RESEARCH COMMUNICATION
socio-demographic and socio-economic factors. It HPV vaccine awareness (p=0.002) (Table 2).
included questions about age, marital status, race, level
of education, total family monthly income and number Knowledge of HPV-related issues
of children. B) Two questions to assess the participants’ Knowledge of the participants on HPV and HPV
awareness towards HPV and HPV vaccine. C) Knowledge vaccine was assessed by seven questions. Sixty five
of the participants on HPV and HPV vaccine was assessed women (21.7%) reported that HPV is transmitted through
by seven questions. D) Attitude toward HPV vaccine was sexual intercourse. Sixty six women (22.0%) reported that
assessed by one question ‘Do you think that the introduction HPV is one of the causes of cervical cancer among women.
of HPV vaccination is a good idea?’ Respondents were Regarding genital warts, 38 women (12.7%) reported
asked to indicate their agreement with that statement. E) that HPV can cause the genital warts among women, 76100.0
Reasons for non-acceptance of the vaccine were assessed (25.3%) knew that HPV vaccination can protect women
6
with nine questions; participants were asked if they were against cervical cancer. Forty seven participants (15.7%)
agreed that these factors were reasons of non-acceptance reported that vaccine can be offered to female children
of HPV vaccine. The questionnaire was given in English, nine and above of age and 54 (18%) reported that HPV 75.0
Bahasa Malaysia and Mandarin languages. It was pre- vaccine requires 2-3 injections.
tested on 15 women before the conduction of the study Seventy of the participants (23.3%) reported that 5
to ensure it was easily understood. vaccine is not only for women with more than one sexual 50.0
partner. (Table3). Age, marital status and number of
Statistical methods children were significantly associated with knowledge of
Data analysis was performed using “Statistical Malaysian women on HPV and HPV vaccine (p=0.048,
Package for Social Sciences (SPSS) version 13. After all p=0.022, p=0.005 respectively) (Table 4). 25.0
data were entered into SPSS, they were reviewed for the 3
accuracy of data entry. All the continuous variables were
categorized. Descriptive statistics was done. Chi square 0
test was performed to explore the relation between socio- Table 4. Factors Associated with Knowledge of HPV
demographic and economic factors and the study outcome and HPV Vaccine Among Malaysian Women
variables (awareness knowledge and Attitude).
Yes N (%) No N (%) P value
Variable
Results Age
17-30 43 (33.6) 85 (66.4)
Socio-demographic characteristics 31-40 20 (20.6) 77 (79.4)
Participants of this study were 300 women with mean >40 16 (21.3) 59 (78.7) 0.048
age of 33.6 years. One hundred twenty eight (42.7%) were Race
in the age group 17-30 years old and seventy five (25%) Malay 70 (25.5) 205 (74.5)
were > 40 years old. Majority of the participants were Chinese 8 (47.1) 9 (52.9)
Malay (91.7%), married (73.3%) with number of children Indian 1 (12.5) 7 (87.5) 0.097
1-3 (70.4%). Majority of the participants have a university Marital status
Single 22 (41.5) 31 (58.5 )
degree (117, 39%). One hundred forty four women (48%)
Married 51 (23.2) 169 (76.8)
had monthly family income between 2000RM to 4000 Divorced 6 (22.2) 21 (77.8) 0.022
RM. (Table1). Education level
Primary 4 (19.0) 17 (81.0)
Awareness of HPV and HPV vaccines Secondary 18 (23.1) 60 (76.9)
Participants were asked if they had heard about human Diploma 23 (27.4) 61 (72.6)
papilloma virus (HPV) and HPV vaccine. University 34 (29.3) 83 (70.9) 0.683
Only seventy eight out of 300 women (26%) have heard Total family income
<2000 8 (38.1) 13 (61.9)
about HPV virus and 65 have heard about HPV vaccine
2000 to 4000 40 (27.8) 104 (72.2)
(21.7%). Only Marital status and level of education were
>4000 31 (23.0) 104 (77.0) 0.295
found to be significantly associated with awareness on No of Children
HPV (p=0.002, p=0.042 respectively) (Table 2). No Children 18 (39.1) 28 (60.9)
Marital status only was significantly associated with 1 to 3 37 (21.3) 137 (78.7)
Asian Pacific Journal of Cancer Prevention, Vol 11, 2010 889
Sami Abdo Radman Al-Dubai et al
Table 5. Factors Associated with Attitude Toward ‘no time to take the vaccine’ (20.3%), ‘vaccine was
HPV Vaccine expensive’(15.7%), ‘vaccine is not reachable’ (11.7%),
Yes N (%) No N (%) P value and ‘vaccination was not needed because they were not
Variable sexually active’ (10.7%) (Table 6).
Age
17-30 84 (65.6) 44 (34.4)
31-40 51 (52.6) 46 (47.4)
Discussion
>40 24 (32.0) 51 (68.0) <0.001
This study found that awareness of HPV (26%) and
Race
Malay 147 (53.5) 128 (46.5)
HPV vaccine (21.7%) were low in comparison to previous
Chinese 8 (47.1) 9 (52.9) studies which reported higher rate of awareness ranged
Indian 4 (50.0) 4 (50.0) 0.864 from 57.6% to 84.3% (Jain et al., 2009 and Christian et
Marital status al ., 2009). However, low level of knowledge was found
Single 37 (69.8) 16 (30.2) by some previous studies from Malaysia (Wong, 2008)
Married 116 (52.7) 104 (47.3) and other countries (Giles & Garland, 2006; Moreira et
Divorced 6 (22.2) 21 (77.8) <0.001 al., 2006; Donders et al., 2008; Vanslyke et al., 2008).
Education level For example, a study in Norway showed that only 20% of
Primary 6 (28.6) 15 (71.4)
women had heard about HPV (Kahn et al., 2003). Lenehan
Secondary 33 (42.3) 45 (57.7)
Diploma 45 (53.6) 39 (46.4) et al., (2008) found low levels of knowledge about some
University 75 (64.1) 42 (35.9) 0.002 specific parameters of HPV vaccination such as ‘what will
Total family income it cost’ and ‘how many injections are required’ (Lenehan
<2000 14 (66.7) 7 (33.3) et al., 2008). In this study, few participants reported that
2000 to 4000 69 (47.9) 75 (52.1) HPV is transmitted through sexual intercourse. Sixty six
>4000 76 (56.3) 59 (43.7) 0.161 women (22.0%) reported that HPV is one of the causes of
Number of Children cervical cancer among women. This is very low compared
No children 28 (60.9) 18 (39.13) to that reported by Holcomb et al. (2004) which reported
1 to 3 85 (48.9) 89 (51.1)
that 39% of the participants knew that HPV could cause
cervical cancer. However, low percentage of knowledge
Attitudes toward HPV vaccination was reported in a previous Norway study which found
Respondents were asked if HPV vaccine introduction that 15% of the participants knew about HPV relationship
was a good idea. One hundred fifty nine out of 300 to cervical cancer (Kahn et al. 2003). Regarding genital
respondents said ‘yes’ (53%) (had positive attitude) warts, thirty eight women (12.7%) reported that HPV
toward the vaccine, 51(17%) said ‘no’ (had negative can cause the genital warts among women. This is very
attitude) and 90 (30%) had no decision. Of those who low compared to Holcomb et al. (2004) study which
had heard about HPV, 52 participants (66.7%) said that reported that 33.8% of the respondents were aware that
vaccine introduction was a good idea whereas 26 (33.3) HPV caused genital warts. The majority of the study
of them said ‘no’. participants reported that vaccine is only for women with
Factors associated significantly with Attitude toward more than one sexual partner. Similar findings reported
HPV vaccine were age (p<0.001), marital status (p<0.001) by Wong (2008) that many young women felt that they
and education level (p= 0.002) (Table 5). did not need the vaccine or would prefer to wait because
they were not sexually active; this highlights the failure
Barriers of being vaccinated to educate women of the importance of vaccination before
Regarding the barriers about the HPV vaccine among exposure to HPV. Young women must be made aware
the participants, one hundred thirty one participants that the vaccine is most effective if administered before
(43.7%) reported that non awareness of the vaccine is initiation of sexual activity (Goldie et al., 2004; Zimet,
considered a barrier. One hundred twenty participants 2005) so they should not delay vaccination.
(40%) concerned about the side effects of the HPV Regarding the barriers about the HPV vaccine among
vaccine. Eighty one (27%) of the participants were afraid the participants, (10.7%) reported that vaccination was not
of needles. Seventy one (23.7%) of the participants were needed if women were not sexually active. similar study
afraid of social stigma related to HPV vaccination. reported that the reason for not receiving HPV vaccination
Other barriers reported by the participants were included not being sexually active (Jain et al., 2009). Some
Table 6. Barriers of Being Vaccinated
Yes N (%) No N (%) Do not know N (%)
Not aware of the vaccine 131 (43.7) 105 (35.0) 64 (21.3)
Concern about side effects of the vaccine 120 (40.0) 104 (34.7) 76 (25.3)
Afraid of needles 81 (27.0) 177 (59.0) 42 (14.0)
Afraid of social stigma 71 (23.7) 152(50.60) 77 (25.7)
Do not have time to take vaccination 61 (20.3) 182 (60.7) 57 (19.0)
Vaccine is expensive 47 (15.7) 51 (17.0) 202 (67.3)
Vaccine is not easily reachable 35 (11.7) 74 (24.7) 191 (63.6)
Vaccination not needed if not sexually active 32 (10.7) 106 (35.3) 162 (54.0)