Knowledge of HPV, its vaccines, and attitudes toward HPV vaccines among obstetrician-gynecologists, pediatricians and immunization services providers in Western China

Figures & data

Table 1. The distribution of social demographics among health care providers

Social demographics	Total (N = 1079)			OB-GYNs (n = 595)		Pediatricians (n = 71)		Immunization services providers (n = 413)
	n	%		n	%	n	%	n	%
Gender
male	57	5.3		20	3.4	8	11.3	29	7.0
female	922	85.4		526	88.4	58	81.7	338	81.8
missing data	100	9.3		49	8.2	5	7.0	46	11.1
Age (years)
≤29	229	21.2		99	16.6	22	31.0	108	26.2
30–39	302	28.0		165	27.7	15	21.1	122	29.5
40–49	288	26.7		187	31.4	18	25.4	83	20.1
≥50	130	12.0		88	14.8	5	7.0	37	9.0
missing data	130	12.0		56	9.4	11	15.5	63	15.3
Region
urban	850	78.8		514	86.4	57	80.3	279	67.6
rural	208	19.3		63	10.6	14	19.7	131	31.7
other^a	15	1.4		14	2.4	0	0.0	1	0.2
missing data	6	0.6		4	0.7	0	0.0	2	0.5
Current Employment
community hospital	328	30.4		67	11.3	28	39.4	233	56.4
general hospital or women’s and children’s hospital	563	52.2		465	78.2	36	50.7	62	15.0
CDC	87	8.1		3	0.5	2	2.8	82	19.9
other	98	9.1		59	9.9	5	7.0	34	8.2
missing data	3	0.3		1	0.2	0	0.0	2	0.5
Education
junior college	419	38.8		146	24.5	43	60.6	230	55.7
bachelor	566	52.5		389	65.4	22	31.0	155	37.5
master or doctor	67	6.2		54	9.1	4	5.6	9	2.2
other	26	2.4		6	1.0	2	2.8	18	4.4
missing data	1	0.1		0	0.0	0	0.0	1	0.2
Province^b
Sichuan	398	36.9		116	19.5	18	25.4	264	63.9
Yunnan	278	25.8		244	41.0	26	36.6	8	1.9
Gansu	136	12.6		57	9.6	9	12.7	70	16.9
Guizhou	83	7.7		69	11.6	0	0.0	14	3.4
Xinjiang	74	6.9		44	7.4	8	11.3	22	5.3
Shannxi	58	5.4		49	8.2	2	2.8	7	1.7
Chongqing	52	4.8		16	2.7	8	11.3	28	6.8
Years in practice
≤5	242	22.4		111	18.7	22	31.0	109	26.4
6–10	203	18.8		99	16.6	12	16.9	92	22.3
11–15	169	15.7		101	17.0	11	15.5	57	13.8
16–20	178	16.5		104	17.5	10	14.1	64	15.5
≥21	285	26.4		178	29.9	16	22.5	91	22.0
missing data	2	0.2		2	0.3	0	0.0	0	0.0

a: “other” means the combination zones between urban and rural areas; b: in our study, Sichuan province includes Chengdu (137), Deyang (103), Meishan (34) and Neijiang (124); Yunnan province includes Kunming (155), Dali (83) and Yuxi (40); Guizhou province includes Zunyi (83); Gansu province includes Lanzhou (136); Shannxi province includes Xi’an (58); Xinjiang Autonomous Region includes Urumchi (74); Chongqing (52) is a municipality.

Table 2. Knowledge of HPV, its vaccines and attitudes toward HPV vaccines among health care providers

Total (N = 1079)			OB-GYNs (n = 595)		Pediatricians (n = 71)		Immunization services providers (n = 413)			χ^2 test
N	%		n	%	n	%	n	%		P value
Knowledge of HPV-Related Diseases
1.What is the primary cause of cervical cancer? (HPV infection) ^b
1015	94.1		564	94.8	69	97.2	382	92.5		.183^a
2.What are the most important two subtypes of high risk HPV? (HPV 16/18) ^b
1007	93.3		570	95.8	61	85.9	376	91.0		<.001^a
3.What other diseases HPV can cause except for cervical cancer？ (Anal cancer/Genital warts/carcinoma of the penis/Oropharyngeal cancer) ^b
466	43.2		326	54.8	18	25.4	122	29.5		<.001
4.What is the most effective prevention from HPV infection? (HPV vaccine) ^b
913	84.6		471	79.2	61	85.9	381	92.3		<.001
Knowledge of Epidemiology in HPV & Cervical Cancer
5.What is the possibility that sexual active women would be infected by HPV in their lifetime, although 90% of the infection would be spontaneously regress within 12–24 months (Around 80%) ^b
705	65.3		409	68.7	42	59.2	254	61.5		.031
6.What is the age distribution pattern of high risk HPV among Chinese women? (Bimodal distribution) ^b
842	78.0		473	79.5	54	76.1	315	76.3		.438
7.What are the most important HPV subtypes that cause about 70% of cervical cancer worldwide？ (HPV 16 and 18) ^b
845	78.3		480	80.7	53	74.7	312	75.5		.112
Knowledge of HPV Vaccines
8. Is HPV vaccine safe? (Yes)
973	90.2		530	89.1	58	81.7	385	93.2		.004
9. Is HPV vaccine effective? (Yes)
909	84.2		479	80.5	57	80.3	373	90.3		<.001
10.What are the possible side effects after HPV vaccination? (Local redness, swelling, heat and pain; fever, headache, vertigo) ^b
810	75.1		439	73.8	50	70.4	321	77.7		.234
11.Is HPV test needed before HPV vaccination？ (No) ^b
545	50.5		258	43.4	31	43.7	256	62.0		<.001
12.Is HPV vaccine still recommended even with a positive HPV test or after treatment？ (Yes) ^b
889	82.4		490	82.4	58	81.7	341	82.6		.983
13.Is screening recommended after HPV vaccination? (Yes) ^b
999	92.6		570	95.8	66	93.0	363	87.9		<.001
Attitudes toward HPV vaccines
14.Are you willing to recommend HPV vaccination to your patients？
799	74.1		414	69.6	52	73.2	333	80.6		<.001

a: Fisher’s exact test; b: referential answer. Boldface reflects statistical significance.

Table 3. Main reasons for health care providers not to recommend HPV vaccination.^a

	Total (N = 280)			OB-GYNs (n = 181)		Pediatricians (n = 19)		Immunization services providers (n = 80)		χ^2 test
	N	%		n	%	n	%	n	%	P value
1	Lack of relevant knowledge about HPV vaccines.
	174	62.1		110	60.8	13	68.4	51	63.8	.759
2	Concerns on the efficacy and safety.
	150	53.6		102	56.4	12	63.2	36	45.0	.163
3	Do not want to be regarded as hard-selling because of the high price.
	126	45.0		81	44.8	8	42.1	37	46.3	.942
4	It is not convenient to talk about because it is sexual related.
	40	14.3		19	10.5	5	26.3	16	20.0	.030^b
5	Patients are not knowledgeable about HPV, so it is a waste of time to talk to them.
	33	11.8		16	8.8	4	21.1	13	16.3	.078^b
6	Screening is enough, so there is no need for HPV vaccination.
	23	8.2		13	7.2	1	5.3	9	11.3	.585^b

a: “not to recommend HPV vaccination” including “not to recommend” and “not clear”; b: Fisher’s exact test. Boldface reflects statistical significance.

Table 4. Logistic Regression for social demographics of attitudes toward HPV vaccines

Characteristics	OR	95%CI		P value
Gender
male	0.66	0.32	1.34	.245
female	1
Age (years)
≤29	0.78	0.26	2.35	.664
30–39	1.06	0.44	2.54	.904
40–49	1.11	0.63	1.94	.727
≥50	1
Region
urban	0.20	0.03	1.60	.129
rural	0.19	0.02	1.55	.120
other^a	1
Current Employment
community hospital	1.20	0.65	2.23	.557
general hospital or women’s and children’s Hospital	1.77	1.00	3.13	.050
CDC	2.34	0.79	6.90	.124
other	1
Education
junior college	2.10	0.75	5.91	.158
bachelor	2.97	1.04	8.52	.043
master or doctor	5.16	1.43	18.59	.012
other	1
Province
Sichuan	0.71	0.28	1.76	.457
Yunnan	0.44	0.18	1.11	.081
Gansu	0.40	0.15	1.02	.054
Guizhou	0.30	0.11	0.83	.021
Xinjiang	2.41	0.56	10.34	.235
Shannxi	0.39	0.14	1.11	.076
Chongqing	1
Years in practice
≤5	1.50	0.53	4.25	.448
6–10	1.29	0.54	3.10	.571
11–15	1.21	0.56	2.63	.631
16–20	1.38	0.78	2.46	.272
≥21	1
Specialty
OB-GYNs	0.44	0.26	0.74	.002
pediatricians	0.65	0.31	1.36	.254
immunization services providers	1

a: “other” means the combination zones between urban and rural areas. Boldface reflects statistical significance.