PLoS One. 2013 Aug 21;8(8):e71827. doi: 10.1371/journal.pone.0071827. eCollection 2013.
Knowledge, attitude, practice and barriers on vaccination against human papillomavirus infection: a cross-sectional study among primary care physicians in Hong Kong.
Wong MC1, Lee A, Ngai KL, Chor JC, Chan PK.
School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
This study explored the knowledge, attitude, practice and barriers to prescribe human papillomavirus (HPV) vaccines among private primary care physicians in Hong Kong. A self-administered questionnaire survey was conducted by sending letters to doctors who had joined a vaccination program for school girls. From 720 surveys sent, 444 (61.7%) completed questionnaires were returned and analyzed. For knowledge, few responded to questions accurately on the prevalence of cervical HPV (27.9%) and genital wart infection (13.1%) among sexually active young women in Hong Kong, and only 44.4% correctly answered the percentage of cervical cancers caused by HPV. For attitude, most agreed that HPV vaccination should be fully paid by the Government (68.3%) as an important public health strategy. Vaccination against HPV was perceived as more important than those for genital herpes (52.2%) and Chlamydia (50.1%) for adolescent health, and the majority selected adolescents aged 12-14 years as the ideal group for vaccination. Gardasil(®) (30.9%) and Cervarix(®) (28.0%) were almost equally preferred. For practice, the factors influencing the choice of vaccine included strength of vaccine protection (61.1%), long-lasting immunity (56.8%) and good antibody response (55.6%). The most significant barriers to prescribe HPV vaccines consisted of parental refusal due to safety concerns (48.2%), and their practice of advising vaccination was mostly affected by local Governmental recommendations (78.7%). A substantial proportion of physicians had recommended HPV vaccines for their female clients/patients aged 18-26 years for protection of cervical cancer (83.8%) or both cervical cancer and genital warts (85.5%). The knowledge on HPV infection was low among physicians in Hong Kong. Prescription of HPV vaccine was hindered by the perceived parental concerns and was mostly relied on Governmental recommendations. Educational initiatives should be targeted towards both physicians and parents, and the Government should consider full subsidy to enhance vaccine uptake rate.
Attitude towards the importance of public health strategies to promote human papillomavirus vaccination.
(A: Partial (∼30%) subsidy by the Government; B: Fully paid by the Government; C: Price offered at 50% discount; D: School immunization program with market price; E: Immunization program jointly organized by school and community doctors with market price).
The assoication between preferred vaccine (Cervarix® vs. Gardasil® vs. no preference) and the reasons to choose vaccines (A to N).
(A: Stronger protection; B: Safety; C: Lower price; D: More HPV types; E: Protect against genital warts; F: Better antibody response; G: Long-lasting immunity; H: Cross-protection for other cancer-associated HPV types; I: Better adjuvant; J: Patients think it’s better; K: Practice management; L: Selected by the Government; M: Credibility of manufacturer; N: Comprehensive service of manufacturer). All comparisons among vaccine preference groups across reasons to choose vaccine categories (A to N) were statistically significant (p<0.05).