Assessing the prevalence, gender differences and factors associated with human papillomavirus vaccination among medical students of a tertiary care hospital: a cross-sectional study

INTRODUCTION

Cervical cancer maintains its position as a severe worldwide public health concern through severe disability and death patterns affecting female populations (morbidity and mortality among women). The World Health Organization mentions that cervical cancer positions as the fourth most common cancer in females; new cervical cancer cases reached 604,000, with 342,000 worldwide deaths in 2020. Approximately 90 percent of cervical cancer fatalities affect people residing in countries that maintain limited access to preventative healthcare services remain limited.¹

Persistent infection with high-risk types of human papillomavirus (HPV), particularly HPV-16 and HPV-18 among high-risk types of HPV accounts for the occurrence of 70% of all cervical cancer cases; thus, HPV vaccination serves as our central defense against primary prevention.² Despite many worldwide initiatives about HPV vaccination and advancements in vaccine technology, disparities in vaccine uptake continue to pose challenges to achieving equitable cervical cancer prevention.

India faces an excessive amount of the worldwide occurrence of cervical cancer. It is the second leading cause of cancer death figures for Indian women between 15–44 years old, with approximately 123,000 new cases and 67,000 annual deaths.³ Factors such as inadequate screening programs, including poor screening efforts as well as delayed medical assessment, socio-cultural obstacles, and limited healthcare center accessibility contribute to the impact of the outcome of cervical cancer troubling statistics.

HPV vaccination, regular screening practices, and prevention methods show great potential to decrease the disease burden. However, the Indian population does not accept HPV vaccinations due to their minimal awareness levels, cultural prejudices and limited financial accessibility.^4,5 Nationwide HPV vaccination programs across the world have produced significant drops in HPV infection rates, precancer lesions and cervical cancer cases. High-income countries have achieved vaccination rates above 70%, as proven by examples from Australia and the United Kingdom.

Healthcare institutions have demonstrated outstanding immunization success through vaccination coverage, reaching more than 70% of the population through national immunization programs and public awareness campaigns.⁶ In contrast, in low- and middle-income countries, Current data shows that India and other similar countries cannot reach vaccination coverage at the same levels.

Although the HPV vaccine was introduced in India in 2006, it has received limited universal acceptance. Government initiatives, such as pilot programs in Punjab and Sikkim, and the recommendation of the National Technical Advisory Group on Immunization (NTAGI) to integrate the HPV vaccine under the Universal Immunization Programme. The Universal Immunization Programme, together with the HPV vaccine, constitute essential measures to improve vaccine access enhancement accessibility.^7,8

HPV vaccination promotion should be understood by medical students who will become critical members in promoting HPV vaccination initiatives. As future healthcare providers, their knowledge, attitudes, and vaccination status, the actions of this particular population group dramatically impact public health results. However, studies have identified barriers. Medical students' failure to adopt HPV vaccines stems from insufficient understanding and incorrect beliefs about the safety of these vaccines, together with their limited perceptions of being risk-prone to HPV infection.^9,10 Assessing gender data regarding vaccination rates between population groups and elements impacting vaccination decisions leads to significant healthcare findings.

A research investigation evaluates the spread of HPV vaccinations alongside sex-based differences and their relationship factors among medical students attending a tertiary care medical facility. The generated findings can support the design of evidence-based approaches to improve vaccine acceptance by identifying vaccination coverage weaknesses and vaccine acceptance determinants. This study supports global initiatives to eliminate cervical cancer as a public health issue for 2030 under World Health Organization’s (WHO) Global Strategy for cervical cancer elimination.¹¹

METHODS

Study area

The study was conducted in BLDE (DU) Shri B. M. Patil Medical College and Hospital, Vijayapura district, Karnataka.

Study period

The study was conducted for 3 months, from August to October 2024.

Study design and participants

The cross-sectional study was employed among medical students. The sample size was determined using Shetty et al considering 95% confidence level and 5% absolute precision. The sample size obtained was 350 participants.¹

Inclusion criteria

The study included medical students who were willing to participate.

Data collection

Data was collected using a self-administered, semi-structured questionnaire assessing knowledge, attitudes, and factors related to HPV vaccination. We collected data from 350 medical students using convenience sampling.

Before data collection, participants received a detailed explanation of the study's purpose, objectives and benefits. Informed verbal consent was obtained from each participant.

Data analysis

The data was presented using numbers, percentages, and chi-square tests, and results were presented in tabular form for clarity and ease of interpretation. These were done using the statistical package for the social sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 26.0).

RESULTS

In our study, out of the 350 participants, 52.5% were female, and 47.5% were male. Most students (61.9%) were aged 20-25 years, followed by those aged 18-20 (37.0%), and only 1.1% were 25–30. Only 10% (n=35) of students had received the HPV vaccine (Figure 1). Among females, 52.3% agreed to take the vaccine, and 52.6% disagreed. Among males, 47.7% agreed to take the vaccine, but 47.4% disagreed.

Most participants identified multiple sexual partners as the most common risk factor, with no significant gender difference. A majority believed HPV is transmitted sexually (53.6% females and 46.4% males). Participants' responses showed a high awareness of other cancers caused by HPV. Cervical cancer-causing HPV types, correct identification was significantly higher in females (58.6%) than males (41.4%) (Table 1).

A more significant proportion of females (56.8%) than males (43.2%) knew about the existence of the vaccine. An important difference was seen in recognizing the recommended age group for vaccination, with females performing better (54.8% correct). Knowledge about vaccine benefits and duration of protection varied slightly between genders, but no significant differences were observed in most cases (Table 2). Students expressed predominantly positive attitudes toward HPV vaccination; 58.8% agreed that HPV infection is severe. 62.4% supported making the vaccine affordable for adolescents. 60.3% expressed willingness to receive the vaccine if it was freely available in clinics or schools. Concerns about embarrassment or stigma related to HPV vaccination were observed but were not predominant (Table 3).

*P value <0.05 is significant

*P value <0.05 is significant

DISCUSSION

Our study findings showed that 10% of students received the HPV vaccine. Similarly, Shetty et al documented similar vaccine uptake at 6% despite their study participants showing better awareness of HPV and its vaccine. Rashid et al documented that 7% of participants in his research sample took the HPV vaccine. Kalra et al established that vaccination frequency reached 14.4%. The bridge between vaccine awareness and actual uptake persists because of factors such as the high cost of vaccines, cultural barriers, and insufficient health policy strategies in India.^16,17

The correct identification of HPV types responsible for cervical cancer was higher among females (58.6%) than males (41.4%) in our study. Still, the research by Rashid et al demonstrated that females (82.45%) showed greater awareness of cervical cancer than males (57.7%). The data in our study indicates that females demonstrated better recognition of both types of HPV that cause cervical cancer and the appropriate vaccination age range. Females exhibited more awareness of HPV-related conditions, including cervical cancer, due to their presumed higher perceived relevance of such diseases. Shetty et al similarly showed that females outperformed males in HPV knowledge tests. Still, the study did not establish substantial distinctions in HPV understanding or cervical cancer consciousness between men and women.^17,18

According to Shetty et al medical trainees and students who performed clinical internships scored higher in their knowledge evaluations. Our study omitted an analysis of the effects of particular academic subjects which the study investigated.¹⁶

The present study showed that 62.4% of participants wanted vaccine affordability for adolescents, and 60.3% indicated willingness to receive it if provided for free. These results support Rashid et al's findings. Similarly, Shetty et al discovered that 65.2% of students planned to get vaccinated as positive perceptions directly influenced their intention to receive the vaccine.

A large proportion of 73.5% of participants expressed in Kalra et al’s research showed their agreement to accept new vaccines if healthcare providers recommended them. Research findings show that accessible and lower-cost vaccination drives better acceptance of vaccines.^16,17,19

The existing gap in understanding HPV transmission methods and vaccine advantages continues to persist. Our research mirrored Shetty et al's findings that 78% of students perceived HPV transmission through sexual contact by showing that 53.6% of female and 46.4% of male participants identified HPV as sexually transmitted.¹⁶

The main impediments among this sample were individuals' unawareness about HPV vaccination (42.7%), their worries about medical safety and adverse reactions (28.3%), and cultural bias against sexually transmitted infections inoculations (24.5%). Research done by Shetty et al revealed that participants were concerned about social stigma during vaccination, while Rashid et al. found no program coverage that matched Kalra et al’s results.^16,17,19

Limitations

The research methodology prevents researchers from establishing cause-effect relationships. Using convenient sampling methods reduces the ability to generalize research findings to different populations. Participant-reported information could have issues with memory recall and social-desirability preference effects.

CONCLUSION

The research shows that medical students have an average understanding of HPV and have favorable impressions of the disease and vaccination protocols. Females had a superior understanding of HPV types linked with cervical cancer coupled with knowledge about vaccine availability and proper vaccination age. Despite this, the vaccination rates showed low participation because 18.6% of registered individuals received the vaccine. The survey found that persuasive majorities (60%) favored vaccine affordability and accessibility, and many medical students showed commitment to receiving the Vaccination if free availability was possible. Improving vaccination rates requires multiple strategies to overcome expenses, social discrimination, and incorrect vaccine beliefs. The research data demonstrates an urgent requirement for specific actions that will boost HPV prevention programs for young adults.

Recommendations

The school curriculum should incorporate comprehensive HPV education to fix misunderstandings and explain the value of Vaccination. State governing bodies should plan for HPV vaccination inclusion in their country-wide immunization services. The vaccine program should be supported by making it affordable through student school programs that provide free accessible vaccinations. The goal of educational campaigns should be to normalize HPV vaccination and reduce stigma by directly addressing false connections between Vaccination and sexually transmitted infections to boost male student acceptance. The advocacy work for HPV vaccination should be supported among vaccinated students and healthcare professionals who can share their experiences to promote peer engagement and demonstrate the protective benefits of the Vaccination.

ACKNOWLEDGEMENTS

Authors would like to thank all the participating medical students of the tertiary care hospital for co–operating during the study. They also acknowledge the guidance and encouragement provided by mentors throughout the study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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