Adolescent femalesknowledge, beliefs and intended behaviours surrounding the HPV

vaccine

Flora DooganJanet Tucker

Maggie Cruickshank

Outline

Background

Need for research

Methodology

Results

Summary

Background

2008National HPV vaccination programme introduced in the UK.3 year vaccination ‘catch up’ programme for girls aged up to 18 years.

2011‘Catch up’ cohort now eligible for cervical screening in Scotland.Vaccine uptake in catch-up cohort much lower than new cohort.

The need for research...

1) Studies in adolescents have shown that knowledge and attitudes towards HPV vaccination are poor. 1, 2

Will attendance at cervical screening decline?Will young women’s sexual and reproductive health be at risk?

These studies are not representative of the population.

The need for research...

2) Women of lower socioeconomic status have lower attendance at cervical screening and colposcopy and a higher risk of cervical cancer.4

Health Belief Model

“Behaviour is a set of core beliefs that have been redefined over years.”

Current beliefs are the foundations for behaviour in the future

Aim

1o To examine the knowledge, beliefs and intended behaviours of adolescent girls on HPV, HPV vaccination and cervical screening

2o Compare differences by socioeconomic group intake of the school attended

MethodDeveloped 30 item questionnaireMulti-level approval3 (of 7) schools accepted the invitation

Parent information and opt-outPupil information and consentQuestionnaire administered to girls in S3/S4 in PSE classesThank you slips with link to sources of guidance

Indicators of socio-economic status at school level

Analysis done in SPSS

Results425 invited2 PSE classes did not run questionnaire78% response rate

85.4% of participants reported that they had received all 3 doses of the vaccine.

Only 36.6% of participants recalled reading a vaccine information leaflet.

Only 17.6% recalled receiving spoken information at school.

Level of deprivationSchool A School B School C

Percentage of free school meals (%)

11.1 <1.0 10.3

Deprivation level Most deprived Least deprived

Percentage achieving >5 awards at Higher level (%)

5 86 16

Deprivation level Most deprived Least deprived

Destination of school leaver = higher education (%)

28 70 42

Deprivation level Most deprived Least deprived

Knowledge statement Results

% Answered correctly

HPV is an infection that can cause cancer. (T) 81.7%

HPV infection is uncommon in sexually active teenage girls. (F) 62.6%

Having a high number of sexual partners is a risk factor for cervical cancer. (T)

63.2%

The HPV vaccine does not lower your risk of cervical cancer. (F) 71.0%

The HPV vaccine offers protection against 2 types of HPV only. (T) 22.4%

The HPV infection cannot be treated. (T) 6.2%

The HPV vaccine works best if you get it before your first sexual experience. (T)

33.1%

Boys do not get the HPV infection. (F) 16.4%

Having sex at 15 or younger is a risk factor for cervical cancer. (T) 23.4%

Table 1: Statements and the results collected with the percentage of pupils that answered correctly.

Figure 1: Box plot diagram describing median scores of knowledge across 3 schools in Aberdeen.

Knowledge significantly higher (p= <0.001) in the school with the highest socio-demographic intake

19.00

A B C

Beliefs statement Results

% Answered positively

The more sexual partners a girl has the more benefit she gets from the HPV vaccine and screening.

55.1%

I will be putting my health at risk if I do not attend my first cervical Screening

79.6%

Cervical screening is not as important for young women who have had the HPV vaccination

56.6%

In the future I might put off going for cervical screening because I think 20 is too young to be at risk of cervical cancer.

76.3%

In the future I intend to go for my cervical screening appointment when I am first invited.

80.1%

Table 2: Statements and the results collected with the percentage of pupils that answered correctly.

School with the lowest socio-demographic had significantly less positive beliefs and intended behaviour towards screening (p= <0.001).

Figure 2: Box plot diagram describing median scores of beliefs and behaviour across 3 schools in Aberdeen.

A B C

Results12% of participants left free text comments.

“I don't actually know what HPV is or what the jab does. I was told it only lasts 6 years. If I knew before I wouldn't have got it.”

“I thought if you got the jab you didn’t have to get a screening test.”

“I remember not so long ago my mum got invited for cervical screening but she didn’t go, so I didn’t think it was that important.”

Box 1: Free text comments illustrating concerns in understanding on HPV and vaccine.

SummaryIn girls 1-2 years after vaccination...

HPV knowledge was lowBeliefs held were positiveThe intention to attend for cervical screening was highSignificant differences between socio-demographic intake

Implications

Full vaccination against HPV does not mean that the individuals understand what this means.

There is a need for appropriate and relevant educational interventions to ensure that the emerging vaccinated cohort appreciate the importance of cervical screening in the future.

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References

1. Hilton S. Smith E. "I thought cancer was one of those random things. I didn't know cancer could be caught...": adolescent girls' understandings and experiences of the HPV programme in the UK. Vaccine. 29(26):4409-15, 2011 Jun 10.

2. Williams K, Et al. Attitudes towards human papillomavirus vaccination: a qualitative study of vaccinated and unvaccinated girls aged 17-18 years. Journal of Family Planning and Reproductive Health Care. 37(1): 22-25, 2011 Jan.

3. Parikh S. Brennan P. Boffetta P. Meta-analysis of social inequality and the risk of cervical cancer. International Journal of Cancer. 105(5):687-91, 2003 Jul 10

4. Fender M. Et al. Teenagers’ knowledge of human papillomavirus and cervical cancer in Bas- Rhin, France. 2009

Thank you...