• Users Online: 262
  • Print this page
  • Email this page

 Table of Contents  
Year : 2021  |  Volume : 9  |  Issue : 3  |  Page : 99-102

Catching them young: Impact of educational intervention on cervical cancer knowledge and human papilloma virus vaccine hesitancy in adolescent girls in urban India

Department of Community Medicine, Bharati Vidyapeeth (DTU) Medical College, Pune, Maharashtra, India

Date of Submission14-Aug-2021
Date of Acceptance11-Oct-2021
Date of Web Publication11-May-2022

Correspondence Address:
Aarati B Pokale
Department of Community Medicine, Bharati Vidyapeeth (DTU) Medical College, Pune 411043, Maharashtra
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/dypj.dypj_51_21

Rights and Permissions

Background and Objectives: Cervical cancer is the most common cancer in females and a leading cause of cancer death in developing countries. The objectives are (1) to assess knowledge regarding cervical cancer and its risk factors among female adolescents and (2) to analyze human papilloma virus (HPV) vaccine status and reasons for vaccine hesitancy. Materials and Methods: This is a cross-sectional interventional study in a women’s engineering college in Pune city, Maharashtra, India. About 230 students were administered pre-test. Educational intervention using videos on cervical cancer was done. Post-test was administered to check the change in knowledge. Statistical Analysis Used: SPSS software is used to calculate percentages and to apply the χ2 test. Results: Most participants had poor knowledge about cervical cancer. About 52% and 57% of the students did not know the cause and mode of spread of HPV. Only 15% were aware about vaccine. Unawareness was a major barrier to HPV vaccination. Conclusion: A need to empower females by educating them about cervical cancer was realized. The risk factors for this malignancy are preventable, and educational intervention can go a long way in raising awareness.

Keywords: Cervical cancer, health education, human papilloma virus, vaccination

How to cite this article:
Mittal A, Pokale AB. Catching them young: Impact of educational intervention on cervical cancer knowledge and human papilloma virus vaccine hesitancy in adolescent girls in urban India. D Y Patil J Health Sci 2021;9:99-102

How to cite this URL:
Mittal A, Pokale AB. Catching them young: Impact of educational intervention on cervical cancer knowledge and human papilloma virus vaccine hesitancy in adolescent girls in urban India. D Y Patil J Health Sci [serial online] 2021 [cited 2022 May 27];9:99-102. Available from: http://www.dypatiljhs.com/text.asp?2021/9/3/99/345105

  Key Messages: Top

The lower percentage of students’ awareness of cervical cancer and the vaccine availability is alarming. Measures like conducting awareness programs early in life, using social media for advertisement and imparting health education, is the need of the hour. The barrier to vaccine acceptance could be the mind-set of the population, for which behavior change communication activities are recommended.

  Introduction Top

Cervical cancer is the fifth most common cancer in humans, the second most common cancer in women worldwide, and the most common cancer cause of death in the developing countries.[1] Sexually transmitted human papilloma virus (HPV) infection is the commonest cause for cervical cancer. The incidence of cervical cancer is approximately 5 lakh new cases annually, with about 3 lakh deaths worldwide.[2] A recent systematic review summarized the evidence that educational interventions increase HPV vaccination acceptance.[3] Hence, there is an urgent need of creating awareness about cervical cancer and HPV vaccine. With this in mind, we need to assess knowledge of cervical and to analyze their HPV vaccine status and reason(s) for vaccine hesitancy.

  Subjects and Methods Top

Study area: This study is conducted in a women’s engineering college in Pune city, Maharashtra, India.

Study type: This is a cross-sectional interventional study.

Study population: The study population consists of students (1st and 2nd year) present at the time of data collection.

Sample size: The total strength of 1st and 2nd year is 230. Considering P = 40% and error 20% with 5% level of significance, the required sample size came to 150.[4] However, all students present in the class and willing to participate were included in the pre-test so that the total came to 230. However, on the day of post-test, only 176 students submitted the Google Form, so 176 responses were analyzed for post-test.

Tools of data collection: Data were collected using online Google Forms and self-administered questionnaire. The pre-test consisted of questions to assess their knowledge regarding cervical cancer: etiology, signs and symptoms, complications, risk factors, and preventive measures. Intervention was done to impart health education before the post-test. An interactive session using PowerPoint presentation and video films (by CDC) on cervical cancer statistics, signs and symptoms, and preventive measures was conducted for all participants. Post-test followed a week after intervention.

Inclusion criteria: All students were present on the day of data collection (both pre-test and post-test).

The study was conducted in a purposively selected women’s engineering college in Pune city. The Institutional Ethics Committee approval was obtained. Permission from the principal of the college was sought and then students were approached in their class.

After explaining the purpose of the study, those students willing to participate were provided the link to the pre-test (as a Google Form). After they had submitted the answers to the questionnaire, a PowerPoint presentation on cervical cancer (etiology, risk factors, signs and symptoms, complications, screening methods, and vaccines) along with video films on Human Papillomavirus by Nucleus Health[5] (You are the key to HPV Cancer prevention by CDC)[6] was shown in the class. Post-test was administered a week later to check their knowledge.

Statistical analysis: Data were entered into Microsoft Excel. SPSS software version 24 was used for analysis. Percentages were calculated, and the χ2 test was applied to check for change in knowledge after intervention. P-value< 0.05 was considered significant. Paired sample t-test was used to compare pre-test and post-test scores.

  Results Top

Two hundred and thirty girls filled the pre-test questionnaire. The mean age of the participants was 20 years. Only 15% were aware of vaccine against HPV and had been vaccinated.

[Table 1] shows comparison of pre- and post-test scores of knowledge of cervical cancer and vaccination among participants. [Table 2] reflects the post-intervention change in attitude towards HPV vaccination.
Table 1: Knowledge, awareness, and attitude about HPV and cervical cancer (n = 176)

Click here to view
Table 2: Attitude of participants regarding vaccination (n = 176)

Click here to view

There was a significant increase in the overall post-test score from 5.90 to 10.06.

According to the study participants, the main barrier to HPV vaccination was lack of awareness about cervical cancer and the vaccine (28.4%).

  Discussion Top

Post-intervention we observed a significant increase in the participant’s knowledge regarding cervical cancer, screening test, and knowledge of risk factors of cervical cancer (score increased from 5.90 to 10.06).

About half of the students (52.4%) had little knowledge and awareness on HPV infection or HPV vaccine but expressed willingness to know more. This shows a positive attitude toward vaccination and is consistent with the study that have reported a favorable attitude.[7]

A study by Kwan et al.[8] among Chinese adolescent girls demonstrated that participants’ knowledge on cervical cancer was poor. Participants had difficulty understanding the link between HPV and cervical cancer.[8] In our study, 98 (42.4%) participants were aware that HPV is transmitted through sexual contact. This knowledge is very important from the point of view of prevention as having multiple sexual partners increases the risk of infection with HPV.

Only 27 (15.3%) of the students were aware that cervical cancer vaccine was available in India. This finding is consistent with the study done by Roy and Tang in Kolkata.[9]

In the present study, though initially students were unaware of HPV, after intervention acceptance rates were high. The second part of the questionnaire has shown a statistically significant improvement in knowledge and awareness for all HPV-related questions.

Recent studies by Cates et al.[10] in 2010 and Brewer et al.[11] in 2011 have shown that vaccine uptake was positively associated with having heard about the vaccine from a healthcare provider.

Our findings also confirmed prior HPV awareness as a positive correlate of HPV vaccine acceptability as majority 105 (59.7%) of the respondents viewed HPV vaccination in a positive light. About 88% of the respondents of the study by Sumita et al.[12] were willing to take the vaccine. Physician’s recommendation was central to the acceptability. The study emphasizes that healthcare providers could play an important role in affecting the adolescents’ attitudes and awareness about vaccination.[13] The major obstacles to implementation of HPV vaccine programs in our country as mentioned by Bhatla and Joseph[14] included cost, acceptability, lack of public awareness and infrastructure, concern about unknown side effects, and social and religious barriers. In their review article by Bharadwaj et al.,[15] high cost of the vaccines was stated as the major concern for mass vaccination program in India.

We used intervention in the form of videos and PowerPoint presentation to educate and create awareness. This informative session to the receptive minds immediately following the intervention will have a great impact.

Limitations of the study

The study was based on purposive sampling. Students from only one college were included which is insufficient to reflect the overall awareness in India.


The role of healthcare providers (doctors, nurses, Anganwadi workers, medical social workers etc.) and even school counsellors and teachers in creating awareness about cervical cancer and HPV vaccination to adolescents cannot be over-emphasized. Using social media, education videos, or even posters will help make the health education interesting and impactful. We need to come out and have timely discussions about the risk factors and preventive measures of cervical cancer with adolescents to catch them young.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Kaarthigeyan K Cervical cancer in India and HPV vaccination. Indian J Med Paediatr Oncol 2012;33:7-12.  Back to cited text no. 1
Sankaranarayanan R, Ferlay J Worldwide burden of gynaecological cancer: The size of the problem. Best Pract Res Clin Obstet Gynaecol 2006;20:207-25.  Back to cited text no. 2
Fu LY, Bonhomme LA, Cooper SC, Joseph JG, Zimet GD Educational interventions to increase HPV vaccination acceptance: A systematic review. Vaccine 2014;32:1901-20.  Back to cited text no. 3
Niveditha Das E, Francis PT. HPV vaccine knowledge and coverage among female students in a medical college, Kerala. Int J Community Med Public Health 2018;5:5133-8.  Back to cited text no. 4
Nucleus Medical Media. Human Papilloma Virus [Video file]. Retrieved from https://hlp.nucleushealth.com/human-papillomavirus-hpv/view-item?ItemID=79541. Last accessed June 2019.  Back to cited text no. 5
Centres for Disease Control and Prevention (CDC). (November 25, 2013). You Are the Key to HPV Cancer Prevention [Video file]. Retrieved from https://www.youtube.com/watch?v=E36aShFlEYo. Last accessed June 2019.  Back to cited text no. 6
Ebu NI, Amissah-Essel S, Asiedu C, Akaba S, Pereko KA Impact of health education intervention on knowledge and perception of cervical cancer and screening for women in Ghana. BMC Public Health 2019;19:1505.  Back to cited text no. 7
Kwan TT, Chan KK, Yip AM, Tam KF, Cheung AN, Lo SS, et al. Acceptability of human papillomavirus vaccination among Chinese women: Concerns and implications. BJOG 2009;116:501-10.  Back to cited text no. 8
Roy B, Tang TS Cervical cancer screening in Kolkata, India: Beliefs and predictors of cervical cancer screening among women attending a women’s health clinic in Kolkata, India. J Cancer Educ 2008;23:253-9.  Back to cited text no. 9
Cates JR, Shafer A, Carpentier FD, Reiter PL, Brewer NT, McRee AL, et al. How parents hear about human papillomavirus vaccine: Implications for uptake. J Adolesc Health 2010;47:305-8.  Back to cited text no. 10
Brewer NT, DiAngi YT, Panozzo CA, Ramogola-Masire D, Steenhoff AP, Brewer NT A cross-sectional study of HPV vaccine acceptability in Gaborone Botswana. PLoS ONE 2011;6:e25481.  Back to cited text no. 11
Sumita M, Shalini R, Geetika G, Neerja G Awareness about human papilloma virus and its vaccine among medical students. IJCM 2013;38:92-4.  Back to cited text no. 12
Gregory DZ Improving adolescent health: Focus on HPV acceptance. J Adolesc health 2005;S17-23.  Back to cited text no. 13
Bhatla N, Joseph E Cervical cancer prevention and the role of human papillomavirus vaccines in India. Indian J Med Res 2009;130:334-340.  Back to cited text no. 14
Bharadwaj M, Hussain S, Nasare V, Das BC HPV & HPV vaccination: Issues in developing countries. Indian J Med Res 2009;130:327-333.  Back to cited text no. 15


  [Table 1], [Table 2]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
  Key Messages:
  Subjects and Methods
   Article Tables

 Article Access Statistics
    PDF Downloaded19    
    Comments [Add]    

Recommend this journal