Knowledge, attitudes and acceptability of human papillomavirus vaccineamong female students and parents in Macao

Abstract

Human papillomavirus (HPV), a family of viruses with more than 40 genotypes is known to infect genital tract of males and females. High-risk HPV including genotypes 16, 18 can cause cervical cancer while low-risk HPV including genotypes 6, 11 can cause benign or low grade cervical lesions and genital warts. Considering HPV infection is the most common sexually transmitted infection worldwide, as well as in Macao, with prevalence up to 8.1%, and given that cervical cancer is the top ten most frequent female cancer which causes high burden in our health care system, it is important to have a comprehensive intervention for control HPV and cervical cancer. Since the HPV vaccine for preventing cervical cancer has been available in Macao, it is worth to know the willingness to be vaccinated among target population. Base on findings from previous studies, the parental attitudes and acceptance is the key factor of vaccination for young girls. Other potential factors, such as the HPV knowledge, vaccine safety and efficacy, cost, the age of daughter and the physician’s attitudes, may also affect parental acceptance. Given that no previous study on this topic has been conducted, this study is aimed to understand the knowledge, attitudes and acceptability of HPV vaccination, and to explore and identify the affecting factors for acceptance among school girls and their parents. A school-based simple cluster random sampling method was used. Data was collected by anonymous self-administrated questionnaires among 574 school girls aged at 12-22 and 702 parents aged at 30-65. About 47% of the school girls had heard of HPV and 88.3% had heard of HPV vaccine, while 57.1% of parents had heard of HPV and 83.2% had heard of HPV vaccine. Although the HPV-related knowledge was poor among young girls and their parents, 92% of girls indicated a positive intention to be vaccinated for herself and 88% parents would willing to consent daughter to be vaccinated if the HPV vaccine became in routine immunization. However, the parental vaccination acceptability for daughters decreased to 40% and only 30% of mothers would willing to accept for themselves, if they had to pay a full course for three doses of HPV vaccine. About 97% of school girls and 95% of parents supported that HPV vaccine should be included in government immunization programme. We also found that young girls and parents are more favor in later HPV vaccination rather than vaccination at recommended age. Cost is the dominant affecting factor in determining parental acceptability of HPV vaccination. In addition, daughter’s age, vaccine safety concern, Pap smear attendance and HPV knowledge are significantly associated with HPV vaccine acceptance. It may be worthwhile to further investigate the reasons for the delay vaccination among the young adolescent girls and among their parents, to examine if any underlying factors were unexpressed.