Knowledge and Acceptance of Human Papillomavirus Vaccine for Cervical Cancer Prevention Among Urban Professional Women in Bangladesh: A Mixed Method Study

The objective of this study was to assess the knowledge, attitude, and acceptance of cervical cancer, human papillomavirus (HPV), and HPV vaccination among highly educated urban professional women in Dhaka, Bangladesh. In 2016, HPV vaccination was introduced for the first time in Bangladesh by the Ministry of Health, with the support from the Global Alliance for Vaccines and Immunizations (GAVI). If the 2-year vaccination introduction programme, running in one district of the country, is successful, GAVI will provide support for national introduction of HPV vaccination. In order to establish a successful national HPV vaccination strategy, data are needed on women's knowledge and attitudes toward cervical cancer and its prevention across different segments of society. To date, studies have been conducted mostly among Bangladeshi women with low educational attainment, low income, and/or rural residency.

In December 2013, the researchers recruited 160 female professionals employed at selected private banks in Bangladesh. Participants were selected using nonprobability-based convenience sampling for interviews through a self-administered questionnaire. Later, in-depth interviews (IDIs) were conducted with 9 of these women. Quantitative data were analysed utilising descriptive statistics, whereas qualitative data were analysed using a thematic approach.

Ninety-eight percent of participants reported that they had previously heard of cervical cancer. Participants reported to have heard of cervical cancer from newspapers or magazines (52%), family or friends (36%), and the television (29%). Less than one-fifth reported to have heard of cervical cancer from their doctor. Only 51% of participants reported having heard of HPV; among those, about half were able to identify HPV as a sexually transmitted infection (STI). Fifty-six percent of participants reported ever having heard of HPV vaccination. Among those who knew of HPV vaccination, the source of knowledge of HPV vaccination was newspaper or magazine (40%), television (30%), their doctor (29%), and their family and friends (24%). Less than 1% of the 160 participants had previously undergone a pap smear, and only 2% were vaccinated with at least one dose of HPV vaccination.

When survey respondents who had previously heard of HPV vaccination (n = 90) were asked about reasons for not taking vaccination, the majority said they did not know enough about vaccination (78%). Some mentioned that their doctor did not recommend it to them (14%), while a few reported reasons such as worries related to the safety of vaccination (7%) and the fact that they were too old for it (6%). The decision to be vaccinated also appeared to be influenced by personal experience, such as a family member previously diagnosed with cervical cancer.

Although knowledge was low, 43% of study participants showed interest in receiving HPV vaccination in the future. Of those who had one or more daughters, 69% wanted their daughters to be vaccinated. However, during the IDI, mothers expressed interest in receiving more information regarding the efficacy and safety of the HPV vaccination before making a final decision.

Almost all women (99%) reported that there should be programmes to raise awareness about HPV and cervical cancer. More than half of women thought reaching out to women through mass media such as television commercials and house-to-house visit or mass campaigns by healthcare workers would be most effective. Through the IDIs, women also emphasised the importance of advertisement through mass media, such as television. Some suggested using billboards for advertisement of HPV vaccination, as many people spend considerable time traveling in Dhaka city due to immense traffic. Other suggestions included seminars or brochures on the topic to disseminate information to women similar to themselves or to other working groups (e.g., garment workers). (Notably, the use of leaflets and newspapers, although effective in highly literate social groups, may be of limited value in populations of lower socioeconomic status.) One woman proposed educational programming through posters in beauty parlors, as women of all age groups and socioeconomic statuses visit them.

Another respondent suggested that men should also be involved in such efforts. As reported here, previous studies conducted in Bangladesh identified the importance of neighbours and relatives as a source of knowledge of cervical cancer, indicating that social network is an important source of knowledge. Involving men in educational efforts could improve the social acceptance of discussing HPV and cervical cancer, which may be vital to efforts in the future to vaccinate young boys in Bangladesh.

The results of this study suggest that despite high level of education, knowledge of the association of HPV and cervical cancer and relevant preventative methods is low. "This reflects the importance of immediate implementation of educational campaigns across Bangladesh before vaccination is made available through a national HPV vaccination program to improve uptake of vaccination and its effectiveness."