Keywords
Cervical cancer
anti-HPV vaccine
Tunisian female students
Abstract
Background: Cervical cancer is the second most common gynecological cancer in Tunisia. The HPV vaccine is a crucial tool for preventing and controlling this disease. Training healthcare providers and equipping them with adequate knowledge is essential.
This study aimed to evaluate the effectiveness of an educational intervention video (EIV) on the knowledge and perceptions of HPV, cervical cancer, and the HPV vaccine among Tunisian female students.
Methods: A quasi-experimental study involving a single interventional group was conducted among 158 female students. Participants were interviewed before and after watching the EIV. The chi-square test using McNemar's method assessed variations between pre- and post-intervention responses. A p-value <0.05 was considered statistically significant.
Results: The average age of participants was 19.74±1.7 years. The EIV had a positive impact on the scores for knowledge and perceptions related to HPV and cervical cancer. A significant association was observed between the intention to receive the HPV vaccine and perceived severity of HPV, perceived benefits of vaccination, and perceived barriers. Notably, 50.6% of female students believed the HPV vaccine should be available upon request and covered by health insurance, while 46.2% thought it should be included in the Tunisian vaccination schedule.
Conclusion: The EIV improved students’ knowledge and perceptions about HPV, cervical cancer, and the HPV vaccine. Tailored educational strategies may enhance vaccine acceptance, especially when integrated early in academic training.
References
Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):e191–e203.
DOI: 10.1016/S2214-109X(19)30482-6
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. DOI: 10.3322/caac.21660
Bruni L, Albero G, Serrano B, Mena M, Collado JJ, et al. Human Papillomavirus and Related Diseases in the World. Summary Report 10 March 2023. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Disponible sur: https://hpvcentre.net/statistics/reports/XWX.pdf.
Ben Hadj Yahia M, et al. The Prevalence, Genotype Distribution and Risk Factors of Human Papillomavirus in Tunisia: A National-Based Study. Pathogens. 2022;11(10):1161. doi: 10.3390/pathogens11101161.
World Health Organization. Regional Office for South-East Asia. Accelerat¬ing the elimination of cervical cancer as a public health problem: towards achieving 90-70-90 targets by 2030. World Health Organization. Regional Office for South-East Asia. 2022. Disponible sur: https://apps.who.int/iris/handle/10665/352939.
ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Tunisia: Human Papillomavirus and Related Cancers, Fact Sheet 2023. Disponible sur: https://hpvcentre.net/statistics/reports/TUN_FS.pdf.
World Health Organization. Cervical cancer. 2022. Disponible sur: https://www.who.int/news-room/fact-sheets/detail/cervical-cancer.
Ferjaoui MA. HPV vaccination: a Tunisian challenge. Int J Gynecol Cancer. 2020;30(9):1248. doi:10.11 36/ijgc-2020-001613
KrennHrubec K, Mrad K, Sriha B, Ben Ayed F, Bottalico DM. HPV Types and Variants Among Cervical Cancer Tumors in Three Regions of Tunisia. J Med Virol. 2011;83(4):651–657. doi:10.1002/jmv.22017.
Laraj O, Benzina B, Gzara A, Kebir A, Abbas A, Ben Miled S. Human papillomavirus vaccination at the national level in Tunisia: a cost-effectiveness analysis using a comparative modeling study. medRxiv. 2024. doi:10.1101/2024.09.17.24313756.
Montgomery K, Smith-Glasgow ME. Human papillomavirus and cervical cancer knowledge, health beliefs, and preventive practices in 2 age cohorts: a comparison study. Gend Med. 2012;9(1):55–66. doi:10.1016/j.genm.2011.10.002.
Marlow LAV, Waller J, Evans REC, Wardle J. Predictors of interest in HPV vaccination: a study of British adolescents. Vaccine. 2009;27(18):2483–2488. doi:10.1016/j.vaccine.2009.01.125.
Juntasopeepun P, Suwan N, Phianmongkhol Y, Srisomboon J. Factors influencing acceptance of human papillomavirus vaccine among young female college students in Thailand. Int J Gynaecol Obstet. 2012;118(3):247–250. doi:10.1016/j.ijgo.2012.03.035.
Allen JD, Mohllajee AP, Shelton RC, Othus MK, Fontenot HB, Hanna R. Stage of adoption of the human papillomavirus vaccine among college women. Prev Med. 2009;48(5):420–425. doi:10.1016/j.ypmed.2009.02.007.
Schaefer KL. Beliefs and attitudes regarding HPV vaccination among college-age women: an application of the health belief model. University of Maryland, College Park; 2010.
Gamaoun R. Awareness and knowledge about cervical cancer prevention methods among Tunisian women. J Prev Med Hyg. 2018;59(1):E30–E35.
Sukrong M, Prapaisilp P, Juntamongkol T, Siranart N, Phoolcharoen N, et al. Knowledge regarding human papillomavirus and cervical cancer prevention among medical students from Chulalongkorn University in Thailand. BMC Womens Health. 2024;24(1):129. doi:10.1186/s12905-024-02903-7.
Du EY, Adjei Boakye E, Taylor DB, et al. Medical students’ knowledge of HPV, HPV vaccine, and HPV-associated head and neck cancer. Hum Vaccin Immunother. 2022;18(6):2109892. doi:10.1080/21645515.2022.2109892.
Patel IS, Dongara AR, Mungala BM, Chapla A, Phatak AG, Nimbalkar SM. Knowledge and attitude about cervical cancer and human papillomavirus vaccine among medical and paramedical students of a university. J Family Med Prim Care. 2021;10(1):462–467. doi:10.4103/jfmpc.jfmpc_1470_20.
Milecki T, Michalak M, Milecki J, et al. Polish Medical Students’ knowledge regarding Human Papillomavirus’s ways of transmission, risk of Cancer Development and Vaccination, and their intention to recommend vaccination. Vaccines (Basel). 2021;9(7):776. doi:10.3390/vaccines9070776.
Redd DS, Altman JD, Jensen JL, Sloan-Aagard CD, Crook TB, et al. A Randomized Study to Determine the Effect of a Culturally Focused Video Intervention on Improving HPV Vaccine Intentions in a Christian Population in the United States. J Community Health. 2024;49(4):661–673. doi:10.1007/s10900-024-01256-9.
Drokow EK, Effah CY, Agboyibor C, Sasu E, Amponsem-Boateng C, Akpabla GS, Ahmed HAW, Sun K. The Impact of Video-Based Educational Interventions on Cervical Cancer, Pap Smear and HPV Vaccines. Front Public Health. 2021;9:681319. doi:10.3389/fpubh.2021.681319.
Ahmed SR, Esa AS, MohamedEl-zayat OS. Health belief model-based educational program about cervical cancer prevention on women knowledge and beliefs. Egypt Nurs J. 2018;15(1):39–45.
Ampofo AG, Gyamfuaah SA, Opoku NS, Owusu SO, Ibitoye MB. A pilot study of a video-based educational intervention and knowledge of cervical cancer among senior high school students in Ghana: a before-after study. J Cancer Policy. 2020;24:100220. doi:10.1016/j.jcpo.2020.100220.
Champion VL, Skinner CS. The health belief model. In: Glanz K, Rimer BK, Viswanath K, eds. Health Behavior and Health Education: Theory, Research, and Practice. 4th ed. San Francisco, CA: Jossey-Bass; 2008:45–65.
Ekstrand M, Tydén T, Larsson M. Exposing oneself and one’s partner to sexual risk-taking as perceived by young Swedish men who requested a Chlamydia test. Eur J Contracept Reprod Health Care. 2011;16(2):100–107. doi:10.3109/13625187.2011.553295.
Herlitz CA, Forsberg M. Sexual behaviour and risk assessment in different age cohorts in the general population of Sweden (1989–2007). Scand J Public Health. 2010;38(1):32–39. doi:10.1177/1403494809352533.
Fouda LM, Elkazeh EA. The impact of an educational intervention on women's knowledge and perception regarding cervical cancer and human papillomavirus vaccines in Tanta city: applying health belief model. Life Sci J. 2013;10(12):997–1005.
• Grandahl M, Rosenblad A, Stenhammar C, Tydén T, Westerling R, Larsson M, Oscarsson M, Andrae B, Dalianis T, Nevéus T. School-based intervention for the prevention of HPV among adolescents: a cluster randomised controlled study. BMJ Open. 2016;6(1):e009875. doi:10.1136/bmjopen-2015-009875.
Ebrahim Mahmoud A, Abdelhakeem Aboud S, Kamal Ali F. Effect of the educational package based on health belief model on nursing students’ knowledge and attitude regarding human papillomavirus and cervical cancer. J Nurs Sci Benha Univ. 2021;2(2):809–828.
Jones M, Cook R. Intent to receive an HPV vaccine among university men and women and implications for vaccine administration. J Am Coll Health. 2008;57(1):23–32. doi:10.3200/JACH.57.1.23-32.
Kahn JA, Rosenthal SL, Jin Y, Huang B, Namakydoust A, Zimet GD. Rates of human papillomavirus vaccination, attitudes about vaccination, and human papillomavirus prevalence in young women. Obstet Gynecol. 2008;111(5):1103–1110. doi:10.1097/AOG.0b013e31817051fa.
Davis K, Dickman ED, Ferris D, Dias JK. Human papillomavirus vaccine acceptability among parents of 10-to 15-year-old adolescents. J Low Genit Tract Dis. 2004;8(3):188–194. doi:10.1097/00128360-200407000-00007.
Dempsey AF, Zimet GD, Davis RL, Koutsky L. Factors that are associated with parental acceptance of human papillomavirus vaccines: a randomized intervention study of written information about HPV. Pediatrics. 2006;117(5):1486–93. doi: 10.1542/peds.2005-1381.
Gerend MA, Magloire ZF. Awareness, knowledge, and beliefs about human papillomavirus in a racially diverse sample of young adults. J Adolesc Health. 2008;42(3):237–42. doi: 10.1016/j.jadohealth.2007.08.022.
Boehner CW, Howe SR, Bernstein DI, Rosenthal SL. Viral sexually transmitted disease vaccine acceptability among college students. Sex Transm Dis. 2003;30(10):774–8. doi: 10.1097/01.OLQ.0000084108.63396.1F.