Knowledge and attitude of Uyghur women in Xinjiang province of China related to the prevention and early detection of cervical cancer. World J Surg Oncol. 2015;13:110. [PMID: 25885660 PMCID: PMC4371720 DOI: 10.1186/s12957-015-0531-8]

Cervical Cancer and HPV vaccination: Insights into knowledge, attitudes, and practices among Albanian women

Introduction

Human papillomavirus (HPV) infection is a widespread skin-to-skin transmitted infection that poses a global health concern. Although Albania faced prior challenges, it has recently introduced a quadrivalent recombinant HPV vaccine, a critical step in preventing cervical cancer among young women. This study aims to identify potential gaps in knowledge and attitudes among Albanian women regarding cervical cancer and HPV infection, as well as provide insights into the effectiveness of the national primary prevention program.

Methods

We conducted a cross-sectional study among 473 Albanian women using an anonymous online questionnaire to collect sociodemographic information, awareness on HPV infection and cervical cancer, and HPV vaccination practices. The association between sociodemographic variables and outcome measures was explored using descriptive statistics and Chi-square tests in SPSS.

Results

Most of the participants fell within the age range of 18 to 30 years old (42.1 %). 71.7 % of the respondents lived in urban areas. According to the study findings, a considerable proportion of the participants demonstrated knowledge of cervical cancer, with 66.6 % correctly identifying HPV infection as a major cause of this disease. Additionally, the study uncovered that a substantial number of participants had an acceptable awareness (59.6 %) about the HPV vaccine. Nevertheless, 48.4 % of the participants expressed concerns about the vaccine's efficacy and safety.

Conclusions

The study reveals knowledge gaps and misconceptions about HPV transmission, hereditary aspects, and its connection to various cancers. While a positive attitude towards preventive measures exists, concerns about HPV vaccination safety and efficacy underscore the need for targeted education campaigns to enhance awareness and accessibility, addressing misconceptions and promoting informed decision-making for effective cervical cancer prevention.

Women's knowledge, attitude, and practice regarding cervical precancerous lesions: a cross-sectional study in Beijing, China

Background

This study aimed to examine the knowledge, attitude, and practice (KAP) of women in Beijing regarding cervical precancerous lesions.

Methods

This web-based, cross-sectional study included women at Dongzhimen Hospital of Beijing University of Chinese Medicine between March 13, 2024 and April 9, 2024. A self-administered questionnaire was developed to collect participants' demographic information and KAP scores toward cervical precancerous lesions.

Results

The study included 951 valid questionnaires, with a mean age of 40.0 years. The mean knowledge, attitude, and practice scores were 12.55 ± 6.23 (possible range: 0-26), 50.66 ± 7.48 (possible range: 13-65), and 26.13 ± 4.98 (possible range: 7-35), respectively. The knowledge score (OR = 1.071, 95%CI: 1.040-1.103, p < 0.001), currently married (OR = 0.548, 95%CI: 0.304-0.985, p = 0.045), and with a history of HPV infection (OR = 2.302, 95%CI: 1.062-4.990, p = 0.035) were independently associated with the attitude score. The knowledge score (OR = 1.155, 95%CI: 1.119-1.192, p < 0.001), monthly income >20,000 (OR = 2.793, 95%CI: 1.249-6.248, p = 0.012), a history of HPV infection (OR = 0.380, 95%CI: 0.222-0.650, p < 0.001), unknown HPV infection status (OR = 0.289, OR = 0.177-0.473, p < 0.001), vaccinated against HPV (OR = 1.752, 95%CI: 1.221-2.514, p = 0.002), giving birth to one child (OR = 1.991, 95%CI: 1.186-3.341, p = 0.009), and giving birth to two or more children (OR = 2.160, 95%CI: 1.240-3.763, p = 0.007) were independently associated with the practice score. The structured equation model showed that knowledge directly influenced attitude (β = 0.237, p = 0.004) and practice (β = 0.490, p = 0.010). Attitude directly influenced practice (β = 0.193, p = 0.009).

Conclusion

This study revealed inadequate knowledge, moderate attitude, and practice toward cervical precancerous lesions among women in Beijing. Educational interventions should be developed to enhance knowledge in this regard.

Knowledge and Behaviors toward Human Papillomavirus and Cervical Cancer in the Women of Reproductive Age in Thailand-Myanmar Border Areas

BACKGROUND

Infectious disease is an important health problem in border areas as there is a possibility that the migrants may carry the disease into the area. The purpose of this study is to evaluate the knowledge and behaviors toward human papillomavirus (HPV) and cervical cancer in the women of reproductive age in the Thailand-Myanmar border area.

METHODS

A survey study in a population of 418 women of reproductive age in Mae Hong Son Province in the Thailand-Myanmar border area. Knowledge and risk behaviors of HPV and cervical cancer were described using descriptive statistics.

RESULTS

Fifty percent of the participants had sexual debut at age less than 20 years, 27% had more than one lifetime sexual partner and only 3% had sex outside a monogamous relationship during the past 12 months. In term of knowledge, 62.5% knew about HPV. The proportion of correct answers about HPV and cervical cancer questions ranged from 14-95% and 52-94%, respectively. Among the cervical cancer screening target, 69.4% accessed the screening. The factors associated with better knowledge about HPV and cervical cancer were education level higher than high school and sexual debut.

CONCLUSION

The women of reproductive age in the Thailand-Myanmar border areas showed relatively low sexually risk behaviors for HPV infection. More than one-third of the participants did not know about HPV. The percentage of correct answer to questions about cervical cancer were low.  We encourage the Thai Ministry of Public Health to increase health promotion and health literacy on prevention of HPV and cervical cancer in the women of pre- and reproductive age in the Thailand-Myanmar border area.

Cervical cancer screening and vaccination: knowledge, awareness, and attitude of female staff in a Nigerian University

BACKGROUND

Poor knowledge and awareness of cervical cancer screening and vaccination are significant barriers to effective cervical cancer prevention in developing countries. Knowledge of cervical cancer and vaccination against cervical cancer remains low in Nigeria. The purpose of this study was to assess the knowledge, awareness, and attitude of female staff of Afe Babalola University towards cervical cancer screening and vaccinations.

METHODS

This study was a cross-sectional study conducted using a semi-structured questionnaire among female staff of Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria. The workers' knowledge and awareness were assessed using yes and no questions while the attitude was assessed using Likert scale questions. The workers' knowledge was ranked as good (≥ 50%) and poor (< 50%) while attitude was ranked as positive (≥ 50%) and negative (< 50%). The relationship between demographics, attitude and knowledge of cervical cancer screening and vaccination was carried out using the Chi-square test. Analyses were conducted using SPSS software version 20.

RESULTS

A total of 200 staff consented to participate in the study out of which 64% were married with mean age 32.81 ± 8.164 years. Majority (60.5%) of the participants knew the causes of cervical cancer while 7.5% strongly agreed that they do not see the need for cervical screening. Majority (63.5%) of the participants showed good knowledge while 46% had a positive attitude towards cervical cancer screening and vaccination.

CONCLUSIONS

The study participants showed good knowledge and awareness but poor attitude towards cervical cancer screening and vaccinations. Interventions and continuous education are needed to improve the population's attitude and eliminate misconceptions.

Attitude and practice on human papilloma virus infection and vaccination among students from secondary occupational health school: a cross-sectional study

Cervical cancer (CC) is reported as the second-most common female cancer worldwide, of which 99% is caused by persistent human papillomavirus (HPV) infection. HPV vaccine protects against HPV infection and most cases of CC, which has only been introduced for a short time in mainland China. This study aimed to evaluate the attitude and practice related to HPV infection and vaccination among students at secondary occupational health school (SOHS) in China. We conducted a cross-sectional study in Southern China where data of 2248 participants were collected through questionnaires to estimate attitude and practice of students. Only 4.1% believed they were easily infected by HPV, 38.2% were willing to receive HPV vaccine and 30.8% intended to do regular screening of HPV infection in the future. Students in the second grade (OR = 1.51, 95%CI [1.25, 1.81]) and third grade (OR = 3.99, 95%CI [2.53, 6.27]) were more willing to take HPV vaccine compared to students in the first grade. Among the non-vaccinated participants, the most frequent reason for not receiving HPV vaccine was insufficient knowledge about HPV (91.1%). Characteristics of higher grade, personal education before enrollment and academic performance, medical specialty, history of sex experience and HPV vaccine and family history of other cancers were associated with higher attitude scores (p < .05). Considering the increasing prevalence of HPV infection and the need of improvement in attitude and practice toward HPV, more education about HPV infection and vaccination should be incorporated into school curriculum.

Few changes shown in cancer information-seeking behaviour among young adults in China between 2012 and 2017

BACKGROUND

The increasing incidence of cancer among young adults (18-40 years old) is of concern in China.

OBJECTIVES

This study aims to examine the influence of cancer information-seeking behaviours (CISB) on young adults' worries about cancer and participation in screening.

METHODS

This study analysed data from two probability sample surveys conducted in 2012 and 2017 in China. The questions in the questionnaire remained the same for better comparison. The sample size was 1212 in the 2012 survey, and 2178 in the 2017 survey.

RESULTS

From 2012 to 2017, among young adults, there was a decline in cancer information seeking, diversity of cancer information sought and cancer worry, while an improvement in cancer information-seeking experience was found. Also, CISB had significant associations with cancer worry and health screening over the 5 years.

DISCUSSION

The level of young adults' cancer information seeking remains low in China, and this group is not fully aware of their potential risks of getting cancer.

CONCLUSION

Although young adults find the experience of looking for cancer information easier in 2017, health campaigns may be necessary to encourage young adults to find out more about their cancer risks, and to participate more in health screening.

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

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

Different Genotype Distribution of Human Papillomavirus between Cervical and Esophageal Cancers: A Study in Both High-Incidence Areas, Xinjiang, China

The aim of this study is to reveal the certain human papillomavirus (HPV) genotype distribution between cervical cancer and esophageal cancer in the both high-incidence geographic regions. For this study, we collected and detected the infection of HPV in 120 paraffin-embedded esophageal tissues and 152 paraffin-embedded cervical tissues, respectively. The esophageal tissues include 40 normal epithelium (ENOR), 26 dysplasia (DYS), and 54 invasive squamous cell carcinoma (ESCC). The cervical tissues consisted of 40 normal epithelium (CNOR), 53 intraepithelial neoplasia (CIN), and 59 invasive squamous cell carcinoma (CSCC). Both esophageal and cervical tissues collected in this study came from the same area, in which both the ESCC and CSCC were in high incidence, Xinjiang province, China. HPV GenoArray test kits were served to analyze the HPV infection. The result shows that among the 59 CSCC tissues, the total infection rate of HPV was 98.3% (58/59). The positive rate of HPV-16 infection was 63.8% (37/58). It indicated that HPV-16 is the most common infection among all of the high-risk HPV. The multiple infection rate was 19.0% (11/58). Among the 54 ESCC, a total of 7 genotypes were detected. The total infection rate of HPV was 61.1% (33/54). The positive rate of HPV-16 infection was 63.6% (21/33). The multiple infection rate was 6.1% (2/33). Our result shows that high-risk-type HPV-16 was associated with both cervical cancer and esophageal cancer, which play a role in the high-incidence area in Xinjiang. We hope that our results could point out the direction for the treatment strategy of HPV-associated cancer, cervical cancer, and esophageal cancer and for the application of HPV vaccines in the future.

Genome-Wide Profiling of Human Papillomavirus DNA Integration into Human Genome and Its Influence on PD-L1 Expression in Chinese Uygur Cervical Cancer Women

Background

The Uygur is the fifth most populous ethnic group in China. Compared to other Chinese population, cervical cancer in them had high incidence, and HPV infection also was particular. Their HPV integration situation has never been reported. We aimed to investigate the integration situation of 20 subtypes of HPV gene into host cell genome in Chinese Uygur cervical cancer patients; meanwhile, we explored the influence of gene integration on PD-L1 expression.

Methods

40 frozen Chinese Uygur cervical cancer specimens with positive HPV infection were obtained from the cancer prevention and treatment institute of Tumor Hospital Affiliated to Xinjiang Medical University. The integration situation of HPV gene into host cell genome was detected by Agilent SureSelect™ Target Enrichment Chip and Next-Generation Sequencing. The related genes were analyzed by GO functional annotation and KEGG pathway enrichment. The expression levels of PD-L1 in cancer cells were tested by immunohistochemical assay (IHC). Meanwhile, the relationship between PD-L1 levels in cancer cells and gene integration were analyzed.

Results

The HPV multiple infection rate by HIVID was as high as 92.5%, much higher than 35.0% by the commercial kit (P < 0.05). There were 13423 integration events in 40 specimens, involving 6867 human genes. These integration events were distributed on all human chromosomes, and chromosome 19 had the excessive concentration phenomenon of integration events. There were some integration hotspots in human genome such as PPP1R37, HECW2, EMBP1, ANKRD50, SPTBN4, LINC00895, LYRM4-AS1, LINC00374, RBFOX1, CSMD1, CDH13, and KLHL4. Insertion breakpoints can be found in all gene regions of the HPV genome. The actual observation of the integration times of E1 and E6 was much higher than the expected value, while the actual observation times of E5 were much lower than the expected value. The result of GO functional analysis showed that binding molecular function and cellular process biological process were the main ways to influence the cell biological behavior of HPV gene integration. The enrichment pathway analysis of KEGG showed that pathways in cancer were the most important enrichment pathways involved in the genomic integration of HPV. The positive PD-L1 rate was 62.5%. Logistic regression analysis showed that 9p24.1 existing integration sites and the number of all gene integration were risk factors for PD-L1 expression (odds ratio 17.313 and 1.012; 95% confidence interval 1.691-177.213 and 1.001-1.023). Conclusions and Relevance. Most high-frequency sites of HPV integration in Chinese Uygur cervical cancer are related to cancer progression, and the gene integration hotspots may be potential HPV carcinogenic targets. The problem of multiple HPV infection in Chinese Uygur cervical cancer patients should be paid attention. L1 and E6 genes are inapposite as the target gene of commercial HPV type detection kit, because of high-frequency breakpoints in these genes. The gene integration especially the integration existing on 9p24.1 could affect the expression level of PD-L1.

Histopathological Patterns and Characteristics of Abnormal Cervical Smear in Madinah Region of Saudi Arabia

Cervical cancer is a major public health problem that continues to be one of the leading female genital cancers worldwide. In the kingdom of Saudi Arabia (KSA), cervical cancer ranks the fifteenth most frequent cancer among females. This study is the first published research study addressing the screening of cervical cancer in Madinah region of KSA. Aim: To evaluate the abnormal cytological entities detected by cervical Pap smear in Madinah region of KSA and to compare the results with other national and international studies. Methods: This retrospective case-control study was conducted in the Departments of Obstetrics and Gynecology, and Histopathology at the Maternity and Children Hospital (MCH), Madinah, KSA from January 2013 to December 2015. Results: Of the 1594 cases reviewed, only 38 cases (2.4%) had epithelial cell abnormalities. High grade squamous intraepithelial lesions (HSIL) and low grade squamous intraepithelial lesions (LSIL) were the most common diagnosis categories, and cervical cancer accounted for 36.8% of the total cases for each, followed by atypical squamous cells of uncertain significance (ASCUS) found in (15.9%). Squamous cell carcinoma (SCC ) was found in (5.3%) of the cases. Patients with abnormal epithelial changes had higher parity (P=0.021) and presented more with a complaint of postcoital bleeding (P<0.0001), tend to have abnormal cervical appearance (P=0.004), more likely bleeding on touch (P=0.001) and associated with cervical erosion (P=0.014). Conclusion: The study showed a relatively low prevalence of epithelial cell lesions. These lesions were mainly squamous cell lesions harbored by females who have an abnormal cervical appearance, and those with high parity who were lacking cervical screening program.

Cervical Cancer, Human Papillomavirus Infection, and Vaccine-Related Knowledge: Awareness in Chinese Women

Cervical cancer (CC) has a high incidence and mortality and is accompanied by lack of organized CC screening programs, lack of health-care facilities, and a lack of human papillomavirus (HPV) vaccination among female population in the world, particularly China. We recruited 487 females who visited the outpatient department of the First People’s Hospital of Yunnan Province from November 2015 to January 2016 to complete a standardized-designed questionnaire. We found that only 39.6% of the females knew about the role of HPVs in the development of cervical cancer. Moreover, none of the females knew that HPV could cause penile carcinomas, perianal carcinomas, and head and neck carcinomas. The majority of the participants acquired information about cervical cancer, HPV, and the HPV vaccine from medical workers. Only 15.6% of the recruited females had heard about the HPV vaccine. The overall HPV vaccine acceptance rate was higher (91.2%) if the vaccine was available free of cost. In this study, we found high acceptability of the HPV vaccine in Chinese women and high awareness about cervical cancer. However, very low levels of knowledge about HPVs and their role in cancer development among the recruited women is alarming. Therefore, it is very important to initiate educational programs to raise awareness and knowledge about cervical cancer, HPV, and the HPV vaccine in this region.

Knowledge, understanding, attitude, perception and views on HPV infection and vaccination among health care students and professionals in Malaysia

The human papilloma virus (HPV) is known to be a major causative agent of cervical cancers and warts, limited study has been conducted on its associated factors among health care students and professionals in Malaysia. The present study was carried to explore the knowledge, understanding, attitude, perception and views about HPV infection and vaccination. A total of 576 respondents were recruited to complete a self-administered questionnaire through convenience sampling across Malaysia. 80.% and of the females respondents exhibited a positive attitude towards knowledge and understanding and 60% exhibited a positive towards attitude, perception and views. Almost 65% of the population were in agreement that HPV can be transmitted sexually, and 56.7% felt strongly that sexually active persons should essentially be vaccinated. The corresponding values were somewhat lower among the male respondents. Regression analysis suggested that knowledge and understanding were strong associated with gender, age, and occupation. Attitude, perception and views were also evidently associated with gender and age. The Ministry of Health should take steps to improve awareness among the citizens. Efforts should be made to educate people on the risk of HPV as a sexually transmitted diseases associated with HPV, and on the availability of discounted and safe HPV vaccines in government hospitals to increase the uptake rate of HPV vaccines among the Malaysian population.

Knowledge and Perception Towards Cervical Cancer among Female Debre Berhan University Students

Background: Cervical cancer is a global public health problem with around five hundred thirty thousand new cases and two hundred sixty five thousand deaths annually in 2015. Risky behaviors, lack of knowledge and preventative measures in young women, increase the risks of cervical cancer later in life. Up to date, there is scarcity of study on level of knowledge and perception towards cervical cancer among young women in Ethiopia. So, this study was aimed to determine the level of knowledge and perception toward cervical cancer among female regular undergraduate Debre Berhan University students. Methods: A facility based cross-sectional study was conducted using self-administered questionnaire among female regular DBU students from May to June, 2015. Two stage cluster sampling technique was used for the study. Data was entered and cleaned in Epi info and imported to SPSS for analysis. Binary logistic regression was carried out to determine factors of good knowledge on cervical cancer. P-value less than 0.05 was considered for statistical significance. Results: Eighty-four (14.5%) of the study participants were sexually active. Of the participants, 232(40.5%) had heard of cervical cancer but only 195 (35.6%) had good knowledge towards cervical cancer and of the study participants, only 185 (33.2%) perceived as they are susceptible for cervical cancer. Using radio and TV as source of information [AOR= 1.918 (95% CI: 1.223, 3.010)], having information about sexually transmitted infections (STI) [AOR =3.030 (95% CI: 1.665, 5.514)] were significantly and independently associated with good knowledge on cervical cancer. Conclusions: The level of knowledge towards cervical cancer and perception of acquiring the disease was poor. Health education interventions are needed to improve the awareness and health seeking behavior in youth women thereby preventing cervical cancer related morbidity and mortality.

Severity of obstructive sleep apnea (OSA) in 382 Han and Uyghur patients with sleep disorders

Objective: Race and ethnicity may impact the prevalence and severity of Obstructive Sleep Apnea (OSA) in adults and children. In this study, we aim to investigate the ethnologic influence on OSA severity between Han and Uyghur OSA patients in Xinjiang, China.

Methods: We enrolled total of 382 (205 Han and 177 Uyghur) patients diagnosed with OSA with apnea/hypopnea index (AHI) or respiratory disturbance index (RDI) [Formula: see text] 5. During admission, the severity of OSA was evaluated by polysomnography (PSG).

Results: From demographic characteristics of enrolled patients, we found that there was no significant difference in sex, age, BMI, and neck circumference between two study populations. Uyghur OSA patients had longer sleep latency, longer REM sleep and N3 stage, but shorter N1 phase than Han OSA patients. AHI and apnea RDI level, but not hypopnea RDI, were evidently higher in Han patients compared with Uyghur patients. There was no distinctive difference between two ethnic populations in average and minimum peripheral capillary oxygen saturation (SaO2) level.

Conclusion: Better understanding of impact factors encompassing ethnicity may help improve OSA diagnosis accuracy, management and treatment for patients in Xinjiang.

Frequency distribution of HLA alleles and haplotypes in Uyghur women with advanced squamous cell cervical cancer and relation to HPV status and clinical outcome

PURPOSE

This study aims to investigate the association of human leukocyte antigen (HLA) alleles and haplotypes in Uyghur women with advanced squamous cell cervical cancer (SCC).

METHODS

A total of 131 Uyghur patients with advanced SCC (IIb-IVa) and 91 healthy subjects from Xinjiang province were genotyped for HLA-I and II genes using Polymerase Chain Reaction Sequence Based Typing. The different frequencies of HLA alleles and haplotypes between patients and controls were compared and the correlations were analyzed between HLA distribution and HPV status and prognosis.

RESULTS

(1) The frequencies of B*51:01, DRB1*07:01, DQB1*02:01, A*01:01-C*06:02, A*01:01-DRB1*07:01, C*06:02-DQB1*02:01, DRB1*07:01-DQB1*02:01 and C*06:02-DRB1*07:01-DQB1*02:01 in cancer group were higher than control group whereas the frequencies of B*44:02, B*58:01, C*05:01, DRB1*04:01, DRB1*12:01, DRB1*13:01, DQB1*02:02, DQB1*05:02, DRB1*03:01-DQB1*02:02 and DRB1*04:01-DQB1*03:02 in cancer group were lower than control group (P < 0.05). (2) The frequencies of A*01:01-C*06:02, A*01:01-DRB1*07:01, C*06:02-DQB1*02:01, DRB1*07:01-DQB1*02:01 and C*06:02-DRB1*07:01-DQB1*02:01 in HPV positive group were lower than HPV negative group, differences of which were statistically significant (P < 0.05). (3) B*44:02 and B*58:01 were associated with reduced disease-specific survival (DSS) (P = 0.010 and 0.007). (4) Multivariate Cox proportional hazard models revealed that age, International Federation of Gynaecology and Obstetrics (FIGO) stage, tumor differentiation and allele B*58:01 as independent predictors for DSS while FIGO stage and tumor differentiation as independent factors for DFS.

CONCLUSIONS

In the development and progression of advanced SCC among Uyghur population, the HLA alleles and its haplotypes play an important role. B*58:01 allele may act as an independent predictor for DSS.

Factors involved in human papillomavirus (HPV) vaccine hesitancy among women in the South-East Asian Region (SEAR) and Western Pacific Region (WPR): A scoping review

A scoping review was performed to identify factors that may lead to human papillomavirus (HPV) vaccine hesitancy among women in low- and middle-income countries in South East Asian Region (SEAR) and Western Pacific Region (WPR). A systematic search of English and non-English articles using Pubmed, EMBASE, PsycINFO, Cochrane, MEDLINE, and CINAHL plus was conducted. Only 63 studies conducted in SEAR and WPR were included from inception until December 2016. Results of these studies have shown that poor awareness and knowledge of practices on cervical cancer prevention was evident in both SEAR and WPR. Concerns on safety and efficacy of the vaccine, and costs in getting vaccinated were significant barriers. Most women stated that they needed more information, and strongly welcomed a physician's recommendation in both geographical regions. Women also felt they have a low risk of acquiring HPV infection and cervical cancer. Most women in SEAR and WPR were unable to decide on whether to accept HPV vaccination.

Assessing Knowledge and Attitudes towards Cervical Cancer Screening among Rural Women in Eastern China

There is a heavy burden of cervical cancer in China. Although the Chinese government provides free cervical cancer screening for rural women aged 35 to 59 years, the screening rate remains low even in the more developed regions of eastern China. This study aimed to assess knowledge and attitudes about cervical cancer and its screening among rural women aged 30 to 65 years in eastern China. A cross-sectional study was conducted in four counties of Jining Prefecture in Shandong Province during August 2015. In total, 420 rural women were randomly recruited. Each woman participated in a face-to-face interview in which a questionnaire was administered by a trained interviewer. A total of 405 rural women (mean age 49 years old) were included in the final study. Among them, 210 (51.9%) participants had high knowledge levels. An overwhelming majority, 389 (96.0%) expressed positive attitudes, whilst only 258 (63.7%) had undergone screening for cervical cancer. Related knowledge was higher amongst the screened group relative to the unscreened group. Age, education and income were significantly associated with a higher knowledge level. Education was the only significant factor associated with a positive attitude. In addition, women who were older, or who had received a formal education were more likely to participate in cervical cancer screening. The knowledge of cervical cancer among rural women in eastern China was found to be poor, and the screening uptake was not high albeit a free cervical cancer screening program was provided. Government led initiatives to improve public awareness, knowledge, and participation in cervical cancer screening programs would likely be highly beneficial in reducing cervical cancer incidence and mortality for rural women.

Perceived Risk of Cervical Cancer and Barriers to Screening among Secondary School Female Teachers in Al Hassa, Saudi Arabia

Background:

No previous studies had addressed the perceived risk of cervical cancer (CC) and its influence on screening practices and perceived barriers in Saudi Arabia.

Methods:

This cross-sectional study was conducted on 506 randomly selected Saudi female secondary school teachers in Al Hassa, Saudi Arabia to assess their level of knowledge about risk factors and signs of CC in relation to perceived risk and to characterize CC screening compliance using a self-administered questionnaire.

Results:

Of the included female Saudi teachers, 65.4% and 63.4% were considered less-knowledgeable about CC risk factors and early signs and symptoms respectively. Only 17.2% reported being previously examined for CC. The majority of participants perceived themselves to be at an average or below average risk of CC. Residing in urban areas was the strongest predictor of CC screening (Odds ratio ‘OR’= 3.39; 95% confidence intervals ‘CI= 1.76-6.46; P=0.001). Awareness of risk factors was significantly associated with higher awareness of signs of CC (OR 2.5; 95% CI=, P=0.001). Exploratory factor analysis showed that personal fears (of screening being embarrassing) was the major factor that hindered CC screening with a high loading eigenvalue of 4.392, explaining 30.8% of the barriers toward utilization, followed by health care related factors.

Conclusion:

Secondary school teachers in Al Hassa, Saudi Arabia showed low perceived risk, poor awareness about risk factors, signs and symptoms of CC and limited uptake of screening practices. This underlines the need for education programs on CC targeting this group.

Awareness of Cervical Cancer and Pap Smear Testing Among Omani Women

Background:

In developed countries, awareness of cervical cancer screening is well documented. In contrast, in Oman as a developing country, public responses regarding cervical screening are unclear. This study aimed to assess the level of awareness about cervical cancer and Papanicolau (Pap) smear testing and to establish any correlations between knowledge and demographic factors among Omani women.

Methods:

In this cross-sectional survey, participants were divided into three groups: patients who attended the Outpatient Gynecology Department in Sultan Qaboos University Hospital (SQUH), Oman, female staff from SQUH, College of Medicine and College of Nursing at Sultan Qaboos University (SQU) and graduating female students at SQU. Data collection was through interview-based and online self-administered questionnaires. Cumulative scoring was used for data analysis.

Results:

There were 204 outpatients, 133 staff and 157 students. Outpatients (79.4%), staff (97.7%) and students (75.2%) had heard of cervical cancer. Nevertheless, their specific knowledge, regarding signs and symptoms, risk factors and Pap smear, was low at 38.7%, 35.3% and 7.6% among outpatients, staff and students, respectively. Some 39.9% of the married outpatients had adequate overall knowledge as compared to none of the single women. Educational level was found to be significantly associated with outpatient knowledge with the highest awareness levels among postgraduates and medical university graduates (61.5%).

Conclusion:

Specific knowledge of cervical cancer, its risk factors and cervical Pap smear is generally poor among Omani women. This lack of knowledge may be one of the contributing factors for the high incidence of cervical cancer in Oman relative to that in developed countries.

Global Perspectives on Cancer Health Disparities: Impact, Utility, and Implications for Cancer Nursing

This paper examines cancer health disparities and contributing factors at national, regional, and international levels. The authors all live in different countries and regions with different health-care systems and practices. Despite the shared cancer nursing perspective, each country or global region approaches cancer disparities differently. With globalization the world is becoming smaller, and in turn becoming interconnected and interdependent. This article focuses on cancer health disparities and global cancer nursing, exemplifying these concepts about the impact and implications of person-centered care.

Awareness and knowledge about human papillomavirus vaccination and its acceptance in China: a meta-analysis of 58 observational studies

Background

The human papillomavirus (HPV) vaccines have been widely introduced in immunization programs worldwide, however, it is not accepted in mainland China. We aimed to investigate the awareness and knowledge about HPV vaccines and explore the acceptability of vaccination among the Chinese population.

Methods

A meta-analysis was conducted across two English (PubMed, EMBASE) and three Chinese (China National Knowledge Infrastructure, Wan Fang Database and VIP Database for Chinese Technical Periodicals) electronic databases in order to identify HPV vaccination studies conducted in mainland China. We conducted and reported the analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

Fifty-eight unique studies representing 19 provinces and municipalities in mainland China were assessed. The pooled awareness and knowledge rates about HPV vaccination were 15.95 % (95 % CI: 12.87–19.29, I² = 98.9 %) and 17.55 % (95 % CI: 12.38–24.88, I² = 99.8 %), respectively. The female population (17.39 %; 95 % CI: 13.06–22.20, I² = 98.8 %) and mixed population (18.55 %; 95 % CI: 14.14–23.42, I² = 98.8 %) exhibited higher HPV vaccine awareness than the male population (1.82 %; 95 % CI: 0.50–11.20, I² = 98.5 %). Populations of mixed ethnicity had lower HPV vaccine awareness (9.61 %; 95 % CI: 5.95–14.03, I² = 99.0 %) than the Han population (20.17 %; 95 % CI: 16.42–24.20, I² = 98.3 %). Among different regions, the HPV vaccine awareness was higher in EDA (17.57 %; 95 % CI: 13.36–22.21, I² = 98.0 %) and CLDA (17.78 %; 95 % CI: 12.18–24.19, I² = 97.6 %) than in WUDA (1.80 %; 95 % CI: 0.02–6.33, I² = 98.9 %). Furthermore, 67.25 % (95 % CI: 58.75–75.21, I² = 99.8 %) of participants were willing to be vaccinated, while this number was lower for their daughters (60.32 %; 95 % CI: 51.25–69.04, I² = 99.2 %). The general adult population (64.72 %; 95 % CI: 55.57–73.36, I² = 99.2 %) was more willing to vaccinate their daughters than the parent population (33.78 %; 95 % CI: 26.26–41.74, I² = 88.3 %). Safety (50.46 %; 95 % CI: 40.00–60.89, I² = 96.6 %) was the main concern about vaccination among the adult population whereas the safety and efficacy (68.19 %; 95 % CI: 53.13–81.52, I² = 98.6 %) were the main concerns for unwillingness to vaccinate their daughters.

Conclusions

Low HPV vaccine awareness and knowledge was observed among the Chinese population. HPV vaccine awareness differed across sexes, ethnicities, and regions. Given the limited quality and number of studies included, further research with improved study designis necessary.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2873-8) contains supplementary material, which is available to authorized users.

Update on human papillomavirus vaccination: Where are we now?

Infection with human papillomavirus (HPV) is the major cause of pre-invasive and invasive lesions of the urogenital tract, resulting in morbidity and mortality worldwide. HPV-related infection is responsible for most cases of cervical cancer, a leading cause of cancer death in women worldwide. Developed countries have screening programs in place to detect precancerous lesions at early stages; in resource-limited settings however, HPV related diseases are often identified in advanced stages. This is due to limitations in the availability and roll out of effective screening programs. The relatively recent availability of the HPV vaccine has provided a new public health opportunity to decrease the incidence of HPV-related disease. The high mortality rates seen in developing countries could be reduced through effective implementation of HPV vaccination programs. Large trials have proven the efficacy of bivalent, quadrivalent vaccine and most recently 9-valent vaccine. Uptake in vaccination remains low due to multiple barriers including lack of education, lack of access, and costs. New strategies are being assessed to increase access, increase knowledge and reduce costs that may result in feasible vaccination programs worldwide. The goal of this article is to review the effectiveness and safety of the current HPV vaccines available, vaccine delivery strategies, cost effectiveness, and efforts to improve the acceptability. A literature search was conducted through PubMed using the terms “HPV vaccination, and safety, and males, and acceptability and strategies, and cost effectiveness,”focusing on articles published between 2006 and 2015. The most relevant and larger scale trials were evaluated for discussion.

Romanian adolescents' knowledge and attitudes towards human papillomavirus infection and prophylactic vaccination

OBJECTIVES

Since licensure of HPV vaccine in 2006, HPV vaccine coverage among Romanian adolescents remains worryingly low. The objectives of the study were to assess the knowledge and attitudes towards HPV infection and vaccination among Romanian adolescents and to explore the barriers to HPV vaccination with a view to developing strategies for expanding primary HPV infection prevention.

STUDY DESIGN

This study was conducted in Bucharest between April and June 2015. A total of 524 adolescents aged 16-18 years old were recruited from the first two general highschools in Bucharest (according to the admission grade) and completed a self-administered questionnaire including demographics, HPV related and Papanicolau smear test knowledge. Odds ratio and 95% confidence intervals were used to identify the strength of association. Logistic regression analysis was used to identify the effect of demographic characteristics on the level of knowledge and HPV vaccination rate. Associations were considered statistically significant at p<0.05.

RESULTS

Of the adolescents interviewed, a very small proportion had heard of HPV infection, HPV vaccine and Papanicolau smear test, that is, 20.22%, 67.92% and 22.9%, respectively. The overall vaccination rate for this group was 2.3%. The most common reason for not receiving the HPV vaccine was the lack of information (80.6%) followed by parents' concerns regarding safety (11%), fear of pain (5.59%) and not being sexually active (2.7%). However, 97.7% of the respondents declared interest in receiving more information about HPV. According to demographic characteristics, age at first sexual intercourse over 16 years old, monthly household income over one thousand euros and self-perceived good relationship with family members were statistically associated on a multivariate logistic regression analysis with a high HPV knowledge score and rate of vaccination.

CONCLUSIONS

This study shows a low level of knowledge about HPV infection and prophylactic vaccination among Romanian adolescents which may be one of the most important factors for the alarmingly low HPV vaccination rate. We specifically call for HPV knowledge and awareness programs; the implication of health professionals, Romanian media and family members should be included as a centrepiece in the effort to inform this vulnerable population group.