HPV vaccine knowledge gaps and vaccination intent: a cross-sectional study of vocational students in Southern Xinjiang of China in 2023.
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BACKGROUND: Female students in tertiary vocational institutions, particularly in regions with limited medical resources, play a crucial role in grassroots healthcare and cervical cancer prevention. Understanding their awareness of human papillomavirus (HPV), willingness to receive the HPV vaccine, and perceived barriers is essential for promoting vaccination equity. METHODS: A cross-sectional study was conducted from March to April 2023 among female vocational students in southern Xinjiang, China, using a standardized electronic questionnaire. The collected data included sociodemographic characteristics, HPV-related knowledge, vaccination willingness, and barriers. Descriptive statistics and logistic regression analyses were performed. RESULTS: Among 1,157 participants, only 37.0% had heard of HPV, and 28.9% were aware of the HPV vaccine. Univariate analysis revealed that non-medical majors and students from rural areas had significantly lower odds of having adequate knowledge (OR = 0.450, 95% CI: 0.360-0.563, p < 0.001; and OR = 0.458, 95% CI: 0.350-0.600, p < 0.001; respectively). In contrast, higher parental education (junior college/bachelor's degree or above) was associated with 58% greater odds of higher awareness (OR = 1.576, 95% CI: 1.119-2.219, p = 0.009). Additionally, students who had not heard of HPV or the HPV vaccine were significantly less likely to possess sufficient awareness (OR = 0.230, 95% CI: 0.181-0.293, p < 0.001; and OR = 0.194, 95% CI: 0.150-0.250, p < 0.001; respectively). Further, multivariate analysis confirmed that major, residence, prior HPV awareness, and vaccine awareness were independent predictors of knowledge level (all p < 0.001). Specifically, medical students demonstrated greater knowledge regarding HPV typing (41.8% vs. 25.6%) and optimal vaccination timing (16.7% vs. 7.9%) than non-medical students. Regarding vaccination attitudes, only 32.1% of the overall students expressed willingness to receive the HPV vaccine, with higher willingness rates observed among medical students (44.6% vs. 19.7%), urban residents (47.8% vs. 27.9%), and individuals who were aware of HPV (50.5%) or the HPV vaccine (59.3%). Actual uptake of HPV vaccine, however, remained low (1.1%-4.5%). Regression analysis showed that medical students had 2.4 times higher vaccination intent, and urban residents exhibited 1.7 times higher intent, compared to their counterparts. Furthermore, awareness was positively correlated with willingness to vaccinate, whereas an earlier age at sexual debut was linked to reduced vaccination intent (OR = 0.57, 95% CI: 0.37-0.89; p = 0.02). The main barrier to vaccination was the low perceived risk associated with young age (45.4%); medical students reported greater concerns about access and cost, whereas psychological barriers, such as worries about side effects and doubts about safety and efficacy, were common across all groups. CONCLUSIONS: HPV awareness and vaccination uptake among female vocational students in southern Xinjiang remain low. Targeted health education initiatives should focus on non-medical students, rural populations, and individuals from lower socioeconomic backgrounds. Enhancing vaccine accessibility and affordability through institutional and governmental efforts is critical to improving vaccination coverage in this population.