Physician-reported Factors Affecting HPV Vaccination and Cervical Cancer Prevention in a Middle-Income Country: Overcoming Cultural Challenges

Abstract

HPV vaccination is a major cancer prevention breakthrough but full-scale implementation of the same is still missing in most of the low-middle income countries. Less than 10% of Indian females aged 13-17 receive the first dose of HPV vaccine. Health care providers are the preferred source in educating individuals on HPV and HPV vaccination. The purpose of this evaluation was to assess awareness among providers and identify feasible, acceptable and effective intervention strategies for improving HPV vaccination in our country. A standardized questionnaire directed to physicians was designed and validated among a group of preventive oncologists. We emailed the same to 800 physicians in various departments involved in care of reproductive age females and cervical cancer patients. Responses were collected on a 5-point Likert scale in combination with open-ended free text responses. SPSS was used for statistical analyses. Descriptive statistics and Chi-square test were applied. A total of 568 complete responses were received. Over 95% responders were physicians from departments of radiation oncology, medical oncology, gynecologic oncology, obstetrics and gynecology and pediatrics. Median age of the responders was 35 years (Range 28-62 years) and 57% were females. All responders were aware that HPV vaccination can prevent Cervical cancer but only 19% were aware of the vaccination schedule and where to refer the patients for vaccination. Physicians working in a dedicated cancer center were more aware compared to rest of the cohort (31% vs 8%, p <0.05). Only 3% were aware that the vaccination schedule can be started as early as 9 years of age. 38% of the responders had referred at least 1 patient for vaccination. Responses to perceived barriers against vaccination have been tabulated below. Most common barrier reported was social norms and values relating to sexual activity. 87% responders believed that multiple sexual partners are the most important risk factor for cervical cancer but only one fifth of them regularly educated their patients about safe sexual practices. 36% responders were aware that the vaccine is available for males as well. 60% responders trusted HPV vaccine to make a real-world difference. About two-thirds of the responders believed that the best way to improve vaccination was by implementing universal immunization policy and improving vaccine availability. Underuse of HPV vaccination is a serious but correctable threat to progress against cervical cancer. Cultural beliefs and lack of awareness are major barriers to vaccination. Overcoming the same requires multi-level intervention strategies including physician education, policy development and collaboration and involvement of all stake holders.Abstract 1037; TableBarrier to VaccinationVery much of a BarrierSomewhat a BarrierNot a barrier at allLack of awareness76%20%4%Safety Concerns35%19%46%Cost11%51%38%Personal Attitude19%43%38%Cultural Beliefs82%16%2% Open table in a new tab