Abstract
BackgroundRegardless of the disease burden of human papillomavirus (HPV), the vaccine has not been included in the Indonesia National Immunization Program. Since 2017 there was a demonstration program of the HPV vaccination in Yogyakarta Province. This vaccine was given free to female primary school students in the 5th and 6th grades (11–13 years old). This study aimed to assess whether a structured-educational intervention focus on HPV increases the parental awareness, knowledge, and perceptions toward HPV and the vaccine acceptability.MethodsWe conducted a pre-post structured-educational intervention study from July to August 2017 before the implementation of the HPV vaccination demonstration program, in Kulon Progo District, Yogyakarta Province, Indonesia. Parents of female primary school students grades 5th and 6th were selected using a school-based proportional random sampling. A pediatric resident provided a structured-educational intervention, which consists of the burden and risk of HPV disease, as well as the benefit and safety of the vaccine. Parents were required to complete validated self-administered questionnaires before and after the structured-educational intervention.ResultsA total of 506 parents participated. Before receiving the structured-educational intervention, parents’ awareness of HPV infection and the vaccines were low. Only 49.2% of parents had heard HPV infection, and 48.8% had heard about the vaccine. After the structured-educational intervention, there were significant improvements in parent’s awareness, knowledge, and perceptions of HPV infection, cervical cancer, and HPV vaccination (all p < 0.001). HPV vaccine’s acceptability increased from 74.3 to 87.4% (p < 0.001). There was a significant correlation between increasing HPV vaccine acceptability with the improvement of awareness, knowledge, and perception toward HPV infection, cervical cancer and HPV vaccination (r = 0.32 to 0.53, p < 0.001). After the structured-educational intervention, better knowledge and positive perceptions of HPV vaccination were predictive of HPV vaccine’s acceptability with OR 1.90 (95%CI:1.40–2.57) and OR 1.31(95%CI,1.05–1.63), respectively.ConclusionsA structured-educational intervention may improve parental awareness, knowledge, and perceptions toward HPV and the acceptability of the vaccine. Further study, a randomized control trial with longer follow-up are needed to evaluate the long-term and actual effectiveness of improving parents’ knowledge, perceptions and HPV vaccine acceptability.
Highlights
Regardless of the disease burden of human papillomavirus (HPV), the vaccine has not been included in the Indonesia National Immunization Program
Knowledge, and perceptions of HPV infection, cervical cancer, and HPV vaccination before the structured-educational intervention The majority of the parents had heard about sexually transmitted infections (STIs) (72.7%) and cervical cancer (73.7)
Only 46.2% of them had ever heard about HPV infection, and 46.2% of them mentioned that HPV caused cervical cancer
Summary
Regardless of the disease burden of human papillomavirus (HPV), the vaccine has not been included in the Indonesia National Immunization Program. Since 2017 there was a demonstration program of the HPV vaccination in Yogyakarta Province This vaccine was given free to female primary school students in the 5th and 6th grades (11–13 years old). The HPV vaccine is added free of charge to an existing school childhood immunization program to girls in primary school, with the 1st dose given for grade 5 (11–12 years old) and the 2nd dose for grade 6 (12–13 years old). This program was initiated in the provinces where the burden of cervical cancer cases was the highest and the provinces were ready to implement the HPV vaccination program. The WHO recommended 2-doses of HPV vaccine, explaining that a 2-doses HPV vaccine schedule provides satisfactory immunological outcomes in adolescent girls less than 15 years old [6]
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