were evaluated. Data were collected from 303 unmarried female students attending university using a questionnaire that included28 items of CPC, 5 items of susceptibility of cervicalcancer and 8 items of HPV knowledge.

RESULTS

K-CPC-28 had reliable internal consistency with Cronbach's alpha=.74 of six subscales ranged from .66 to .80. Factor loadings of the 28 items of subscales ranged from .31 to .86. Six factors in this study explained 55% of the total variance. In convergent validity of the K-CPC-28, the subscales of K-CPC-28 were significantly correlated with susceptibility scale of cervical cancer and HPV knowledge scale.

CONCLUSION

K-CPC-28has satisfactory construct validity and reliability. It seems to be an acceptable tool to assess the attitudes toward cervical cancer prevention and Pap smear in unmarried women. This tool would be also applicable to screen the risk group in cervical cancer prevention and to identify its association with actual Pap test or cervical cancer prevention behaviors.