A Nationwide Study Comparing Knowledge and Beliefs about HPV among Female Students before and after HPV Vaccination

Abstract

Study Objective To assess the knowledge and beliefs regarding HPV and the HPV vaccine among girls before and after vaccination in the Malaysian HPV Immunisation Programme. Design A nationwide longitudinal survey. Setting Thirty-two randomly selected schools from 13 states and 3 federal territories in Malaysia from February to March 2013, and October to November 2013. Participants Form One female students (13-year-old). Interventions None. Main Outcome Measures Mean knowledge score of HPV infection. Results A total of 2,644 students responded to the pre-vaccination survey, of whom 2,005 (70%) completed the post-vaccination survey. The mean knowledge score was 2.72 (SD ± 2.20) out of a maximum score of 10 in the pre-vaccination survey, which increased significantly to 3.33 (SD ± 1.73) after the 3 doses of HPV vaccine (p = 0.001). Many answered incorrectly that, ‘Only females can get HPV infection’ (91.5% pre-vaccination versus 96.1% post-vaccination), and only a few were aware that, ‘Vaccinating boys helps to protect girls against HPV infection’ (11.7% for pre-vaccination versus 10.2% for post-vaccination). The mean knowledge score was significantly higher post-vaccination among higher-income families and those with parents of a higher occupational status. Regarding beliefs about the HPV vaccine, 89.4% in the pre-vaccination survey held the view that they would not get a HPV infection, and the percentage remained similar in the post-vaccination survey. Perceived severity of HPV infection also remained low in both pre- and post-intervention groups. Only 21.5% reported receiving health information about HPV along with the provision of the HPV vaccine; those who received health information showed higher levels of knowledge. Conclusion Findings revealed a general lack of knowledge and erroneous beliefs about HPV and the HPV vaccine even after receiving vaccination. This suggests that imparting accurate knowledge about HPV along with vaccine administration is essential. Specifically, girls from lower socioeconomic groups should be a target of educational intervention.