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Wang W. The role of personal health beliefs and altruistic beliefs in young Chinese adult men's acceptance of the human papillomavirus vaccine. Sci Rep 2024; 14:20341. [PMID: 39242754 PMCID: PMC11379873 DOI: 10.1038/s41598-024-71494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 08/27/2024] [Indexed: 09/09/2024] Open
Abstract
Administering the human papillomavirus (HPV) vaccine to men offers substantial health benefits for both themselves and their female partners. In mainland China, the HPV vaccine has not been approved for men, and little is known about their acceptance of it. This study aims to assess the acceptability of HPV vaccine among young Chinese adult men and examine the association between personal health beliefs, altruistic beliefs, and HPV vaccination intentions and behavioral attempts. A cross-sectional study was conducted among male university students using a multistage cluster sampling method in eight universities across five districts in Zhejiang Province, China. Data were collected from December 2020 to January 2021 using a self-administered, anonymous online questionnaire. Of the 1937 participants, 1009 who had heard of the HPV vaccine completed the questionnaire. Over one-third (40.4%, 408/1009) had high levels of HPV and HPV vaccine knowledge. A total of 695 of 1009 (68.9%) expressed an intention to receive the HPV vaccine when available, and 329 of 1009 (32.6%) had proactively inquired about male HPV vaccination. Perceived susceptibility, perceived benefits, perceived gender barriers, and perceived benefits of male HPV vaccination for female partner were associated with HPV vaccination intentions. Lower perceived vaccine barriers, greater perceived benefits, and stronger vaccination intentions were associated with higher HPV behavioral attempts. There is an emerging demand for HPV vaccinations among young adult men in mainland China. Personal health beliefs and altruistic beliefs are crucial in promoting young adult men's acceptance of the HPV vaccine. Emphasizing both male-specific benefits and altruistic motivations may enhance HPV vaccine acceptability among young adult men.
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Affiliation(s)
- Weiyi Wang
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Erqi District, Zhengzhou, 450052, Henan, China.
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Wang S, Ren W, Zhang B, Chen M, Liu S, Zhu Y, Wu A, Bao Y, Zhao F, Qiao Y. Knowledge, Attitude, and Uptake of Human Papillomavirus (HPV) Vaccination among Chinese Female Adults: A National Cross-sectional Web-Based Survey Based on a Large E-commerce Platform. Matern Child Health J 2024; 28:746-757. [PMID: 38334863 DOI: 10.1007/s10995-023-03888-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination is a promising step toward cervical cancer elimination. This study was conducted to investigate the knowledge, attitude, and HPV vaccine uptake among female adults in mainland China based on a large e-commerce platform. METHODS We conducted a cross-sectional online survey of female adults between March 4 to April 20, 2022. The survey consisted of sociodemographic information, related knowledge, vaccination uptake, and attitudes toward vaccination. We included women aged 18-45 years in the final analysis. Logistic regressions were conducted to explore influencing factors associated with related knowledge, HPV vaccination uptake, and willingness to be vaccinated. RESULTS In total, 3,572 female adults (34 years, IQR 30-39) were included in the analysis. The majority of the participants were highly educated (78.7%) with a high monthly family income (79.0%). The median HPV knowledge score was 8.25 out of 11. More than 75% of respondents were unvaccinated, while 95.8% of unvaccinated female adults are willing to be vaccinated. Variables such as age, insurance, vaccination history, and whether one had heard of the HPV vaccine influence HPV vaccination practice (all p-values < 0.05). The main barriers to vaccination were vaccine inaccessibility and the high cost of the vaccine. CONCLUSION The findings of our study highlight a moderate knowledge level, poor vaccination rate, and strong willingness to be vaccinated among Chinese female adults who were better educated and wealthier. Targeted health education and practical support should be provided in the future, to reduce gaps between vaccine uptake and vaccine acceptance.
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Affiliation(s)
- Sumeng Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenhui Ren
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingyang Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shujun Liu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yitong Zhu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Aiyuan Wu
- The Affiliated Cancer Hospital of Xinjiang Medical University, Suzhou Dong Street No. 789, Urumqi, China
| | - Yanping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Fanghui Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Youlin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Aragaw GM, Anteneh TA, Abiy SA, Bewota MA, Aynalem GL. Parents' willingness to vaccinate their daughters with human papillomavirus vaccine and associated factors in Debretabor town, Northwest Ethiopia: A community-based cross-sectional study. Hum Vaccin Immunother 2023; 19:2176082. [PMID: 36794293 PMCID: PMC10026865 DOI: 10.1080/21645515.2023.2176082] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
The Human Papilloma Virus (HPV) is the primary causative agent of cervical cancer. Vaccination against the HPV infection is an effective prevention measure for HPV-related diseases. This study aimed to assess parents' willingness to vaccinate their daughters with Human Papillomavirus vaccine and associated factors in Debre Tabor town. A community-based cross-sectional study was conducted among parents of daughters in Debre Tabor town, and a cluster sampling technique was used to select 738 study participants. A structured and interviewer-administered questionnaire was used to collect the data. Data were entered into EPI data version 4.6 and exported to SPSS version 26 for analysis. Multivariable logistic regression was done and a p-value of ≤ 0.05 was used to declare the level of significance. In this study, parents' willingness for HPV vaccination was found to be 79.10% (95% CI: 76.00, 82.00). Parents having media exposure, had good knowledge of HPV infection, and HPV vaccine, positive attitude, and positive perceived behavioral control toward the HPV vaccine had statistically significant association with willingness for the HPV vaccination of their daughters. Parents' willingness to HPV vaccination for their daughters was higher compared with a previous study done in the setting. Parental knowledge and their beliefs on HPV vaccination, and media exposure play an important role in the HPV vaccination of adolescents. Strengthening community-based education and effective promotion through multimedia on HPV infection and its prevention, addressing parental safety concerns and promoting their positive beliefs about the vaccine are important to increase parents' willingness.
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Affiliation(s)
- Getie Mihret Aragaw
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tazeb Alemu Anteneh
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Saron Abeje Abiy
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulunesh Abuhay Bewota
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getie Lake Aynalem
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Jia S, Pan B, Hong D, Zhang Q, Jiang H, Hong Y, Hong J. A survey of potential acceptance of 9-valent HPV vaccine among Chinese male college students. Hum Vaccin Immunother 2023; 19:2272533. [PMID: 37969075 PMCID: PMC10760362 DOI: 10.1080/21645515.2023.2272533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/14/2023] [Indexed: 11/17/2023] Open
Abstract
Human papillomavirus (HPV) has a great impact on world health. Vaccination is among the most important methods of preventing HPV infection. This study investigated Chinese male college students' knowledge of, attitude toward, and acceptance of the 9vHPV vaccine and the independent predictors. An online cross-sectional study was conducted among male college students at Chinese colleges and universities from March 12 to March 23, 2022. Based on a literature review of similar studies, a self-questionnaire was designed to investigate the students' knowledge of, attitude toward, and acceptance of the 9vHPV vaccine. Multivariate logistic regression analysis was performed to identify factors influencing their willingness to be vaccinated. In addition, the structural equation model was constructed. A total of 1,547 male college students completed the survey. Of all the students, 54.95% were unwilling to receive a 9vHPV vaccination, while only 45.05% expressed willingness. Multivariate logistic regression analysis revealed that the male college students willing to receive the vaccine included medical students, those in a romantic relationship, those whose relatives and friends had cervical cancer, those whose relatives and friends had received the 9vHPV vaccine, those supportive of promoting the vaccine for men, and those who would recommend the vaccine to their relatives and friends. Male college students exhibited high hesitancy toward the 9vHPV vaccine. Acceptance of the 9vHPV vaccine by male college students can be improved by deepening their accurate understanding of the vaccine and enhancing their positive attitude toward it.
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Affiliation(s)
- Shu Jia
- Honor College, Wuhan Universtiy, Wuhan, Hubei Province, China
- School of History, Nanjing University, Nanjing, Jiangsu Province, China
| | - Bo Pan
- Department of Integrative Oncology, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai, China
| | - Dandan Hong
- Child Healthcare Department, Hanshan Country Maternal and Child Health Care and Family Planning Service Center, Maanshan, Anhui Province, China
| | - Qingmei Zhang
- Chaohu Hospital, Anhui Medical University, Hefei, Anhui Province, China
| | - Han Jiang
- The First Clinical Medical College, Anhui University of Chinese Medicine, Hefei, Anhui Province, China
| | - Ying Hong
- Pharmacy Department, Hanshan Country People’s Hospital, Maanshan, Anhui Province, China
| | - Jing Hong
- Department of Integrative Oncology, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai, China
- Department of Integration of Chinese and Western Medicine, School of Basic Medical Sciences, Peking University, Beijing, China
- Internal Medicine Department, Traditional Chinese Medicine Hospital of Hanshan County, Maanshan, Anhui Province, China
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Huang X, Li J, Pang X, Zhu J, Pan J, Li Y, Tang J. Gene polymorphism and prediction of toxicity to platinum-based chemotherapy in patients with gynecologic cancer. Clin Transl Sci 2023; 16:2519-2529. [PMID: 38013655 PMCID: PMC10719482 DOI: 10.1111/cts.13642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 11/29/2023] Open
Abstract
The relationship between single nucleotide polymorphisms (SNPs) at various loci and adverse drug reactions (ADRs) in patients with gynecologic cancer receiving platinum-based chemotherapy (PPCT) remains unexplored. This research aimed to investigate the correlation between SNPs at several loci (e.g., GSTP1 rs1695, MTHFR rs1801133, XPC rs2228001, TP53 rs1042522, and ERCC1 rs3212986) and ADRs in patients with gynecologic cancer receiving PPCT. A total of 244 patients with gynecologic cancer who received first-line PPCT were included in this retrospective study. Blood fluorescence quantitative polymerase chain reaction was used to detect genotypes. Logistic regression, Pearson's Chi-square test, and Fisher's exact test were used to explore the correlations between these SNPs and the occurrence of ADRs. The logistic regression results showed that different genotypes of the five genes had no statistical significance in the overall grade greater than or equal to 3 ADRs. The results of Pearson's Chi-square test showed the same results. On specific adverse reactions, we found that the rs1042522 GG genotype significantly increased the risk of grade greater than or equal to 3 leucopenia compared with the CG and the CC genotypes (p = 0.002). The rs1695 AG genotype showed higher correlation for grade greater than or equal to 3 neutropenia (p = 0.020). The rs2228001 CC genotype also had a higher risk for grade greater than or equal to 3 neutropenia (p = 0.003). This study found that whereas the overall grade greater than or equal to 3 adverse reactions in patients with gynecologic cancer receiving PPCT were not associated with SNPs, specific SNPs (rs1042522 GG, rs1695 AG, and rs2228001 CC) were linked to higher risks of leucopenia and neutropenia, indicating their potential as predictors of hematotoxicity in PPCT-treated patients with gynecologic cancer.
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Affiliation(s)
- Xuan Huang
- Department of PharmacyObstetrics & Gynecology Hospital of Fudan UniversityShanghaiChina
| | - Junmin Li
- Department of PharmacyObstetrics & Gynecology Hospital of Fudan UniversityShanghaiChina
| | - Xiaoying Pang
- Department of PharmacyObstetrics & Gynecology Hospital of Fudan UniversityShanghaiChina
| | - Jialei Zhu
- Department of PharmacyObstetrics & Gynecology Hospital of Fudan UniversityShanghaiChina
| | - Jiaqian Pan
- Department of PharmacyObstetrics & Gynecology Hospital of Fudan UniversityShanghaiChina
| | - Yueyan Li
- Department of PharmacyObstetrics & Gynecology Hospital of Fudan UniversityShanghaiChina
| | - Jing Tang
- Department of PharmacyObstetrics & Gynecology Hospital of Fudan UniversityShanghaiChina
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Yuan D, Liu S, Liu Y, Ouyang F, Ai W, Shi L, Liu X, Qiu T, Wang B, Zhou Y. HPV Infection Profiles among People Living with HIV and HPV Vaccine Acceptance among Individuals with Different HIV Infection Statuses in China: A Systematic Meta-Analysis. Vaccines (Basel) 2023; 11:1614. [PMID: 37897016 PMCID: PMC10610837 DOI: 10.3390/vaccines11101614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/24/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
To understand the HPV infection profiles among Chinese HIV/AIDS patients and the HPV vaccine acceptance among unvaccinated Chinese people with different HIV infection statuses after the HPV vaccine launch in China, this study searched Web of Science, PubMed, Cochrane Library, Embase, Scopus, CNKI, WANFANG, SinoMed, and VIP databases up to 23 June 2023, according to the registered protocol (CRD42023449913). A total of 58 studies were included. The results showed that the HPV infection rate among Chinese HIV/AIDS patients was 52.54% (95% CI: 42.11-62.86%) and higher in males than in females (74.55% vs. 41.04%); meanwhile, the rate was higher in the anus than in the cervix (69.22% vs. 41.71%). Although there was no statistical difference, the high-risk HPV infection rate (38.98%) was higher than low-risk HPV (23.86%), and single infections were more common (28.84%) than multiple infections (19.23%). HPV vaccine acceptance among the unvaccinated Chinese population was 59.19% (95% CI: 52.50-65.89%), and was slightly higher among HIV-infected rather than non-HIV-infected individuals (67.72% vs. 59.58%). There was a difference in acceptance among respondents from different regions. Although the difference in acceptance rate between males and females was not statistically significant (61.10% vs. 61.18%), MSM had a higher acceptance rate than non-MSM (84.28% vs. 59.05%). HPV infection is prevalent among HIV patients, demonstrating the need to increase the frequency of HPV screening for PLWH. The HPV vaccine acceptance rate is higher than that of non-HIV-infected individuals. Male acceptance is almost the same as female's, with MSM acceptance higher than non-MSM, suggesting that using MSM, especially MSM in PLWH, as an entry point may be a practical avenue to explore to further expand the scope of HPV vaccination.
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Affiliation(s)
- Defu Yuan
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China; (D.Y.); (S.L.); (Y.L.); (F.O.)
| | - Shanshan Liu
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China; (D.Y.); (S.L.); (Y.L.); (F.O.)
| | - Yangyang Liu
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China; (D.Y.); (S.L.); (Y.L.); (F.O.)
| | - Fei Ouyang
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China; (D.Y.); (S.L.); (Y.L.); (F.O.)
| | - Wei Ai
- School of Public Health, Nanjing Medical University, Nanjing 211166, China;
| | - Lingen Shi
- Department of HIV/STD Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China; (L.S.); (X.L.); (T.Q.)
| | - Xiaoyan Liu
- Department of HIV/STD Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China; (L.S.); (X.L.); (T.Q.)
| | - Tao Qiu
- Department of HIV/STD Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China; (L.S.); (X.L.); (T.Q.)
| | - Bei Wang
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China; (D.Y.); (S.L.); (Y.L.); (F.O.)
| | - Ying Zhou
- Department of HIV/STD Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China; (L.S.); (X.L.); (T.Q.)
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Alaamri AM, Alghithi AM, Salih S, Omer HM. Acceptance and Associated Risk Factors of Human Papillomavirus Vaccine Among Parents of Daughters in Intermediate Schools in Tabuk City, Saudi Arabia. Cureus 2023; 15:e43483. [PMID: 37711956 PMCID: PMC10499461 DOI: 10.7759/cureus.43483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Women in Saudi Arabia have little knowledge of cervical cancer, human papillomavirus (HPV), and its vaccine. This study assessed the acceptance, barriers, and facilitators of HPV vaccination and its associated factors among parents of daughters in intermediate schools during the academic year September 2022-June 2023 in Tabuk City, Saudi Arabia. PURPOSE The objective of this study was to evaluate the barriers and facilitators of HPV vaccination and its associated factors among parents of daughters in intermediate schools in Tabuk City, Saudi Arabia. METHODS This was an analytical community-based cross-sectional study that targeted 947 parents of girls older than 15 in intermediate schools in Tabuk City. A structured questionnaire was used to collect data using a web-based survey. RESULTS The knowledge about HPV and its vaccine in mothers was 1.627 times higher than in fathers, mainly when employed, highly educated, aged <40 years, and earning a higher income. In addition, the Saudis' knowledge of HPV and its vaccine was 1.275 times higher than non-Saudis. The HPV vaccine acceptability among mothers was 1.259 times higher than the fathers, especially when non-employed, aged <40 years, and with higher income. The parent who knows the relationship between HPV and cervical cancer accepts the vaccine 1.794 times higher than those who ignore this relationship. On the other hand, the Saudi's acceptability of the vaccine was 0.671 times lower than non-Saudis.
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Affiliation(s)
- Atheer M Alaamri
- Preventive Medicine, King Salman Armed Forces Hospital, Tabuk, SAU
| | | | - Safa Salih
- Preventive Medicine, Ministry of Health, Tabuk, SAU
| | - Hamza M Omer
- Preventive Medicine, Ministry of Health, Tabuk, SAU
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Qiu D, Liu Y, Wang Z, Zhang Z, Nie M, Xia N, Li S, Zhao Q. Precision and correlation of ED 50 and endpoint titer method in measuring HPV vaccine immunogenicity. J Virol Methods 2023; 316:114716. [PMID: 36965633 DOI: 10.1016/j.jviromet.2023.114716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/27/2023]
Abstract
Cervical cancer, the second leading cause of cancer-related deaths among women, is caused by human papillomavirus (HPV), a sexually transmitted virus. Vaccination is an effective preventive measure against viral infections and subsequent development of cervical cancer. Enzyme-linked immunosorbent assay (ELISA) is commonly used to measure specific binding antibody titers and assess the immunogenicity of test vaccines in preclinical models or clinical volunteers. Two methods of deriving titers, the endpoint titer (ET) and the effective dilution producing a median maximal effective fold of dilution (ED50) with a cut-off value, are widely used. For HPV, a pseudovirion-based neutralization assay (PBNA) is used to measure functional antibody titers. The ELISA binding titers and functional PBNA titers were found to be well-correlated for all nine HPV types tested in the vaccine, consistent with previous studies on HPV 16/18. Comparing the PBNA results with the two titration methods, the ED50 method showed higher precision and a closer correlation with PBNA results, both for individual types and pooled data analysis for all nine types. When comparing the titration results of the ET method based on a cut-off value with the ED50 method using all the data points across the dilution series, the ED50 method demonstrated better precision and a stronger correlation with PBNA results.
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Affiliation(s)
- Dekui Qiu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, Fujian 361102, PR China; School of Public Health, Xiamen University, Xiamen, Fujian 361102, PR China
| | - Yue Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, Fujian 361102, PR China; School of Public Health, Xiamen University, Xiamen, Fujian 361102, PR China
| | - Zhiping Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, Fujian 361102, PR China; School of Life Sciences, Xiamen University, Xiamen, Fujian 361102, PR China
| | - Zhigang Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, Fujian 361102, PR China; School of Public Health, Xiamen University, Xiamen, Fujian 361102, PR China
| | - Meifeng Nie
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, Fujian 361102, PR China; School of Public Health, Xiamen University, Xiamen, Fujian 361102, PR China
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, Fujian 361102, PR China; School of Public Health, Xiamen University, Xiamen, Fujian 361102, PR China; Xiang An Biomedicine Laboratory, Xiamen, Fujian 361102, PR China; The Research Unit of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, PR China
| | - Shaowei Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, Fujian 361102, PR China; School of Public Health, Xiamen University, Xiamen, Fujian 361102, PR China; Xiang An Biomedicine Laboratory, Xiamen, Fujian 361102, PR China.
| | - Qinjian Zhao
- College of Pharmacy, Chongqing Medical University, Chongqing 400016, PR China.
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Alsulami FT, Sanchez J, Rabionet SE, Popovici I, Baraka MA. 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. Vaccines (Basel) 2023; 11:422. [PMID: 36851299 PMCID: PMC9959595 DOI: 10.3390/vaccines11020422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
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.
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Affiliation(s)
- Fahad T. Alsulami
- Sociobehavioral and Administrative Pharmacy Department, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
- Clinical Pharmacy Department, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
| | - Jesus Sanchez
- Sociobehavioral and Administrative Pharmacy Department, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Silvia E. Rabionet
- Sociobehavioral and Administrative Pharmacy Department, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Ioana Popovici
- Sociobehavioral and Administrative Pharmacy Department, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Mohamed A. Baraka
- Clinical Pharmacy Program, College of Pharmacy, Al Ain University, Al Ain P.O. Box 64141, United Arab Emirates
- Clinical Pharmacy Department, College of Pharmacy, Al-Azhar University, Cairo 11884, Egypt
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Xie L, Ren J, Min S, Zhu X, Xu D, Qiao K, Chen X, Liu M, Xiao Z, Tan Y. Knowledge, attitude, and perception regarding HPV-related diseases and vaccination among the general public in Guizhou Province of China. Vaccine 2023; 41:1119-1131. [PMID: 36610933 DOI: 10.1016/j.vaccine.2022.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The rising prevalence of high-risk human papillomavirus (HR-HPV) type-related diseases pose an ongoing health challenge in China. In this study, we assessed the current views of the general public of the Guizhou Province on HPV and HPV vaccinations to provide recommendations for future directions regarding the rollout of HPV vaccination in the area. METHODS An online questionnaire survey was conducted that included 3412 (2532 females and 880 males) native adult residents of the Guizhou Province. Data on the socio-demographic characteristics, knowledge of HPV, and perceptions of HPV vaccinations were collected. Data comparisons were made between students and non-students and between participants with and without medical backgrounds. All statistical analyses were performed using SPSS 26.0. RESULTS The self-reported HPV infection rates were 5.85% in women and 0.86% in men. A total of 46.29% of women and 34.43% of men achieved acceptable knowledge levels of HPV and 47.54% of women possessed an acceptable knowledge level of HPV vaccines. Non-students and medical participants performed significantly better in the knowledge tests than their respective opposing groups. Online media was the most popular HPV information source for all the participants. A total of 93.58% of women and 87.88% of men expressed willingness toward HPV vaccination. The major facilitators of vaccination acceptance were females (OR = 1.932, 95% CI: 1.390-2.685, p < 0.001) or students (OR = 2.276, 95% CI: 1.207-4.291, p = 0.011), and participants with higher HPV knowledge level (OR = 1.796, 95% CI: 1.300-2.481, p < 0.001). Ages 41-50 (OR = 0.255, 95% CI: 0.121-0.538, p = 0.001) or > 50 (OR = 0.141, 95% CI: 0.059-0.337, p < 0.001) were significant predictors of a negative attitude towards HPV vaccination. CONCLUSION Guizhou residents had poor knowledge of HPV-related issues. The percentage of healthcare workers who achieved acceptable knowledge levels was one-half or less. The increasing HPV prevalence and cervical cancer incidence can be contained if more affordable vaccines are developed and the low knowledge levels pervading young adults and medical staff is eliminated.
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Affiliation(s)
- Luhong Xie
- Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China; School of Clinical Laboratory Science, Guizhou Medical University, Guiyang 550004, Guizhou, China.
| | - Ji Ren
- Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Shaoju Min
- Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Xiaoyu Zhu
- Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Dianqin Xu
- Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Kun Qiao
- School of Clinical Laboratory Science, Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Xiaowei Chen
- School of Clinical Laboratory Science, Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Min Liu
- Guiyang Healthcare Vocational University, Guiyang 550081, Guizhou, China
| | - Ziwen Xiao
- Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China.
| | - Yujie Tan
- Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China; School of Clinical Laboratory Science, Guizhou Medical University, Guiyang 550004, Guizhou, China.
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Lu X, Ji M, Wagner AL, Huang W, Shao X, Zhou W, Lu Y. Willingness to pay for HPV vaccine among female health care workers in a Chinese nationwide survey. BMC Health Serv Res 2022; 22:1324. [PMID: 36335333 PMCID: PMC9637298 DOI: 10.1186/s12913-022-08716-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
Abstract
Background Payment methods for human papillomavirus (HPV) vaccine could substantially influence vaccination behavior. In China, HPV vaccination uptake remains currently low. This study aims to determine willingness to pay (WTP) for HPV vaccines among Chinese female health care workers under different payment scenarios. Methods This is a nationwide online survey recruiting female health care workers aged 18–45 years from 31 provinces throughout China. We collected the respondents’ vaccination status of HPV vaccines and their sociodemographics. Two WTPs were defined and estimated in the study. A general WTP for HPV vaccination was determined using the contingent valuation method with double dichotomous choice bidding. A WTP out-of-pocket was estimated for each HPV vaccine under two scenarios, including partial coverage by governmental subsidy or partial incorporation in basic medical insurance. Accordingly, a multivariable linear regression model was employed to determine the association between sociodemographis and general WTP. Then the maximum WTP out-of-pocket was compared among the respondents’ attitude shift towards HPV vaccination, payment scenarios, and levels of vaccine attributes, using non-parametric Kruskal-Wallis test. Results A total of 15,969 respondents were included in the study. The median general WTP was 2000 CNY (interquartile range, 1000–3200 CNY), positively associated with younger age, unmarried status, higher monthly income, fewer children, more positive vaccination behavior, working in tertiary hospital, higher local GDP and HDI (each P < 0.05). Moreover, the median WTP out-of-pocket was 1250 CNY (540–2000 CNY). It was significantly higher for vaccines partly covered by governmental subsidy (median, 1250 CNY; interquartile range, 560–2000 CNY), imported vaccines (1260 CNY; 630–1960 CNY), and 9-valent vaccines (1400 CNY; 750–2240 CNY) (each P < 0.001). Additionally, majority of respondents did not change their attitude towards HPV vaccination between two payment scenarios; those remaining with more expensive HPV vaccines (51.1%) had higher WTP out-of-pocket (1400 CNY; 560–2250 CNY) than those with cheaper vaccines (39.0%) (1120 CNY; 490–1960 CNY) (P < 0.001). Conclusion Chinese female health care workers have high WTP for HPV vaccines. A direct public funding for HPV vaccination is more preferable. Our findings may facilitate the adjustment of HPV vaccination strategy and payment mechanism in China. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08716-6.
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Si M, Su X, Jiang Y, Wang W, Zhang X, Gu X, Ma L, Li J, Zhang S, Ren Z, Liu Y, Qiao Y. 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. J Med Internet Res 2022; 24:e37848. [PMID: 36178723 PMCID: PMC9568820 DOI: 10.2196/37848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/28/2022] [Accepted: 09/06/2022] [Indexed: 12/05/2022] Open
Abstract
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.
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Affiliation(s)
- Mingyu Si
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyou Su
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjun Wang
- School of Nursing, Jining Medical University, Jining, China
| | - Xi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaofen Gu
- Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi, China
| | - Li Ma
- School of Public Health, Dalian Medical University, Dalian, China
| | - Jing Li
- West China School of Public Health, West China Forth Hospital, Sichuan University, Chengdu, China
| | - Shaokai Zhang
- Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Zefang Ren
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Youlin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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13
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Wang D, Wu J, Du J, Ong H, Tang B, Dozier M, Weller D, Campbell C. Acceptability of and barriers to human papillomavirus vaccination in China: A systematic review of the Chinese and English scientific literature. Eur J Cancer Care (Engl) 2022; 31:e13566. [PMID: 35229931 PMCID: PMC9287030 DOI: 10.1111/ecc.13566] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Widespread adoption of the human papillomavirus (HPV) vaccine will require population acceptance and tailoring of immunisation services to community needs and preferences. We examined peer-reviewed publications on the acceptability of and barriers to the HPV vaccine across China. METHODS We searched English (MEDLINE, Embase, and Web of Science) and Chinese (CNKI, VIP, Wanfang data) databases between 1 January 2006 and 31 December 2017. We adopted a narrative approach for data synthesis. RESULTS We identified 73 studies. The overall median acceptability of HPV vaccine was 71.8% (Q1-Q3: 58.6%-81%). Low levels of acceptability (<40%) of HPV vaccine were found in eastern regions of China. The largest differences of acceptability were observed between rural western regions (all >90%) and urban eastern regions (all <35%). Despite these regional variations, common barriers to HPV vaccine acceptance were concerns about vaccine safety, uncertainty over vaccine effectiveness, low perceived risk of cervical cancer and the price of the vaccine. The level of willingness to pay for the HPV vaccine (over 153 US dollars) was very low (<7%). CONCLUSION The acceptability of and attitudes towards HPV vaccine vary by regions and populations across China. HPV vaccination programmes will need to tailor service delivery as well as information materials to take account of regional concerns.
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Affiliation(s)
- Du Wang
- Usher Institute, Teviot Place, University of Edinburgh, Edinburgh, UK.,The George Institute for Global Health, Peking University Health Science Center, Beijing, China
| | - Jing Wu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - Haley Ong
- Usher Institute, Teviot Place, University of Edinburgh, Edinburgh, UK
| | - Biwei Tang
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Marshall Dozier
- College Lead for Library Academic Support, Medicine & Veterinary Medicine Library & University, University of Edinburgh, Edinburgh, UK
| | - David Weller
- Usher Institute, Teviot Place, University of Edinburgh, Edinburgh, UK
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Kim HW, Lee EJ, Lee YJ, Kim SY, Jin YJ, Kim Y, Lee JL. Knowledge, attitudes, and perceptions associated with HPV vaccination among female Korean and Chinese university students. BMC Womens Health 2022; 22:51. [PMID: 35197031 PMCID: PMC8867647 DOI: 10.1186/s12905-022-01624-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Hae Won Kim
- College of Nursing, The Research Institute of Nursing Science, Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project Seoul National University, Seoul, Republic of Korea
| | - Eun Ju Lee
- Department of Nursing, Inha University, Inchon, Republic of Korea
| | - Young Jin Lee
- Department of Nursing, College of Life and Health Sciences, Hoseo University, Cheonan, Republic of Korea
| | - Seo Yun Kim
- College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - You Jing Jin
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Youngji Kim
- Department of Nursing, College of Nursing and Health, Kongju National University, Gongju, Republic of Korea
| | - Jung Lim Lee
- Department of Nursing, Daejeon University, Daejeon, Republic of Korea.
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15
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Lin Y, Hu Z, Alias H, Wong LP. The role of nurses as human papillomavirus vaccination advocates in China: perception from nursing students. Hum Vaccin Immunother 2022; 18:2030169. [PMID: 35148251 PMCID: PMC8993049 DOI: 10.1080/21645515.2022.2030169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This study aimed to investigate nursing students' perspectives regarding the role of nurses as HPV vaccine advocates and their perception of barriers to advocacy. A cross-sectional study using a Web-based survey was sent out to all undergraduate nursing students enrolled at the Fujian Medical University, Fuzhou, China. A total of 1,041 students responded to the survey. In total, 58.0% of students expressed an intent to advocate HPV vaccines as a counselor and 56.4% as an HPV information provider in their future practice. However, 33.4% stated that they do not intend to be HPV vaccine advocates. Grade 1 students, students from homes with higher annual household incomes and those with a higher level of knowledge about HPV and HPV vaccination expressed higher intentions to advocate for HPV vaccines as a counselor. Students who have a higher level of knowledge about HPV and HPV vaccination and have received HPV vaccines reported a higher advocacy intent in the provision of HPV information. The main perceived barriers in HPV vaccine advocacy include inadequate training (87.1%) and insufficient HPV-related knowledge (84.8%); also, anxious patients may not feel comfortable with nurses discussing HPV vaccination (52.8%). Nurses are uniquely positioned to nurture patient HPV vaccine acceptance and maybe the key strategy to increase HPV vaccination coverage in China. Institutional support is needed to train nurses as HPV vaccine advocates and should focus on enhancing HPV-related knowledge while destigmatising the embarrassment around discussing HPV-related issues with patients.
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Affiliation(s)
- Yulan Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Haridah Alias
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Li Ping Wong
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China.,Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Chew KT, Kampan N, Shafiee MN. Perception and knowledge of human papillomavirus (HPV) vaccine for cervical cancer prevention among fully vaccinated female university students in the era of HPV vaccination: a cross-sectional study. BMJ Open 2021; 11:e047479. [PMID: 34876417 PMCID: PMC8655553 DOI: 10.1136/bmjopen-2020-047479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To assess the perception and knowledge of cervical cancer prevention among fully vaccinated female university students in the era of human papillomavirus (HPV) vaccination. DESIGN Cross-sectional using a validated questionnaire. SETTING Face-to-face interview at a public university in Malaysia. PARTICIPANTS 384 fully vaccinated female students were included in the study. RESULTS The total knowledge score in the questionnaire was 18 and was ranked according to score level into three groups: poor (score ≤5), moderate (score 6-10) and good (score ≥11). Mean score for knowledge of cervical cancer prevention was 8.24 (SD ±3.85), with 170 respondents (44.3%) scoring moderate knowledge level. The mean score for knowledge of HPV infection and its association with cervical cancer was 4.56±2.47, while the mean score for knowledge of HPV vaccination for cervical cancer prevention was 3.68 (SD ±1.98). A total of 186 (48.4%) respondents perceived that regular Pap smear was unnecessary after HPV vaccination. Respondents' perceived seriousness and susceptibility of HPV infection correlated well with knowledge of cervical cancer prevention. Two main reasons for their acceptance of HPV vaccine were self-health awareness and free vaccination. CONCLUSION The knowledge of HPV vaccination for cervical cancer prevention was average among vaccinated university students. Many of them had poor knowledge about Pap smear and did not consider regular Pap smear as an important cervical cancer screening tool following HPV vaccination. There is still a need for continued health education to improve the perception and knowledge about HPV infection and cervical cancer prevention among young adults in the community.
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Affiliation(s)
- Kah Teik Chew
- Obstetrics & Gynaecology, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Nirmala Kampan
- Obstetrics & Gynaecology, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Mohamad Nasir Shafiee
- Obstetrics & Gynaecology, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Malaysia
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Oliveira PSD, Gonçalves CV, Watte G, Costa JSDD. Vaccination coverage against human papillomavirus (HPV) and associated factors in female academics from a university in southwestern Goiás, Brazil. Rev Saude Publica 2021; 55:65. [PMID: 34706041 PMCID: PMC8522710 DOI: 10.11606/s1518-8787.2021055003144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/30/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To check the coverage of the HPV vaccine in women enrolled in health courses at a university in southwest Goiás, Brazil, and the factors associated with vaccination. METHODS This is a cross-sectional study, including female university students of health courses, aged 18 years or more. A standardized and self-applying questionnaire was used. Participants who received two or more doses of the vaccine were considered immunized. Multiple analysis was performed using multinomial logistic regression. RESULT We observed that, of the 1510 participants, 473 (31.3%) had two or more doses of HPV vaccine, 167 (11.0%) one dose and 870 (57.6%) were unvaccinated. Participants under 21 years of age and in socioeconomic stratum A were 2 times more likely to have received two or more doses of the vaccine (Prevalence Ratio = 1.95; 95%CI 1.40-2.70 and Prevalence Ratio = 2.09; 95%CI 1.39-3.13, respectively). CONCLUSIONS The research revealed extensive possibility for interventions with the aim of achieving greater vaccination coverage among female university students. Even women with more knowledge and high economic stratum showed low vaccination coverage, suggesting that results of higher vaccine coverage can be obtained with vaccination carried out in a school environment.
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Affiliation(s)
| | | | - Guilherme Watte
- Universidade Católica do Rio Grande do Sul. Programa de Pós-Graduação em Medicina e Ciências da Saúde da Pontifícia, Porto Alegre, RS, Brasil
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Shokri Jamnani A, Rezapour A, Moradi N, Langarizadeh M. Willingness to pay for and acceptance of cervical cancer prevention methods: A systematic review and meta-analysis. Med J Islam Repub Iran 2021; 35:81. [PMID: 34291005 PMCID: PMC8285557 DOI: 10.47176/mjiri.35.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Indexed: 11/11/2022] Open
Abstract
Background: The Willingness to pay (WTP) for and acceptance of cervical cancer prevention (CCP) methods have an important role in the control of this type of cancer. Therefore, the aim of this study was to estimate the WTP and acceptance of CCP methods with the contingent valuation method (CVM). Methods: In this systematic review and meta-analysis study, the required information was collected by searching relevant keywords in PubMed, Scopus, Embase, Web of Knowledge, and their Persian equivalent in the Scientific Information Database (SID) and Elmnet databases during January 1, 2000 to June 30, 2020. All studies that reported the WTP and CCP methods with the CVM in English or Persian were included. The reporting quality of studies was assessed by strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Comprehensive meta-analysis (CMA: 2) software was used to conduct the meta-analysis. The content analysis method was used for qualitative data analysis. Results: Finally, 28 articles (with 49610 people) were included in the study. Most of the participants were women (35.7%). The HPV vaccine was the most common method of prevention (75%). The overall acceptance rate was 64% and the overall positive WTP rate was 66%. The average WTP was US$30.44, which accounts for about 0.84% of GDP per capita. The most significant effective factors included income, age, education, high-risk sexual behaviors, and awareness of cervical cancer, belief in the risk of cervical cancer, and belief about the effectiveness of prevention methods. The cost was the most important reason for the unwillingness to pay and accept. Conclusion: Results show that the WTP and acceptance rate of CCP methods are relatively high. It is recommended to reduce the cost of prevention methods, especially the HPV vaccine, and to increase awareness and improve the attitude of people. Also, it is recommended to consider other methods of estimation of WTP and other cancers in future studies.
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Affiliation(s)
- Anahita Shokri Jamnani
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Najmeh Moradi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Langarizadeh
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Wang Y, Hu Y, Chen Y, Liang H. Preference and willingness to pay of female college students for human papillomavirus vaccination in Zhejiang Province, China: A discrete choice experiment. Hum Vaccin Immunother 2021; 17:3595-3602. [PMID: 34142926 DOI: 10.1080/21645515.2021.1932215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The study aimed to quantify the preferences of female college students for human papillomavirus (HPV) vaccination in Zhejiang Province, China, using a discrete choice experiment (DCE). One medical college and one nonmedical college were selected using convenience sampling, and the respondents were identified using stratified cluster sampling. A DCE focused on vaccine-related and service-related attributes was conducted in 2019. Latent class analysis was used to estimate the vaccine-related attributes, and conditional logistic regression was used to construct the choice model for the service-related attributes. In total, 850 female college students finished the study. Two latent classes were identified. Those who had more knowledge of HPV and felt more pressure about the related infection and diseases had a significantly higher chance of belonging to class 1 and were more likely to choose vaccination (percentages of respondents choosing no vaccination was 1.1% in class 1 versus 84.7% in class 2, χ2 = 641.1, P < .01). There were 742 respondents who chose vaccination in vaccine-related scenes, and 98.8% of them still chose to receive the vaccine in service-related scenes. Ways of making an appointment, number of weeks waiting for vaccination, service time for vaccination, time to the nearest vaccination site, and added cost all impacted the probability of choosing HPV vaccination services. It is concluded that higher levels of HPV knowledge and sociopsychological pressure led to a higher probability of HPV vaccination uptake in China. It is necessary to disseminate proper knowledge of HPV to improve the coverage and equality of HPV vaccination.
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Affiliation(s)
- Ying Wang
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Yu Hu
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Yaping Chen
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Hui Liang
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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20
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Ou L, Chen ACC, Reifsnider E. Review of Chinese young adults' human papillomavirus knowledge, attitudes, and vaccine acceptability. Public Health Nurs 2021; 38:701-714. [PMID: 33715199 DOI: 10.1111/phn.12893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/18/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The human papillomavirus (HPV) vaccine is effective in reducing HPV-related disease. The 2-, 4-, and 9-valent HPV vaccines have been approved by the Chinese FDA since 2016; however, factors associated with HPV vaccine acceptability and use in Chinese young adults remain unclear. DESIGN AND SAMPLE We conducted a systematic review to analyze factors affecting HPV vaccine acceptability and use in Chinese young adults. A comprehensive search of databases (e.g., PubMed, CINAHL, and PsycINFO) was conducted, and articles between 2011 and 2020 were included. RESULTS Seventeen studies were included in the final review, and eleven were conducted in mainland China and six in Hong Kong. All studies reported low level of HPV-related knowledge. Better knowledge, more concerns about HPV-associated diseases, and being female were found associated with higher vaccine acceptability. The vaccine cost and safety were the major concerns for vaccination. CONCLUSIONS Findings suggested a low level of HPV-related knowledge and suboptimal vaccination rate in Chinese young adults. Theory-based interventions addressing knowledge and other influencing factors and involving both males and females are urgently needed to increase vaccine acceptability and use in Chinese young adults.
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Affiliation(s)
- Lihong Ou
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Angela Chia-Chen Chen
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Elizabeth Reifsnider
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
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21
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Wang Q, Zhang W, Cai H, Cao Y. Understanding the perceptions of Chinese women of the commercially available domestic and imported HPV vaccine: A semantic network analysis. Vaccine 2020; 38:8334-8342. [PMID: 33190947 DOI: 10.1016/j.vaccine.2020.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/08/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND A domestic human papillomavirus (HPV) vaccine, Cecolin, that protects against HPV strains 16 and 18 was introduced to the Chinese market at a relatively low price in May 2020.This study has explored Chinese women's perceptions of both domestic and imported HPV vaccines, which differ in price and valency. METHODS Sentiment analysis and semantic network analyses were performed based on a sample of 45,729 domestic HPV vaccine-related posts from females on the Sina Weibo between April 17 and May 2, 2020. The geographic distribution was also analyzed based on the users' locations, which were retrieved from the database. RESULTS Most of the posts were positive and neutral (85%), although 15% were negative (e.g., expressions of anger, sadness, fear and disgust). Semantic analyses of the negative posts revealed that Chinese women generally had positive attitudes towards the HPV vaccine and were willing to be vaccinated. However, obvious geographical variations were identified. Women who lived in economically developed areas expressed a stronger desire to obtain imported quadrivalent or nonavalent vaccines due to concerns regarding effectiveness and quality. The women expressed disgust and anger mainly regarding difficulties in making an appointment, age restrictions for the nonavalent vaccine and gender restrictions. However, the population targeted by the domestic vaccine, namely women who lived in economically undeveloped areas and had relatively low incomes, had a low awareness of the HPV vaccine. CONCLUSION Government should provide programs, which educate females that bivalent HPV vaccine can offer protection against the majority of high-risk HPV types. Increasing awareness of the domestic vaccine among the population in economically undeveloped areas and provision of free domestic bivalent HPV vaccination/screening for low-income high-risk women would help to prevent cervical carcinoma. This issue also depends on rebuilding trust and repairing damage to the relationship between government/domestic vaccine manufacturers and the public.
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Affiliation(s)
- Qi Wang
- School of Industrial Design, Hubei University of Technology, 28 Nanli Road, Wuhan 430068, PR China
| | - Wen Zhang
- School of Journalism and Culture Communication, Zhongnan University of Economics and Law, 182 Nanhu Avenue, Wuhan 430073, PR China.
| | - Hongning Cai
- Department of Gynecological Oncology, Hubei Maternal and Child Health Care Hospital, Wuhan 430070, Hubei, PR China
| | - Yuan Cao
- Cloud-clone Diagnostic Reagents Institute, Wuhan 430056, Hubei, PR China
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22
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Wong LP, Wong PF, Megat Hashim MMAA, Han L, Lin Y, Hu Z, Zhao Q, Zimet GD. Multidimensional social and cultural norms influencing HPV vaccine hesitancy in Asia. Hum Vaccin Immunother 2020; 16:1611-1622. [PMID: 32429731 PMCID: PMC7482900 DOI: 10.1080/21645515.2020.1756670] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/11/2020] [Indexed: 12/27/2022] Open
Abstract
HPV vaccine hesitancy in Asia is unique compared to Western countries due to multidimensional social-cultural norms that influence beliefs regarding vaccination. Reviews on HPV vaccine hesitancy in Asia lack of in-depth discussion regarding the traditional and social-cultural norms dimensions. This paper puts forward opinions in which culture, normative beliefs, and religion influence HPV vaccine hesitancy in Asian countries. Issues surrounding HPV hesitancy among parents, young adult women, adult women, men and the sexual and gender minority people in Asian countries were highlighted. The shortage of HPV vaccine supply would soon be reduced as some Asian countries are on the way to producing the HPV vaccine which production is currently dominated by Western European countries. The culture of favoring imported Western products among many in Asia and in addition to long-existing fake vaccine crisis pose a challenge for the newly emerging HPV vaccine produced in Asia. Some recommendations, research gaps, and future research needs were discussed.
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Affiliation(s)
- Li Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pooi-Fong Wong
- Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Liyuan Han
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Yulan Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Qinjian Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian Province, China
| | - Gregory D. Zimet
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, U.S
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23
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Lin Y, Su Z, Chen F, Zhao Q, Zimet GD, Alias H, He S, Hu Z, Wong LP. Chinese mothers' intention to vaccinate daughters against human papillomavirus (HPV), and their vaccine preferences: a study in Fujian Province. Hum Vaccin Immunother 2020; 17:304-315. [PMID: 32401617 DOI: 10.1080/21645515.2020.1756152] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Little is known regarding Chinese mothers' intention to vaccinate their daughters against human papillomavirus (HPV) since the HPV vaccine was approved for use in China in 2016. The aim was to explore maternal HPV vaccination acceptance, preference for 2-, 4- or 9-valent HPV vaccine and acceptance of domestically manufactured HPV vaccines. Study participants were mothers of primary school children in Southeastern region of Fujian. An online cross-sectional survey was undertaken between June and August 2019. Among the total of 3,586 completed responses (response rate 28.5%), the intention to vaccinate daughter against HPV was high (83.3%). Higher maternal education and perceived benefit and barriers were associated with greater intention to vaccinate. Among mothers who did not intend to vaccinate their daughters, the three most common reasons were daughter being too young to receive HPV vaccination (40.6%), fear of side effects (31.9%) and vaccine price is too high (16.0%). The largest proportion (41.4%) preferred their daughter to be vaccinated with the 9-valent HPV vaccine (9vHPV). Greater preference for 9vHPVwas strongly associated with higher maternal education level and annual household income. The majority of mothers expressed a preference for imported HPV vaccine (56.3%). Our result indicates that lower intentions to vaccinate daughters against HPV among less educated and lower-income mothers may lead to significant social inequalities in HPV vaccine uptake in the country.
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Affiliation(s)
- Yulan Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University , Fuzhou, Fujian Province, China.,Department of Nutrition, Harvard T.H. Chan School of Public Health , Boston, MA, USA
| | - Zhitai Su
- Yongding Health Inspection Bureau , Longyan City, Fujian Province, China
| | - Fulian Chen
- Longyan Health Inspection Bureau , Longyan City, Fujian Province, China
| | - Qinjian Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University , Xiamen, Fujian, PR China
| | - Gregory D Zimet
- Department of Pediatrics, School of Medicine, Indiana University , Indianapolis, IN, USA
| | - Haridah Alias
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
| | - Shuqiong He
- Prenatal Diagnosis Center, Fujian Provincial Maternity andChildren's Hospital of Fujian Medical University , Fuzhou, Fujian Province, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University , Fuzhou, Fujian Province, China
| | - Li Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
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24
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You D, Han L, Li L, Hu J, D. Zimet G, Alias H, Danaee M, Cai L, Zeng F, Wong LP. Human Papillomavirus (HPV) Vaccine Uptake and the Willingness to Receive the HPV Vaccination among Female College Students in China: A Multicenter Study. Vaccines (Basel) 2020; 8:E31. [PMID: 31963370 PMCID: PMC7157221 DOI: 10.3390/vaccines8010031] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 12/30/2019] [Accepted: 01/14/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study aimed to determine human papillomavirus (HPV) vaccine uptake and willingness to receive HPV vaccination among female college students, in China, and its associated factors. METHODS An online cross-sectional survey of female college students across the eastern, central, and western regions of China was undertaken between April and September 2019. Partial least squares structural equation modeling (PLS-SEM) was used to examine factors associated with the HPV vaccine uptake and willingness to receive the HPV vaccine. RESULTS Among the total 4220 students who participated in this study, 11.0% reported having been vaccinated against HPV. There are direct effects of indicators of higher socioeconomic status, older age (β = 0.084 and p = 0.006), and geographical region (residing in Eastern China, β = 0.033, and p = 0.024) on HPV vaccine uptake. Higher knowledge (β = 0.062 and p < 0.000) and perceived susceptibility (β = 0.043 and p = 0.002) were also predictors of HPV vaccine uptake. Of those who had not received the HPV vaccine, 53.5% expressed a willingness to do so. Likewise, social economic status indicators were associated with the willingness to receive the HPV vaccine. Total knowledge score (β = 0.138 and p < 0.001), both perceived susceptibility (β = 0.092 and p < 0.001) and perceived benefit (β = 0.088 and p < 0.001), and sexual experience (β = 0.041 and p = 0.007) had a positive and significant direct effect on the willingness to receive the HPV vaccine, while perceived barriers (β = -0.071 and p < 0.001) had a negative effect on the willingness to receive the HPV vaccine. CONCLUSIONS Geographical region and socioeconomic disparities in the HPV vaccination uptake rate and willingness to receive the HPV vaccine provide valuable information for public health planning that aims to improve vaccination rates in underserved areas in China. The influence of knowledge and perceptions of HPV vaccination suggests the importance of communication for HPV immunization.
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Affiliation(s)
- Dingyun You
- Department of Epidemiology, School of Public Health, Kunming Medical University, Kunming 650500, China;
| | - Liyuan Han
- Department of Epidemiology, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo 315200, China; (L.H.); (L.L.); (J.H.)
| | - Lian Li
- Department of Epidemiology, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo 315200, China; (L.H.); (L.L.); (J.H.)
| | - Jingcen Hu
- Department of Epidemiology, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo 315200, China; (L.H.); (L.L.); (J.H.)
| | - Gregory D. Zimet
- Department of Pediatrics, School of Medicine, Indiana University, 410 W, 10th St., HS 1001, Indianapolis, IN 46202, USA;
| | - Haridah Alias
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (H.A.); (M.D.)
| | - Mahmoud Danaee
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (H.A.); (M.D.)
| | - Le Cai
- Department of Epidemiology, School of Public Health, Kunming Medical University, Kunming 650500, China;
| | - Fangfang Zeng
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou 510632, China;
| | - Li Ping Wong
- Department of Epidemiology, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo 315200, China; (L.H.); (L.L.); (J.H.)
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (H.A.); (M.D.)
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