Knowledge and attitude toward HPV vaccination promotion after COVID-19 epidemic in various populations in China
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摘要:
目的 调查新冠疫情之后一般人群、宫颈癌患者、医务人员、政府及机构管理者对人乳头瘤病毒(HPV)疫苗接种和推广的态度。 方法 于2020年12月 — 2021年4月,采用分层整群抽样方法对全国七大区3599名不同身份的对象进行问卷调查。 结果 分别有1387(80.4 %)、296(80.0 %)、989(92.8 %)、419(95.7 %)名一般人群、宫颈癌患者、医务人员、政府及机构管理者听说过HPV疫苗。女性和受教育水平高者HPV疫苗知晓率更高。分别有803(96.8 %)和352(95.1 %)名女性一般人群和宫颈癌患者愿意接种HPV疫苗。分别有341(82.0 %)和176(67.2 %)名有女儿的女性一般人群和宫颈癌患者明确表示愿意为女儿接种HPV疫苗。784名(79.3 %)医务人员愿意推荐HPV疫苗。428名(97.7 %)政府及机构管理者愿意推广HPV疫苗,399人(93.2 %)认为通过鼓励适龄女性进行疫苗接种、318人(74.3 %)认为可通过将HPV疫苗纳入计划免疫实现其大规模推广。 结论 新冠疫情后中国女性HPV疫苗接种意愿较高,但家长给女儿接种HPV疫苗的意愿较低。政府推广意愿较高,但是医务人员推荐意愿不强烈。有针对性加强HPV疫苗健康教育,提高HPV疫苗推荐意愿十分重要。 Abstract:Objective To investigate the acceptability and willingness to recommend human papillomavirus (HPV) vaccine in Chinese women, cervical cancer patients, health workers and governmental officers after coronavirus disease 2019 (COVID-19) epidemic. Methods With stratified cluster random sampling, a face-to-face questionnaire survey was conducted from December 2020 to April 2021 among 3 791 persons with different identities in seven geographical regions of China. Results Among the 3 599 respondents with complete information, the proportion (number) of persons having heard about HPV vaccine was 80.4% (1 387) in general women, 80.0% (296) in cervical cancer patients, 92.8% (989) in health workers, and 95.7% (419) in government officers, respectively, and the proportion was relatively higher in women and the respondents with higher education. In the female respondents with daughters, 341 (82.0%) general women and 176 (67.2%) cervical cancer patients reported the willingness to have their daughters being vaccinated. Of the health workers, 79.3% (784) expressed the willingness to recommend HPV vaccine to attendees in their routine work. Among government officers, 428 (97.7%) demonstrated a positive attitude toward HPV vaccination promotion, of which, 93.2% (399) considered that the women of right ages should be encouraged to receive HPV vaccine voluntarily and 318 (74.3%) thought that HPV vaccine should be included in national vaccination program for large-scale promotion of HPV vaccination. Conclusion After the incidence of COVID-19 epidemic, the willingness of having HPV vaccination increased among Chinese women but parental willingness to have their daughters being vaccinated was low. Despite high willingness of HPV vaccination promotion among governmental officers, the intention of recommending HPV vaccine to attendees in their routine work is not strong among health workers. The results suggest that specific health education on HPV vaccine is important for promoting HPV vaccination willingness in the public. -
Key words:
- human papillomavirus vaccine /
- knowledge /
- acceptability /
- recommendation willingness
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表 1 调查对象一般人口学特征
项目 合计 一般人群 宫颈癌患者 医务人员 政府及机构管理者 人数 % 人数 % 人数 % 人数 % 人数 % 性别 男性 1112 32.7 695 45.5 0 0.0 244 22.9 173 39.5 女性 2290 67.3 833 54.5 370 100.0 822 77.1 265 60.5 民族 汉族 3239 90.0 1539 89.2 346 93.5 945 88.7 409 93.4 少数名族 360 10.0 186 10.8 24 6.5 121 11.4 29 6.6 学历 高中及以下 395 11.0 182 10.6 171 46.2 20 1.9 22 5.0 本科或大专 2 406 66.9 1 207 70.1 178 48.1 751 70.5 270 61.6 研究生及以上 794 22.1 332 19.3 21 5.7 295 27.7 146 33.3 婚姻状况 未婚 1 896 52.7 1405 81.5 98 26.5 277 26.0 116 26.5 已婚 1622 45.1 287 16.6 259 70.0 760 71.3 316 72.2 其他 81 2.3 33 1.9 13 3.5 29 2.7 6 1.4 常住地址 城市 2943 81.8 1276 74.0 254 68.7 999 93.7 414 94.5 农村 656 18.2 449 26.0 116 31.4 67 6.3 24 5.5 家庭年总收入(万元) < 5 854 23.7 551 31.9 105 28.4 153 14.4 45 10.3 5~ 1416 39.3 619 35.9 172 46.5 483 45.3 142 32.4 11~ 1178 32.7 471 27.3 78 21.1 402 37.7 227 51.8 35~ 151 4.2 84 4.9 15 4.1 28 2.6 24 5.5 表 2 HPV疫苗知晓率及影响因素分析
因素 一般人群 a 宫颈癌患者 e 医务人员 g 知晓人数 知晓率(%) aOR b 95 % CI 知晓人数 知晓率(%) aOR b 95 % CI 知晓人数 知晓率(%) aOR b 95 % CI 年龄(岁) ≤ 25 104 82.5 1.0 63 94.0 1.0 100 87.7 1.0 26~35 596 80.2 0.8 0.5~1.3 69 90.8 0.4 0.1~2.0 443 95.3 3.1 d 1.1~9.0 36~45 301 78.8 0.7 0.4~1.1 58 82.9 0.3 0.1~1.3 279 94.3 2.8 0.8~9.5 > 45 214 79.9 0.7 0.4~1.3 104 68.9 0.1 d 0.0~0.6 164 87.7 1.4 0.4~4.7 性别 男性 470 68.1 1.0 — — 213 87.3 1.0 女性 745 89.9 4.1 c 3.1~5.5 294 80.8 ~ f 773 94.5 2.8 c 1.7~4.8 民族 汉族 1 080 80.4 1.0 278 81.5 1.0 881 93.6 1.0 少数名族 135 76.7 0.7 0.5~1.1 16 69.6 0.5 0.2~1.3 105 86.8 0.4 d 0.2~0.7 学历 高中及以下 103 61.7 1.0 120 71.9 1.0 13 65.0 1.0 本科或大专 868 79.7 2.4 c 1.6~3.6 156 88.1 1.6 0.8~3.2 691 92.3 5.0 d 1.7~14.3 研究生及以上 244 92.8 7.2 c 3.9~13.1 18 90.0 1.6 0.3~8.8 282 96.3 11.5 c 3.4~38.5 婚姻状况 未婚 1014 81.5 1.0 87 91.6 1.0 256 93.4 1.0 已婚 179 73.1 0.6 d 0.4~0.9 198 77.3 1.3 0.4~4.6 704 92.8 0.4 0.2~4.1 其他 22 73.3 1.1 0.4~2.7 9 69.2 0.7 0.3~9.9 26 89.7 0.4 0.1~1.9 常住地址 农村 299 71.7 1.0 84 75.0 1.0 57 85.1 1.0 城市 916 83.1 1.7 c 1.2~2.3 210 83.3 1.0 0.5~1.9 929 93.4 1.8 0.7~4.5 家庭年总收入(万元) < 5 398 77.4 1.0 72 71.3 1.0 133 87.5 1.0 5~ 438 80.2 1.2 0.8~1.6 142 83.0 2.1 d 1.1~4.1 444 92.3 1.9 1.0~3.8 11~ 323 83.0 1.8 c 1.2~2.5 67 87.2 2.6 d 1.1~6.5 384 95.5 3.2 d 1.5~7.0 35~ 56 80.0 1.3 0.7~2.7 12 85.7 2.3 0.4~13.0 25 92.6 1.9 0.4~9.6 注:a 一般人群删除缺失值206人,共纳入分析1519人,1215人听说过HPV疫苗;b 多因素分析纳入变量为年龄、性别(宫颈癌患者除外)、民族、学历、婚姻状况、常住地址、家庭总收入,aOR为调整OR值简称;c P < 0.001,d P < 0.05;e 宫颈癌患者删除缺失值6例,共纳入分析364例,294例听说过HPV疫苗;f 全部宫颈癌患者均为女性,未作统计分析;g 医务人员删除缺失值 4例,共纳入分析1062例,986人听说过HPV疫苗。 表 3 HPV疫苗接种意愿及影响因素分析
因素 一般人群 a 宫颈癌患者 d 愿意接种人数 愿意接种率(%) aOR b 95 % CI 愿意接种人数 愿意接种率(%) aOR b 95 % CI 年龄(岁) ≤ 25 65 94.2 1.0 65 97.0 1.0 26~35 379 95.7 1.0 0.3~3.4 74 97.4 1.8 0.1~30.1 36~45 204 99.0 4.8 0.8~27.9 69 98.6 1.9 0.1~59.7 > 45 155 98.1 2.4 0.5~11.7 138 91.4 0.2 0.1~4.4 民族 汉族 705 96.8 1.0 324 95.0 1.0 少数名族 98 97.0 10.0 0.3~3.7 22 95.7 1.3 0.1~14.2 学历 高中及以下 72 87.8 1.0 158 94.6 1.0 本科或大专 561 97.7 5.2 c 1.9~13.9 170 96.1 0.4 0.1~1.5 研究生及以上 170 98.3 6.8 c 1.7~28.1 18 90.0 0.1 c 0.0~0.5 婚姻状况 未婚 673 97.3 1.0 92 96.8 1.0 已婚 116 95.9 1.0 0.3~3.3 243 94.9 0.6 0.0~8.1 其他 14 87.5 0.8 0.1~4.8 11 84.6 0.3 0.0~6.1 常住地址 农村 193 94.6 1.0 105 93.8 1.0 城市 610 97.6 2.1 0.9~4.9 241 95.6 0.9 0.3~2.9 家庭年总收入(万元) < 5 281 97.2 1.0 90 89.1 1.0 5~ 301 96.8 0.8 0.3~2.1 166 97.1 5.1 c 1.5~20.0 11~ 188 96.4 0.7 0.2~2.3 76 97.4 9.1 c 1.5~56.0 35~ 33 97.1 1.0 0.1~8.9 14 100.0 ~ e ~ e 注:a 一般人群删除缺失值4人,共纳入829人分析,803人愿意接种HPV疫苗;b 多因素分析纳入变量为年龄、性别(宫颈癌患者除外)、民族、学历、婚姻状况、常住地址、家庭总收入,aOR为调整OR值简称;c P < 0.05;d 宫颈癌患者删除6例缺失值,共纳入364例分析,246人愿意接种HPV疫苗;e 样本量不足,未作统计分析。 表 4 医务人员推荐HPV疫苗意愿
意愿 合计 宫颈癌相关科室 其他科室 人数 % 人数 % 人数 % 是否愿意推荐适龄女生接种HPV疫苗 是 784 79.3 85 91.4 699 78.0 否 13 1.3 0 0.0 13 1.5 中立 192 19.4 8 8.6 184 20.5 是否赞成我国推广HPV疫苗 是 833 84.2 85 91.4 748 83.5 否 4 0.4 0 0.0 4 0.4 中立 133 13.4 6 6.5 127 14.2 不清楚 19 1.9 2 2.2 17 1.9 对女生接种HPV疫苗的看法 适龄女生应该接种HPV疫苗,同时定期进行妇科检查 681 68.9 65 69.9 616 68.8 适龄女生更应该接种疫苗,以后不必进行妇科检查 17 1.7 0 0.0 17 1.9 向妇女客观介绍疫苗,由妇女自己决定 151 15.3 12 12.9 139 15.5 如果适龄女性咨询疫苗,推荐其到相关部门了解 140 14.2 16 17.2 124 13.8 表 5 政府及机构管理者对推广HPV疫苗的态度
态度 合计 市级及以上 市级以下 人数 % 人数 % 人数 % 预防宫颈癌最有效且性价比高的措施 接种预防性宫颈癌疫苗 279 63.7 128 60.4 151 66.8 定期进行宫颈癌筛查 121 27.6 63 29.7 58 25.7 及时有效治疗 10 2.3 5 2.4 5 2.2 提高个人卫生 20 4.6 11 5.2 9 4.0 不知道 8 1.8 5 2.4 3 1.3 HPV疫苗合理支付方式 完全自费 27 6.2 9 4.2 18 8.0 政府完全覆盖 116 26.5 61 28.8 55 24.3 两者按比例支付 295 67.4 142 67.0 153 67.7 政府应支付疫苗费用比例 10 %~ 19 6.4 11 7.7 8 5.2 30 %~ 109 36.9 55 38.7 54 35.3 50 %~ 128 43.4 60 42.3 68 44.4 70 %~90 % 39 13.2 16 11.3 23 15.0 政府是否应该促进HPV疫苗推广 是 428 97.7 207 97.6 221 97.8 否 10 2.3 5 2.4 5 2.2 -
[1] World Health Organization/International Agency for Research on Cancer. Launch of the WHO global strategy to accelerate the elimination of cervical cancer[EB/OL]. (2020 – 11 – 17)[2021 – 09 – 26]. https://iarc.who.int/news-events/launch-of-the-who-global-strategy-to-accelerate-the-elimination-of-cervical-cancer/. [2] Zhang YR, Wang Y, Liu L, et al. Awareness and knowledge about human papillomavirus vaccination and its acceptance in China: a meta-analysis of 58 observational studies[J]. BMC Public Health, 2016, 16(1): 216. doi: 10.1186/s12889-016-2873-8 [3] Hu SY, Xu XQ, Zhang YY, et al. A nationwide post-marketing survey of knowledge, attitude and practice toward human papillomavirus vaccine in general population: implications for vaccine roll-out in mainland China[J]. Vaccine, 2021, 39(1): 35 – 44. doi: 10.1016/j.vaccine.2020.11.029 [4] 刘捷宸, 吴琳琳, 白庆瑞, 等. 上海市2017 — 2019年人乳头瘤病毒疫苗接种率和疑似预防接种异常反应监测[J]. 中国疫苗和免疫, 2020, 26(3): 322 – 325,348. [5] Holman DM, Benard V, Roland KB, et al. Barriers to human papillomavirus vaccination among US adolescents: a systematic review of the literature[J]. JAMA Pediatrics, 2014, 168(1): 76 – 82. doi: 10.1001/jamapediatrics.2013.2752 [6] Gilkey MB, Calo WA, Moss JL, et al. Provider communication and HPV vaccination: the impact of recommendation quality[J]. Vaccine, 2016, 34(9): 1187 – 1192. doi: 10.1016/j.vaccine.2016.01.023 [7] MacDonald NE, The SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: definition, scope and determinants[J]. Vaccine, 2015, 33(34): 4161 – 4164. doi: 10.1016/j.vaccine.2015.04.036 [8] Ladner J, Besson MH, Audureau E, et al. Experiences and lessons learned from 29 HPV vaccination programs implemented in 19 low and middle-income countries, 2009 – 2014[J]. BMC Health Services Research, 2016, 16(1): 575. doi: 10.1186/s12913-016-1824-5 [9] 石雅佳, 王洪岩, 张菱, 等. 华北地区大学生对HPV及其疫苗的认知现况调查[J]. 现代预防医学, 2021, 48(4): 727 – 731. [10] 阎彤菲, 林昕, 李榕. 女大学生宫颈癌防治及HPV疫苗认知现况调查[J]. 职业与健康, 2020, 36(10): 1399 – 1401. [11] Ma Y, Wang CX, Liu FH, et al. Human papillomavirus vaccination coverage and knowledge, perceptions and influencing factors among university students in Guangzhou, China[J]. Human Vaccines and Immunotherapeutics, 2021, 17(10): 3603 – 3612. doi: 10.1080/21645515.2021.1927411 [12] Yin G, Zhang YL, Chen CY, et al. Have you ever heard of human papillomavirus (HPV) vaccine? The awareness of HPV vaccine for college students in China based on meta-analysis[J]. Human Vaccines and Immunotherapeutics, 2021, 17(8): 2736 – 2747. doi: 10.1080/21645515.2021.1899731 [13] 何佳露, 洪琳佳, 刘垚鑫, 等. 杭州9~14岁女童家长对HPV及疫苗认知和接种意愿调查[J]. 中国公共卫生, 2020, 36(10): 1478 – 1481. doi: 10.11847/zgggws1124125 [14] Zhang X, Liu CR, Wang ZZ, et al. Effect of a school-based educational intervention on HPV and HPV vaccine knowledge and willingness to be vaccinated among Chinese adolescents: a multi-center intervention follow-up study[J]. Vaccine, 2020, 38(20): 3665 – 3670. doi: 10.1016/j.vaccine.2020.03.032 [15] 许小凤, 尹文强, 刘敏, 等. 母亲HPV疫苗犹豫的现状及影响因素探究[J]. 现代预防医学, 2020, 47(19): 3509 – 3512. [16] Oh NL, Biddell CB, Rhodes BE, et al. Provider communication and HPV vaccine uptake: a meta-analysis and systematic review[J]. Preventive Medicine, 2021, 148: 106554. doi: 10.1016/j.ypmed.2021.106554 [17] Xu XQ, Wang YY, Liu YW, et al. A nationwide post-marketing survey of knowledge, attitudes and recommendations towards human papillomavirus vaccines among healthcare providers in China[J]. Preventive Medicine, 2021, 146: 106484. doi: 10.1016/j.ypmed.2021.106484 [18] Leung SOA, Akinwunmi B, Elias KM, et al. Educating healthcare providers to increase human papillomavirus (HPV) vaccination rates: a qualitative systematic review[J]. Vaccine:X, 2019, 3: 100037. doi: 10.1016/j.jvacx.2019.100037 [19] Moghtaderi A, Adams S. The role of physician recommendations and public policy in human papillomavirus vaccinations[J]. Applied Health Economics and Health Policy, 2016, 14(3): 349 – 359. doi: 10.1007/s40258-016-0225-6 [20] Masserey Spicher V, Weiss MG. Policy and socio-cultural differences between cantons in Switzerland with high and low adolescent vaccination coverage for hepatitis B and HPV[J]. Vaccine, 2019, 37(52): 7539 – 7546. doi: 10.1016/j.vaccine.2019.09.085
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