The present study provided the first insight into women’s knowledge and awareness of cervical cancer, HPV infection and attitudes toward vaccines in Taizhou area, southeast of China. Among our survey participants who visited the gynaecological clinic, women had a good knowledge of cervical cancer. 92.4% of women had ever heard of cervical cancer. 85.1% agreed that cervical cancer screening is important for cancer prevention, and 77.3% believed that cervical cancer could be prevented and cured. These findings might be due to the large-scale promotion of National Cervical Cancer Early Detection Program in China since 2009. However, only 14.0% of women correctly answered on the cause of cervical cancer, including HPV infection, sexually transmitted diseases, multiple sexual partners, and smoking habit. The majority of these women (88.3%) who correctly answered on the cause of cervical cancer have college or above education. In previously reported studies, only 35.0% of adolescents had ever heard of cervical cancer [15, 16], this proportion was much lower than that among parents of young adolescents or undergraduates (approximately 79.0%) [17, 18]. In addition, the age of cervical cancer incidence tends to be younger [1, 2]. Therefore, in order to ensure the success of adolescents HPV vaccination in future, it is important to educate women on the ideal time to vaccinate their children. Acquiring knowledge is an important initial step; HPV related health education should be included in the school-based sexual education for adolescents.
Results from this study showed that 57.5% of women had ever heard of HPV, which was higher rate than that reported in underdeveloped western China (28.9%) , southern China (37.7%) , Shandong province (19.3%) , but was consistent with the data reported from Australia (63%) ; this results might be due to thriving economy of Taizhou, suggesting that women who lived in richer regions may know more about HPV. However, HPV related knowledge of our survey participants still needs to be improved, including healthcare providers, which reflects the fact that HPV DNA tests in cervical screening programs was difficult to promote in clinic . In addition, only 1.0% (7/736) of women correctly answered all knowledge questions in HPV infection section. Only 27.9% were aware that HPV infection was common among sexually active women. 51.5% of women agreed that HPV infection may cause cervical cancer, but few women knew that HPV infection may also cause penile cancer (9.5%), anal cancer (4.6%), and genital warts (14.8%). The low rates of knowledge of HPV related cancer was consistent with rates reported from United States (approximately 10.0%) . There was no significant difference in the level of HPV related knowledge between period I and period II (P>0.05). Low levels of knowledge on HPV infection and its connection to cervical cancer are considered to be the major hurdle for the successful implementation of HPV vaccination.
With the approval of HPV vaccines in mainland China recently years, women’s knowledge and awareness on vaccines in period II was significantly higher than that in period I (68.7% vs. 43.7%, P<0.05), which might be due to the Chinese government’s role in promoting the HPV vaccines through print and electronic media. Surprisingly, only 4.3% of women have been vaccinated with HPV in this study. 75.9% of women questioned the efficacy of HPV vaccines which were the main problem in hinders the acceptance of HPV vaccination. 37.8% of women concerned the safety about vaccination, and 16.0% of women questioned the source of HPV vaccines in this study. The 2016 vaccines incident of Changsheng Biotechnology and Wuhan institute of Biological Products seriously damaged the confidence of the Chinese public in the vaccine system , and rebuilding trust is a daunting task. Although women with the low knowledge on HPV, the willingness to receive HPV vaccination was high (94.1%) if vaccines are available. It is noteworthy that if girls aged 9–15 years are left unvaccinated, about 381,000 cases of cervical cancer and 212,000 related deaths will occur among this group of girls in China . Most importantly, the Chinese government has the responsibility to ensure that HPV vaccines produced and used in China are effective and safe . Furthermore, communication of the beneﬁts of HPV vaccination to these women in a coordinated manner might contribute to the progress of the preventive interventions.
Our results identified several factors which positively correlated with HPV related knowledge: marital status, education, occupation, and family annual income (P<0.05). Especially for women with lower education, they should be more educated about HPV related knowledge. In this study, all survey participants got an information brochure on current status of cervical cancer in China, the relationship between HPV infection and cervical cancer, HPV vaccines, and high risk population of cervical cancer, to ensure successful implementation of HPV vaccination program in future. Furthermore, our survey women prefer to obtain health information from trusted sources, including lecture-based health education from physicians and community-based interventions from healthcare professionals. Thus, our future work should ensure regular health education on cervical cancer prevention at a shorter interval to ensure continuous effective [14, 27].
Our study has some limitations. First, the present survey is a cross-sectional study, and owing to its characteristics that prevents us from making any statements regarding causality. Second, all survey participants were patients who spontaneously visited the gynaecological clinic which cannot represent the general population in Taizhou area. Third, this study focused on Taizhou area of Zhejiang province, which located in China’s most developed southeast coastal area. Compared with other parts of China, women’s HPV related knowledge is relatively higher. Thus, our results may not be generalizable to the entire Chinese population.