HPV vaccination attitudes and perceptions

We conducted a brief review of scientific articles published from 2012 to 2022 to see how the perceptions and attitudes towards HPV vaccination in Romania varied. According to the materials found, over the last decade, awareness of HPV and its vaccine has generally increased in Romania. However, the level of knowledge and the quality of information varied. Misconceptions, fueled in part by media and pseudoscientific sources, persisted. This led to hesitancy and low vaccination rates, even among those aware of HPV. The role of medical professionals was consistently highlighted as crucial for disseminating accurate information and influencing positive attitudes towards HPV vaccination.

Evolution of Attitudes Towards HPV Vaccination in Romania (2012-2022):

2012: Concerns were high, with predominant reasons being the perceived riskiness of the vaccine, conspiracy theories, and general mistrust in the health system. The need for clear and factual information was highlighted.
2013: Online forums showed mixed views, with evidence-based positive views competing against pseudoscientific and emotional anti-vaccine views. The vaccine was seen by critics as dangerous and part of a conspiracy. Supporters viewed it as beneficial.
2014: Media coverage was mixed. While almost a third were neutral, a slightly lesser percentage were negative or extremely negative. Only 23.6% were positive. Concerns included side effects and inadequate testing. Media was often not comprehensive or accurate.
2015: Knowledge among adolescents was extremely low. Most were unaware of HPV, its vaccine, or the Papanicolau smear test. Yet, there was a significant interest in receiving more information.
2018: Awareness among Romanian women was moderate, but with minimal and often incomplete knowledge. The majority had heard of the vaccine, but only half had a positive attitude. Concerns included side effects, risk perception, and financial barriers. (North-eastern Romania): Among vaccinated women, knowledge was good. There was strong awareness of HPV and its relation to cervical cancer. The decision to vaccinate was majorly influenced by healthcare professionals.
2019: Vaccine hesitancy (VH) was evident, with media being a major negative influence. The HPV vaccine, among others, induced hesitation.
2022: A large survey revealed confusion. Despite a high awareness of HPV and its related cancers, a small fraction was vaccinated. Most respondents did not receive their HPV information from medical professionals.
2022 (data from 2021): Awareness was high among medical students, doctors, and a significant portion of parents. However, the knowledge quality varied. Many believed vaccination should be considered after 18 years. There was a noted gap in detailed knowledge about HPV among students and parents. Most respondents believed that doctors and healthcare professionals should provide accurate HPV information.

The sources used for the analysis above:

2012 “Who will take the blame?”: Understanding the reasons why Romanian mothers decline HPV vaccination for their daughters [1]

Results show as main reasons for not vaccinating their daughters perceiving the vaccine as risky, the belief that the vaccine represents an experiment that uses their daughters as guinea pigs, the belief that the vaccine embodies a conspiracy theory that aims to reduce the world's population and general mistrust in the ineffective health system. Mothers stated they would need clear, factual information about the HPV vaccine and its link to cervical cancer in order to motivate them to accept it for their daughters.

2013 Dangerous Agent or Saviour? HPV Vaccine Representations on Online Discussion Forums in Romania [2]

Twenty discussion forums, with a total sample size of 2,240 comments (2007–2012), were included.

Positive discourses relying on evidence-based arguments or cancer-related experiences battled with negative discourses that focused mostly on pseudo-scientific information and affect-based testimonials.
Both camps made use of appeals to authority in order to provide powerful messages.
Critics expressed high levels of mistrust in the health system and perceived the vaccine as dangerous, as part of a conspiracy, as unnecessary or as a promoter of promiscuity.
By contrast, supporters considered the HPV vaccine to be helpful and criticized the irrationality of opponents.
Ambivalence and uncertainty also emerged, along with criticism toward the suboptimal organization of the vaccination programmes.

Findings highlight ways in which views about the vaccine are embedded in broader perspectives about science, the national medical system, society development and economic inequality.

2014 Mass media coverage of HPV vaccination in Romania: a content analysis [3]

Content analysis of 271 media reports (from newspapers, magazines, videos and informational websites) published online between November 2007 and January 2012. Overall, results indicated that

31.4% of the materials were neutral,
28% were negative or extremely negative,
17% were mixed,
while 23.6% were positive towards the vaccine.

The most dominant vaccine-related concerns were side effects and insufficient testing. Elementary information about the vaccine and HPV was constantly left out and sometimes inaccuracies were found. Negatively disposed reports were more likely to contain incorrect data about vaccine efficacy and less likely to provide comprehensive information about the vaccine and HPV-related diseases. Some dimensions of media coverage varied across time and media outlets. The present findings suggest that educational interventions are greatly needed as a response to suboptimal and incomplete media coverage of HPV vaccination.

2015 Romanian adolescents’ knowledge and attitudes towards human papillomavirus infection and prophylactic vaccination [4]

A total of 524 adolescents aged 16–18 years old were recruited from the first two general highschools in Bucharest (according to the admission grade) and completed a self-administered questionnaire including demographics, HPV related and Papanicolau smear test knowledge

Of the adolescents interviewed, a very small proportion had heard of HPV infection, HPV vaccine and Papanicolau smear test, that is, 20.22%, 67.92% and 22.9%, respectively. The overall vaccination rate for this group was 2.3%. The most common reason for not receiving the HPV vaccine was the lack of information (80.6%) followed by parents’ concerns regarding safety (11%), fear of pain (5.59%) and not being sexually active (2.7%). However, 97.7% of the respondents declared interest in receiving more information about HPV.

2018 Awareness and Knowledge About HPV and HPV Vaccine Among Romanian Women [5]

69.2% of women were aware about HPV but their knowledge was minimal and incomplete. While 62.3% had heard about HPV vaccine, only 50.7% had a positive attitude toward it. The main barriers to vaccination were the fear of side effects, the perception that is risky, and the financial concerns. Deficiencies in knowledge were noted for vaccine, genital warts, or risks factors for HPV infection like the early onset of sexual life. The information regarding HPV and vaccine is not always accurate and complete, and only 50.7% of women have a positive attitude toward the vaccine.

2018 HPV and HPV vaccine knowledge among HPV-vaccinated women in North-eastern Romania [6]

Among the participants (n = 120), knowledge of HPV, HPV vaccine, and cervical screening was good. Most respondents were aware of the causal relationship between HPV and cervical cancer (83.3%), the sexual transmission of HPV (81.6%), and its asymptomatic nature (68.3 %). The women with a high knowledge score were more likely to have attained a high educational level, to work in the healthcare system, and to consult more health information sources. A major role in deciding to get the vaccination was the physician (gynaecologist or general practitioner) who proposed the vaccination and explained the importance of being immunized with the HPV vaccine.

2019 Qualitative Assessment of Vaccine Hesitancy in Romania Cluj [7]

Human Papillomavirus (HPV) 24.1%. One-third of the investigated population had expressed VH, and a further one-third of these had refused a vaccine for their child. Chicken Pox, Measles, Mumps, Rubella (MMR), and HPV vaccines generated the most hesitation. Negative information from the media was the most frequently evoked reason for VH.

2022 Barriers and Facilitators of Romanian HPV (Human Papillomavirus) Vaccination [8]

1122 responders were interviewed; mean age 36.39 ±10.7 years (limits: 19–62), majority women, 999 (89.04%), and from urban areas, 930 (82.89%). Most of the participants in the survey (684 (60.96%)) had university and post-university studies, and 459 (40.91%) participants were related to the medical domain.

Out of the 666 parents, only 67 (5.97%) parents were themselves vaccinated against HPV, and 91 (8.11%) had the intention to vaccinate themselves against HPV in the future. The participants with children eligible for HPV vaccination had one, two, three, or even four children. Altogether, there were 609 children, but 303 were aged 9 to 15 years. Out of these 303 children, 75 (24.75%) children were HPV vaccinated: 69 girls and 6 boys.

The Romanian population is very confused when it comes to the importance of the HPV vaccine. Although the majority of interviewed Romanians are aware of HPV and related cancers (1023 (91.18%)) and believe that the HPV vaccine poses no risk (823 (73.35%)), only 324 (28.88%) received their HPV information from the medical doctors, and only 118 (10.51%) are HPV vaccinated.

2022 Assessing the Level of Knowledge, Beliefs and Acceptance of HPV Vaccine: A Cross-Sectional Study in Romania [9] (data from 2021)

Awareness on HPV infection:

Almost 86% of all parents (6^th-8th pupils) in Targu Mures (Northern Romania)
89.7% medical students and 100% doctors
70.4% boys in the 11th–12th grades, 74.3% girls in the 11th-12th grades and 82.8% of their mothers

Awareness on HPV vaccination:

The level of information about HPV infection was satisfactory for almost half of the doctors (47.3%)
A good level of information was identified in 32.1% doctors and 28.9% medical students.
The degree of information on HPV vaccination was satisfactory for 44.6% doctors, while for the other categories of respondents the poor level of information was predominant

Optimal administration age opinions

69.0% of the medical students, 72.3% doctors and 30.9% boys in the 11th–12th grades considered that optimal vaccination should occur between 12–14 years,
while 44.5% of the parents of pupils in the 6th–8th grades and 50.6% of the mothers of high-school students in the 11th–12th grades believed that vaccination should be considered after the age of 18 years.
50.6% girls in the 11th–12th grades believed that vaccination should be administered before becoming sexually active.

Overall, there was a very low level of knowledge among students and their parents regarding the clinical signs, methods of transmission, infection site, infection consequences, risk factors and prophylaxis of HPV infection.

Very few respondents sought information from their general practitioner or HPV specialist, at the same time considering that accurate information about HPV should be provided by physicians and healthcare professionals.

Overall, the HPV vaccination barriers in Romania are related to:

Lack of awareness and knowledge: Studies highlighted a general lack of awareness and knowledge about HPV and its associated risks, as well as the benefits of vaccination. This lack of understanding could lead to hesitancy or refusal among parents and adolescents.
Misperceptions and fears: Misconceptions and fears regarding the safety and efficacy of the HPV vaccine. Rumors and misinformation about adverse effects or unfounded beliefs may play a role in vaccine refusal.
Cultural and social factors: Cultural norms and societal attitudes towards sexual health discussions and vaccination can influence decisions about HPV vaccination. Conservative views or stigma associated with discussions about sexually transmitted infections might hinder vaccine acceptance.
Trust in healthcare providers: The level of trust and confidence that individuals have in healthcare providers and authorities may impact their decision to vaccinate. If there are doubts about the credibility of healthcare advice, vaccination rates could be affected.
Access and availability: Challenges in accessing healthcare facilities or concerns about the cost and availability of the vaccine could be barriers to vaccination.
Media influence: The media's portrayal of HPV vaccination, including both positive and negative coverage, can influence public perception and decisions about vaccination.
Vaccine education campaigns: The effectiveness of educational campaigns promoting HPV vaccination might be assessed to understand their impact on vaccine acceptance.

References