Women’s Knowledge, Attitudes, and Intentions Concerning Human Papillomavirus Vaccination: Findings of a Waiting Room Survey of Obstetrics-Gynaecology Outpatients

doi:10.1016/S1701-2163(16)32864-X

Journal of Obstetrics and Gynaecology Canada

Volume 30, Issue 6, June 2008, Pages 489-499

https://doi.org/10.1016/S1701-2163(16)32864-X Get rights and content

Abstract

Objective

To assess women’s knowledge, attitudes, and behaviours related to Human Papillomavirus (HPV) and HPV vaccination.

Methods

A self-administered questionnaire was completed by 98 women (90.7% response rate) attending a hospital-based obstetrics and gynaecology outpatient clinic in a mid-size Ontario city.

Results

Women had a moderate level of knowledge of general HPV-related issues, but lacked information about the ability of barrier contraception to prevent HPV and about characteristics of HPV vaccination. Women were strongly supportive of HPV vaccination for both male and female teenagers, but reported low levels of intention to receive vaccination themselves. Physician recommendation was the most influential factor in women intention to be vaccinated, and younger women were more likely to say they intended to be vaccinated. HPV-related knowledge, level of education, and number of previous sexual partners were unrelated to women’s intentions to receive HPV vaccination.

Conclusion

Findings indicate that women’s knowledge about HPV vaccination is inconsistent, that women are supportive of vaccinating both male and female teenagers, and that physician recommendation and younger age are associated with women’s interest in receiving the vaccine.

Résumé

Objectif

Évaluer les connaissances, les attitudes et les comportements des femmes en ce qui a trait au virus du papillome humain (VPH) et à la vaccination anti-VPH.

Méthodes

Un questionnaire auto-administré a été rempli par 98 femmes (taux de réponse de 90,7 %) qui ont fréquenté une clinique hospitalière offrant des services ambulatoires en obstétrique-gynécologie au sein d’une ville ontarienne de taille moyenne.

Résultats

Les femmes présentaient un niveau modéré de connaissances quant aux questions générales associées au VPH, mais manquaient de renseignements au sujet de la capacité des méthodes contraceptives de barrière de prévenir le VPH, ainsi qu’au sujet des caractéristiques de la vaccination anti-VPH. Les femmes affirmaient être fortement en faveur de la vaccination anti-VPH tant pour les adolescentes que pour les adolescents, mais signalaient de faibles niveaux d’intention quant à leur propre vaccination. La recommandation de la part d’un médecin constituait le facteur ayant le plus d’influence sur la décision des femmes de se faire vacciner; de plus, les jeunes femmes étaient plus susceptibles d’affirmer qu’elles avaient l’intention de se faire vacciner. Les connaissances au sujet du VPH, le niveau de scolarité et le nombre de partenaires sexuels précédents n’exerçaient aucune influence sur les intentions des femmes quant à la vaccination anti-VPH.

Conclusion

Les résultats indiquent que les connaissances des femmes au sujet de la vaccination anti-VPH sont hétérogènes, que les femmes soutiennent la vaccination tant des adolescentes que des adolescents et que la recommandation de la part d’un médecin et le jeune âge sont associés à l’intérêt qu’éprouvent les femmes envers la vaccination.

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Cited by (36)

A Multiple Streams analysis of the decisions to fund gender-neutral HPV vaccination in Canada
2017, Preventive Medicine
Citation Excerpt :
Canadian studies report high acceptability of HPV vaccination for males. For example, a questionnaire conducted in a mid-size Ontario city revealed that mothers supported HPV vaccination for their daughters or sons (77.8% and 70.7% respectively) in their early teens; however, mothers were less willing to consent to vaccination of their younger children, 9 or 10-year-old daughters or sons (41.5% and 38.3%) (Lenehan et al., 2008). Ogilvie et al. (2008) examined acceptability of HPV vaccination for boys (N = 1381) across Canada and found that 67.8% of Canadian parents planned to vaccinate their sons but acceptability varied (from 61.7% in British Columbia/Yukon to 79.8% in Atlantic Canada) (Ogilvie et al., 2008).
In Canada, the human papillomavirus (HPV) vaccine is licensed and recommended for females and males. Although all Canadian jurisdictions fund school-based HPV vaccine programs for girls, only six jurisdictions fund school-based HPV vaccination for boys. The research aimed to analyze the factors that underpin government decisions to fund HPV vaccine for boys using a theoretical policy model, Kingdon's Multiple Streams framework. This approach assesses policy development by examining three concurrent, but independent, streams that guide analysis: Problem Stream, Policy Stream, and Politics Stream. Analysis from the Problem Stream highlights that males are affected by HPV-related diseases and are involved in transmitting HPV infection to their sexual partners. Policy Stream analysis makes clear that while the inclusion of males in HPV vaccine programs is suitable, equitable, and acceptable; there is debate regarding cost-effectiveness. Politics Stream analysis identifies the perspectives of six different stakeholder groups and highlights the contribution of government officials at the provincial and territorial level. Kingdon's Multiple Streams framework helps clarify the opportunities and barriers for HPV vaccine policy change. This analysis identified that the interpretation of cost-effectiveness models and advocacy of stakeholders such as citizen-advocates and HPV-affected politicians have been particularly important in galvanizing policy change.
Global Delivery of Human Papillomavirus Vaccines
2016, Pediatric Clinics of North America
Acceptability of using standing orders to deliver human papillomavirus vaccines in the outpatient obstetrician/gynecologist setting
2015, Vaccine
Citation Excerpt :
Instead, the majority of women surveyed (60%) indicated that they would prefer to first speak with their Ob/Gyn provider before receiving an HPV vaccine dose. This result highlights the well-documented importance of a clinician's recommendation in HPV vaccine utilization [18–21], and the fact that many patients look to their provider as the main source of vaccine-related information [11,22,23]. However, it also indicates that for a substantial proportion of women (i.e. 40%) a conversation with the clinician may not be necessary.
Standing orders, an effective method for increasing vaccination, are not widely used for HPV vaccine. This is especially so among obstetrician/gynecologists (Ob/Gyns) – the specialty many women use as their primary care provider. We sought to understand the acceptability of using standing orders for HPV vaccination among a sample of women attending outpatient Ob/Gyn clinics.
From February to April 2014, an on-line survey was administered to a convenience sample of 400 women aged 15–26 recruited from 9 Ob/Gyn practices in Colorado. The survey identified attitudes about standing orders for HPV vaccination, demographics and prior experience with HPV vaccines.
The response rate was 44%. Receipt of prior HPV vaccine doses was reported by 67% of respondents. Approximately half (53%) were comfortable with the idea of standing orders for HPV vaccination at Ob/Gyn clinics among women generally, but only 40% of the 154 women not initially opposed to HPV vaccination indicated they would personally feel comfortable receiving HPV vaccines offered under a standing order policy. General and personal acceptance of standing orders for HPV vaccination was significantly higher among women who reported receiving HPV vaccine doses previously, but not by any demographic or experiential variables. Acceptability of standing orders for HPV vaccines was higher for series completion than initiation (88% vs. 70%, p < 0.001) and was more commonly supported for adult patients (79%) than for adolescents (43%). Acceptability of standing orders increased if the patient was first told that the provider ‘strongly recommended the vaccine’, even for a majority (52%) of those who generally were not comfortable receiving the vaccine using standing orders.
Because standing orders for HPV vaccine are generally acceptable to women attending Ob/Gyn clinics, to increase vaccination uptake among adults Ob/Gyn providers may want to consider adoption of standing orders for HPV vaccine, at least for series completion.
HPV Awareness in Higher-Risk Young Women: The Need for a Targeted HPV Catch-Up Vaccination Program
2015, Journal of Obstetrics and Gynaecology Canada
To determine levels of HPV awareness and knowledge in higher-risk young women and their attitudes toward HPV vaccination and catch-up programs.
An anonymous, cross-sectional, Internet-based, self-reported questionnaire was completed by women ages 13 to 25 attending two outreach clinics. Primary outcomes were HPV infection/vaccine awareness, vaccination rates, and catch-up program acceptability. Chi-square, Fisher exact test, and logistic regression analyses were performed.
Of 105 respondents (mean age 19.32), 66.7% received social assistance and 54.3% relied on walk-in clinics. Overall HPV awareness was 81.0% and vaccine awareness was 76.2%. HPV awareness was significantly higher in women < 20 years old (P = 0.032) and with past sexually transmitted infection (STI) history (P = 0.039) but didn’t differ by education level. Vaccine awareness differed significantly with STI history (P = 0.031) but not by age or education level. Awareness of HPV’s association with genital warts and cervical cancer was low (30.0%, 41.9%) and didn’t differ by education level or sexually transmitted infection history. Thirty percent had been vaccinated (of those, 42% had received 3 doses), mainly in school-based programs (71%). Odds of vaccination were significantly higher in those with a family doctor (OR 8.08). Reasons for not being vaccinated included: “Did not know about it”(28.5%) and “Don’t know” (28.5%). Catch-up program acceptability was high (92.8%, 95.2% if free) and did not differ significantly by age or education level.
Higher-risk young women may have high levels of HPV infection/vaccine awareness but lack knowledge of HPV consequences. Those who missed or did not complete HPV vaccination opportunities would support free catch-up vaccination programs in accessible, youth-friendly centres.
Déterminer le niveau de sensibilisation au VPH et l’état des connaissances à ce sujet chez des jeunes femmes exposées à des risques accrus, ainsi que les attitudes de ces dernières envers la vaccination anti-VPH et les programmes de rattrapage.
Un questionnaire Web d’autoévaluation anonyme et transversal a été rempli par des femmes (âges : 13-25 ans) fréquentant deux cliniques destinées à des groupes mal desservis. La sensibilisation à l’infection au VPH / à la vaccination anti-VPH, les taux de vaccination et l’acceptabilité des programmes de rattrapage constituaient les critères d’évaluation principaux. Le test de chi carré, le test exact de Fisher et des analyses de régression logistique ont été menés.
Parmi les 105 répondantes (âge moyen : 19,32), 66,7 % recevaient de l’aide sociale et 54,3% avaient recours aux services de cliniques sans rendez-vous. Le taux global de sensibilisation au VPH était de 81,0 % et le taux de sensibilisation à la vaccination était de 76,2 %. La sensibilisation au VPH était considérablement accrue chez les femmes de moins de 20 ans (P = 0,032) et chez celles qui présentaient des antécédents d’infection transmissible sexuellement (ITS) (P = 0,039); toutefois, elle n’était pas affectée par le niveau de scolarité. La sensibilisation à la vaccination variait considérablement en fonction des antécédents d’ITS (P = 0,031), mais non pas en fonction de l’âge ou du niveau de scolarité. La sensibilisation à l’association entre le VPH et les verrues génitales et le cancer du col utérin était faible (30,0 %, 41,9 %) et ne variait ni en fonction du niveau de scolarité ni en fonction des antécédents d’ITS. Trente pour cent des répondantes avaient été vaccinées (chez celles-ci, 42 % avaient reçu trois doses), principalement dans le cadre de programmes scolaires (71 %). La probabilité d’une vaccination était considérablement accrue chez les répondantes qui pouvaient compter sur les services d’un médecin de famille (RC, 8,08). Parmi les raisons expliquant le fait de ne pas avoir été vaccinée, on trouvait les suivantes : « Je n’étais pas au courant » (28,5 %) et « Je ne sais pas » (28,5 %). L’acceptabilité des programmes de rattrapage était élevée (92,8 %, 95,2 % si l’accès était gratuit) et ne variait pas de façon considérable en fonction de l’âge ou du niveau de scolarité.
Les jeunes femmes exposées à des risques accrus pourraient disposer d’une sensibilisation élevée à l’infection au VPH / à la vaccination anti-VPH, tout en présentant un manque de connaissances quant aux conséquences du VPH. Celles qui n’ont pu se prévaloir d’occasions de se faire vacciner contre le VPH (ou qui n’ont pu terminer un cycle de vaccination anti-VPH) seraient en faveur de l’offre de programmes gratuits de rattrapage de la vaccination au sein de centres accessibles et axés sur la jeunesse.
Self-reported barriers and facilitators to preventive human papillomavirus vaccination among adolescent girls and young women: A systematic review
2014, Preventive Medicine
Widespread uptake of preventive human papillomavirus vaccination among target groups is an important public health goal. To evaluate barriers and facilitators to human papillomavirus vaccination, we conducted a systematic review of self-reported views of adolescent girls and young women.
Twenty-two studies including 8079 females aged 9–26 years in North America, published between 2008 and 2011 (representing studies conducted post-vaccine availability), were included. Two reviewers performed all levels of screening and data abstraction in duplicate. We collated findings pertaining to vaccination barriers and facilitators, study characteristics, and study quality.
Participants were mainly unvaccinated (70%) and sexually active. Twenty-one barriers to vaccination were identified. Cost was the most frequently reported barrier, followed by feelings that vaccination was unnecessary, and concerns regarding vaccine safety and side effects. Facilitators included perceived benefit of vaccination, health care provider recommendations, and social norms. Few studies specifically sought to isolate the views of adolescents, though not being sexually active was the most commonly reported barrier among this group.
Understanding factors which arbitrate in vaccination decisions among key target groups can improve the success of health promotion interventions. Additional studies of superior methodological quality are needed to produce reliable data to inform health promotion strategies.
The Impact of Ethnicity on Awareness and Knowledge of and Attitudes Towards the Human Papillomavirus and Vaccine Among Adult Women
2013, Journal of Obstetrics and Gynaecology Canada
Citation Excerpt :
If participants answered yes, they then responded to 10 true or false questions related to the vaccine. The items assessing vaccine knowledge were adapted from a published Canadian study.16 The correct responses were totalled to create a vaccine knowledge score, ranging from 0 to 10.
To determine whether ethnicity affects awareness, knowledge, and attitudes regarding the human papillomavirus (HPV) and the HPV vaccine.
English speaking women (n = 172) aged 18 and older were recruited from an outpatient gynaecology clinic to complete a self-administered cross-sectional questionnaire that gathered information about (1) virus awareness and knowledge, (2) vaccine awareness and knowledge, (3) attitudes towards the vaccine and (4) participant demographics. Subjects received a virus knowledge score (0 to 6), a vaccine knowledge score (0 to 10) and an attitudes score (8 to 40), with a higher score indicating more positive attitudes towards the vaccine.
Virus and vaccine awareness was significantly higher in Caucasian respondents than in non-Caucasian respondents: 93% versus 69% (P < 0.001) and 94% versus 64%, (P < 0.001), respectively. In a multivariate logistic regression model, the Caucasian ethnic group, higher education status, and greater number of years in Canada each emerged as independent predictors of vaccine awareness. Both virus and vaccine knowledge scores were significantly higher in Caucasian than non-Caucasian women: 4.6 versus 3.89 (P = 0.001) and 7.2 versus 6.4, (P = 0.042), respectively. Caucasian women had significantly higher (more positive) attitudes towards the vaccine than non-Caucasians (31.4 vs. 29.2, P = 0.021). Higher HPV vaccine knowledge was positively associated with an interest in vaccination (r² = 0.26, P < 0.01) and a more positive vaccine attitudes score (r² = 0.40, P < 0.001).
Virus and vaccine awareness were both higher in Caucasian women than in non-Caucasian women. Improving HPV vaccination knowledge has the potential to improve attitudes and vaccine uptake.
Déterminer si l’ethnicité affecte la sensibilisation au virus du papillome humain (VPH) et au vaccin anti-VPH, ainsi que les connaissances et les attitudes à leur égard.
La participation de femmes d’expression anglaise (n = 172) de 18 ans ou plus a été sollicitée au sein d’une clinique externe de gynécologie; nous leur avons demandé de remplir un questionnaire transversal autoadministré visant la collecte de données au sujet (1) de la sensibilisation au virus et des connaissances à cet égard; (2) de la sensibilisation au vaccin et des connaissances à cet égard; (3) des attitudes envers le vaccin; et (4) des caractéristiques démographiques des participantes. Celles-ci se sont vu attribuer un score sur les connaissances au sujet du virus (de 0 à 6), un score sur les connaissances au sujet du vaccin (de 0 à 10) et un score sur les attitudes (de 8 à 40), l’obtention d’un score accru indiquant des attitudes plus positives à l’égard du vaccin.
La sensibilisation au virus et au vaccin était considérablement plus élevée chez les répondantes de race blanche que chez les répondantes d’autres origines ethniques : 93 % vs 69 % (P < 0,001) et 94 % vs 64 %, (P < 0,001), respectivement. Dans le cadre d’un modèle de régression logistique multivariée, le groupe ethnique de race blanche, un niveau de scolarité supérieur et un nombre supérieur d’années passées au Canada ont tous constitué des facteurs prédictifs indépendants de la sensibilisation au vaccin. Les scores sur les connaissances au sujet du virus et du vaccin ont tous deux été considérablement plus élevés chez les répondantes de race blanche que chez les répondantes d’autres origines ethniques : 4,6 vs 3,89 (P = 0,001) et 7,2 vs 6,4, (P = 0,042), respectivement. Les répondantes de race blanche ont obtenu des scores sur les attitudes considérablement plus élevés (attitudes plus positives) en ce qui concerne le vaccin que les répondantes d’autres origines ethniques (31,4 vs 29,2, P = 0,021). Le fait de disposer de plus vastes connaissances au sujet du vaccin anti-VPH a été positivement associé au fait de s’intéresser à la vaccination (r² = 0,26, P < 0,01) et à l’obtention d’un score sur les attitudes à l’égard du vaccin plus positif (r² = 0,40,P < 0,001).
La sensibilisation au virus et au vaccin était plus élevée chez les répondantes de race blanche que chez les répondantes d’autres origines ethniques. L’amélioration des connaissances au sujet de la vaccination anti-VPH a le potentiel d’entraîner l’amélioration des attitudes et de la mesure dans laquelle le vaccin est utilisé.

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WOMEN'S HEALTHWomen’s Knowledge, Attitudes, and Intentions Concerning Human Papillomavirus Vaccination: Findings of a Waiting Room Survey of Obstetrics-Gynaecology Outpatients

Abstract

Objective

Methods

Results

Conclusion

Résumé

Objectif

Méthodes

Résultats

Conclusion

J Obstet Gynaecol Can

Lancet Infect Dis

Vaccine

Vaccine

J Adolesc Health

Eur J Obstet Gynecol Reprod Biol

Obstet Gynecol

J Obstet Gynaecol Can

Gynecol Oncol

Comprehensive cervical cancer control: a guide to essential practice

Aberrant cell cycle regulation in cervical carcinoma

Yonsei Med J

Human Papillomavirus: the most common sexually transmitted infection

Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: a meta-analysis update

Int J Cancer

Delivering on the promise: HPV vaccines and cervical cancer

Nat Rev Microbiol

Head and neck cancer

N Engl J Med

Human papillomavirus (HPV) in head and neck cancer. An association of HPV 16 with squamous cell carcinoma of Waldeyer’s tonsillar ring

Cancer

Prevalence of HPV infection among females in the United States

JAMA

Factors important in promoting cervical cancer screening among Canadian women: findings from the 1996–97 National Population Health Survey (NPHS)

Can J Public Health

Condom use and the risk of genital human papillomavirus infection in young women

N Engl J Med

WOMEN'S HEALTH
Women’s Knowledge, Attitudes, and Intentions Concerning Human Papillomavirus Vaccination: Findings of a Waiting Room Survey of Obstetrics-Gynaecology Outpatients