Effect of a School-Based Educational Intervention on HPV and HPV Vaccine Knowledge and Willingness to Be Vaccinated among Chinese Adolescents: A Multi-Center Intervention Follow-up Study

"[A] successful vaccination program should include a robust health information campaign that disseminates accurate information about HPV vaccines prior to implementation in communities."

Adequate knowledge and awareness of cervical cancer, human papillomavirus (HPV), and HPV vaccines have been found to play a critical role in uptake of cervical cancer screening and HPV vaccination. In China, the imported bivalent vaccine and quadrivalent vaccine were launched in July 2016 and May 2017, respectively; studies have shown that awareness is low. In the context of Project HOPE's "Cervical Cancer and HPV Infection Prevention Health Education Program", this study sought to assess HPV and HPV vaccine knowledge among Chinese adolescents (aged 13-14) and to evaluate the effect of a school-based educational intervention, immediately and one year later, on HPV knowledge and vaccine acceptability.

A school-based interventional follow-up study was conducted among 5,024 middle school students (male and female) in 7 representative cities in mainland China from May 2015 to May 2017. Students in the intervention classes received a 45-minute PowerPoint (PPT)-oriented lecture conducted by a school health education teacher who was previously trained by professionals on HPV and HPV vaccines. After the health education lecture, students were asked to complete a post-education questionnaire assessing their respective knowledge on HPV and HPV vaccines. Students in the control classes were not offered the health education lecture, but were later asked to complete the same questionnaire as the intervention class. One year after the intervention, the same questionnaire was provided to students from both the intervention classes and the control classes on the same day.

Baseline HPV knowledge was low among Chinese adolescents, with only 12.6% and 15.7% of students having heard of HPV and HPV vaccines, respectively. After the group intervention, 85.8% of the students understood that sexual transmission was the primary route of HPV infection, and most (88.7%) of them identified HPV vaccination as the most effective way to prevent HPV infection. In addition, the majority (91.9%) were willing to be vaccinated if HPV vaccines were available. Students with higher knowledge levels of HPV and HPV vaccines were more willing to get vaccinated. One year after the intervention, the knowledge of HPV and HPV vaccines was dramatically diminished. However, knowledge was significantly higher in intervention classes compared to control classes. Students in the intervention classes were more likely to vaccinate themselves compared with the control classes (74.2% vs. 63.7%, p < 0.001) one year after the intervention.

The researchers note that the primary channels for adolescents to obtain health knowledge are from their family members, schoolteachers, and peers. However, in general, most Chinese families have limited professional health knowledge. Thus, integrating HPV education into the current sexual health education curriculum for middle school students in mainland China is a viable strategy, they say.

In conclusion: "Integrating health education on HPV into the existing school-based sexual health curriculum could be an effective way to increase HPV vaccination coverage and help to eliminate preventable HPV-associated cancers in China."