Abstract
The human papillomavirus (HPV) vaccine is one of the most cost-effective public health measures for preventing cervical cancer and other HPV-related diseases. However, the vaccine uptake in many countries remains suboptimal. This cross-sectional study aimed to assess the knowledge and awareness of parents towards HPV, related diseases, and HPV vaccines, as well as to examine the effect of brief educational information on parents’ vaccine acceptability. We used a structured interviewer-administered questionnaire to collect information from 227 outpatient visitors to a healthcare center who had children under the age of 19 years. We asked parents again about their acceptance of HPV vaccines after being provided brief educational information. Of all the parents, 43% were aware of HPV and related diseases, and 59% of those had sufficient knowledge regarding HPV while 45% of them reported that they were aware of HPV vaccines. Being Northern Cypriot was a predictor of having good knowledge, whilst being a female, having a higher education level, being 35 years or older, and being employed were the significant predictors of having greater awareness of HPV and related diseases. The HPV vaccine acceptance of the parents increased substantially in all sociodemographic groups after the provision of the educational information. The findings demonstrated that the vaccination rates of children of parents who have insufficient knowledge and awareness of HPV and vaccines are also very low. Effective educational interventions based on the specific sociodemographic characteristics of the patients should be given a stronger focus to improve vaccine acceptability among this population.
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29 January 2022
The journal title in the running head was published as ‘The Journal of Primary Prevention’. This has been corrected as ‘Journal of Prevention’.
References
Adjei Boakye, E., Tobo, B. B., Rojek, R. P., Mohammed, K. A., Geneus, C. J., & Osazuwa-Peters, N. (2017). Approaching a decade since HPV vaccine licensure: Racial and gender disparities in knowledge and awareness of HPV and HPV vaccine. Human Vaccines and Immunotherapeutics, 13(11), 2713–2722. https://doi.org/10.1080/21645515.2017.1363133
Bianco, A., Pileggi, C., Iozzo, F., Nobile, C. G. A., & Pavia, M. (2014). Vaccination against human papilloma virus infection in male adolescents: Knowledge, attitudes, and acceptability among parents in Italy. Human Vaccines and Immunotherapeutics, 10(9), 2536–2542. https://doi.org/10.4161/21645515.2014.969614
Brewer, N. T., & Fazekas, K. I. (2007). August 9). Predictors of HPV vaccine acceptability: A theory-informed, systematic review. Preventive Medicine, 45, 107–114. https://doi.org/10.1016/j.ypmed.2007.05.013
Chido-Amajuoyi, O. G., Jackson, I., Yu, R., & Shete, S. (2021). Declining awareness of HPV and HPV vaccine within the general US population. Human Vaccines and Immunotherapeutics, 17(2), 420–427. https://doi.org/10.1080/21645515.2020.1783952
Clark, K. T., & Trimble, C. L. (2020). Current status of therapeutic HPV vaccines. Gynecologic Oncology, 156(2), 503–510. https://doi.org/10.1016/j.ygyno.2019.12.017
Creed, S., Walsh, E., & Foley, T. (2021). A qualitative study of parental views of HPV vaccination in Ireland. European Journal of General Practice, 27(1), 1–9. https://doi.org/10.1080/13814788.2020.1851677
Cunningham, M. S., Davison, C., & Aronson, K. J. (2014). December 1). HPV vaccine acceptability in Africa: A systematic review. Preventive Medicine, 69, 274–279. https://doi.org/10.1016/j.ypmed.2014.08.035
Dang, J. H. T., Stewart, S. L., Blumberg, D. A., Rodriguez, H. P., & Chen, M. S. (2020). “There’s always next year”: Primary care team and parent perspectives on the human papillomavirus vaccine. Human Vaccines and Immunotherapeutics, 16(8), 1814–1823. https://doi.org/10.1080/21645515.2019.1710410
Davis, K., Dickman, E. D., Ferris, D., & Dias, J. K. (2004). Human papillomavirus vaccine 10- to 15-year-old adolescents. Journal of Lower Genital Tract Disease, 8(3), 188–194.
de Sanjose, S., Brotons, M., LaMontagne, D. S., & Bruni, L. (2019). Human papillomavirus vaccine disease impact beyond expectations. Current Opinion in Virology, 39, 16–22. https://doi.org/10.1016/j.coviro.2019.06.006
Della Polla, G., Pelullo, C. P., Napolitano, F., & Angelillo, I. F. (2020). HPV vaccine hesitancy among parents in Italy: A cross-sectional study. Human Vaccines and Immunotherapeutics, 16(11), 2744–2751. https://doi.org/10.1080/21645515.2020.1744367
Denny, L. A., Franceschi, S., de Sanjosé, S., Heard, I., Moscicki, A. B., & Palefsky, J. (2012). Human papillomavirus, human immunodeficiency virus and immunosuppression. Vaccine, 30, F168–F174. https://doi.org/10.1016/j.vaccine.2012.06.045
Dixon, B. E., Zimet, G. D., Xiao, S., Tu, W., Lindsay, B., Church, A., & Downs, S. M. (2019). An educational intervention to improve HPV vaccination: A cluster randomized trial. Pediatrics, 143(1), e20181457. https://doi.org/10.1542/peds.2018-1457
Drolet, M., Bénard, É., Pérez, N., Brisson, M., Ali, H., Boily, M. C., Yu, B. N., et al. (2019). Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: Updated systematic review and meta-analysis. The Lancet, 394(10197), 497–509. https://doi.org/10.1016/S0140-6736(19)30298-3
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016a). Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1–4. https://doi.org/10.11648/j.ajtas.20160501.11
Fesenfeld, M., Hutubessy, R., & Jit, M. (2013). Cost-effectiveness of human papillomavirus vaccination in low and middle income countries: A systematic review. Vaccine, 31(37), 3786–3804. https://doi.org/10.1016/j.vaccine.2013.06.060
Fisher, H., Trotter, C. L., Audrey, S., MacDonald-Wallis, K., & Hickman, M. (2013). Inequalities in the uptake of human papillomavirus vaccination: A systematic review and meta-analysis. International Journal of Epidemiology, 42(3), 896–908. https://doi.org/10.1093/ije/dyt049
Gantz, L., Calvo, A., Hess-Holtz, M., Gonzales, F., Alguero, L., Murphy, S., Baezconde-Garbanati, L., et al. (2019). Predictors of HPV knowledge and HPV vaccine awareness among women in Panama City, Panama. World Medical and Health Policy, 11(1), 95–118. https://doi.org/10.1002/wmh3.293
Gargano, L. M., Herbert, N. L., Painter, J. E., Sales, J. M., Morfaw, C., Rask, K., Hughes, J. M., et al. (2013). Impact of a physician recommendation and parental immunization attitudes on receipt or intention to receive adolescent vaccines. Human Vaccines and Immunotherapeutics, 9(12), 2627–2633. https://doi.org/10.4161/hv.25823
George, C., Roberts, R., Brennen, D., Deveaux, L., & Read, S. E. (2020). Knowledge and awareness of human papillomavirus (HPV) and HPV vaccines among Caribbean youth: The case of the Bahamas. Human Vaccines and Immunotherapeutics, 16(3), 573–580. https://doi.org/10.1080/21645515.2019.1661205
Hansen, B. T., Campbell, S., Burger, E., & Nygård, M. (2015). Correlates of HPV vaccine uptake in school-based routine vaccination of preadolescent girls in Norway: A register-based study of 90,000 girls and their parents. Preventive Medicine, 77, 4–10. https://doi.org/10.1016/j.ypmed.2015.04.024
Hansen, C. E., Credle, M., Shapiro, E. D., & Niccolai, L. M. (2016). “It all depends”: A qualitative study of parents’ views of human papillomavirus vaccine for their adolescents at ages 11–12 years. Journal of Cancer Education, 31(1), 147–152. https://doi.org/10.1007/s13187-014-0788-6
Holman, D. M., Benard, V., Roland, K. B., Watson, M., Liddon, N., & Stokley, S. (2014). Barriers to human papillomavirus vaccination among us adolescents a systematic review of the literature. JAMA Pediatrics, 168, 76–82. https://doi.org/10.1001/jamapediatrics.2013.2752
Klug, S. J., Hukelmann, M., & Blettner, M. (2008). Knowledge about infection with human papillomavirus: A systematic review. Preventive Medicine, 46(2), 87–98. https://doi.org/10.1016/j.ypmed.2007.09.003
Lefevere, E., Hens, N., Theeten, H., Van Den Bosch, K., Beutels, P., De Smet, F., & Van Damme, P. (2011). Like mother, like daughter? Mother’s history of cervical cancer screening and daughter’s Human Papillomavirus vaccine uptake in Flanders (Belgium). Vaccine, 29(46), 8390–8396. https://doi.org/10.1016/j.vaccine.2011.08.039
Lei, J., Ploner, A., Elfström, K. M., Wang, J., Roth, A., Fang, F., et al. (2020). HPV vaccination and the risk of invasive cervical cancer. New England Journal of Medicine, 383(14), 1340–1348. https://doi.org/10.1056/nejmoa1917338
Lin, Y., Su, Z., Chen, F., Zhao, Q., Zimet, G. D., Alias, H., et al. (2021). Chinese mothers’ intention to vaccinate daughters against human papillomavirus (HPV), and their vaccine preferences: A study in Fujian Province. Human Vaccines and Immunotherapeutics, 17(1), 304–315. https://doi.org/10.1080/21645515.2020.1756152
Marlow, L. A. V., Waller, J., & Wardle, J. (2007a). Public awareness that HPV is a risk factor for cervical cancer. British Journal of Cancer, 97(5), 691–694. https://doi.org/10.1038/sj.bjc.6603927
Marlow, L. A. V., Waller, J., & Wardle, J. (2007b). Parental attitudes to pre-pubertal HPV vaccination. Vaccine, 25(11), 1945–1952. https://doi.org/10.1016/j.vaccine.2007.01.059
Marlow, L. A. V., Zimet, G. D., McCaffery, K. J., Ostini, R., & Waller, J. (2013). Knowledge of human papillomavirus (HPV) and HPV vaccination: An international comparison. Vaccine, 31(5), 763–769. https://doi.org/10.1016/j.vaccine.2012.11.083
Radisic, G., Chapman, J., Flight, I., & Wilson, C. (2017). Factors associated with parents’ attitudes to the HPV vaccination of their adolescent sons: A systematic review. Preventive Medicine, 95, 26–37. https://doi.org/10.1016/j.ypmed.2016.11.019
Statistical Institute. (2020). Turkish Republic of Northern Cyprus Statistical Yearbook 2019. Nicosia.
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209–249. https://doi.org/10.3322/caac.21660
Waller, J., Ostini, R., Marlow, L. A. V., McCaffery, K., & Zimet, G. (2013). Validation of a measure of knowledge about human papillomavirus (HPV) using item response theory and classical test theory. Preventive Medicine, 56(1), 35–40. https://doi.org/10.1016/j.ypmed.2012.10.028
Wang, R., Pan, W., Jin, L., Huang, W., Li, Y., Wu, D., et al. (2020b). Human papillomavirus vaccine against cervical cancer: Opportunity and challenge. Cancer Letters, 471(2019), 88–102. https://doi.org/10.1016/j.canlet.2019.11.039
WHO. (2014). Comprehensive cervical cancer control: A guide to essential practice (2nd edn). Retrieved from https://apps.who.int/iris/bitstream/handle/10665/144785/9789241548953_eng.pdf;jsessionid=68E7F784D21BFCB74C625DB7A6857484?sequence=1%0Ahttp://apps.who.int/iris/bitstream/10665/144785/1/9789241548953_eng.pdf. Accessed 5 May 2021
WHO. (2016). Scaling-up HPV vaccine introduction. In National Health Programs. I.World Health Organization (Vol. 1). Retrieved from http://www.who.int. Accessed 20 January 2019
WHO. (2017). Human papillomavirus vaccines: WHO position paper,May 2017. Weekly Epidemiological Record, 92(19), 241–268. Retrieved from https://www.who.int/wer. Accessed 4 May 2021
WHO. (2018). Human Papillomavirus: Vaccine-Preventable Diseases Surveillance Standards. World Health Organization, Geneva Switzerland. Retrieved from: https://www.who.int/publications/m/item/vaccine-preventable-diseases-surveillance-standards-hpv. Accessed 10 May 2021
WHO. (2020). Human Papillomavirus (HPV) and Cervical Cancer. Retrieved from Key Facts website: https://www.who.int/en/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer. Accessed 15 May 2021
Acknowledgements
The authors would like to thank intern doctors Feriha Tümer, Gülcihan Deniz, Cemal Özanalp, Deniz Aksoy, and Fikret Muhyi for their contribution in data collection process. Moreover, also thank the participants for participating the study and sharing their valuable information.
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Abuduxike, G., Asut, O., Cali, S. et al. Knowledge and Awareness of Parents Towards Human Papillomavirus (HPV) and HPV Vaccines, and Vaccine Acceptability in Northern Cyprus. J Primary Prevent 43, 225–240 (2022). https://doi.org/10.1007/s10935-021-00657-w
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DOI: https://doi.org/10.1007/s10935-021-00657-w