Our study revealed that the majority (90.6%) of the participants were aware of cervical cancer, whereas the awareness index in the studies reported earlier was lesser than that of the participants in this study [9, 10]. When asked about the HPV, 94.7% of the study subjects mentioned that they have heard of it, and 86.2% knew that HPV causes cervical cancer which seems to be better than a similar study in which only 73% of study subjects heard of HPV [9]. A similar study was conducted in Yogyakarta Province in Indonesia from December 2013 to March 2014, which revealed that only 60% of the women participants have heard about cervical cancer [11].
A mixed-method study was conducted in Dhaka, Bangladesh in December 2013 among professional women employed by private banks. It revealed that only 26% of the participants had heard about cervical cancer and 56.6% of them had heard about HPV vaccination [12].
In the present study, 83.3% of people knew that PAP smear test detects cervical cancer even before the symptoms appear, which were in comparison with similar studies [13,14,15]. While 29.2%% of the eligible participants have undergone PAP smear test in our study, it was only 5% in few other studies [16, 17]. This shows that we lack an organized opportunistic screening program for cervical cancer in India. This could be done by making it mandatory to screen all eligible women when they visit health care units for other services. 68.2% of the study subjects knew that cancer cervix could be prevented by vaccination. In our study, 24% of the eligible subjects had the HPV vaccine, which was higher when compared to studies by Swarnapriya et al.[18], Ganju et al. [19], wherein vaccination coverage was 6.8% and 5.5%, respectively. In contrast, 26.73% of them were vaccinated in a study conducted by Hoblidar et al. [20]. We found that awareness regarding the availability of HPV vaccine for boys was also very low (34.9%).
Common reasons for not getting vaccination reported in our study were lack of awareness regarding HPV vaccination, the importance of the vaccine, and high cost which was in agreement with other studies reported earlier [21, 22].
The same finding was also observed in the study conducted by Bhuiyan et al. [12], which also revealed that a lack of knowledge about cervical cancer and HPV has an impact on uptake of HPV vaccination [12]. Also, various studies have reported that people with a family history of genital cancer had shown greater acceptability for vaccination against HPV [22]. 77.2% of the participants in our study were willing for vaccination and recommending the same to their friends and family members, which was in contrast with other studies in which they were not keen on getting vaccinated.16 India is considered to be a slightly conservative country where there are still taboos regarding cervical cancer because HPV infection is predominantly sexually transmitted. Providing information regarding HPV vaccination and screening sensitively can help in the proper execution of these interventions. Unlike other vaccines, the HPV vaccine does not provide 95–100% protection against HPV infection and even after completion of a full course of this high-priced vaccine, one must undergo screening for HPV infection lifelong. All these are seen as drawbacks and reasons for poor uptake.
The profession, knowledge on cervical cancer, HPV screening, and availability of vaccine-associated (statistically significant association) have a negative effect on the administration of HPV vaccination. Knowledge on HPV vaccine to pregnant women associated with showed a positive effect on HPV vaccination. When all the variables were put together, only the variables on the knowledge of HPV vaccination in pregnant women were positively associated with the decision to administer the HPV vaccine or recommend the administration of HPV vaccination to the family and friends.
There is a large gap that has to be filled to improve awareness about HPV vaccination. This could be achieved by promoting awareness emphasizing that every child needs to be vaccinated, and every mother needs to be screened. In developing countries like India, investing and motivating towards preventive measures like vaccination and screening of cervical cancer could help reduce the burden of advanced disease. Since the HPV vaccine is not available to free of cost currently by the Govt of India, its uptake in society is very poor. This needs to be addressed at the earliest because many countries like Australia have nearly eradicated cervical cancer among their population through vaccination and active screening [23]. Conducting surveys and intervention programs to promote vaccination at least annually or opportunistically (during the annual health checkups) could help in developing a positive attitude towards vaccination and screening among health care professionals.
