The role of nurses as human papillomavirus vaccination advocates in China: perception from nursing students

Figures & data

Table 1. Demographic characteristics and factors associated with advocacy intent (N = 1041)

	N (%)	HPV vaccine advocates through patient counseling				HPV vaccine advocates through provision of information/recommendation
		Univariable analysis			Multivariable analysis	Univariable analysis		Multivariable analysis
		Strongly intent/ Intent (n = 604)		p-Value	OR (95%CI)^a Strongly intent/ Intent vs. Not intent/ Strongly not intent	Strongly intent/Intent (n = 590)	p-Value	OR (95%CI)^a Strongly intent/ Intent vs. Not intent/ Strongly not intent
Demographic characteristics
Age
<20	423 (40.6)	242 (57.2)		.682		237 (56.0)	.863
20–21	473 (45.4)	281 (59.4)				268 (56.7)
22–24	145 (13.9)	81 (55.9)				85 (58.6)
Gender
Male	150 (14.4)	81 (54.0)		.285		90 (60.0)	.423
Female	891 (85.6)	523 (58.7)				500 (56.1)
Ethnicity
Han	934 (89.7)	549 (58.8)		.149		535 (57.3)	.258
Others	107 (10.3)	55 (51.4)				55 (51.4)
Place of birth
Urban	319 (30.6)	203 (63.6)		.017	1.31 (0.98–1.74)	194 (60.8)	.078
Rural	722 (69.4)	401 (55.5)			1	396 (54.8)
Geographic region of origin
East China	629 (60.4)	382 (60.7)		.066		368 (58.5)	.165
West China	243 (23.3)	127 (52.3)				125 (51.4)
Central China	169 (16.2)	95 (56.2)				97 (57.4)
Study grade
Grade 1	290 (27.9)	180 (62.1)		.030	1.55 (1.02–2.36)*	176 (60.7)	.005	1.23 (0.81–1.88)
Grade 2	281 (27.0)	143 (50.9)			0.94 (0.63–1.40)	134 (47.7)		0.69 (0.46–1.04)
Grade 3	295 (28.3)	180 (61.0)			1.22 (0.83–1.80)	173 (58.6)		0.97 (0.66–1.44)
Grade 4	175 (16.8)	101 (57.7)			1	107 (61.1)		1
Average annual family income (CNY¥)^†
<50000	529 (50.8)	294 (55.6)		.010	1	292 (55.2)	.080
50000–120000	368 (35.4)	210 (57.1)			0.98 (0.75–1.30)	204 (55.4)
More than 120000	144 (13.8)	100 (69.4)			1.53 (1.01–2.31)*	94 (65.3)
HPV vaccination status
Have taken HPV vaccine
Yes	78 (7.5)	53 (67.9)		.074		55 (70.5)	.012	1.84 (1.10–3.06)*
No	963 (92.5)	551 (57.2)				535 (55.6)		1
HPV-related knowledge
Total knowledge score
Score 0–11	513 (49.3)	275 (53.6)		.005	1	266 (51.9)	.002	1
Score 12–20	528 (50.7)	329 (62.3)			1.46 (1.10–1.93)**	324 (61.4)		1.43 (1.08–1.88)*
Health beliefs toward HPV vaccination
Perceived susceptibility
Agree	826 (79.3)	489 (59.2)		.141		481 (58.2)	.053
Disagree	216 (20.7)	115 (53.5)				109 (50.7)
Perceived severity
Agree	968 (93.0)	563 (58.2)		.806		553 (57.1)	.327
Disagree	73 (7.0)	41 (56.2)				37 (50.7)
Perceived benefit of HPV vaccination
Agree	937 (90.0)	555 (59.2)		.021	1.48 (0.97–2.25)	542 (57.8)	.028	1.43 (0.94–2.19)
Disagree	104 (10.0)	49 (47.1)			1	48 (46.2)		1

*p < .05, **p < .01.

^aHosmer–Lemeshow test, chi-square: 9.036, p-value: 0.339; Nagelkerke R²: 0.041.

^bHosmer–Lemeshow test, chi-square: 3.341, p-value: 0.648; Nagelkerke R²: 0.039.

^†1 USD = 6.4 CNY.

Figure 1. Knowledge about HPV and HPV vaccination (N = 1041).

Figure 2. Perception of barriers in advocacy (N = 1041).

Table 2. Factors associated with perceived barriers in advocacy (N = 1041)

	Total perceived barriers scores
	Univariable analysis			Multivariable analysis
	Score 6–14 (n = 354)	Score 15–24 (n = 687)	p-Value	OR (95%CI)^a score 15–24 vs. 1–14
Demographic characteristics
Age
<20	157 (37.1)	266 (62.9)	.011	1
20–21	163 (34.5)	310 (65.5)		1.16 (0.88–1.53)
22–24	34 (23.4)	111 (76.6)		2.02 (1.31–3.12)**
Gender
Male	313 (35.1)	578 (64.9)	.063
Female	41 (27.3)	109 (72.7)
Ethnicity
Han	322 (34.5)	612 (65.5)	.389
Others	32 (29.9)	75 (70.1)
Place of birth
Urban	116 (36.4)	203 (63.6)	.288
Rural	238 (33.0)	484 (67.0)
Geographic region of origin
East China	240 (38.2)	389 (61.8)	.002	1
West China	71 (29.2)	172 (70.8)		1.43 (1.03–1.98)*
Central China	43 (25.4)	126 (74.6)		1.81 (1.22–2.67)**
Study grade
Grade 1	114 (39.3)	176 (60.7)	.071
Grade 2	86 (30.6)	195 (69.4)
Grade 3	103 (34.9)	192 (65.1)
Grade 4	51 (29.1)	124 (70.9)
Average monthly family income (CNY¥)
<50000	158 (29.9)	371 (70.1)	.016	1.33 (0.90–1.98)
50000–120000	140 (38.0)	228 (62.0)		1.00 (0.67–1.49)
More than 120000	56 (38.9	88 (61.1)		1

*p < .05, **p < .01.

^aHosmer–Lemeshow test, chi-square: 6.945, p-value: 0.435; Nagelkerke R²: 0.038.

Table

A.1	Age	____________________years.
A.1	Gender	[] Male [] Female
A.1	Ethnicity	[] Han [] Others
A.1	Place of birth	[] Urban [] Rural
A.1	Region of origin	[] East China [] West China [] Central China
A.1	Study grade	[] Grade 1 [] Grade 2 [] Grade 3 [] Grade 4
A.1	Annual monthly household income (CNY¥)	[] <50,000 CNY¥ [] 50,000–120,000 CNY¥ [] >120,000 CNY¥

Table

B.1

Have you received HPV vaccination

[] Yes [] No

Table

		True	False	Don’t know/Not sure
C.1.1	HPV infection is common HPV	[]	[]	[]
C.1.2	There are many types of HPV	[]	[]	[]
C.1.3	HPV infection is most common among women aged 20 to 30 years	[]	[]	[]
C.1.4	The annual pap smear test can detect cell change at the cervix	[]	[]	[]
C.1.5	HPV infection is related to the development of cervical cancer HPV	[]	[]	[]
C.1.6	HPV infection is sexually transmitted	[]	[]	[]
C.1.7	Most people with HPV do not experience any symptoms	[]	[]	[]
C.1.8	HPV cause genital warts HPV	[]	[]	[]
C.1.9	HPV can cause oral cancer HPV	[]	[]	[]
C.1.10	HPV can cause anal cancer	[]	[]	[]
C.1.11	HPV infection can occur without symptoms HPV	[]	[]	[]
C.1.12	HPV can infect both men and women HPV	[]	[]	[]
C.1.13	HPV can be cured by antibiotics	[]	[]	[]
C.1.14	Using condom will decrease the chance of getting HPV	[]	[]	[]
C.1.15	There is a cure for HPV infection HPV	[]	[]	[]
	Following are questions regarding knowledge of HPV vaccine	True	False	Don’t know/Not sure
C.1.16	HPV vaccine can prevent all types of HPV infection HPV	[]	[]	[]
C.1.17	Someone who has had HPV vaccine cannot develop cervical cancer	[]	[]	[]
C.1.18	It is best for young girls to receive HPV vaccination before their first sexual intercourse	[]	[]	[]
C.1.19	HPV vaccine is only for people who are sexually active HPV	[]	[]	[]
C.1.20	After receiving the HPV vaccine, women no longer have to be screened for cervical cancer	[]	[]	[]

Table

D.1	Perceived susceptibility to HPV and HPV-related diseases among women in general
D.1.1	Women, in general, have a high risk of contracting HPV in their lifetime	[] Agree [] Disagree
D.2	Perceived severity of contracting HPV or having HPV-related diseases
D.2.1	Harms of HPV infection for women are severe	[] Agree [] Disagree
D.3	Perceived benefit of HPV vaccination
D.3.1	HPV vaccines are highly effective in preventing HPV infection	[] Agree [] Disagree

Table

E.1	Providing my professional service as HPV vaccine advocate through patients counseling	[] Strongly not intent [] Not intent [] Intent [] Strongly intent
E. 2	Providing my professional service as HPV vaccine advocate through the provision of information/recommendation	[] Strongly not intent [] Not intent [] Intent [] Strongly intent

Table

F.1	I believe nurses do not receive adequate training in advocating for HPV vaccination	[] Strongly agree [] Agree [] Disagree [] Strongly disagree
F.2	I believe nurses do not have adequate knowledge about cervical cancer, HPV and HPV vaccination.	[] Strongly agree [] Agree [] Disagree [] Strongly disagree
F.3	I don’t believe it is a nurse professional role to engage in advocating for HPV vaccination, it is better done by others in the healthcare team (eg. doctors)	[] Strongly agree [] Agree [] Disagree [] Strongly disagree
F.4	I am worried patients may not be comfortable with nurses discussing with them about HPV vaccination	[] Strongly agree [] Agree [] Disagree [] Strongly disagree
F.5	I feel uncomfortable engaging with patients in advocating for HPV vaccination	[] Strongly agree [] Agree [] Disagree [] Strongly disagree
F.6	I am personally uncomfortable discussing with patients about HPV infection and HPV vaccination	[] Strongly agree [] Agree [] Disagree [] Strongly disagree

Table

	Odds ratio (OR) Knowledge score 12–20 vs 0–11	95% CI	P
Demographic characteristics
Age
<20	1	-
20–21	3.15	2.40–4.15	<0.001
22–24	4.85	3.22–7.30	<0.001
Gender
Male	1	-
Female	2.32	1.61–3.33	<0.001
Ethnicity
Han	1	-
Others	0.71	0.47–1.06	0.093
Place of birth
Urban	1	-
Rural	0.83	0.64–1.08	0.170
Geographic region of origin
East China	1	-
West China	0.72	0.53–0.96	0.026
Central China	0.52	0.37–0.73	<0.001
Study grade
Grade 1	1	-
Grade 2	1.83	1.29–2.61	0.001
Grade 3	5.31	3.73–7.58	<0.001
Grade 4	13.37	8.34–21.43	<0.001
Average monthly family income (CNY¥)
<50000	1	-
50000–120000	1.39	1.06–1.81	0.17
Above 120000	1.48	1.02–2.14	0.39

Table

	Odds ratio (OR) No intention in both advocacies (n = 348) vs Intent in either one of advocacy or both advocacies (n = 693)	95% CI	P
Demographic characteristics
Age
<20	1
20–21	0.97	0.74–1.29	0.852
22–24	1.04	0.70–1.55	0.841
Gender
Male	1
Female	0.88	0.61–1.26	0.471
Ethnicity
Han	1
Others	1.27	0.84–1.92	0.259
Place of birth
Urban	1
Rural	1.25	0.94–1.66	0.130
Geographic region of origin
East China	1
West China	1.38	1.02–1.88	0.039
Central China	1.12	0.78–1.60	0.551
Study grade
Grade 1	1
Grade 2	1.55	1.10–2.20	0.013
Grade 3	1.16	0.82–1.65	0.398
Grade 4	1.17	0.78–1.75	0.460
Average monthly family income (CNY¥)
<50000	1
50000–120000	0.99	0.75–1.30	0.927
Above 120000	0.52	0.34–0.80	0.003