INTRODUCTION:

Human Papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide, with significant health consequences. High-risk HPV types 16 and 18 are responsible for approximately 74% of cervical cancers, and are also linked to cancers of the anus, penis, vulva, vagina, mouth, and oropharynx¹. Low-risk HPV types 6 and 11 cause nearly all cases of genital warts².

Cervical cancer remains a major public health challenge, particularly in low- and middle-income countries, due to late diagnosis and limited access to screening and preventive measures³. Vaccination against HPV has been shown to be highly effective in preventing infection and the development of HPV-related cancers and genital warts²⁶. Two prophylactic vaccines — Gardasil (Merck, approved in 2006) and Cervarix (GlaxoSmithKline, approved in 2009) — are licensed for use in young women. Gardasil protects against HPV types 6, 11, 16, and 18, while Cervarix targets types 16 and 18⁴. Despite proven efficacy, vaccine uptake remains suboptimal, often due to limited awareness, misconceptions about safety, cultural barriers, and lack of access⁵.

Knowledge and understanding of HPV infection and vaccination are critical in enabling informed decision-making. HPV infection is highly prevalent, yet most infections are transient and asymptomatic, which complicates lay understanding of the disease⁶. While protective measures such as condom use can reduce the risk, they are not fully effective against HPV⁷. Assessing females’ knowledge, attitudes, concerns, and willingness to receive the HPV vaccine is essential for designing targeted health education programs and improving vaccine acceptance⁸. This correlational study was conducted to assess knowledge, attitude, concerns, and willingness towards HPV vaccination among females aged 14–24 years in Aikkaranad Panchayat, Ernakulam District, Kerala.

MATERIALS AND METHODS:

A quantitative research approach with a descriptive correlational survey design was adopted to assess knowledge, attitude, concerns, and willingness towards HPV vaccination among females aged 14 – 24 years residing in Aikkaranad Panchayat, Ernakulam District, Kerala. A convenience sample of 138 participants was recruited, excluding victims of sexual abuse and females with mental challenges. Data were collected using five structured tools: a socio-demographic proforma, and instruments assessing knowledge, attitude, concerns, and willingness regarding HPV vaccination. The tools were validated by three experts in obstetrics and gynecological nursing, with Content Validity Index (CVI) scores ranging from 0.94 to 1.0, and reliability was confirmed using Cronbach’s alpha, yielding coefficients of 0.86–0.94. A pilot study confirmed feasibility, and necessary permissions were obtained prior to data collection. Informed consent was obtained from all participants. Data were analyzed using SPSS software.

RESULTS:

As the data were normally distributed, descriptive statistics including mean, percentage, and standard deviation were used to summarize the findings, while inferential statistics such as Pearson’s correlation, was used to examine relationships.

Table 1: Frequency and percentage distribution of sample characteristics based on socio-demographic variables. (n=138)

Variables	Frequency (f)	Percentage (%)
1. Age
a) 14-16	25	18.1
b) 17-20	43	31.2
c) 21-24	70	50.7
2. Education
a) No formal education	0	0
b) Up to 10th	33	23.9
c) Plus two	32	23.2
d) Diploma / Graduate and above	73	52.9
3. Religion
a) Hindu	59	42.8
b) Christian	73	52.9
c) Muslim	6	04.3
4. Gynaecological Diseases
Yes	30	21.7
No	108	78.3
5. Family History of cervical cancer
Yes	2	01.4
No	136	98.6
6. Heard about HPV vaccination
Yes	52	37.7
No	86	62.3
7. Taken HPV vaccine
Yes	32	23.2
No	106	76.8

The data presented in table 1 showed that, regarding age, the largest group was 21–24 years, comprising slightly more than half of the sample (50.7%). Educationally, the majority of participants had a diploma or graduate-level education and above (52.9%). In terms of religion, Christians constituted the largest segment (52.9%), followed by Hindus (42.8%). Most participants reported no history of gynecological diseases (78.3%) and no family history of cervical cancer (98.6%). Notably, a significant proportion (62.3%) had not heard about HPV vaccination, which aligns with the large majority (76.8%) who had not received the HPV vaccine.

Table 2: Frequency and percentage distribution of knowledge regarding HPV vaccination (n=138)

Categories of Knowledge	Frequency (f)	Percentage (%)	Mean	Standard Deviation (SD)
Poor (0 - 6)	15	10.9	9.29	2.05
Average (7 - 12)	119	86.2
Good (13 - 18)	04	02.9

Table 2 showed that, the knowledge level regarding HPV vaccination among the 138 participants was predominantly average, with 119 participants (86.2%) falling into this category (scores 7 – 12). A smaller proportion of the sample exhibited poor knowledge, with 15 participants (10.9%, scores 0 – 6), and only 4 participants (2.9%, scores 13 – 18) demonstrated good knowledge. The overall mean knowledge score was 9.29 with a standard deviation of 2.05. These findings indicate that while most participants had a basic or foundational awareness of HPV vaccination, there was a significant gap in comprehensive understanding, with very few participants demonstrating good knowledge of the subject.

Table 3: Frequency and percentage distribution of attitude regarding HPV Vaccination (n=138)

Categories of

Attitude

Frequency (f)

Percentage (%)

Mean

Standard Deviation (SD)

Negative Attitude

(10 - 30)

34.1

32.81

5.27

Positive Attitude

(31 - 50)

65.9

The data presented in table 3 showed that, the majority of participants (65.9%, 91 out of 138) demonstrated a positive attitude towards HPV vaccination, with scores ranging from 31 to 50, while 47 participants (34.1%) exhibited a negative attitude, scoring between 10 and 30. The overall mean attitude score was 32.81 with a standard deviation of 5.27.

Table 4: Frequency and percentage distribution of concerns regarding HPV vaccination (n=138)

Categories of Concern	Frequency (f)	Percentage (%)
No concern (0)	1	0.7
Mild concern (1-8)	78	56.5
Severe concern (9-15)	59	42.8

Table 4 revealed that, the majority of participants (56.5%, 78 subjects) reported mild concerns regarding HPV vaccination, while a substantial proportion (42.8%, 59 subjects) expressed severe concerns. Only a very small fraction (0.7%, 1 subject) indicated no concern at all.

Table 5: Frequency and percentage distribution of willingness regarding HPV Vaccination (n=138)

Willingness	Frequency (f)	Percentage (%)
Yes	86	62.3
No	52	37.7

Table 5 showed that, when assessing willingness to take the HPV vaccination, the majority of participants (62.3%, 86 subjects) reported being willing to receive the vaccine, while 52 participants (37.7%) expressed unwillingness. These findings indicate that although a majority were open to vaccination, a considerable proportion still demonstrated hesitancy.

Table 6: Correlation between knowledge, attitude, concern and willingness (n= 138)

Variables	Pearson correlation Coefficient (r)	p value
Knowledge and Attitude	0.090	0.294
Knowledge and Concerns	0.017	0.845
Knowledge and Willingness	0.039	0.652
Attitude and Concerns	0.048	0.575
Attitude and Willingness	0.085	0.320
Concerns and Willingness	0.145	0.089

p < 0.05 level of significance

Table 6 revealed that there was no significant relationship between knowledge, attitude, concerns, and willingness towards HPV vaccination. The correlation analysis showed the following results: knowledge and attitude (r = 0.090, p = 0.294), knowledge and concerns (r = 0.017, p = 0.845), knowledge and willingness (r = 0.039, p = 0.652), attitude and concerns (r = 0.048, p = 0.575), attitude and willingness (r = 0.085, p = 0.320), and concerns and willingness (r = 0.145, p = 0.089). These findings indicate that none of the variables were significantly correlated in this sample.

DISCUSSION:

The present study aimed to assess the knowledge, attitude, concerns, and willingness towards HPV vaccination among females and to examine the interrelationship between these variables. The findings revealed that only 2.9% of the participants demonstrated good knowledge of HPV vaccination. Despite the low knowledge levels, a majority (65.9%) expressed a positive attitude towards vaccination. Concerns about HPV vaccination were prevalent, with 42.8% reporting severe concern, while more than half of the participants (62.3%) indicated willingness to receive the vaccine. These results highlight the persistent gap between knowledge and vaccine acceptance in India, where cervical cancer continues to be a major public health challenge associated with HPV infection.⁹

These findings are in line with earlier research. A study among medical students in Gujarat reported that 60.6% recognized HPV as a preventable cause of cervical cancer, while vaccine coverage was only 13.4% and willingness stood at 41.8%.¹⁰ Similarly, research among medical and paramedical students in South India found that 44.9% demonstrated good knowledge, but only 6.8% had received the vaccine, and nearly half of the unvaccinated were unwilling to get vaccinated.¹¹ Comparable patterns have also been reported in other countries, where positive attitudes towards HPV vaccination are often undermined by poor awareness and lack of uptake.¹²

The present study further demonstrated no significant correlation between knowledge, attitude, concern, and willingness, which is supported by findings from dental students in India, where knowledge of HPV and cervical cancer did not influence attitudes, although it was significantly associated with willingness to pay for the vaccine.¹³ Similarly, a study among Indian women indicated that while general awareness of HPV and its vaccine was moderate, knowledge strongly predicted intention to vaccinate oneself and recommend it to children.¹⁴

Socio-demographic factors also played a role in shaping perceptions. In our study, age and education were significantly associated with attitudes and concerns regarding HPV vaccination. Prior research supports this, showing that higher education, marital status, and parental responsibilities are often linked with greater vaccine acceptability.¹⁵ International studies also suggest that concerns regarding vaccine safety, efficacy, and cost are major barriers to acceptance.¹⁶ This evidence highlights that even when attitudes are positive, misconceptions and contextual barriers may hinder vaccine uptake.

Overall, our findings emphasize the need for structured and culturally relevant health education programs. Previous work from India and globally has shown that community-based interventions and school- or college-based awareness initiatives can improve HPV knowledge and increase vaccine uptake.¹⁷ Without such efforts, the disconnect between willingness and actual vaccination may continue, limiting progress in cervical cancer prevention.

CONCLUSION:

This study concludes that there is no significant correlation between knowledge, attitude, concern, and willingness towards HPV vaccination among young females aged 14–24 years. Although most participants exhibited a positive attitude and willingness, low knowledge and high levels of concern remain barriers. These findings echo previous Indian and global studies highlighting the need for targeted awareness campaigns and accessible vaccination services.⁹ Strengthening education about HPV and cervical cancer, addressing misconceptions about vaccine safety and efficacy, and ensuring cost-effective availability could enhance vaccine acceptance.Public health strategies such as nurse-led education programs, integration of HPV vaccination into school health initiatives, and community outreach are crucial to improve uptake.¹¹ Ultimately, such measures will contribute to reducing the burden of cervical cancer and achieving broader cancer prevention goals.¹⁸

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Received on 08.10.2025 Revised on 17.11.2025

Accepted on 19.12.2025 Published on 21.02.2026

Available online from February 23, 2026

Asian J. Nursing Education and Research. 2026;16(1):39-42.

DOI: 10.52711/2349-2996.2026.00009

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