Knowledge and Attitudes of Human Papillomavirus (HPV) Vaccination among Secondary School Students in Selangor, Malaysia
Knowledge and Attitudes of HPV Vaccinations
Vol. 19 No. 1 : 2024 (230-244)
Abstract
Cervical cancer is a significant cause of female mortality in Malaysia, primarily linked to Human Papillomavirus (HPV) infection. To address this, the Malaysian government launched a HPV vaccination program targeting secondary school students. This study aimed to investigate the level of knowledge and attitude toward HPV vaccination and its association with demographics as a determinant among Malaysian secondary school students. A survey study using random sampling was conducted for 182 secondary school students in Selangor between the aged 13-17 years old. A validated questionnaire was used to collect data on demographics, knowledge, and attitudes toward HPV vaccination. The students demonstrated moderate knowledge (M=3.75, SD=.85) and generally positive attitudes (M=3.48, SD=3.57) towards HPV vaccination. Gender (χ2=6.39, p=.011), ethnicity (χ2=6.57, p=.037), religion (χ2=15.51, p=.004), and age (χ2=12.61, p=.013) were statistically significant factors affecting knowledge. Gender (χ2=8.44, p=.004) and family income (χ2=11.63, p=.040) significantly influenced attitudes. The Malaysian national HPV immunisation program has been effective, but improvements are needed. These include adopting a gender-neutral approach, educating parents to foster positive attitudes, and promoting acceptance of HPV vaccination. Strategies like introducing sexual education and collaboration with the Ministry of Health School Health Unit (UKS) are vital for enhancing public awareness and understanding of HPV vaccination.
Keywords :
Attitude,
Human Papillomavirus,
HPV,
knowledge,
school student,
Correspondance Address
Muhamad Nur Fariduddin bin Abdul Aziz. Department of Physical & Health Education, Faculty of Education, Universiti Teknologi MARA (UiTM), Cawangan Selangor, Kampus Puncak Alam, 42300, Bandar Puncak Alam, Selangor, Malaysia. Tel: +603-32584920 Email: fariduddin@uitm.edu.my
References
Al-Naggar, R.A., Bobryshev, Y.V., Al-Jashamy, K., Al-Musli, M. 2012. Practice of HPV vaccine and associated factors among school girls in Melaka, Malaysia. Asian Pac J Cancer Prev 13(8): 3835-40.
Alsanafi, M., Salim, N.A., Sallam, M. 2023. Willingness to get HPV vaccination among female university students in Kuwait and its relation to vaccine conspiracy beliefs. Hum Vaccin Immunother 19(1): 2194772.
Awadh, A.I., Hassali, M.A., Al-Lela, O.Q., Bux, S.H., Elkalmi, R.M., Hadi, H. 2014. Does an educational intervention improve parents’ knowledge about immunization? Experience from Malaysia. BMC Pediatrics 14(1): 1-7.
Bogani, G., Ghelardi, A., Sopracordevole, F., Annoni, M., Ciavattini, A., Giannella, L., De Vincenzo, R., Cattani, P., Barbero, M., Vercellini, P., Raspagliesi, F. 2023. Human papillomavirus (HPV) vaccination: A call for action in Italy. Int J Gynecol Cancer 33(7): 1132-9.
Buang, S.N., Ja’afar, S., Pathmanathan, I., Saint, V. 2018. Human papillomavirus immunisation of adolescent girls: Improving coverage through multisectoral collaboration in Malaysia. BMJ 363: k4602.
Buang, S.N. 2013. School Health Service - PORTAL MyHEALTH. http://www.myhealth.gov.my/en/school-health-service/ [16 February 2023]
Chan, N.N., Ong, K.W., Siau, C.S., Lee, K.W., Peh, S.C., Yacob, S., Chia, Y.C., Seow, V.K., Ooi, P.B. 2022. The lived experiences of a COVID-19 immunization programme: Vaccine hesitancy and vaccine refusal. BMC Public Health 22(1): 296.
Chiang, V.C., Wong, H.T., Yeung, P.C., Choi, Y.K., Fok, M.S., Mak, O.I., Wong, H.Y., Wong, K.H., Wong, S.Y., Wong, Y.S., Wong, E.Y. 2016. Attitude, acceptability and knowledge of HPV vaccination among local university students in Hong Kong. Int J Environ Res Public Health 13(5): 486.
Chin, K.Y., Ekeuku, S.O., Hamzah, M.R. 2022. The role of healthcare providers in promoting human papillomavirus vaccines among men who have sex with men: A scoping review. Vaccines 10(6): 930.
Choi, J., Tamí-Maury, I., Cuccaro, P., Kim, S., Markham, C. 2023. Digital health interventions to improve adolescent HPV vaccination: A systematic review. Vaccines 11(2): 249.
Darraj, A.I., Arishy, A.M., Alshamakhi, A.H., Osaysi, N.A,, Jaafari, S.M,, Sumayli, S.A., Mushari, R.Y., Alhazmi, A.H. 2022. Human papillomavirus knowledge and vaccine acceptability in Jazan Province, Saudi Arabia. Vaccines 10(8): 1337.
Ezat, S.W., Hod, R., Mustafa, J., Mohd Dali, A.Z., Sulaiman, A.S., Azman, A. 2013. National HPV immunisation programme: Knowledge and acceptance of mothers attending an obstetrics clinic at a teaching hospital, Kuala Lumpur. Asian Pac J Cancer Prev 14(5): 2991-9.
Feng, Y., Feng, R., Liu, Y. 2023. Social media promotion, risk perception, and parental support for adolescent girls’ HPV vaccination: Taking consideration of future consequences and sexual attitudes as moderators. Health Care Women Int 13: 1-4.
Fowler, J.R., Jack, B.W. 2020. Cervical Cancer [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK431093/ [22 August 2022]
Iannelli, V. 2012. Are there religious exemptions to vaccines? Verywell Family. Verywellfamily. https://www.verywellfamily.com/religious-exemptions-to-vaccines-2633702 [22 August 2022]
Jalani, F.F., Rani, M.D., Isahak, I., Aris, M.S., Roslan, N. 2016. Knowledge, attitude and practice of human papillomavirus (HPV) vaccination among secondary school students in rural areas of Negeri Sembilan, Malaysia. Int J Collab Res Intern Med Public Health 8(6): 420-34.
Keane, A., Ng, C.W., Simms, K.T., Nguyen, D., Woo, Y.L., Saville, M., Canfell, K. 2021. The road to cervical cancer elimination in Malaysia: Evaluation of the impact and cost-effectiveness of human papillomavirus screening with self-collection and digital registry support. Int J Cancer 149(12): 1997-2009.
Khoo, S.P., Muhammad Ridzuan Tan, N.A., Rajasuriar, R., Nasir, N.H., Gravitt, P., Ng, C.W., Woo, Y.L. 2022. Changes in genital Human Papillomavirus (HPV) prevalence among urban females a decade after the Malaysian HPV vaccination program. Plos One 17(12): e0278477.
Krejcie, R.V., Morgan, D.W. 1970. Determining sample size for research activities. Edu Psych Meas 30(3): 607-10.
Mathur, M.B., Mathur, V.S., Reichling, D.B. 2010. Participation in the decision to become vaccinated against human papillomavirus by California high school girls and the predictors of vaccine status. J Pediatr Health Care 24(1): 14-24.
Mohd Noor, U.M. 2019. Bayan linnas siri Ke-167: kewajiban mengambil vaksin mengikut jadual imunisasi kebangsaan daripada Perspektif Islam [Internet]. Pejabat Mufti Wilayah Persekutuan. https://muftiwp.gov.my/artikel/bayan-linnas/3129-bayan-linnas-siri-ke-166-kewajiban-mengambil-vaksin-mengikut-jadual-imunisasi-kebangsaan-daripada-perspektif-islam [27 March 2023]
Muhamad, N.A., Buang, S.N., Jaafar, S., Jais, R., Tan, P.S., Mustapha, N., Lodz, N.A., Aris, T., Sulaiman, L.H., Murad, S. 2018. Achieving high uptake of human papillomavirus vaccination in Malaysia through school-based vaccination programme. BMC Public Health 18 (1): 1402.
Newman, P.A., Logie, C.H., Lacombe-Duncan, A., Baiden, P., Tepjan, S., Rubincam, C., Doukas, N., Asey, F. 2018. Parents’ uptake of human papillomavirus vaccines for their children: A systematic review and meta-analysis of observational studies. BMJ Open 8(4): e019206.
Ortiz, R.R., Smith, A., Coyne-Beasley, T. 2019. A systematic literature review to examine the potential for social media to impact HPV vaccine uptake and awareness, knowledge, and attitudes about HPV and HPV vaccination. Hum Vaccin Immunother 15(7-8): 1465-75.
Pillai, S. 2022. Pandemic disrupted HPV vaccination for over 560,000 girls in Malaysia. Code Blue. https://codeblue.galencentre.org/2022/08/30/pandemic-disrupted-hpv-vaccination-for-over-560000-girls-in-malaysia/ [12 April 2023]
Rajiah, K., Maharajan, M.K., Chin, N.S., Num, K.S. 2015. Awareness and acceptance of human papillomavirus vaccination among health sciences students in Malaysia. Virusdisease 26(4): 297-303.
Rao, S.R., Kampan, N., Chew, K.T., Shafiee, M.N. 2022. The impact of the COVID-19 pandemic on the national HPV immunization program in Malaysia. Front Public Health 10: 907720.
Rashwan, H., Ishak, I., Sawalludin, N. 2013. Knowledge and views of secondary school students in Kuala Lumpur on cervical cancer and its prevention. Asian Pac J Cancer Prev 14(4): 2545-9.
Rashwan, H., Lubis, S.H., Ni, K.A. 2011. Knowledge of cervical cancer and acceptance of HPV vaccination among secondary school students in Sarawak, Malaysia. Asian Pac J Cancer Prev 12(7): 1837-41.
Shafei, M.N., Zainon, N., Zulkifli, N.F., Ibrahim, M.I. 2014. Knowledge and perception on human papilloma virus infection and vaccination among medical students of a university in Malaysia. Procedia Soc Behav Sci 116: 2707-10.
Shaikh, M.Y., Hussaini, M.F., Narmeen, M., Effendi, R., Paryani, N.S., Ahmed, A., Khan, M., Obaid, H. 2019. Knowledge, Attitude, and barriers towards human papillomavirus (HPV) vaccination among youths of Karachi, Pakistan. Cureus 11(11): e6134.
Sham, F., Zaidi, W.N., Zahari, Z.N., Danis, A., Razali, S. 2020. Sexuality means” sex”: Opinions of parents on sexuality education in Malaysia. Int J Caring Sci 13(3): 1818-25.
Siseho, K.N., Omoruyi, B.E., Okeleye, B.I., Okudoh, V.I., Amukugo, H.J., Aboua, Y.G. 2022. Women’s perception of cervical cancer pap smear screening. Nurs Open 9(3): 1715-22.
Sopian, M.M., Shaaban, J., Yusoff, S.S., Mohamad, W.M. 2018. Knowledge, decision-making and acceptance of human papilloma virus vaccination among parents of primary school students in Kota Bharu, Kelantan, Malaysia. Asian Pac J Cancer Prev 19(6): 1509-14.
Tusimin, M., Yee, C.L., Razak, N.Z., Zainol, M.I., Minhat, H.S,, Rejali, Z. 2019. Sociodemographic determinants of knowledge and attitude in the primary prevention of cervical cancer among University Tunku Abdul Rahman (UTAR) students in Malaysia: Preliminary study of HPV vaccination. BMC Public Health 19(1): 1-6.
Ulasan, S., Nahrawi, N.A., Mustafa, W.A., Kanafiah, S.N. 2020. Knowledge of Human Papillomavirus (HPV) and cervical cancer among Malaysia Residents: A review. Sains Malaysiana 49(7): 1687-95.
Vethasalam, R. 2023. HPV vaccination resumes for Form 1 female students [Internet]. The Star. https://www.thestar.com.my/news/nation/2023/01/06/hpv-vaccination-resumes-for-form-1-female-students [12 April 2023]
Vinodhini, K., Shanmughapriya, S., Das, B.C., Natarajaseenivasan, K. 2012. Prevalence and risk factors of HPV infection among women from various provinces of the world. Arch Gynecol Obstet 285(3): 771-7.
Widjaja, V.N. 2019. Awareness, knowledge and attitudes of human papillomavirus (HPV) among private university students-Malaysia perspective. Asian Pac J Cancer Prev 20(7): 2045-50.
Wijayanti, K.E., Schütze, H., MacPhail, C. 2021a. Parents’ attitudes, beliefs and uptake of the school-based human papillomavirus (HPV) vaccination program in Jakarta, Indonesia–A quantitative study. Prev Med Rep 24: 101651.
Wijayanti, K.E., Schütze, H., MacPhail, C., Braunack-Mayer, A. 2021b. Parents’ knowledge, beliefs, acceptance and uptake of the HPV vaccine in members of The Association of Southeast Asian Nations (ASEAN): A systematic review of quantitative and qualitative studies. Vaccine 39(17): 2335-43.
Wong, L.P., Raja Muhammad Yusoff, R.N., Edib, Z., Sam, I.C., Zimet, G.D. 2016. Nationwide survey of knowledge and health beliefs regarding human papillomavirus among HPV-vaccinated female students in Malaysia. PLoS One 11(9): e0163156.
Workowski, K.A., Bolan, G.A. 2015. Sexually transmitted diseases treatment guidelines, 2015. Recommendations and Reports: Morbidity and Mortality Weekly Report 64(RR-03): 1-137.
Yousefi, Z., Aria, H., Ghaedrahmati, F., Bakhtiari, T., Azizi, M., Bastan, R., Hosseini, R., Eskandari, N. 2022. An update on human papilloma virus vaccines: History, types, protection, and efficacy. Font Immunol 12: 805695.
