Knowledge And Attitudes Toward Prophylactic Human Papillomavirus(HPV)Vaccines Among The Mainland Chinese Population

ObjectiveTo assess knowledge of and attitudes toward prophylactic HPV vaccines among the mainland Chinese population and to determine possible influencing factors and solutions,in order to provide reference data for policymakers to develop HPV vaccination strategies in China.Besides,by investigating the age of sexual debut and parents’ concept of sex education,the study is to determine the best age group of children to receive education about sex and HPV vaccination.MethodsTwo large-scale national cross-sectional epidemiological studies were conducted from May to December 2009,and from November 2011 to May 2012 especially,in general female population,healthcare providers,government officials and junior school students9 parents,college students.Respondents were selected and recruited according the sample size and proportion in each site of the seven geographical regions.Informed consent was done before the investigation.Participants’ basic information,as well as their knowledge of and attitudes toward HPV vaccines,sexual history,sexual education concept,etc were collected through questionnaires.SPSS 21.0 was used for the statistical analysis.Except for descriptive statistics,rank-sum tests and Chi-Square tests were used for group comparisons,while univariate and multivariate logistic regression were performed to detect the influencing factors.Awareness rate,cognitive rate and acceptance rate were the main statistical index.See detailed definition in text body.ResultsA total of 11235 women responded effectively.Awareness rate,cognitive rate and acceptance rate were 28.6%,15.0%and 86.8%,respectively.Rural female population knew less about HPV vaccines but were more willing to be vaccinated,while those who had regular gynecological examinations knew more and were more likely to get vaccinated Occupation,education level,age,household income,etc affected the perception of HPV vaccines.Moreover,awareness of the HPV vaccines was the most important factor influencing women’s acceptance(adjusted OR was 2.82 and 95%CI was 2.48-3.21).Women primarily heard of HPV vaccines from doctors(44.1%)and participants who did not accept HPV vaccination were concerned mainly about the safety of the vaccines(54.7%).With regard to the vaccines’ prices,the median prices of imported and domestic vaccines that the investigated women could afford were 402.9 RMB and 227.9 RMB,respectively.Besides,the median age of sexual initiation was 21.4 years among mainland Chinese female population.In total,758 healthcare providers responded effectively to the questionnaire.Awareness rate,cognitive rate and acceptance rate were 62.7%,51.2%and 86.7%,respectively.88.7%would like to promote HPV vaccination.Healthcare providers from different departments and education levels had different knowledge of HPV vaccines.Gynecologists and pediatricians had a better understanding and more of positive attitudes toward HPV vaccines.Moreover,awareness of the HPV vaccines was the most important determinant affecting healthcare providers’ willingness to promote HPV vaccination(adjusted OR was 2.44 and 95%CI was 1.48-4.03).Respondents who were unlikely to promote HPV vaccination were concerned mainly about the safety issue(66.3%),while those who knew the appropriate period for HPV vaccination thought 16-18 years of age the best age to be vaccinated.In total,762 government officials responded effectively to the questionnaire.Awareness rate,cognitive rate and acceptance rate were 33.2%,26.0%and 90.6%,respectively.75.9%suggested that HPV vaccines be included in NIP.Respondents above 45 years of age knew more about HPV vaccines(adjusted OR was 1.65 and 95%CI was 1.12-2.41),while female staffs held more positive opinions toward inclusion of HPV vaccines in NIP(adjusted OR was 3.16 and 95%CI was 1.43-6.98).The government officials who knew the appropriate period for HPV vaccination thought 16-18 years of age the best age to be vaccinated.A total of 2198 parents responded effectively.Awareness rate,cognitive rate and acceptance rate were 14.9%,10.1%and 72.3%,respectively.However,merely 38.0%parents wanted their children to get vaccinated against HPV.Parents who were healthcare providers/teachers,with AHI≥50000 RMB or higher education levels knew more about HPV vaccines.Awareness of the HPV vaccines was the most important factor affecting parents’ willingness to vaccinate their children(adjusted OR was 2.15 and 95%CI was 1.79-2.58).Moreover,female parents had less interests in HPV vaccines for their children than their male counterparts(adjusted OR was 0.53 and 95%CI was 0.44-0.64)as women tended to consider more.Parents who did not accept HPV vaccination for their children were concerned most about the safety of the vaccines(67.3%),while integration of HPV vaccines in NIP might change viewpoint of 73.4%opponents.With regard to the price of the vaccines,the median prices of imported and domestic vaccines that the investigated parents could afford were 166.3 RMB and 129.7 RMB,respectively.Besides,89.7%parents thought it was necessary to educate children about sex and believed that 13-15 years the best age to be educated.A total of 3015 college students responded effectively.Awareness rate,cognitive rate and acceptance rate were7.4%,3.3%and 77.9%,respectively.Junior,Han,and science students had more knowledge of HPV vaccines.Awareness of the HPV vaccines was the most important factor affecting college students’ acceptance(adjusted OR was 2.18 and 95%CI was 1.82-2.62).Moreover,junior and female students showed more interests in HPV vaccines.The main concern of those who were reluctant to be vaccinated was the safety issue(72.8%).As to HPV vaccine prices,the median prices of imported and domestic vaccines that the investigated college students were able to afford were 152.4 RMB and 143.7 RMB,respectively.Besides,the proportion of college students who’d had sex was 8.9%.ConclusionsMainland Chinese people generally know little about HPV vaccines.However,most of them think positively about vaccinations.Knowledge of vaccines is the primary determinant of peopled attitudes toward vaccination or vaccine promotion.Those with negative attitudes think most about vaccine safety issue.Besides,the price people are willing to pay is far below the current market price and there exist differences between rural and urban areas.On the whole,girls aged 13～15 are the most appropriate population for vaccination campaigns in mainland China.To sum up,it is high time for the China government to include HPV vaccines into NIP and medical insurance coverage,to launch funding projects for women in poverty,to vaccinate junior middle school students collectively and execute catch-up HPV vaccination for eligible young women.Furthermore,HPV and cervical cancer health education campaigns should be initiated to disseminate benefits of HPV vaccination as well as to eliminate people’s concerns about vaccine safety.