Evaluation of Knowledge and Attitude Toward HPV and Vaccination Among Medical Staff, Medical Students, and Community Members in Fujian Province

Figures & data

Table 1 Demographic Characteristics of Participants

Characteristics*		Medical Staff^a(A)N=146 (%)	Medical Student (B) N=102	Community Population (C) N=1001	P(A,B,C)	P(A,B)	P(A,C)	P(B,C)
Age range (years)	≤ 25	5(3.4)	87(85.3)	122(12.2)	<0.001	<0.001	<0.001	<0.001
	26–30	32(21.9)	15(14.7)	433(43.3)
	31–35	22(15.1)	0(0.0)	446(44.6)
	36–40	15(10.3)	0(0.0)	0(0.0)
	≥41	72(49.3)	0(0.0)	0(0.0)
Gender	Male	15(10.3)	30(29.4)	0(0.0)	<0.001	<0.001	<0.001	<0.001
	Female	131(89.7)	72(70.6)	1001(100.0)
Education	Master and above	13(8.9)	42(41.2)	15(1.5)	<0.001	<0.001	<0.001	<0.001
	Undergraduate/Junior college	127(87.0)	59(57.8)	435(43.5)
	High school/Technical secondary school	6(4.1)	1(1.0)	297(29.7)
	Junior middle school	0(0.0)	0(0.0)	227(22.7)
	Primary School	0(0.0)	0(0.0)	24(2.4)
	Illiterate	0(0.0)	0(0.0)	3(0.3)
Birthplace	Metropolitan	111(76.0)	57(55.9)	596(59.5)	<0.001	<0.001	<0.001	0.526
	Rural area	35(24.0)	45(44.1)	405(40.5)
Average familyincome ^b(per capita monthly)	<¥3000	16(11.0)	43(42.2)	223(22.3)	<0.001	<0.001	0.002	<0.001
	¥3001-5000	59(40.4)	28(27.5)	427(42.7)
	¥5001-8000	38(26.0)	18(17.6)	203(20.3)
	>¥8000	33(22.6)	13(12.7)	148(14.8)

Notes: ^aMedical staff include doctors, nurses, pathologists, pharmacists, radiologists and laboratory physicians. ^b¥=Yuan (China). Bold formatting means statistically significant (p<0.05). *More complete demographic characteristics in supplementary Table 1.

Table 2 Knowledge About HPV and HPV Vaccination Among the Participants Demographic

Knowledge Question (Correctly Answered,%)	Medical Staff ^a(A) N=145*	Medical Student (B) N=98*	Community Population (C)N=449*	P(A,B,C)	P(A,B)	P(A,C)	P(B,C)
Knows about HPV*	145(99.3)	98(96.1)	449(44.9)	<0.001	0.162^b	<0.001	<0.001
When HPV is mentioned, you will think of (multi-choice):
Sexually transmitted diseases	65(44.8)	59(60.2)	138(30.7)	<0.001	0.026	0.002	<0.001
Genital warts	82(56.6)	64(65.3)	144(32.1)	<0.001	0.184	<0.001	<0.001
Cervical cancer	138(95.2)	96(98.0)	346(77.1)	<0.001	0.320^b	<0.001	<0.001
HIV (wrong answer)	126(86.9)	93(94.9)	410(91.3)	0.093	0.048	0.146	0.307
No knowledge about HPV(wrong answer)	145(100.0)	98(100.0)	449(86.9)	<0.001	0.309	<0.001	<0.001
Knows that men can be infected by HPV	141(97.2)	90(91.8)	225(50.1)	<0.001	0.072^b	<0.001	<0.001
How is the HPV transmitted?
Sexual contact	53(36.6)	51(52.0)	185(41.2)
Indirect contact	1(0.7)	0(0.0)	7(1.6)
Both (correct answer)	91(62.8)	46(46.9)	175(39.0)	<0.001	0.018	<0.001	0.173
Not clear	0(0.0)	1(1.0)	81(18.0)
What is the prevalence of the HPV in the population?
More than 70%	24(16.6)	11(11.2)	39(8.7)
50-70%	41(28.3)	22(22.4)	68(15.1)
30-50%	33(22.8)	26(26.5)	83(18.5)
Less than 30% (correct answer)	34(23.4)	17(17.3)	73(16.3)	0.141	0.266	0.062	0.880
Not clear	13(9.0)	22(22.4)	186(41.43)
What are the risks of HPV infection?
High risk (correct answer)	105(72.4)	62(63.3)	345(77.0)	0.019	0.158	0.316	0.007
Low risk	35(24.1)	27(27.6)	22(4.9)
No risk	0(0.0)	3(3.1)	1(0.2)
Not clear	5(3.4)	6(6.1)	80(17.9)

Notes: *Denotes the number of the participants who had heard of HPV would answered the below questions. Bold formatting means statistically significant (p<0.05). ^aMedical staff include doctors, nurses, pathologists, pharmacists, radiologists and laboratory physicians. ^bMore than 20% of cells in this subtable have expected cell counts less than 5. Chi-square results may be invalid.

Table 4 Factors Associated with Willing to Promote HPV Vaccination Among the Medical Staff and Medical Student

Variables	Willing to Promote (N=248)				Chi-Square	P	Code OR
	nyes=158	%	nno=90	%
Age range (years)					36.516	<0.001^a
≤25	42	45.7	50	54.3			1
26–30	26	55.3	21	44.7			1.474(0.727–2.987)
31–35	14	63.6	8	36.4			2.083(0.797–5.445)
36–40	11	73.3	4	26.7			3.274(0.971–11.041)
≥41	65	90.3	7	9.7			11.054(4.581–26.678)
Gender					4.469	0.035
Male	22	48.9	23	51.1			1
Female	136	67.0	67	33.0			2.122(1.104–4.080)
Education					2.228	0.518
Master and above	32	58.2	23	41.8			-
Undergraduate	91	63.6	52	36.4			-
Junior college	29	67.4	14	32.6			-
Technical secondary school	6	85.7	1	14.3			-
Profession					31.716	<0.001
Medical student	44	43.1	58	56.9			1
Medical staff	114	78.1	32	21.9			4.696(2.698–8.175)
Average family income					9.485	0.023
<¥3000	30	50.8	29	49.2			1
¥3001-5000	62	71.3	25	28.7			2.397(1.202–4.780)
¥5001-8000	32	57.1	24	42.9			1.289(0.618–2.689)
>¥8000	34	73.9	12	26.1			2.739(1.191–6.299)
Willing to receive HPV vaccination					10.620	0.002
No	7	31.8	15	68.2			1
Yes	151	66.8	75	33.2			4.314(1.687–11.032)
Professional Title					36.620	<0.001^a
No technical titles (Intern physician)	47	44.8	58	55.2			1
Resident	31	62.0	19	38.0			2.013(1.011–4.008)
Attending physician	45	81.8	10	18.2			5.553(2.531–12.185)
Associate chief physician	27	90.0	3	10.0			11.106(3.172–38.893)
Chief physician	8	100.0	0	0.0			-

Notes: n₀: Combine people with neutral, ambiguous and negative views into people who do not actively recommend HPV vaccine. Bold formatting means statistically significant. ^aLinear by linear association. ^bContinuity correction. Adash indicates that data are not available.

Table 5 Factors Affecting the Medical Staff and Medical Student Accepting or Rejecting HPV Vaccine

Item	N=248	Do You Want to Be Vaccinated Against HPV?				Chi-Square	P
		nyes=226	%	nno=22	%
Accepted costs (3 does)						10.679	0.020
<¥200 (<US$29.0)	47	40	17.7	7	31.8
¥200-500 (US$29.0–72.4)	84	75	33.2	9	40.9
¥500-1000(US$72.4–144.9)	71	65	28.8	6	27.3
>¥1000(>US$144.9)	46	46	20.4	0	0.0
Expectations after vaccination with HPV						0.894	0.859
Not in the future	22	19	9.4	3	13.6
Not for years	62	56	24.8	6	27.3
Still possible	155	143	63.3	12	54.5
Do not know	9	8	3.5	1	4.5
What are the risks of HPV infection?						6.802	0.63
High risk	168	158	69.9	10	45.5
Low risk	62	52	23.0	10	45.5
No risk	3	2	0.9	1	4.5
Not clear	15	14	6.2	1	4.5
Education						1.717	0.721
Master and above	55	50	22.1	0	0.0
Undergraduate	143	131	58.0	5	22.7
Junior college	43	38	16.8	12	54.5
Technical secondary school	7	7	3.1	5	22.7
Average family income						2.740	0.445
<¥3000	59	51	22.6	8	36.4
¥3001–5000	87	79	35.0	8	36.4
¥5001–8000	56	53	23.5	3	13.6
>¥8000	46	43	19.0	3	13.6

Note: Bold formatting means statistically significant.

Table 3 Reasons for Willing and Unwilling to Be Vaccinated and Accepted Cost

Item	Medical Staff ^a(A) N=146	Medical Student (B)N=102	Community Population (C) N=1001	P(A,B,C)	P(A,B)	P(A,C)	P(B,C)
Willing to take the HPV vaccine	134(91.8)	92(90.2)	838(83.7)	0.012	0.821	0.013	0.114
Reasons for unwilling to be vaccinated	12(8.2)	10(9.8)	163(16.3)	<0.001^b	0.073^b,c	<0.001^b,c	<0.001^b,c
I do not have risk	4/12	4/10	51/163
Do not think vaccination works	1/12	2/10	19/163
It has not been widely used	5/12	2/10	112/163
Vaccination causes risks	6/12	1/10	58/163
Doubts on the source	6/12	0/10	27/163
The vaccine is expensive	4/12	8/10	/
The process of vaccination is cumbersome	3/12	2/10	/
Reasons for willing to be vaccinated	134(91.8)	92(90.2)	838(83.7)	<0.001	0.076^c	<0.001^c	0.004^c
Self benefit	118/134	78/92	671/838
Fear of infecting HPV	69/134	53/92	391/838
Fear of cervical cancer in yourself/your partner	70/134	40/92	393/838
Fear of having genital warts	40/134	26/92	222/838
Accepted costs (3 does)	146(100.0)	102(100.0)	1001(100.0)	<0.001	0.264	<0.001	<0.001
<¥200	26/146	21/102	416/1001
¥200-500	46/146	38/102	382/1001
¥500-1000	41/146	30/102	126/1001
>¥1000	33/146	13/102	77/1001

Notes: ^aMedical staff include doctors, nurses, pathologists, pharmacists, radiologists and laboratory physicians. ^bMore than 20% of cells in this subtable have expected cell counts less than 5. Chi-square results may be invalid. ^cLikelihood ratio for aChi-square test. Bold formatting means statistically significant (p<0.05).