Knowledge of HPV and Willingness to accept HPV Vaccine among HCW in a tertiary health facility in Abakaliki, Ebonyi State

doi:10.21203/rs.3.rs-5023113/v1

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Knowledge of HPV and Willingness to accept HPV Vaccine among HCW in a tertiary health facility in Abakaliki, Ebonyi State

https://doi.org/10.21203/rs.3.rs-5023113/v1

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Background: Human Papillomavirus (HPV) is a leading cause of cervical cancer and other malignancies. Despite an effective vaccine, uptake remains low in regions like Nigeria. Healthcare workers (HCWs) are key in promoting vaccination, and their knowledge and attitudes influence vaccine acceptance.

Objective: This study assessed HPV knowledge and vaccine acceptance among HCWs at a tertiary health facility in Abakaliki, Ebonyi State, Nigeria, aiming to identify knowledge gaps and barriers to acceptance.

Methods: A cross-sectional study was conducted among HCWs at Alex Ekwueme Federal University Teaching Hospital Abakaliki. A stratified random sample of 242 participants, including doctors, nurses, and laboratory scientists, completed a structured questionnaire. Data were analyzed using descriptive and inferential statistics, with significance set at p<0.05.

Results: Among participants, 92.6% had heard of HPV, with a moderate knowledge score (mean 9.81±4.99 out of 21). Vaccine acceptability had a mean score of 2.39±3.80 out of 8. While 72.7% agreed on the necessity of vaccinating girls, only 50.0% supported vaccinating boys. The main reasons for vaccination were protection against genital cancer (67.8%) and safeguarding future sexual partners (40.9%). Vaccine hesitancy was primarily due to fear of adverse effects (14.9%) and insufficient information (7.4%). A positive correlation (r=0.475, p=0.000) was found between HPV knowledge and vaccine acceptance.

Conclusion: HCWs in Abakaliki show moderate knowledge of HPV and a willingness to accept the vaccine, especially with medical recommendation. However, concerns about vaccine safety and lack of information are barriers. Educational interventions targeting HCWs are crucial to enhancing HPV vaccine uptake and reducing HPV-related disease burdens.

Human Papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide, with certain strains being strongly associated with the development of cervical cancer, anogenital warts, and other malignancies. Despite the availability of an effective HPV vaccine, which has the potential to significantly reduce the incidence of HPV-related diseases, the uptake of the vaccine remains suboptimal in many regions, particularly in low- and middle-income countries like Nigeria.

Healthcare workers (HCWs) play a pivotal role in the promotion of public health initiatives, including vaccination programs. Their knowledge and attitudes towards the HPV vaccine can influence their willingness to recommend and administer the vaccine to patients, as well as their own uptake of the vaccine. Understanding the level of knowledge and willingness to accept the HPV vaccine among HCWs is crucial for designing effective interventions to increase vaccination rates and ultimately reduce the burden of HPV-related diseases.

This study aims to assess the knowledge of HPV and the willingness to accept the HPV vaccine among healthcare workers in a tertiary health facility in Abakaliki, Ebonyi State. By identifying gaps in knowledge and potential barriers to vaccine acceptance, this research will provide valuable insights into how to improve HPV vaccination coverage among both healthcare workers and the broader population in the region.

Study Design

This study was a cross-sectional descriptive study conducted among healthcare workers (HCWs) at a tertiary health facility in Abakaliki, Ebonyi State. The study aim was to assess the knowledge of Human Papillomavirus (HPV) and the willingness to accept the HPV vaccine among the participants.

Study Setting

The study was conducted at Alex Ekwueme Federal University Teaching hospital Abakaliki(AEFUTHA), a major referral center in Abakaliki, the capital of Ebonyi State. The facility provides a wide range of healthcare services and has a diverse workforce that includes doctors, nurses, pharmacists, laboratory scientists, and other allied health professionals.

Sample Size Determination

The sample size was determined using the formula for estimating proportions in a cross-sectional study with an infinite population > 10,000:

Where:

n = required sample size
Z = Z-score for a 95% confidence level (1.96)
p = estimated proportion of healthcare workers with good knowledge of HPV or willingness to accept the vaccine (assumed to be 50% since no prior data is available)
d = margin of error (5%)

After calculating the sample size, an additional 10% was added to account for non-response or incomplete data, resulting in a final sample size.

Sampling Technique

A stratified random sampling technique was employed to select participants. The healthcare workers was stratified by their professional category (doctors, nurses, pharmacists, laboratory scientists, etc.), and a proportional number of participants was randomly selected from each category to ensure adequate representation.

Data Collection

Data was collected using a structured, self-administered questionnaire. The questionnaire was developed based on a review of existing literature and consist of three sections:

Demographic Information: This section gathers information on age, gender, profession, years of experience, and other relevant demographic variables.
Knowledge of HPV: This section assesses participants' knowledge about HPV, its transmission, associated diseases, and the HPV vaccine.
Willingness to Accept the HPV Vaccine: This section explores participants' attitudes towards the HPV vaccine, including their willingness to receive the vaccine and recommend it to others.

The questionnaire was pre-tested on a small group of 10 healthcare workers at a different facility to ensure clarity and validity. Necessary adjustments were made based on the feedback from the pre-test.

Data Analysis

Data was entered into IBM Statistics software program(SPSS) and analysed. Descriptive statistics was used to summarize the data, including frequencies, percentages, means, and standard deviations. Inferential statistics, correlation, was used to assess the association between knowledge of HPV and willingness to accept the vaccine, as well as other relevant variables.

A p-value of less than 0.05 was considered statistically significant.

Ethical Considerations

Ethical approval

for the study was obtained from the research and Ethics Committee of Alex Ekwueme Federal Univrsity Teaching Hospital Abakaliki Ebonyi state. Informed consent was obtained from all participants prior to their inclusion in the study. Participation was voluntary, and participants assured of the confidentiality of their responses. No identifying information was be collected, and data stored securely to protect participants' privacy.

Study Population

The study population consist of healthcare workers employed at the tertiary health facility. The participants include doctors, nurses, pharmacists, laboratory scientists, and other allied health professionals who are directly or indirectly involved in patient care.

A total of 250 questionnaires were produced and distributed. All recruited participants filled the questionnaire. However after unmarked questionnaires were excluded 242 were included in the analysis.

Sociodermographic characteristics

The participants were doctors 113(46.7%), nurses 56(23.1%), lab scientists 40(16.5%), and non-medical hospital staff 33(13.6%). Majority were female 160(66.1%), aged 40-49years109(45.0%) and had 4 chilkdren 74(30.6%).

HPV knowledge

Significantly, 224(92.6%) of respondents had heard of HPV infection. There was a significant association between knowledge of HPV and profession as all those who responded negatively to the question “Have you heard of HPV?” were non-medical hospital staff. All doctors, nurses and lab scientists had heard of HPV.

Knowledge about HPV when put together was on the average with a mean score of 9.81 ± 4.99 out of a total of 21, a modal score of 12 (10.7%) and median score of 11(10.2%). Two participants (0.8%) obtained the total score of 21 for HPV infection knowledge. The least score zero was obtained by 22(9.1%)

A significant proportion (79%) of respondents agreed that HPV is a serious health problem (39.7% totally agree and 39.3% agree) and 48.7% agreed that it was one of the most common sexually transmitted diseases (13.2% totally agree, 35.5% agree). Only 10.3% and 14.5% responded as not sure to both questions.

Majority (92.6%) of respondents identified sexual transmission as the mode of transmission of HPV. They correctly responded that girls (78.9%), women(80.2%), boys(55.0%) and men(51.7%) could get infected. Cervical cancer (71.5%) and genital wart (59.1%) were the diseases that the respondents associated most with HPV.

Respondents were also able to recognize that HPV was associated with other diseases such as vaginal cancer (28.1%), penile cancer (25.2%) and anal cancer(18.2%). Majority (80.6%) of respondents say that vaccination was the prevention for HPV infection whereas 10.7% did not know the possible methods of its prevention.

HPV Vaccine acceptability

The mean score for HPV vaccine acceptability was 2.39 ± 3.80 out of a total of 8. The median score was 0.0(10.7%) and modal score was 5(14.9%). There was a high level of agreement(72.7%) in considering HPV vaccination necessity in Girls(agree 24.4%,strongly agree48.3%), similarly, 50.0%(33.9% agree, 16.1% strongly agree) of respondents agree in the necessity of HPV vaccination in boys. Majority(65.3%) agree to vaccinate if a doctor recommends HPV vaccine to them however 24.4% responded that they disagree/strongly disagree to the question, “I would vaccinate my Child”.

Protecting them against genital cancer and/or genital warts was the main reason for vaccination (67.8%) another 40.9% responded that their reason for wanting to vaccinate their child was “to protect their future sexual partners against genital cancer and/or genital warts”. Among those who refused to vaccinate their children, the reasons for choosing not to vaccinate was “I’m afraid of possible adverse effects”(14.9%) followed by “there isn’t enough information about HPV Vaccination”(7.4%).

With regards to the type of information they needed for HPV Vaccination to be acceptable 16.5% respondents that they would request specific information about vaccine safety; and 14.9% would require a general information about HPV vaccine. Only 2.5% would require recommendation from their doctor to vaccinate.

The responses to the question who/where would you go to for information for HPV vaccination yielded gynecologists(67.4%), pediatricians(44.2%) family physicians(44.2%) and internet/social media(27.3%).

Correlation of HPV Knowledge and Acceptability

HPV knowledge and Vaccine acceptability was positively and significantly correlated with a correlation coefficient of 0.475(sig: 0.000). The line graph(FIG:1) shows that as the knowledge score increased, acceptability score increased.

The findings of this study highlight the current state of knowledge regarding Human Papillomavirus (HPV) and the willingness to accept the HPV vaccine among healthcare workers (HCWs) at a tertiary health facility in Abakaliki, Ebonyi State. The results indicate a generally high level of awareness about HPV, but with varying degrees of knowledge and vaccine acceptability across different professional groups.

The study revealed that a significant majority (92.6%) of respondents had heard of HPV, with all doctors, nurses, and lab scientists being aware of the infection. This is consistent with other studies that have found high levels of awareness among healthcare professionals due to their exposure to relevant information through professional training and practice. However, the overall knowledge score was moderate, with a mean score of 9.81 ± 4.99 out of a possible 21, indicating that while most HCWs are aware of HPV, there may be gaps in their detailed understanding of the virus and its associated risks.

The association of HPV with serious health issues, such as cervical cancer (71.5%) and genital warts (59.1%), was well recognized by the participants. However, knowledge about HPV’s link to other cancers, such as penile (25.2%) and anal cancer (18.2%), was less widespread. This finding aligns with previous research, which suggests that while HCWs may be familiar with the most common HPV-related conditions, they might not be fully aware of the broader spectrum of diseases associated with the virus.

The acceptability of the HPV vaccine among respondents was varied, with a mean score of 2.39 ± 3.80 out of 8. While there was a strong consensus on the importance of vaccinating girls (72.7% agreement), there was less agreement on vaccinating boys (50.0% agreement). This difference may reflect lingering misconceptions about HPV being predominantly a female issue, despite increasing evidence that HPV vaccination is equally important for males.

A significant finding was that while 65.3% of respondents would vaccinate if recommended by a doctor, only 24.4% were willing to vaccinate their children. The reluctance to vaccinate one’s own child, despite acknowledging the vaccine's importance, is concerning and mirrors findings from other studies where HCWs, despite their knowledge, express hesitancy due to concerns about vaccine safety and insufficient information. The most common reasons for refusal were fear of adverse effects (14.9%) and a perceived lack of information (7.4%). This suggests that despite their role as healthcare providers, HCWs may also require more detailed and accessible information about HPV vaccines to overcome hesitancy.

The positive and significant correlation (r = 0.475, p < 0.001) between HPV knowledge and vaccine acceptability indicates that better-informed HCWs are more likely to accept the vaccine. This finding underscores the importance of targeted educational interventions aimed at improving comprehensive HPV knowledge, which could subsequently enhance vaccine acceptability among HCWs. Other studies have similarly demonstrated that increasing knowledge about HPV and its vaccine correlates with higher acceptance rates.

Implications for Public Health

Given that healthcare workers are influential in shaping public attitudes toward vaccination, their hesitancy could have broader implications for public health efforts, especially in regions with already low vaccination coverage. The results highlight the need for continuous professional development programs that address both the knowledge gaps and concerns about vaccine safety among HCWs. Furthermore, strategies that promote the role of HCWs as advocates for vaccination, not just as providers, could be crucial in improving HPV vaccine uptake in the general population.

Study Limitation

This study is not without limitations. The cross-sectional design limits the ability to establish causality between knowledge and vaccine acceptability. Additionally, the use of self-reported data may introduce response bias, particularly with sensitive topics such as vaccine hesitancy. Finally, the study's findings may not be generalizable beyond the specific setting of the tertiary health facility in Abakaliki.

This study provides valuable insights into the knowledge and attitudes of healthcare workers towards HPV and its vaccine in a tertiary health facility in Abakaliki, Ebonyi State. While awareness of HPV is high, there are significant gaps in detailed knowledge and vaccine acceptability, highlighting the need for targeted educational interventions. Addressing these gaps could enhance vaccine uptake, ultimately contributing to the reduction of HPV-related diseases in the region.

Ethics approval and consent to participate - 'Not applicable'
Consent for publication - 'Not applicable'
Availability of data and materials - The dataset for the study can be obtained from the corresponding author upon reasonable request.
Competing interests - The authors declare that they have no competing interests
Funding - This study is made possible by personal funds of the authors.
Authors' contributions-
Conceptualization and Design: AOU, CTE, EOB, JCI, AUV,CTA
Data Collection: AOU, CTE,CTA
Analysis: AOU, EOB
Manuscript Script Writing for first draft: AOU and CTA
Review of drafts and recommendations for final drafts: All authors
Endorsement for the final version: All authors

Acknowledgements

The authors are thankful to all the health workers for their time and consent in participation.

Adegbesan-Omilabu MA, Okunade KS, Omilabu SA. (2019). Knowledge and awareness of Human Papillomavirus (HPV) infection and vaccines among mothers attending an antenatal clinic in Lagos, Nigeria. J Cancer Educ, 34(4), 704–9.
Di Giuseppe G, Abbate R, Liguori G, Albano L, Angelillo IF. (2008). Human Papillomavirus and vaccination: Knowledge, attitudes, and behavioral intention in adolescents and young women in Italy. Br J Cancer, 99(2), 225–9.
Saslow D, Andrews KS, Manassaram-Baptiste D, Smith RA, Fontham ETH., & American Cancer Society. (2020). Human Papillomavirus Vaccination 2020 Guideline Update: American Cancer Society Guideline Adaptation. CA: A Cancer Journal for Clinicians, 70(4), 274–280.
Holman DM, Benard V, Roland KB, Watson M, Liddon N, Stokley S. (2014). Barriers to Human Papillomavirus vaccination among US adolescents: A systematic review of the literature. JAMA Pediatr, 168(1), 76–82.
Rosenthal SL, Rupp R, Zimet GD, Meza HM, Loza ML, Short MB, Succop PA. (2008). Uptake of HPV vaccine: Demographics, sexual history and psychosocial factors. Health Psychol, 27(3), 307–15.

Table 1

Sociodemographic characteristics of respondents
s/n	Variable	Freq	%
A	Gender
	Male Female	82 160	33.9 66.1
B	Age group
	< 29 30–39 40–49 50–59 > 59	20 55 109 56 2	8.3 22.7 45.0 23.1 0.8
C	Profession
	Doctor Nurse Lab scientist Non-medical hospital staff	113 56 40 33	46.7 23.1 16.5 13.6
D	Number of Children
	0 1 2 3 4 5 6 7	35 12 30 51 74 20 14 6	14.5 5.0 12.4 21.1 30.6 8.3 5.8 2.5

Table 2

HPV Infection Knowledge
s/n	Variable	Freq	%
A	HPV is the most common STD
	I totally disagree I disagree I agree I totally agree Im not sure	35 54 86 32 35	14.5 22.3 35.5 13.2 14.5
B	HPV is a serious health problem
	I totally disagree I disagree I agree I totally agree Im not sure	20 6 95 96 25	8.3 2.5 39.3 39.7 10.3
C	Mode of transmission of HPV
	Sexually transmitted Blood transfusion Use of public toilet Mother to child during pregnancy Im not sure	224 42 16 40 10	92.6 17.4 6.6 16.5 4.1
D	Diseases related to HPV
	Bladder cancer Genital wart HIV/AIDS Hepatitis Infertility Cancer of the Penis Irritable bowel syndrome Cancer of the oral cavity Esophageal cancer Recurrent cystitis Anal cancer Vulval cancer Vaginal cancer Cervical cancer None Im not sure	22 143 54 18 35 61 12 54 26 18 44 64 68 173 0 26	9.1 59.1 22.3 7.4 14.5 25.2 5.0 22.3 10.7 7.4 18.2 26.4 28.1 71.5 0.0 10.7
E	Those who could get infected
	Girls Women Boys Men Nobody Im not sure	191 194 133 125 4 14	78.9 80.2 55.0 51.7 1.7 5.8
F	Prevention of HPV infection
	Use of condoms Vaccination against HPV Late start of sexual activity Good personal heigiene Low sexual activity Use of antibiotics Birth control pills Cannot be prevented I don’t know	145 195 55 56 64 8 8 0 26	59.9 80.6 22.7 23.1 26.4 3.3 3.3 0.0 10.7

Table 3

HPV vaccine acceptability
s/n	Variable	Freq	%
A	HPV Vaccination in girls is necessary
	I strongly disagree I disagree I agree I strongly disagree I do not have enough information to answer	18 22 59 117 26	7.4 9.1 24.4 48.3 10.7
B	HPV Vaccination in boys is necessary
	I strongly disagree I disagree I agree I strongly disagree I do not have enough information to answer	24 45 82 39 52	9.9 18.6 33.9 16.1 21.5
C	The doctor recommends HPV Vaccine to me
	I strongly disagree I disagree I agree I strongly disagree I do not have enough information to answer	20 36 108 50 28	8.3 14.9 44.6 20.7 11.6
D	I would vaccinate my son/daughter
	I strongly disagree I disagree I agree I strongly disagree I do not have enough information to answer	29 30 78 79 26	12.0 12.4 32.2 32.6 10.7
E	Reason for vaccinating my child
	To protect them against sexually transmitted diseases To protect them against genital cancer and/or genital warts To protect their future sexual partners against genital cancer and/or genital warts I am aware of cancer and its prevention, because I know some cases amongst my closest relatives and friends. To comply with the immunization schedule It was the Doctor’s recommendation	75 164 99 36 32 10	31.0 67.8 40.9 14.9 13.2 4.1
F	Reason for not vaccinating my child
	I’m afraid of possible adverse effects In my opinion, too many vaccines are given My son/daughter is too young to be vaccinated It is too late, my son/daughter has already had his/her first sexual intercourse I don´t consider my son/daughter at risk of being infected with HPV I prefer that my son/daughter decides later by him/herself to get vaccinated My doctor told me vaccination is not necessary I don’t have enough information about HPV vaccine Vaccine price I’d rather wait before taking this decision	36 0 2 8 4 6 0 18 2 2	14.9 0.0 0.8 3.3 1.7 2.5 0.0 7.4 0.8 0.8
G	What type of information would you need to decide to vaccinate your child against HPV
	Specific information about vaccine safety Specific information about vaccine efficacy General information about HPV General information about HPV vaccine Recommendation from my Doctor Other	40 22 24 36 6 0	16.5 9.1 9.9 14.9 2.5 0.0
H	Who/where would you go for information concerning HPV?
	Pediatrician Family physician Gynecologist Urologist Nurse Pharmacist Other healthcare workers Friends and relatives Newspaper/magazines Radio and TV Internet and social media Others textbooks, vaccinologist	107 107 163 35 48 8 10 4 12 32 66 4	44.2 44.2 67.4 14.5 19.8 3.3 4.1 1.7 5.0 13.2 27.3 1.6

Table 4

Cross-tabulations of profession and I would vaccinate my child
	I would vaccinate my child against HPV
Profession	Strongly disagree	Disagree	Agree	Strongly agree	I do not have enough information to respond	Total	ꭓ2
Doctor	8(7.1)	8(7.1)	46(40.71)	47(41.6)	4(3.5)	113
Nurse	2(3.6)	14(25.0)	16(28.6)	20(35.7)	4(7.1)	56
Lab scientist	4(10.0)	8(20.0)	12(30.0)	12(30.0)	4(10.0)	40
Non-medical hospital staff	15(45.5)	0(0.0)	4(12.1)	0(0.0)	14(42.4)	33
Total	29(12.0)	30(12.4)	78(32.2)	79(32.6)	26(10.7)	242

No competing interests reported.

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You are reading this latest preprint version

Knowledge of HPV and Willingness to accept HPV Vaccine among HCW in a tertiary health facility in Abakaliki, Ebonyi State

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Version 1

Abstract

Figures

Introduction

Methodology

Study Design

Study Setting

Sample Size Determination

Sampling Technique

Data Collection

Data Analysis

Ethical Considerations

Study Population

Results

Sociodermographic characteristics

HPV knowledge

HPV Vaccine acceptability

Correlation of HPV Knowledge and Acceptability

Discussion

Implications for Public Health

Study Limitation

Conclusion

Declarations

References

Tables

Additional Declarations

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