Knowledge of human papillomavirus and cervical cancer among young women recruited using a social networking site
- Bharathy Gunasekaran1,
- Yasmin Jayasinghe2,3,4,
- Yeshe Fenner2,5,
- Elya E Moore2,5,
- John D Wark6,7,
- Ashley Fletcher2,5,
- Sepehr N Tabrizi2,3,5,
- Suzanne M Garland2,3,5,8
- 1Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
- 2Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
- 3Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- 4Department of Gynaecology, Royal Children's Hospital, Parkville, Victoria, Australia
- 5Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- 6Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia
- 7Bone and Mineral Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
- 8Department of Microbiology, Royal Children's Hospital, Parkville, Victoria, Australia
- Correspondence to Professor Suzanne M Garland, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Locked Bag 300, Parkville, Victoria 3052, Australia;
- Accepted 30 August 2012
- Published Online First 9 October 2012
Objectives Human papillomavirus (HPV) is the commonest sexually transmitted infection. Despite the significant morbidity and mortality associated with HPV-related diseases, previous studies have demonstrated low HPV knowledge in the general population. The objectives of this study were to assess knowledge of cervical cancer and HPV among young women and investigate predictors of high knowledge.
Methods Female subjects, aged 16–25 years living in Victoria, Australia, were recruited using targeted advertising on Facebook from May to September 2010. A web-based questionnaire was used in a cross-sectional pilot study for a large longitudinal study on women's health, The Young Female Health Initiative.
Results A total of 278 women completed the questionnaire. The geographic region, indigenous status and socio-economic status of participants were representative of the target population. Overall, 63% knew what HPV was, but only 48% knew it was a common virus. Predictors of high HPV knowledge on multivariate analyses were older age (adjusted OR (aOR) 2.78, 95% CI 0.77 to 10.04), higher socio-economic status (aOR 1.39, 95% CI 0.66 to 2.95), being Australian-born (aOR 3.10, 95% CI 1.15 to 8.36), older age at first vaginal intercourse (aOR 1.84, 95% CI 0.66 to 5.14), awareness of HPV vaccines (aOR 2.16, 95% CI 0.68 to 6.85) and chlamydia (aOR 2.57, 95% CI 1.11 to 5.94), and self-reported HPV vaccination status (aOR 1.83, 95% CI 0.76 to 4.41).
Conclusions HPV and cervical cancer knowledge among participants were relatively high compared with other studies conducted both worldwide and in Australia. However, deficits in knowledge exist and warrant address in educational initiatives.
Human papillomavirus (HPV) is the commonest viral sexually transmitted infection.1 Persistent high-risk HPV infection is a necessary prerequisite for cervical cancer.2 Despite the high prevalence of HPV and the associated mortality and morbidity, studies have consistently reported low HPV and cervical cancer knowledge.3 Australia was the first country to implement a nationally-funded school-based HPV vaccination programme in April 2007.4 Awareness and knowledge have increased since HPV vaccine licensure, but remain limited.3 ,5–7
Recruitment of young people into research can be challenging. A promising recruitment strategy is using social networking sites which are popular among young Australians regardless of geographical location, background and age.8
The objectives of this study were to assess cervical cancer and HPV knowledge among young women using social networking sites in Victoria, Australia, and to investigate predictors of high knowledge.
Participants were recruited using targeted advertising on Facebook from 19 May to 30 September 2010. Participants were eligible if they identified themselves as female, between 16 and 25 years of age, living in Victoria, Australia. A web-based questionnaire was developed by a core team of multidisciplinary researchers. This was a pilot study for a large longitudinal study on women's health, The Young Female Health Initiative, the detailed methods of which have been reported.9
The primary outcome variables described in this paper are cervical cancer knowledge plus HPV awareness and knowledge. Cervical cancer knowledge was assessed using seven questions relating to ways of reducing a person's risk of cervical cancer. One point was given to each correct answer and a knowledge scale (0–7) was constructed. The cervical cancer scale was collapsed into three subgroups: low (0–2), moderate (3–4) and high knowledge (5–7).
HPV awareness was defined by a ‘yes’ response to the question, ‘Do you know what HPV is?’ HPV knowledge was only investigated among participants who knew of HPV using six additional ‘true/false/don't know’ questions. One point was given to each correct answer and a knowledge scale (0–6) was constructed (participants who did not know of HPV were automatically given a score of zero). The HPV knowledge scale was collapsed into three subgroups: low (0–1), moderate (2–4) and high knowledge (5–6).
Logistic regression models were estimated to identify independent predictors of HPV knowledge, the primary outcome variable. The adjusted model included all variables considered, a priori, to be potential confounders or predictors of interest. These included age, Socio-economic Indexes for Areas and education. Statistical significance for all tests was set at p≤0.05.
Ethics approval was obtained through the Human Research and Ethics Committees at the Royal Women's Hospital, Melbourne, and written informed consent was obtained from all participants.
Recruitment and participation
Participant characteristics have been described elsewhere.9 Overall, 278 women completed the questionnaire. The geographic region, indigenous status and socio-economic status of participants did not differ from the Australian Bureau of Statistics distributions.10 However, women aged 16–17 and women whose highest level of education completed was below Year 12 (final year of high school) were under-represented.
Cervical cancer knowledge
Overall, most knew that regular Pap smears (91.4%), vaccination (94.2%) and safe sex (71.9%) can reduce cervical cancer risk. However, only 42.8% knew of the association between smoking and cervical cancer. The mean cervical cancer knowledge score was 5.02 of 7 (95% CI 4.91 to 5.13). On univariate analyses, Australian-born participants were significantly more likely to know that regular Pap smears can reduce cervical cancer risk compared with overseas-born participants (OR 6.41, 95% CI 2.66 to 15.43). On multivariate analyses, contraception use at first vaginal intercourse was the only significant predictor of high overall cervical cancer knowledge (OR 2.63, 95% CI 1.11 to 6.26).
Overall, 62.9% (95% CI 57.1 to 68.4%) answered ‘yes’ when asked if they knew what HPV was compared with 77.7% who were aware of chlamydia. Women who were significantly more likely to know what HPV was were women aged 22–25 years compared with women aged 16–17 years (OR 3.35, 95% CI 1.55 to 7.20), women from higher socio-economic backgrounds (OR 2.44, 95% CI 1.35 to 4.44), and women whose highest level of education completed was Year 12 or higher (OR 2.83, 95% CI 1.45 to 5.53).
HPV knowledge was assessed among the 173 participants who reported knowing what HPV was. Of these, 73.4% knew HPV is a sexually transmitted infection, 92.4% knew it is linked to cancer, but only 47.9% knew that it is a common virus that most women acquire. Australian-born participants were significantly more likely to know that HPV is common (OR 3.54, 95% CI 1.15 to 10.89) and of the link between HPV and cervical cancer (OR 2.02, 95% CI 1.07 to 3.84) compared with overseas-born participants. The mean HPV knowledge score, including the participants who stated that they did not know what HPV was, was 2.82 out of 6 (95% CI 2.54 to 3.11). Table 1 shows predictors of high HPV knowledge.
In comparison with studies conducted both worldwide and in Australia, the proportions of participants who were aware of HPV and had high HPV knowledge were relatively large.3 ,5–7 An Australian study performed prior to public discussion regarding the HPV vaccination programme reported that only 59.7% of women of ages 18–25 had heard of HPV and of these 72.5% knew that HPV is linked to cancer.6
This study provides a guide for educational initiatives by identifying the gaps in cervical cancer and HPV knowledge. For example, that high HPV prevalence and the link between smoking and cervical cancer should be emphasised. Culturally sensitive educational interventions should be used to address the lower knowledge in overseas-born women. More attention should also be paid to young women who are less educated, less likely to be vaccinated and those with higher risk sexual behaviours.
This study has some limitations. The study sample was not completely representative of the target population but is similar to other convenience methods of sampling and is based on a small sample of Facebook users in Victoria and may not be generalised to all women in Victoria.
Whilst knowledge among women has increased with the realisation that HPV is a sexually transmitted infection, and linked to cervical cancer, a better understanding that HPV is a common virus is required. Overall, most knew that regular Pap smears, HPV vaccination and safe sex can reduce cervical cancer.
The link between smoking and cervical cancer should be emphasised.
Use of social networking sites for recruitment was an efficient and cost effective method.
The authors wish to thank the members of our Young Women's Advisory Group for their feedback about the study website, logo, advertisements and questionnaire. We also thank all the young women who took part in this study.
Handling editor Jackie Cassell.
Contributors SMG, JDW, YJ, EEM and SNT conceived the study. The original research protocol was jointly written by YJ, EEM, SMG and JDW. All authors participated in the study design. YF was responsible for executing the study with assistance from BG. Statistical analysis was done by BG with input from EEM, YF and AF, and BG was responsible for drafting the manuscript. All authors had full access to all of the data in the study, and read, revised and approved the final manuscript.
Funding This work was supported by a grant from the Dean Robert Winter Trust, which is managed by the ANZ Trustees, and the National Health and Medical Research Council (Programme Grant #568971), and the Victorian Government's Operational Infrastructure Support Programme.
Competing interests None.
Ethics approval Ethics approval was provided by the Human Research and Ethics Committee, The Royal Women's Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.