Medical students’ knowledge of the human papillomavirus (HPV), cervical cancer, and HPV vaccination

Wanderley, Miriam da Silva; Sobral, Dejano Tavares; Resende, Ceres Nunes; Levino, Lívia de Azevedo; Marques, Luísa de Assis; Feijó, Mateus Silva; Aragão, Nathália Regina Cardoso

doi:10.1590/1981-5271v45.3-20210071.ING

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ORIGINAL ARTICLE • Rev. bras. educ. med. 45 (03) • 2021 • https://doi.org/10.1590/1981-5271v45.3-20210071.ING copy

Medical students’ knowledge of the human papillomavirus (HPV), cervical cancer, and HPV vaccination

Conhecimento dos alunos de medicina sobre papilomavírus humano (HPV), câncer cervical e vacinação contra HPV

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Introduction:

Medical students still have many doubts regarding HPV (Human papillomavirus) and the vaccine against this virus.

Objective:

The study aimed to assess the University of Brasilia medical students’ grasp of knowledge about HPV, its relationship with cancer, and the vaccine against the virus.

Methods:

A cross-sectional study was undertaken by applying a survey questionnaire on the topics. The evaluation involved 379 respondents, 72.7% of the 521 students from the 1^st to the 6^th years enrolled in the second semester of 2017. The statistical analyses included differences between means and proportions, effect size measures, and the correlation between the identified indicators. The study was approved by the Ethics Committee in Research on Human Beings of the School of Medicine (1,989,835).

Results:

The 50-item knowledge score increased progressively with the year attended by the medical students (r= .706, p< .001), and was higher among the sexually-active compared to celibate participants (t = 3.26, df = 275, p = 0.001, d = 0.37), as well as among participants with higher family income compared to those with lower family income (t= 2.91, df= 366, p= .004, d= .35). No significant score differences emerged between participants grouped by gender, sexual behavior, or HPV vaccination status. Furthermore, gender (female; OR= 6.5, p<.001), age range (<24 years; OR= 3.3, p= .001), sexuality (active; OR= 2.7, p= .002), but not overall knowledge were predictors of the wish to be vaccinated among the 297 unvaccinated students.

Conclusion:

The study revealed a strong correlation of medical students’ HPV-related knowledge with medical school year and significantly higher scores among sexually active and higher-income respondents, but there were no essential differences between males and females or between vaccinated and unvaccinated students. Among the latter participants, gender, age, and sexuality, but not knowledge, were the best predictors of the wish to be vaccinated. The findings suggest the need for improving HPV screening and vaccination programs and educational strategies regarding HPV-related diseases.

Keywords:
Medical Students; Knowledge; Human Papillomavirus; Vaccination; Sexual Behavior

Students’ Conditions	Groups	N	K-test scores	Difference (95% CI)	Cohen’s d
Students’ Conditions	Groups	N	Mean (SD)	Difference (95% CI)	Cohen’s d
Level of study	Years 5-6	108	76.6 (9.3)	22.3 (20.1, 24.7)	1.91
Level of study	Years 1-4	271	54.3 (12.5)	22.3 (20.1, 24.7)	1.91
Sexuality	Sexually Active	267	62.2 (14.7)	5.6 (2.2, 9.0)	0.37
Sexuality	Celibate	110	56.6 (15.5)	5.6 (2.2, 9.0)	0.37
Monthly family income	>US$300	279	62.0 (15.3)	5.4 (1.8, 9.1)	0.35
Monthly family income	<US$300	89	56.6 (15.2)	5.4 (1.8, 9.1)	0.35
Gender	Male	218	60.3 (15.6)	-0.08 (-3.9, 2.4)	0.05
Gender	Female	161	61.1 (15.2)	-0.08 (-3.9, 2.4)	0.05

Survey items (ordered by increasing percentage of overall correct answers)	Correct/ Incorrect Response	Study Levels		Odds Ratio (95% CI)	Fisher’s Exact test
	Correct/ Incorrect Response	Year 1-4	Year 5-6
HPV is a cause of infertility	C	7	34	17.2 (7.3,40.5)	<0.0001
HPV is a cause of infertility	I	263	74	17.2 (7.3,40.5)	<0.0001
The preventive Pap smear can detect HPV infection	C	16	32	6.7 (3.5,12.8)	<0.0001
The preventive Pap smear can detect HPV infection	I	254	76	6.7 (3.5,12.8)	<0.0001
HPV causes genital herpes	C	68	77	7.4 (4.5,12.2)	<0.0001
HPV causes genital herpes	I	202	31	7.4 (4.5,12.2)	<0.0001
HPV vaccine is available to both boys and girls	C	95	90	9.2 (5.2,16.2)	<0.0001
HPV vaccine is available to both boys and girls	I	175	18	9.2 (5.2,16.2)	<0.0001
HPV can be transmitted by sitting on a toilet seat	C	109	95	10.8 (5.8,20.2)	<0.0001
HPV can be transmitted by sitting on a toilet seat	I	161	13	10.8 (5.8,20.2)	<0.0001
HPV may cause anal and oral cancers	C	151	85	2.9 (1.7,4.9)	<0.0001
HPV may cause anal and oral cancers	I	119	23	2.9 (1.7,4.9)	<0.0001
Early sex is a risk factor for cervical cancer	C	164	99	7.2 (3.5,14.8)	<0.0001
Early sex is a risk factor for cervical cancer	I	107	9	7.2 (3.5,14.8)	<0.0001
HPV vaccination is inadequate for males	C	186	95	3.3 (1.7,6.2)	0.0001
HPV vaccination is inadequate for males	I	84	13	3.3 (1.7,6.2)	0.0001
Most HPV infections are symptomatic	C	183	101	6.9 (3.1,15.4)	<0.0001
Most HPV infections are symptomatic	I	87	7	6.9 (3.1,15.4)	<0.0001
HPV vaccination promotes sexual promiscuity	C	205	85	1.2 (0.7,2.0)	0.5922
HPV vaccination promotes sexual promiscuity	I	66	23	1.2 (0.7,2.0)	0.5922
The efficacy of HPV vaccination is higher before sexual initiation	C	210	101	4.1 (1.8,9.3)	0.0003
	I	60	7	4.1 (1.8,9.3)	0.0003
Multiple sexual partners are a risk factor for cervical cancer	C	215	107	27.9 (3.8,204)	<0.0001
	I	56	1	27.9 (3.8,204)	<0.0001
The HPV vaccine is available in the public health services	C	246	108	10.5 (1.4,78.9)	0.0047
The HPV vaccine is available in the public health services	I	24	1	10.5 (1.4,78.9)	0.0047

Survey Items (number)	Correct, Incorrect Response	Acceptance of Vaccine		Odds Ratio	Fisher’s Exact Test
Survey Items (number)	Correct, Incorrect Response	Not Wishing	Wishing	(95% CI)
49. The HPV vaccine is available in the public health services	C	73	205	3.1 (1.3,7.6)	0.0137
	I	11	10	3.1 (1.3,7.6)	0.0137
50. The HPV vaccine is available to both boys and girls	C	31	110	1.8 (1.1,3.0)	0.0289
50. The HPV vaccine is available to both boys and girls	I	53	105	1.8 (1.1,3.0)	0.0289
36. Most HPV infections are symptomatic	C	55	167	1.8 (1.1,3.2)	0.0390
36. Most HPV infections are symptomatic	I	29	48	1.8 (1.1,3.2)	0.0390
11. Multiple sexual partners are a risk factor for cervical cancer	C	65	185	1.8 (.95,3.4)	0.0822
	I	19	30	1.8 (.95,3.4)	0.0822

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