HPV knowledge, awareness, and vaccine beliefs among women attending gynecological care in Türkiye: implications for cervical cancer prevention.

Abstract

Background: Despite the availability of effective HPV vaccines, vaccination rates remain low in many countries, including Türkiye. Cervical cancer prevention continues to rely largely on opportunistic screening. Although HPV knowledge, awareness, and vaccine beliefs are recognized as important determinants of vaccination behavior, how these factors interact among women attending gynecological care has not been fully elucidated.

Methods: This cross-sectional study included 300 women aged 18-49 years attending the obstetrics and gynecology outpatient clinic of a university hospital in the Marmara region of Türkiye for gynecological examination. Data were collected using a sociodemographic questionnaire, the HPV Knowledge Scale (HPV-KS), the Human Papilloma Virus Awareness and Concern Scale (HPV-ACS), and the Carolina HPV Vaccination Attitudes and Beliefs Scale (CHPV-VABS). Group comparisons, correlation analyses, and multivariate analysis of variance were performed to examine associations between participant characteristics and HPV knowledge, awareness and concern, and vaccine beliefs.

Results: Participants showed limited HPV knowledge (11.01 ± 8.77 out of 33), moderate HPV-related awareness and concern (43.57 ± 9.95), and moderate HPV vaccine attitudes and beliefs (37.18 ± 7.42). HPV vaccination uptake was low, with only 12.3% of participants reporting prior vaccination. Higher educational attainment was associated with greater HPV knowledge scores (p < .001), and vaccinated participants had significantly higher knowledge scores than unvaccinated participants (p < .001). Education level was also significantly associated with the combined outcome of HPV knowledge, awareness and concern, and vaccine beliefs (F(3, 293) = 2.76, p=.044, η²p = .05). Correlation analyses showed strong positive associations between HPV knowledge and HPV-related awareness and concern (r = .60, 95% CI [0.52, 0.67], p < .001) and between HPV-related awareness and concern and vaccine beliefs (r = .61, 95% CI [0.53, 0.68], p < .001). In contrast, HPV knowledge showed a weak inverse correlation with vaccine beliefs (r = - .16, 95% CI [- 0.27, - 0.05], p = .005).

Conclusion: Women attending gynecological examinations demonstrated limited HPV knowledge and very low HPV vaccination uptake despite moderate levels of HPV-related awareness and concern. These findings suggest that awareness alone may be insufficient to promote vaccination and highlight the importance of improving HPV knowledge through targeted educational interventions. As higher educational attainment was associated with greater HPV knowledge, integrating structured counseling and evidence-based communication into routine gynecological care may help address knowledge gaps and strengthen cervical cancer prevention efforts in Türkiye.