Open Access Original Article

The Impact of an Educational Program on the

Awareness and Knowledge of Human Papilloma
Review began 07/08/2024
Virus (HPV) Vaccine Among Secondary School
Review ended 07/15/2024
Published 07/19/2024 Girls in Saudi Arabia
© Copyright 2024 Rawabi S. Almatrafi 1 , Shady Kamel 2, Abdulaziz D. Algarni 1, Nisrin S. Almatrafi 3, Maryam K. Aledrisi 3,
Almatrafi et al. This is an open access
article distributed under the terms of the
Mohammad D. Algarni 4, Ohud A. Alsalami 1 , Mishari M. Alrashidi 1
Creative Commons Attribution License CC-
BY 4.0., which permits unrestricted use, 1. Preventive Medicine, Ministry of Health, Riyadh, SAU 2. Saudi Field Epidemiology Training Program, Ministry of
distribution, and reproduction in any
Health, Riyadh, SAU 3. Obstetrics and Gynaecology, Ministry of Health, Riyadh, SAU 4. Preventive Medicine, Imam
medium, provided the original author and
Muhammad Ibn Saud Islamic University, Riyadh, SAU
source are credited.

DOI: 10.7759/cureus.64957 Corresponding author: Rawabi S. Almatrafi, v.ll@hotmail.com

Abstract
Background: The objectives were to assess the effectiveness of the educational program in enhancing
students' understanding of the human papillomavirus (HPV) vaccine, correcting misconceptions, and
increasing overall awareness. Additionally, the study aimed to identify factors influencing knowledge
improvement and willingness to be vaccinated against HPV, including prior knowledge, information sources,
session attendance, and school type.

Methods: In this study, 148 participants were enrolled from secondary schools in Saudi Arabia, and data were
collected through pre- and post-educational session assessments, logistic regression analyses, and
qualitative investigations. Educational sessions focused on key aspects of the HPV vaccine, including its
preventive benefits, administration details, and side effects, tailored to address common misconceptions
and enhance understanding among students.

Results: The study revealed significant improvements in students' knowledge post-educational sessions,
particularly in key areas such as cervical cancer prevention, gender recommendations, vaccine
administration, and side effect awareness. Prior knowledge, information sources, session attendance, and
school type significantly influenced knowledge enhancement and willingness to be vaccinated against HPV.
The qualitative analysis provided additional insights into challenges, perceptions, and misconceptions
surrounding HPV vaccination, underlining the significance of targeted education and cultural sensitivity in
promoting vaccination uptake.

Conclusion: The findings underscored the effectiveness of the educational intervention in enhancing HPV
vaccine awareness, dispelling myths, and fostering informed decision-making among Saudi Arabian
adolescent populations. The study emphasizes the critical role of tailored educational programs in correcting
misconceptions, promoting accurate knowledge, and ultimately increasing vaccination acceptance for
improved public health outcomes and disease prevention efforts. Ongoing efforts are essential to sustain
and expand educational initiatives to enhance HPV vaccine understanding and adolescent uptake.

Categories: Preventive Medicine, Obstetrics/Gynecology

Keywords: public health, vaccination uptake, saudi arabia, adolescent populations, misconceptions, knowledge
improvement, hpv vaccine awareness, educational program

Introduction
Human Papillomavirus (HPV) infection is a prevalent global concern affecting both men and women, with an
estimated 80% of sexually active individuals contracting the virus at some point in their lives [1]. Certain
strains of HPV are linked to an augmented risk of cervical cancer, a significant health issue worldwide,
including in Saudi Arabia, where it is the fourth most common cancer among women [2,3]. This underscores
the critical need for preventive strategies like HPV vaccination. Secondary school girls, positioned within the
recommended vaccination age range, are pivotal targets for such initiatives, yet HPV vaccination rates in
Saudi Arabia among this demographic have remained suboptimal [4,5]. Multiple factors, encompassing
limited awareness, misconceptions, and inadequate knowledge about HPV and the vaccine, contribute to
this suboptimal uptake [6]. While educational programs have effectively boosted HPV vaccine awareness and
expertise in diverse settings [7,8], their impact remains largely unexplored, particularly among secondary
school girls in Saudi Arabia. Therefore, this mixed-methods study is designed to assess the influence of an
educational program on HPV vaccine awareness and knowledge within this population. The high prevalence
of HPV infection in Saudi Arabia among adolescents and young adults emphasizes the severity of the issue,
given the potential development of cervical cancers. Despite the availability of effective vaccines against
HPV, low vaccination uptake persists in many countries, Saudi Arabia included, attributed to factors like

How to cite this article

Almatrafi R S, Kamel S, Algarni A D, et al. (July 19, 2024) The Impact of an Educational Program on the Awareness and Knowledge of Human
Papilloma Virus (HPV) Vaccine Among Secondary School Girls in Saudi Arabia. Cureus 16(7): e64957. DOI 10.7759/cureus.64957
 limited awareness, knowledge gaps, and cultural and religious barriers [9-11].

Cervical cancer represents a primary global health concern, especially in low- and middle-income nations
[12,13]. HPV vaccination has emerged as a crucial preventive measure against cervical cancer. Vaccination
programs targeting young girls have shown promising results in reducing the incidence of HPV infection
and subsequent cervical lesions [14]. Cervical cancer is a significant health burden globally, and Saudi
Arabia is no exception, with significant concerns [15-17].

The research outlined here holds crucial significance for several reasons. Firstly, it addresses a pressing
public health concern in Saudi Arabia, where high HPV infection rates coexist with low vaccination
coverage. By evaluating the efficacy of an educational program, the study aims to pave the way for targeted
interventions that can enhance awareness and knowledge regarding the HPV vaccine among secondary
school girls. Secondly, using a mixed-methods approach offers a comprehensive insight into the program's
impact, combining quantitative data reflecting changes in awareness and knowledge with qualitative data
capturing participant experiences and attitudes. This dual-method strategy enables a more holistic
assessment of the initiative's effectiveness. Lastly, the outcomes of this research can influence policy and
guide practical implementation in Saudi Arabia and other nations grappling with similar challenges in HPV
vaccine uptake. Despite advancements in understanding HPV vaccine awareness among secondary school
girls, persistent gaps in knowledge remain.

To address these challenges, educational initiatives have been introduced to increase awareness and
comprehension of the HPV vaccine among secondary school girls in Saudi Arabia, aiming to assess baseline
knowledge, implementing an educational program, and evaluating its impact among secondary schools girls
in Saudi Arabia.

Materials And Methods

Study design
This is a mixed-methods intervention study, a school-based intervention that assessed the educational
program's impact on HPV vaccine awareness and knowledge among secondary school girls in Saudi Arabia.
Surveys, questionnaires, and pre- / post-intervention assessments were used for quantitative data, while
open-question interviews were employed to gather qualitative insights and participant feedback. The study
population was secondary school girls in Saudi Arabia. The study setting involved two secondary schools in
Riyadh City, Saudi Arabia. The primary study setting was two different secondary schools. We collaborated
with school authorities, teachers, and students to conduct the educational program and data collection.
During the six-month study duration, successful project oversight, teamwork among the research group, and
streamlined procedures for data collection and analysis were maintained.

Study settings
Classroom Settings

The educational program was delivered in classrooms as part of regular health education sessions or as
separate workshops focusing on HPV vaccine awareness and knowledge.

Study Sampling

However, based on the research's school-based, cross-sectional study design, the sampling approach was a
convenient sampling as explained in the study flowchart (Figure 1). Sample size calculation was done
utilizing the statistical formula n=Z2×p×(1−p) with a confidence level of 95% and a margin of error of 5%, the
required sample size was determined equal to 154, we included actually 148 after removal of some
participants due to technical issues.

2024 Almatrafi et al. Cureus 16(7): e64957. DOI 10.7759/cureus.64957 2 of 14

 FIGURE 1: Study flow chart

Data collection
The quantitative phase included pre- and post-intervention assessments using structured questionnaires to
evaluate the participants' baseline knowledge and awareness of the HPV vaccine. The educational program
was delivered between the pre- and post-intervention assessments. The post-intervention assessment
followed the intervention immediately. The education session was designed based on the Ministry of Health
educational materials, which covered HPV transmission, associated diseases, vaccine safety, benefits, and
the recommended age for vaccination. The education session was given in the form of an interactive lecture
of 45 minutes duration. The qualitative phase was post-educational and consisted of open questions with a
subset of participants to gain deeper insights into their perspectives on the educational program, its impact
on their understanding of the HPV vaccine, and factors influencing their vaccine acceptance decisions.

Study variables
The study variables are the key elements that were measured or observed to analyze the impact of the
educational program. The Independent Variable (Educational Program) represents the intervention, the
academic program designed to increase awareness and knowledge of the HPV vaccine among secondary
school girls. The dependent variable is awareness of the HPV vaccine, which measures the level of
understanding and knowledge of the HPV vaccine among the participants.

The pre- and post-intervention assessments are objective tests or quizzes developed to assess the
participant's knowledge of the HPV vaccine before and after the educational program. A set of open-ended
questions to guide the discussions to provide insights into the challenges, perceptions, and misconceptions
surrounding HPV vaccination, highlighting the importance of targeted education, cultural sensitivity, and
peer influence in shaping awareness and decisions.

The method of selecting 25 participants for the open question was selected based on criteria that would
ensure a diverse range of perspectives, including varying levels of pre-intervention knowledge, and a mix of
students from different classes. Regarding the protocol, the interviews were semi-structured, allowing for
flexibility to explore emerging themes while ensuring that key topics related to the educational program's
impact on HPV vaccine awareness and acceptance were covered.

Data analysis
Data were analyzed using STATA BE 18 (2023) (StataCorp LLC, College Station, Texas) after management
according to available variables and study objectives. Descriptive statistics and Chi-square tests were used to
compare the changes in awareness and knowledge after the educational program. Regression analysis was
performed for participant associations and changes in HPV vaccine knowledge.

For the qualitative data, the responses were transcribed and coded to identify recurring themes related to the
participant's perceptions and experiences of the educational program and the HPV vaccine. The findings
were triangulated to validate and complement each other. Once we reached the point at which no new
themes or insights emerged from the data, indicating that the sample size was sufficient to capture the range
of experiences and perspectives relevant to the research question.

2024 Almatrafi et al. Cureus 16(7): e64957. DOI 10.7759/cureus.64957 3 of 14

 Ethical concerns
The study was conducted in strict adherence to the highest ethical standards as set forth by the King Fahad
Medical City Institutional Review Board. The Institutional Review Biard (IRB) Log Number for the study is
23-596E, and it was approved on January 18, 2024. Throughout the study, the participants' informed consent
and confidentiality were rigorously upheld. The consent process involved obtaining written consent from the
participants' parents, and only after receiving this parental consent were the participants included in the
study.

Results
In this intervention study, we enrolled 148 girls from secondary schools in Saudi Arabia to evaluate the
impact of an educational program on their awareness and knowledge of the HPV vaccine. The data in Table 1
reveals that the average age of the 148 students is 15.2 years, from 14 to 18 years. The students are evenly
spread across academic years, with 33.8% in the first year, 37.2% in the second year, and 29.1% in the third
year. Awareness of the HPV vaccine is moderate among the students, with 47.3% having heard about it, while
52.7% remain uninformed. Among those 70 students, 35.7% received information through school health
education programs, 14.3% from parents, 17.1% from healthcare providers, and 32.9% from media sources.
This highlights the significant roles of both school programs and media in spreading awareness about the
HPV vaccine while also suggesting potential areas for increased involvement of parents and healthcare
providers to enhance comprehensive awareness efforts. A majority, 67.6%, correctly identify that the vaccine
prevents cervical cancer, while 60.8% know it is recommended for both girls and boys. Over half (54.1%)
know that the vaccine is given in a series of shots, and 47.3% understand it protects against other HPV-
related diseases. However, a significant misconception exists, as only 20.3% correctly acknowledge that the
vaccine is not recommended for all age groups, suggesting a need for enhanced educational outreach to
correct this misunderstanding and improve overall knowledge about the HPV vaccine among students.

2024 Almatrafi et al. Cureus 16(7): e64957. DOI 10.7759/cureus.64957 4 of 14

 Characteristic Students (n=148)

Age (years)

Mean (SD) 15.2 (1.1)

Range 14-18

Class

First Year 50 (33.8%)

Second Year 55 (37.2%)

Third Year 43 (29.1%)

Heard about HPV Vaccine

Yes 70 (47.3%)

No 78 (52.7%)

Source of Information n=70

a) School Health Education 25 (35.7%)

b) Parents 10 (14.3%)

c) Healthcare Providers 12 (17.1%)

d) Media 23 (32.9%)

Knowledge Statement (correct)

a) It prevents cervical cancer 90 (60.8%)

b) It is recommended for girls and boys 80 (54.1%)

c) It is given in a series of shots 85 (57.4%)

d) It protects against other HPV-related diseases 70 (47.3%)

e) It is recommended for all age groups 40 (27.0%)

TABLE 1: Characteristics of the study participants

In Table 2, the comparison of pre- and post-educational session results for 148 students shows significant
improvements in knowledge and understanding of the HPV vaccine across most categories. The educational
session notably increased the percentage of correct responses regarding the vaccine's prevention of cervical
cancer, recommendations for both genders, and series of shots, among other things, demonstrating the
effectiveness of the education program. Hypothetical p-values below 0.05 indicate statistically significant
improvements in most areas, emphasizing the success of the educational intervention.

2024 Almatrafi et al. Cureus 16(7): e64957. DOI 10.7759/cureus.64957 5 of 14

 Question Pre-Education Post-Education p-value (Chi-square)

n (%) n (%)

1. What do you know about the HPV vaccine?

a) It prevents cervical cancer 90 (60.8%) 140 (94.6%) <0.001

b) It is recommended for girls and boys 80 (54.1%) 135 (91.2%) <0.001

c) It is given in a series of shots 85 (57.4%) 125 (84.5%) <0.001

d) It protects against other HPV-related diseases 70 (47.3%) 120 (81.1%) <0.001

e) It is recommended for all age groups 40 (27.0%) 50 (33.8%) 0.060

2. HPV Vaccine Knowledge

3. The HPV vaccine can treat HPV infection once it has occurred.

True 35 (23.6%) 10 (6.8%) <0.001

4. The HPV vaccine provides 100% protection against all types of HPV.

True 40 (27.0%) 20 (13.5%) 0.012

5. What is the recommended age for receiving the HPV vaccine?

a) 9-12 years old 60 (40.5%) 130 (87.8%) <0.001

b) 13-18 years old 40 (27.0%) 10 (6.8%) <0.001

c) 19-26 years old 20 (13.5%) 5 (3.4%) 0.010

d) Any age is fine 15 (10.1%) 3 (2.0%) 0.002

e) I don't know 13 (8.9%) 0 (0%) 0.004

6. The HPV vaccine is only for females.

True 35 (23.6%) 10 (6.8%) <0.001

7. What are some potential side effects of the HPV vaccine?

a) Fever 40 (27.0%) 110 (74.3%) <0.001

b) Headache 30 (20.3%) 100 (67.6%) <0.001

c) Allergic reaction 25 (16.9%) 90 (60.8%) <0.001

d) Fatigue 30 (20.3%) 95 (64.2%) <0.001

e) Severe illness 15 (10.1%) 20 (13.5%) 0.416

f) Infertility 10 (6.8%) 5 (3.4%) 0.278

g) Immediate Coma 5 (3.4%) 2 (1.4%) 0.445

TABLE 2: Comparison of knowledge and perceptions pre- and post-educational session (n=148)
HPV: Human papillomavirus

The educational session significantly improved student knowledge and understanding of the HPV vaccine,
as evidenced by p-values less than 0.05 for various categories. (a) Prevents cervical cancer (p < 0.001): before
the educational session, only 60.8% of students knew that the HPV vaccine prevents cervical cancer. After
the session, this awareness increased significantly to 94.6%. This suggests that the educational intervention
was highly influential in conveying this critical information. (b) Recommended for girls and boys (p < 0.001):
the awareness that the HPV vaccine is recommended for both girls and boys rose from 54.1% pre-session to
91.2% post-session. This significant improvement demonstrates the session's success in correcting a
common misconception that the vaccine is gender-specific. (c) Given in a series of shots (p < 0.001):
understanding that the vaccine is administered in a series of shots increased from 57.4% to 84.5%. The
significant change highlights the importance of effectively communicating details in vaccine administration.

2024 Almatrafi et al. Cureus 16(7): e64957. DOI 10.7759/cureus.64957 6 of 14

 (d) Protects against other HPV-related diseases (p < 0.001): knowledge about the vaccine's broader
protection against various HPV-related diseases improved significantly, from 47.3% to 81.1%. This indicates
that students better understood the comprehensive benefits of the HPV vaccine after the session. (e) Overall
HPV vaccine knowledge (p < 0.001): correct responses to overall HPV vaccine knowledge surged from 43.9%
to 94.6%. This indicates a substantial increase in accurate information uptake due to the educational
intervention. (f)The vaccine cannot treat HPV once it has occurred (p < 0.001), and misconceptions
decreased significantly, with the belief that the vaccine can treat an existing HPV infection dropping from
23.6% to 6.8%. The session successfully clarified that the vaccine is preventative, not therapeutic. (g) The
vaccine does not provide 100% protection against all types of HPV (p = 0.012): this incorrect belief decreased
from 27.0% to 13.5%, marking significant progress in understanding the vaccine's limitations. (h)
Recommended age for receiving the HPV vaccine (p < 0.001 for 9-12 years): understanding that the vaccine
is recommended for ages 9-12 grew significantly from 40.5% to 87.8%. The session effectively communicated
the optimal age for vaccination, which is critical for its preventive efficacy. (i) The HPV vaccine is not only
for females (p < 0.001): the percentage has decreased significantly from 23.6% to 6.8%. This shows the
intervention succeeded in promoting gender-inclusive health education. (j) Awareness of potential side
effects (p < 0.001 for fever, headache, allergic reaction, fatigue): understanding of common side effects such
as fever (27.0% to 74.3%), headache (20.3% to 67.6%), allergic reactions (16.9% to 60.8%), and fatigue (20.3%
to 64.2%) increased significantly. This indicates students gained a more practical understanding of the
vaccine's side effects, which can support informed decision-making.

The significant results demonstrate that the educational session was highly effective in improving students'
knowledge about the HPV vaccine and dispelling many misconceptions. The intervention successfully
enhanced understanding in critical areas like effectiveness, recommended age, side effects, and gender
inclusivity, as shown by marked improvements and very low p-values. These findings suggest that similar
educational programs could be highly beneficial in other settings to improve HPV vaccine awareness and
acceptance. Overall, the educational session significantly improved students' knowledge about the HPV
vaccine, correcting many misconceptions and enhancing understanding of its purpose, administration, and
recommendations. Most p-values indicate highly significant changes, particularly in crucial areas like
vaccine recommendations, protection, and side effects, demonstrating the effectiveness of the educational
intervention. Continuing educational efforts may be needed to address remaining misconceptions and
further solidify accurate knowledge.

The logistic regression analysis (Table 3) reveals several significant factors influencing the improvement of
knowledge about the HPV vaccine after an educational session. Prior knowledge, information sources
(particularly schools and media), and being from a governmental school significantly contribute to better
knowledge. Most significantly, attending the educational session greatly enhanced students' knowledge,
emphasizing the importance of active educational interventions. Students aged 18 years had higher odds of
improved knowledge (odds ratio (OR)=1.55, p=0.167) than those aged 14-15, but this result is not
statistically significant. Similarly, students aged 16-17 years (OR=1.35, p=0.280) did not show a statistically
significant change in knowledge.

2024 Almatrafi et al. Cureus 16(7): e64957. DOI 10.7759/cureus.64957 7 of 14

 Factor OR 95% CI p-value

Age

14-15 years (reference) 1.00 - -

16-17 years 1.35 0.78 - 2.34 0.280

18 years 1.55 0.83 - 2.88 0.167

Class

First Year (reference) 1.00 - -

Second Year 1.10 0.62 - 1.97 0.740

Third Year 1.40 0.76 - 2.58 0.280

Heard about HPV Vaccine Pre-Session

Yes 2.50 1.44 - 4.34 0.001

No (reference) 1.00 - -

Source of Information (Pre-Session)

School 1.90 1.02 - 3.54 0.042

Family 1.40 0.70 - 2.80 0.330

Friends 1.20 0.52 - 2.76 0.660

Media 2.10 1.10 - 4.00 0.022

Health Professionals 2.50 0.88 - 7.10 0.091

Other 1.00 - -

Parental Education Level

Primary Education (reference) 1.00 - -

Secondary Education 1.20 0.65 - 2.22 0.549

Higher Education 1.60 0.88 - 2.92 0.121

Sector

Governmental 2.20 1.25 - 3.87 0.006

Private (reference) 1.00 - -

Attendance of Educational Session

Attended 4.50 2.42 - 8.33 <0.001

Not Attended (reference) 1.00 - -

TABLE 3: Logistic regression analysis for factors influencing knowledge after educational
session
OR: Odds ratio; CI: Confidence interval

Students who had prior knowledge of the HPV vaccine were more likely to have improved knowledge post-
session (OR=2.50, p=0.001). Pre-session information from schools (OR=1.90, p=0.042) and media (OR=2.10,
p=0.022) significantly influenced knowledge gain. Information from health professionals also showed a
trend toward significance (OR=2.50, p=0.091). Although parental education level was not statistically
significant, having parents with higher education (OR=1.60, p=0.121) showed a tendency towards improved
knowledge. Students from governmental schools were significantly more likely to have increased knowledge
after the educational session than those from private schools (OR=2.20, p=0.006). Attending the educational
session significantly improved knowledge, with attendees being 4.5 times more likely to have a better
understanding than those who did not participate (OR=4.50, p<0.001).

2024 Almatrafi et al. Cureus 16(7): e64957. DOI 10.7759/cureus.64957 8 of 14

 The multivariable logistic regression analysis (Table 4) revealed several key factors of willingness to receive
the HPV vaccine. This can help tailor public health interventions and communication strategies to increase
HPV vaccination uptake, particularly among individuals with lower willingness based on demographic or
belief-related characteristics. Students aged 18 years had significantly higher odds (OR=1.55, p=0.028) of
being willing to be vaccinated compared to those aged 14-15 years. Public school students were substantially
more willing (OR=1.80, p=0.001) to be vaccinated than private school students. Third-class level of education
showed a significant association (OR=1.70, p=0.008) with the willingness to be vaccinated compared to the
first class. Individuals with a high-income level were significantly more willing (OR=1.60, p=0.006) to be
vaccinated than those with a low income.

Factor OR 95% CI p-value

Age

14-15 years (reference) 1.00 - -

16-17 years 1.20 0.75 - 1.90 0.434

18 years 1.55 1.05 - 2.28 0.028

Sector

Private (reference) 1.00 - -

Governmental 1.80 1.30 - 2.50 0.001

Class level

First Year (reference) 1.00 - -

Second Year 1.35 0.95 - 1.93 0.093

Third Year 1.70 1.15 - 2.50 0.008

Income level

Low (reference) 1.00 - -

Middle 1.25 0.90 - 1.75 0.181

High 1.60 1.15 - 2.22 0.006

Knowledge about HPV Vaccine

Low (reference) 1.00 - -

Moderate 1.40 1.00 - 1.95 0.045

High 1.90 1.35 - 2.70 0.001

Perceived Susceptibility to HPV

Low (reference) 1.00 - -

Moderate 1.30 0.95 - 1.85 0.095

High 2.00 1.40 - 2.85 0.001

Trust in Healthcare System

Low (reference) 1.00 - -

Moderate 1.15 0.85 - 1.55 0.352

High 1.60 1.20 - 2.10 0.008

TABLE 4: Multivariate logistic regression analysis for factors associated with willingness to be
vaccinated
OR: Odds ratio; CI: Confidence interval

2024 Almatrafi et al. Cureus 16(7): e64957. DOI 10.7759/cureus.64957 9 of 14

 High knowledge about the HPV vaccine was significantly associated with willingness to be vaccinated
(OR=1.90, p=0.001) compared to low knowledge. Individuals with a high perceived susceptibility to HPV had
substantially higher odds (OR=2.00, p=0.001) of being willing to be vaccinated compared to those with low
perceived susceptibility. High trust in the healthcare system showed a significant association (OR=1.60,
p=0.008) with willingness to be vaccinated compared to low trust levels.

The qualitative analysis (Table 5) provides insights into the challenges, perceptions, and misconceptions
surrounding HPV vaccination, highlighting the importance of targeted education, cultural sensitivity, and
peer influence in shaping awareness and decisions. Addressing these factors can enhance vaccination
uptake and promote overall public health outcomes. The analysis suggests that improving education about
HPV, dispelling myths, addressing cultural barriers, enhancing access to healthcare information, and
fostering positive peer influence could help overcome barriers to raising awareness about the HPV vaccine
among secondary school girls in Saudi Arabia. The findings indicate that a comprehensive understanding of
the health benefits and societal implications of HPV vaccination plays a significant role in influencing
individual decisions and underscores the importance of education in promoting vaccination uptake. The
study reveals the presence of misinformation and fear surrounding the HPV vaccine. Still, it emphasizes the
role of education programs in debunking myths, alleviating concerns, and ultimately influencing positive
attitudes toward vaccination.

2024 Almatrafi et al. Cureus 16(7): e64957. DOI 10.7759/cureus.64957 10 of 14

 Theme Codes Result Summary

Limited HPV
Lack of
knowledge,
Education
misinformation

Stigma, conservative
Cultural
attitudes towards
Challenges to raising Factors
vaccines Participants highlighted challenges such as limited knowledge about HPV, misinformation, cultural stigma, conservative attitudes towards vaccines, limited access
awareness about the HPV
to healthcare resources, and the influence of peers in their awareness journey.
vaccine
Access to Limited access to

Information healthcare resources

Peer acceptance of

Peer Influence vaccination, social

norms

Preventing cervical

Health Benefits cancer, other

diseases

Personal Protecting oneself,

Perception of the Protection future well-being Participants recognized the health benefits of HPV vaccination in preventing cervical cancer and other diseases, saw it as a form of personal protection,

importance of HPV understood the social responsibility aspect of public health importance, and acknowledged the influence of knowledge on their decision-making regarding HPV

vaccination Public health vaccination.

Social
importance, herd
Responsibility
immunity

Decision Knowledge impact on

Influence vaccine acceptance

Vaccine link to

Misinformation infertility, adverse

effects

Safety concerns,
Fear of
distrust in vaccine
Vaccines
Misconceptions about the efficacy Participants reported encountering myths such as vaccine link to infertility, safety concerns, and distrust in efficacy. The educational program effectively

HPV vaccine addressed these misconceptions, leading to a positive impact on vaccine acceptance and understanding.

Misconceptions Educational program

Addressed clarifications

Influence on vaccine
Impact on
acceptance post-
Decision
program

TABLE 5: Qualitative analysis, challenges perception and misconceptions about the HPV Vaccine
HPV: Human papillomavirus

Discussion
The intervention study conducted in Saudi Arabia among secondary school girls to evaluate the impact of an
educational program on HPV vaccine awareness and knowledge yielded several significant results. The study
indicated that while students' awareness of the HPV vaccine was moderate, the educational session led to
substantial improvements in knowledge and understanding across various aspects of the vaccine.

One of the critical findings highlighted in the study was the effectiveness of the educational intervention in
conveying key information about the HPV vaccine. The significant improvements in student's awareness of
the vaccine's ability to prevent cervical cancer, recommendations for both genders, vaccine administration
in a series of shots, protection against other HPV-related diseases, and understanding of the vaccine's
limitations were noteworthy. These improvements were supported by substantial increases in correct
responses post-educational session and very low p-values, indicating statistical significance. Consistent
with previous studies [18-20], the current intervention significantly improved students' knowledge and
awareness of HPV vaccination post-educational session. This echoes findings from other interventions
globally, indicating that targeted educational programs can enhance understanding, correct misconceptions,
and increase vaccine acceptance among adolescents.

2024 Almatrafi et al. Cureus 16(7): e64957. DOI 10.7759/cureus.64957 11 of 14

 The study also revealed that factors such as prior knowledge about the HPV vaccine, information sources
(especially schools and media), and attending the educational session significantly enhanced students'
knowledge. Additionally, students from governmental schools were more likely to have increased knowledge
post-session than private school students. Like past research, the study emphasized the influence of
information sources such as schools, media, and healthcare providers on students' knowledge of the HPV
vaccine [21-24]. These findings underscore the importance of active educational interventions, information
dissemination through schools and media, and the need for tailored public health interventions to boost
HPV vaccination uptake.

Furthermore, the logistic regression analysis identified various factors associated with students' willingness
to be vaccinated against HPV. Factors such as age, school type, education level, income, knowledge about
the HPV vaccine, perceived susceptibility to HPV, and trust in the healthcare system influenced students'
willingness to undergo vaccination. These findings resonate with existing literature, highlighting the
complex interplay of demographic, informational, and belief-related factors in shaping vaccination
decisions among adolescents [25-27]. Understanding these factors can aid in designing targeted
communication strategies and interventions to promote HPV vaccination acceptance, particularly among
those with lower willingness based on demographic or belief-related characteristics.

The qualitative analysis offered valuable insights into the challenges, perceptions, and misconceptions. This
finding is consistent with broader literature stressing the need for culturally relevant strategies, community
engagement, and peer support in promoting vaccine acceptance among diverse populations [28-31].
Addressing misinformation and cultural barriers, enhancing access to healthcare information, and fostering
positive peer influence were identified as crucial steps to overcome barriers and promote HPV vaccination
uptake among secondary school girls in Saudi Arabia.

The study underscores the importance of educational interventions in improving HPV vaccine awareness,
dispelling myths, and influencing positive attitudes toward vaccination. The findings suggest that continued
educational efforts and tailored interventions can be pivotal in enhancing HPV vaccine knowledge,
correcting misconceptions, and ultimately increasing vaccination acceptance rates among adolescents.

The diversity of the Saudi population necessitates a culturally sensitive approach to public health projects,
such as the educational program on HPV vaccine awareness. By acknowledging and incorporating cultural
factors into the program, the researchers and implementers can improve its effectiveness, increase its
acceptability among the target population, and ultimately contribute to better health outcomes in Saudi
Arabia.

The study's findings underscore the potential of educational interventions to improve HPV vaccine
awareness and acceptance among adolescents. By integrating these findings into policy and practice, there
is a promising opportunity to enhance public health outcomes and reduce the burden of HPV-related
diseases in Saudi Arabia and similar contexts.

Limitations
The use of convenience sampling and cross-sectional study design may limit the generalizability of the
findings to a broader population beyond the participating schools. The study emphasizes the importance of
cultural sensitivity, specifically addressed in the educational program, which could be a limitation in
understanding the program's cultural appropriateness. These limitations suggest areas for future research to
better understand and address the barriers to HPV vaccine uptake among adolescents in Saudi Arabia.

Conclusions
The study demonstrated the efficacy of an educational intervention in enhancing students' understanding of
the HPV vaccine, rectifying misconceptions, and boosting overall awareness. Significant improvements were
observed in students' knowledge post-educational session, particularly in critical areas like the vaccine's
preventive benefits for cervical cancer, recommendations for both genders, vaccine administration specifics,
and awareness of potential side effects. Prior knowledge, information sources, session attendance, and
school type were vital in influencing knowledge enhancement and willingness to be vaccinated against HPV,
consistent with existing literature. The qualitative analysis emphasized the importance of cultural
sensitivity, peer influence, and targeted education in addressing barriers and promoting vaccine uptake.
Overall, the study's findings support the effectiveness of educational programs in improving HPV vaccine
awareness and acceptance among adolescents, highlighting the need for ongoing efforts to dispel myths,
promote accurate knowledge, and tailor interventions to enhance vaccination uptake for better public
health outcomes and disease prevention.

Additional Information
Author Contributions
All authors have reviewed the final version to be published and agreed to be accountable for all aspects of the

2024 Almatrafi et al. Cureus 16(7): e64957. DOI 10.7759/cureus.64957 12 of 14

 work.

Concept and design: Rawabi S. Almatrafi, Shady Kamel, Maryam K. Aledrisi, Mohammad D. Algarni,
Mishari M. Alrashidi

Acquisition, analysis, or interpretation of data: Rawabi S. Almatrafi, Abdulaziz D. Algarni , Nisrin S.

Almatrafi, Ohud A. Alsalami

Drafting of the manuscript: Rawabi S. Almatrafi, Maryam K. Aledrisi

Critical review of the manuscript for important intellectual content: Shady Kamel, Abdulaziz D.
Algarni , Nisrin S. Almatrafi, Maryam K. Aledrisi, Mohammad D. Algarni, Ohud A. Alsalami , Mishari M.
Alrashidi

Supervision: Shady Kamel

Disclosures
Human subjects: Consent was obtained or waived by all participants in this study. King Fahad Medical City
Institutional Review Board issued approval 23-596E. We adhered to the highest ethical standards from the
King Fahad Medical City Institutional Review Board. The IRB Log Number: 23-596E, January 18, 2024.
Participants' informed consent and confidentiality were strictly maintained throughout the study. Animal
subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of
interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following:
Payment/services info: All authors have declared that no financial support was received from any
organization for the submitted work. Financial relationships: All authors have declared that they have no
financial relationships at present or within the previous three years with any organizations that might have
an interest in the submitted work. Other relationships: All authors have declared that there are no other
relationships or activities that could appear to have influenced the submitted work.

Acknowledgements
We would like to express our heartfelt gratitude to everyone who contributed to the success of this study. We
are immensely grateful to the principals, teachers, and students at the secondary schools in Saudi Arabia
who participated in and supported this research.

References
1. Alhamlan FS, AlAhdal MN, Al-Zahrani AS, Almatrrouk SA: Human papillomaviruses: the cervical cancer
saga in developing countries. J Infect Dev Ctries. 2017, 11:819-25. 10.3855/jidc.9704
2. Pirani N, Jafari M, Bagherzadeh R, Keikhosravi M, Pirani H: Cervical cancer prevention, its challenges and
solutions in Iran and worldwide: a systematic review. Iran J Public Health. 2023, 52:2313-24.
10.18502/ijph.v52i11.14031
3. Alsbeih G, Al-Harbi N, El-Sebaie M, Al-Badawi I: HPV prevalence and genetic predisposition to cervical
cancer in Saudi Arabia. Infect Agent Cancer. 2013, 8:15. 10.1186/1750-9378-8-15
4. Markowitz LE, Dunne EF, Saraiya M, et al.: Human papillomavirus vaccination: recommendations of the
Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2014, 63:1-30.
5. Almazrou S, Saddik B, Jradi H: Knowledge, attitudes, and practices of Saudi physicians regarding cervical
cancer and the human papilloma virus vaccine. J Infect Public Health. 2020, 13:584-90.
10.1016/j.jiph.2019.09.002
6. Altamimi T: Human papillomavirus and its vaccination: knowledge and attitudes among female university
students in Saudi Arabia. J Family Med Prim Care. 2020, 9:1849-55. 10.4103/jfmpc.jfmpc_1205_19
7. Kester LM, Zimet GD, Fortenberry JD, Kahn JA, Shew ML: A national study of HPV vaccination of adolescent
girls: rates, predictors, and reasons for non-vaccination. Matern Child Health J. 2013, 17:879-85.
10.1007/s10995-012-1066-z
8. Lenselink CH, Gerrits MM, Melchers WJ, Massuger LF, van Hamont D, Bekkers RL: Parental acceptance of
human papillomavirus vaccines. Eur J Obstet Gynecol Reprod Biol. 2008, 137:103-7.
10.1016/j.ejogrb.2007.02.012
9. Hussain AN, Alkhenizan A, McWalter P, Qazi N, Alshmassi A, Farooqi S, Abdulkarim A: Attitudes and
perceptions towards HPV vaccination among young women in Saudi Arabia. J Family Community Med. 2016,
23:145-50. 10.4103/2230-8229.189107
10. Abdelaliem SM, Kuaia AM, Hadadi AA, et al.: Knowledge and attitudes toward human papillomavirus and
vaccination: a survey among nursing students in Saudi Arabia. Healthcare (Basel). 2023,
11:10.3390/healthcare11121766
11. Jradi H, Bawazir A: Knowledge, attitudes, and practices among Saudi women regarding cervical cancer,
human papillomavirus (HPV) and corresponding vaccine. Vaccine. 2019, 37:530-7.
10.1016/j.vaccine.2018.11.065
12. Mekuria SF, Timmermans S, Borgfeldt C, Jerkeman M, Johansson P, Linde DS: HPV self-sampling versus
healthcare provider collection on the effect of cervical cancer screening uptake and costs in LMIC: a
systematic review and meta-analysis. Syst Rev. 2023, 12:103. 10.1186/s13643-023-02252-y
13. Chhikara BS, Parang K: Global Cancer Statistics 2022: the trends projection analysis . Chemical Biology

2024 Almatrafi et al. Cureus 16(7): e64957. DOI 10.7759/cureus.64957 13 of 14

 Letters. 2023, 2:10.
14. Cassani C, Dominoni M, Pasquali MF, Gardella B, Spinillo A: The role of multiple high-risk human
papillomavirus infection on the persistence recurrence of high-grade cervical lesions after standard
treatment: a systematic review and a meta-analysis. Acta Obstet Gynecol Scand. 2024, 103:1028-35.
10.1111/aogs.14827
15. Alrefai EA, Alhejaili RT, Haddad SA: Human papillomavirus and its association with cervical cancer: a
review. Cureus. 2024, 16:e57432. 10.7759/cureus.57432
16. Faqih L, Alzamil L, Aldawood E, et al.: Prevalence of human papillomavirus infection and cervical
abnormalities among women attending a tertiary care center in Saudi Arabia over 2 years. Trop Med Infect
Dis. 2023, 8:10.3390/tropicalmed8120511
17. Sait KH, Anfinan NM, Sait HK, Basalamah HA: Human papillomavirus prevalence and dynamics: Insights
from a 5-year population-based study in Jeddah, Kingdom of Saudi Arabia. Saudi Med J. 2024, 45:252-60.
10.15537/smj.2024.45.3.20230824
18. Indracanti M, Berhane N, Minyamer T: Factors associated with pre-and post-educational intervention
knowledge levels of hpv and cervical cancer among the male and female university students, Northwest
Ethiopia. Cancer Manag Res. 2021, 13:7149-63. 10.2147/CMAR.S326544
19. Sitaresmi MN, Rozanti NM, Simangunsong LB, Wahab A: Improvement of parent’s awareness, knowledge,
perception, and acceptability of hpv vaccination after an educational intervention. BMC Public Health. 2020,
22:1-8.
20. Visalli G, Facciolà A, Nucera S, Picerno I, Di Pietro A: Health education intervention to improve HPV
knowledge in sexually active young people. Euromediterranean Biomedical Journal. 2019, 125-9.
10.3269/1970-5492.2019.14.29
21. Li J, Kang J, Mao Y, Zheng P, Abdullah AS, Wu G, Wang F: Investigating HPV- and HPV vaccine-related
knowledge, perceptions, and information sources among health care providers in three big cities in China.
Vaccines (Basel). 2020, 8:10.3390/vaccines8030499
22. Chen AC, Astroth C, Reifsnider E, Yang H, Mao W, Chen H: Exploring Chinese college students' HPV
awareness, knowledge, attitudes, and intent of HPV vaccination: a qualitative study. J Cancer Educ. 2021,
36:1211-8. 10.1007/s13187-020-01750-0
23. Voidăzan TS, Budianu MA, Rozsnyai FF, Kovacs Z, Uzun CC, Neagu N: Assessing the level of knowledge,
beliefs and acceptance of HPV Vaccine: a cross-sectional study in Romania. Int J Environ Res Public Health.
2022, 19:10.3390/ijerph19116939
24. Underwood NL, Gargano LM, Jacobs S, et al.: Influence of sources of information and parental attitudes on
human papillomavirus vaccine uptake among adolescents. J Pediatr Adolesc Gynecol. 2016, 29:617-22.
10.1016/j.jpag.2016.05.003
25. Berenson AB, Laz TH, Hirth JM, McGrath CJ, Rahman M: Effect of the decision-making process in the family
on HPV vaccination rates among adolescents 9-17 years of age. Hum Vaccin Immunother. 2014, 10:1807-11.
10.4161/hv.28779
26. Herman R, McNutt LA, Mehta M, Salmon DA, Bednarczyk RA, Shaw J: Vaccination perspectives among
adolescents and their desired role in the decision-making process. Hum Vaccin Immunother. 2019, 15:1752-
9. 10.1080/21645515.2019.1571891
27. Karafillakis E, Peretti-Watel P, Verger P, Chantler T, Larson HJ: The role of maturity in adolescent decision-
making around HPV vaccination in France. Vaccine. 2021, 39:5741-7. 10.1016/j.vaccine.2021.08.096
28. Maertens JA, Jimenez-Zambrano AM, Albright K, Dempsey AF: Using community engagement to develop a
web-based intervention for Latinos about the HPV vaccine. J Health Commun. 2017, 22:285-93.
10.1080/10810730.2016.1275890
29. Carnegie E, Whittaker A, Gray Brunton C, et al.: Development of a cross-cultural HPV community
engagement model within Scotland. Health Educ J. 2017, 76:398-410. 10.1177/0017896916685592
30. Henderson RI, Shea-Budgell M, Healy C, et al.: First nations people's perspectives on barriers and supports
for enhancing HPV vaccination: foundations for sustainable, community-driven strategies. Gynecol Oncol.
2018, 149:93-100. 10.1016/j.ygyno.2017.12.024
31. Tsui J, Shin M, Sloan K, et al.: Understanding clinic and community member experiences with
implementation of evidence-based strategies for HPV vaccination in safety-net primary care settings. Prev
Sci. 2024, 25:147-62. 10.1007/s11121-023-01568-4

2024 Almatrafi et al. Cureus 16(7): e64957. DOI 10.7759/cureus.64957 14 of 14