2.1 Study design and Purpose
The present study is a cross sectional survey, that was designed to investigate knowledge about CC and awareness about HPV vaccine among medical students in Jordan.
2.2 Study Participants and ethical Considerations
The protocol of the study was approved by the Scientific Research Committee at Yarmouk University. The study was conducted after obtaining ethical approval from the Institutional Review Board (IRB) of Jordan University of Science and Technology (JUST) and King Abdulla University Hospital (KAUH), Irbid, Jordan (13/128/2019). All methods were performed in accordance with the relevant guidelines and regulations
The questionnaire was distributed utilizing an electronic format, through Google Forms. The link to the survey was shared with medical students in six universities in Jordan. The questionnaire was prefaced by a page explaining the nature and objectives of the study and the voluntary nature of participation with a consent statement, if they would like to take part in the study. Informed consent was obtained from all subjects. The questionnaire was terminated automatically if participants declined to take part. This procedure was approved by the IRB committee.
The participants were assured that the outcomes of the research would not be used for routine appraisal of the participants. The individuals were requested to complete the questionnaire without textbooks or consulting materials.
The study was conducted for a period of 3 months in the colleges of Medicine at six different Universities in Jordan. Third year to sixth year students form all medical colleges in Jordan were invited to participate in the study.
2.3 Study Instruments
The study questionnaire was developed by authors by extensive review of literature. A Printed English version of a pre-validated questionnaire, consisting of items as modified from questionnaires used in other studies [14,16] was used. The questionnaire was reviewed by the authors and then subjected to pilot testing by 30 participants to ensure clarity of the questions, which resulted in several minor amendments.
The final version of the questionnaire consists of 3 parts. The first one was about demographic information of participants which included age, gender, year of study, and average monthly income. The second part assesses the knowledge about CC and HPV. Finally, the third part assessed the awareness and acceptance of HPV vaccination.
The knowledge of the students about CC was evaluated using 14 multiple choice questions with 34 statements related to disease etiology, risk factors, clinical features and screening recommendations according to world health organization (WHO). Each answer was scored as incorrect or correct. The respondent was given a zero point for each wrong answer and one point for each correct answer.
Total knowledge score was calculated for each participant out of 34. Participants were categorized to have poor, moderate, and good knowledge if their score was 0–17, 18-25, and 26-34, respectively.
Regarding respondents’ awareness about the HPV vaccination, this part consists of 7 questions. Each question was scored out of 2 points. Poor awareness was given to the students with maximum %39 of awareness mean, average awareness level was allocated to those with at most %40-%69 of awareness mean and good awareness level was assigned to people with over %70 of awareness mean i.e. if their awareness score was 0–5, 6-9, and 10-14 respectively.
Last three questions in the questionnaire assessed the acceptance of HPV vaccination in Jordan among Medical students in Jordan, perceived barriers of HPV vaccination and source of information about it.
2.4 Statistical Analysis
Data was analyzed using SPSS software version 24. Descriptive data was expressed as frequencies and percentages. Chi square was used to analyze significant differences between categorical variables. Student's t-test was used to compare the means between two groups. All p-values were two sided and any p-value of less than 0.05 was considered statistically significant.
2.5 Sample Size Calculation
The sample size was calculated utilizing the online Raosoft software sample size calculator. The minimum required sample size assuming a 95% confidence level, 50% recruitment rate, 5% margin of error and a and a maximal sample size of 6000 students, would be 362 participants.