Urban–Rural Disparities in Knowledge and Awareness of Human Papillomavirus and The Hpv Vaccine Among Adults in Sargodha District, Punjab, Pakistan

Abstract

HPV vaccination and screening are the main strategies to prevent cervical cancer, but a foundation for gaining acceptance of vaccination is an understanding of HPV. The methods employed were a cross sectional survey of adults (age 18 and above) and the questionnaire was validated and translated (English/Urdu) and was administered during seven weeks in urban and rural Sargodha. Recruitment was stratified quota (125 urban, 125 rural) and the administration was mixed (online and paper administered by interviewer). The scores of 17 knowledge items were added together (range 0–17, ≥10 = adequate). The difference among groups was analyzed by chi square/Fisher's exact, t and Mann–Whitney tests. Crude and adjusted prevalence ratios (PR) were used to determine factors associated with adequate knowledge and vaccine awareness. 250 questionnaires were completed and analysed from a total of 287 questionnaires started. There was a significantly higher level of HPV awareness among urban respondents (67.2%) compared with rural respondents (31.2%) and HPV vaccine awareness among urban respondents (58.4%) compared with rural respondents (24.8%) (both p < 0.001). Adequate knowledge was found in 22.4% overall (urban 37.6%, rural 7.2%; p < 0.001). 58.8% (urban 70.4% and rural 47.2%) were willing to vaccinate or Page 1 of 13 Urban–Rural Disparities in Knowledge and Awareness of HPV and the HPV Vaccine among Adults in Sargodha, Pakistan allow vaccination and 4.4% had been vaccinated before. Problems with knowledge (80.6%), safety concerns (63.1%) and cost (55.3%) were the primary barriers among 103 respondents who were unwilling or not sure. The most trusted source of recommendation was physicians. Following adjustment, rural living was still correlated with lower The strongest positive correlates were adequate knowledge (PR 0.42; 95% CI 0.21–0.84) and lower vaccine awareness (PR 0.61; 0.43–0.87); graduate education (PR 3.64) and healthcare employment (PR 2.55) were the strongest positive correlates. Knowledge level of adults about HPV and HPV vaccines is limited and this is significantly lower in rural areas, which can be attributed to education and socio economic status, although not entirely. Attitudes towards vaccination are more prevalent than knowledge.