HPV Vaccine Uptake, Willingness to Receive, and Causes of Vaccine Hesitancy: A National Study Conducted in Saudi Arabia Among Female Healthcare Professionals

Figures & data

Table 1 Differences in Participants’ Uptake of the HPV Vaccine According to Their Sociodemographic and Reproductive Characteristics, Saudi Arabia (N=1857)

Characteristics	Overall	Participants’ Uptake of HPV Vaccine		P value
	N (%)	Yes N (%) 369 (19.9)	No N (%) 1488 (81.1)
Age in years^a	32.07±8.45	30.33±6.55	32.50±8.81	< 0.001
Level of education				< 0.001
Bachelor	1213 (65.3)	280 (23.1)	933(76.9)
Health Diploma	151 (8.1)	33 (21.9)	118 (78.1)
Master’s degree	148 (8.0)	22 (14.9)	126 (85.1)
PhD or Residency	345 (18.6)	34 (9.9)	311(90.1)
Occupation				< 0.001
Physician	784 (42.2)	116 (14.8)	668 (85.2)
Nurse	536 (28.9)	137 (25.6)	339 (74.4)
Others	537(28.9)	116(21.6)	421(78.4)
Marital status				0.187
Single (Never married)	849 (45.7)	180 (21.2)	669 (78.8)
Current/Ever married	1008 (54.3)	189 (18.8)	819 (81.2)
Age of first sexual activity^a b	24.21±3.95	23.57±3.74	24.36±4.01	0.014
History of previous HPV infection				< 0.001
Yes	65 (3.5)	16 (43.2)	20 (56.8)
No	1792 (96.5)	173 (17.8)	740 (82.2)
Family history cervical cancer				< 0.001
Yes	60 (6.2)	27 (45.0)	33 (55.0)
No	1797 (93.8)	342 (19.0)	1455 (81.0)
History of ever having more than one legitimate sexual partner in a period of one year^b				0.028
Yes	53 (5.3)	16 (30.2)	37 (69.8)
No	955 (94.7)	173 (18.1)	782 (81.9)
History of cervical cancer screening^b				0.075
Yes	248 (24.6)	56 (22.6)	192 (77.4)
No	760 (75.4)	133 (17.5)	627 (82.5)

Notes: ^aData are presented as mean ± SD, ^bdescriptives were calculated from current and ever married health care workers excluding single(n=1008).

Abbreviation: N, number of participants.

Table 2 Pattern of the HPV Vaccine Uptake Among Female HCWs, Saudi Arabia (N=1857)

Variable	N	%
Age at first dose of HPV vaccine (n=369)
≤18	88	23.8
19-<27	143	38.8
≥27	44	11.9
Do not remember	94	25.5
Number of received doses of HPV vaccine (n=369)
1	165	44.7
2	126	34.2
3	78	21.1
Are you willing to take the vaccine this year?
Yes	833	44.9
No	1024	55.1
Is HPV vaccine provided or available at your workplace?
Yes	417	22.5
No	443	23.9
I do not know	997	53.7
Where would you be willing to take the HPV vaccine?
Your workplace	537	28.9
Other healthcare facility	498	26.8
Does not matter	822	44.3
Would you be willing to vaccinate your children?
Yes	1172	63.1
No	236	12.7
I am not sure	449	24.2

Abbreviation: N, number of participants.

Table 3 Differences in the Willingness of HPV Vaccine Future Uptake According to Different Characteristics of Female HCWs in Saudi Arabia (n=1857)

Characteristics	Willingness of the participants to receive HPV vaccine this year		P value
	Yes N (%) 833 (44.9)	No N (%) 1024 (55.1)
Age in years^a	31.58±7.86	32.46±8.87	0.024
Level of education			0.045
Bachelor	542 (44.7)	671 (55.3)
Health Diploma	54 (35.8)	97 (64.2)
Master’s degree	76 (51.4)	72 (48.6)
PhD or Residency	161 (46.7)	184 (53.3)
Occupation			0.734
Physician	350 (44.6)	434 (55.4)
Nurse	235 (43.8)	301 (56.2)
Others	248 (46.2)	289 (53.8)
Marital status			0.165
Single (Never married)	366 (43.1)	483 (56.9)
Current/Ever married	467 (46.3)	541 (53.7)
Age of first sexual activity^a b	24.0±3.60	24.39±4.25	0.118
History of previous HPV infection			<0.001
Yes	46 (70.8)	19 (29.2)
No	787 (43.9)	1005 (56.1)
Family history cervical cancer			<0.001
Yes	39 (65.0)	21 (35.0)
No	794 (44.2)	1003 (55.8)
History of ever having more than one legitimate sexual partner in a period of one year ^b			0.208
Yes	29 (54.7)	24 (45.3)
No	438 (45.9)	517 (54.1)
History of cervical cancer screening^b			0.003
Yes	135 (54.4)	113 (45.6)
No	332 (43.7)	428 (56.3)
History of previous HPV vaccine dose			<0.001
Yes	199 (53.9)	170 (46.1)
No	634 (42.6)	854 (57.4)

Notes: ^aData are presented as mean ± SD, ^bdescriptives were calculated from current and ever married health care workers excluding single (n=1008).

Abbreviation: N, number of participants.

Table 4 Logistic Regression Analysis of Participants’ Characteristics in Regard to HPV Vaccine Uptake (N=1857)

Characteristics	Vaccine Uptake
	Unadjusted OR [95% CI]	Adjusted OR [95% CI]
Age in years	0.96 [0.95–0.98]	0.97 [0.95–0.99]
Level of education (Ref: Bachelor)
Health Diploma	0.93 [0.62–1.40]	0.73 [0.47–1.15]
Master’s degree	0.58 [0.36–0.93]	0.69 [0.42–1.14]
PhD or Residency	0.36 [0.25–0.53]	0.54 [0.35–0.83]
Occupation (Ref: Physician)
Nurse	1.98 [1.50–2.61]	1.56 [1.14–2.13]
Others	1.59 [1.19–2.11]	1.25 [0.92–1.71]
Marital status (Ref: Single)
Current/Ever married	0.86 [0.68–1.08]	1.46 [0.89–1.49]
History of previous HPV infection (Ref: No)
Yes	3.44 [2.08–5.69]	2.54 [1.39–4.63]
Family history cervical cancer
(Ref: No) Yes	3.48 [2.07–5.87]	2.39 [1.28–4.47]

Abbreviations: OR, odds ratio; CI, confidence interval.

Table 5 Logistic Regression Analysis of Participants’ Characteristics in Regard to the Willingness to Receive HPV Vaccine

Characteristics	Willingness to Receive the Vaccine this Year
	Unadjusted OR [95% CI]	Adjusted OR [95% CI]
Age in years	0.98 [0.97–0.99]	0.97 [0.96–0.99]
Level of education (Ref: Bachelor)
Health Diploma	0.69 [0.49–0.98]	0.62 [0.42–0.91]
Master’s degree	1.31 [0.93–1.84]	1.52 [1.06–2.18]
PhD or Residency	1.08 [0.85–1.38]	1.37 [1.02–1.85]
Occupation (Ref: Physician)
Nurse	0.97 [0.78–1.03]	1.08 [0.83–1.40]
Others	1.06 [0.85–1.33]	1.14 [0.89–1.46]
Marital status (Ref: Single)
Current/Ever married	0.88 [0.73–1.06]	1.29 [1.05–1.59]
History of previous HPV infection (Ref: No)
Yes	3.09 [1.80–5.32]	2.68 [1.45–4.94]
Family history cervical cancer (Ref: No)
Yes	2.35 [1.37–4.02]	1.61 [0.87–2.99]
History of previous HPV Vaccine dose.
Yes	1.58 [1.25–1.98]	1.48 [1.17–1.88]

Abbreviations: OR, odds ratio; CI, confidence interval.

Table 6 Reasons for HPV Vaccine Hesitancy Among Female HCWs Who Did Not Take the Vaccine (n=1488)

Reasons For vaccine Hesitancy	N	%^$
I do not have adequate knowledge regarding the vaccine	560	37.6
I am not married or sexually active	450	30.2
I am not under risk for a human papillomavirus infection	349	23.5
I am too busy to go for vaccination	345	23.2
Not interested in taking the vaccine	321	21.6
Lack of awareness about where this service is available	306	20.6
My physician did not offer it to me	273	18.3
I do not know who to consult to take this vaccine	206	13.8
Human papillomavirus vaccine is not a commonly administered vaccine	205	13.8
The problem (cervical cancer) is not common in the society	220	14.8
I am not at appropriate age to go for this vaccination	184	12.4
I do not have confidence in the safety of the vaccine.	126	8.5
The vaccine has many sides effects	94	6.3
The government does not pay for the vaccine cost	87	5.8
Fear from injections/painful	74	5.0
Fear of possible stigma following this vaccine/ Cultural concerns regarding vaccinating for a known sexually transmitted infection	67	4.5
Family/ husband refusal	27	1.8

Notes: Multiple responses allowed, $ Percentages are calculated from non-utilizers (n=1488), percentages ≠100%.

Data Sharing Statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.