Document Type : Original Article

Authors

1 Department of Pharmacy, College of Nursing, King Abdullah International Medical Research Centre, King Saud Bin Abdul Aziz University for Health Sciences, National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, Saudi Arabia

2 Department of Medical Education, College of Medicine, King Abdullah International Medical Research Centre, King Saud Bin Abdul Aziz University for Health Sciences, National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, Saudi Arabia

Abstract

BACKGROUND: Human papillomavirus (HPV) infection is the major risk factor for cervical 
cancer (CC) in women of reproductive age. Despite advances in treatment and prevention of CC by 
HPV vaccination, very few women utilize them because of a lack of awareness about HPV.
MATERIALS AND METHODS: We conducted this cross‑sectional study among Health Professions 
Students (HPS) at King Saud Bin Abdul Aziz University for Health Sciences, Jeddah. Data were 
collected using a predesigned and validated study questionnaire to assess the knowledge, attitude, 
and perception of HPS toward HPV.
RESULTS: A total of 580 HPS responded to the survey; 128 (22.1%) were male, while 452 (77.9%) 
were female with the mean age ± standard deviation 20.36 ± 1.74 years. There was no significant 
difference between males and females related to screening of HPV and CC (82.8%; 82.3%). 
A minority (30.3%) of participants thought that HPV infection leads to CC, while 38.3% did not know 
about it. Furthermore, knowledge about HPV screening and vaccination was poor.
CONCLUSIONS: Students from the college of medicine had more knowledge and awareness 
about HPV (34.9%, P < 0.001). Thus, it is important to implement effective education programs, 
curricular activities, and awareness campaigns for health professions to augment the learning 
process effectively.

Keywords

1. W.H.O. Human Papillomavirus (HPV) and Cervical Cancer; 2020. 
Available from: https://www.who.int/news‑room/fact‑sheets/
detail/human‑papillomavirus‑(hpv)‑and‑cervical‑cancer. [Last 
accessed on 2020 Apr 06].
2. C.D.C. Genital HPV Infection; 2020. Available from: https://
www.cdc.gov/std/hpv/stdfact‑hpv.htm. [Last accessed on 
2020 Apr 06].
3. Khan TM, Buksh MA, Rehman IU, Saleem A. Knowledge, 
attitudes, and perception towards human papillomavirus among 
university students in Pakistan. Papillomavirus Res 2016;2:122‑7.
4. FormanD, de MartelC, LaceyCJ, SoerjomataramI, Lortet‑TieulentJ, 
Bruni L, et al. Global burden of human papillomavirus and related 
diseases. Vaccine 2012;30 Suppl 5:F12‑23.
5. Stanley M. Pathology and epidemiology of HPV infection in 
females. Gynecol Oncol 2010;117:S5‑10.
6. Al‑Darwish AA, Al‑Naim AF, Al‑Mulhim KS, Al‑Otaibi NK, 
Morsi MS, Aleem AM. Knowledge about cervical cancer early 
warning signs and symptoms, risk factors and vaccination among 
students at a medical school in Al‑Ahsa, Kingdom of Saudi Arabia. 
Asian Pac J Cancer Prev 2014;15:2529‑32.
7. Muñoz N, Bosch FX, de Sanjosé S, Herrero R , 
Castellsagué X, Shah KV, et al. Epidemiologic classification of 
human papillomavirus types associated with cervical cancer. 
N Engl J Med 2003;348:518‑27.
8. Turki R, Sait K, Anfinan N, Sohrab SS, Abuzenadah AM. 
Prevalence of human papillomavirus in women from Saudi 
Arabia. Asian Pac J Cancer Prev 2013;14:3177‑81.
9. Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J,
et al. Estimates of incidence and mortality of cervical cancer in 
2018: A worldwide analysis. Lancet Glob Health 2020;8:e191‑203.
10. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. 
Global cancer statistics 2018: GLOBOCAN estimates of incidence 
and mortality worldwide for 36 cancers in 185 countries. CA 
Cancer J Clin 2018;68:394‑424.
11. 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.
12. Global Cancer Observatory (GCO). Cancer in Saudi Arabia. 
GLOBOCAN; 2018. Available from: https://gco.iarc.fr/today/
data/factsheets/populations/682‑saudi‑arabia‑fact‑sheets.pdf. 
[Last accessed on 2020 Apr 08].
13. Alsbeih G. HPV infection in cervical and other cancers in Saudi 
Arabia: Implication for prevention and vaccination. Front Oncol 
2014;4:65.
14. Sait KH. Attitudes, knowledge, and practices in relation to cervical 
cancer and its screening among women in Saudi Arabia. Saudi 
Med J 2009;30:1208‑12.
15. Jassim G, Obeid A, Al Nasheet HA. Knowledge, attitudes, and 
practices regarding cervical cancer and screening among women 
visiting primary health care Centres in Bahrain. BMC Public 
Health 2018;18:128.
16. Al‑Meer FM, Aseel MT, Al‑Khalaf J, Al‑Kuwari MG, Ismail MF. 
Knowledge, attitude and practices regarding cervical cancer and 
screening among women visiting primary health care in Qatar. 
East Mediterr Health J 2011;17:855‑61.
17. Al‑Shaikh GK, Almussaed EM, Fayed AA, Khan FH, Syed SB, 
Al‑Tamimi TN, et al. Knowledge of Saudi female university 
students regarding cervical cancer and acceptance of the human 
papilloma virus vaccine. Saudi Med J 2014;35:1223‑30.
18. 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.
19. Alnafisah RA, Alsuhaibani R, Alharbi MA, Alsohaibani AA, 
IsmailAA. Saudi women’s knowledge and attitude toward cervical 
cancer screening, treatment, and prevention: A cross‑sectional 
study in Qassim region (2018‑2019). Asian Pac J Cancer Prev 
2019;20:2965‑9.
20. Sait K, Turki R, Abuzenadah AM, Jiffiri OH, Bohmaidah A, 
Sohrab SS. Genetic diversity and phylogenetic analysis of HPV 16 & 18 variants isolated from cervical specimens of women in 
Saudi Arabia. Saudi J Biol Sci 2019;26:317‑24.
21. Manji M. Cervical cancer screening program in Saudi Arabia: 
Action is overdue. Ann Saudi Med 2000;20:355‑7.
22. Malibari S. Knowledge about cervical cancer among women in 
Saudi Arabia. Egypt J Hosp Med 2018;70:1823‑5.
23. Al Shaman A, Samir O, Al Shaman D, Al-Enze B, Al Atawi H, 
Al-Ghamde K, et al. Knowledge, attitude and practice regarding 
cervical cancer and its prevention among females at Tabuk 
University, Saudi Arabia. Int J Adv Res 2016;4:344‑55. Available 
at : https://www.journalijar.com/article/8018/knowledge,attitude-and-practice-regarding-cervical-cancer-and-itsprevention-among-females-in-tabuk-university,-ksa/.
24. Narayana G, Suchitra MJ, Sunanda G, Ramaiah JD, Kumar BP, 
Veerabhadrappa KV. Knowledge, attitude, and practice 
toward cervical cancer among women attending Obstetrics and 
Gynecology Department: A cross‑sectional, hospital‑based survey 
in South India. Indian J Cancer 2017;54:481‑7.
25. Tonguc E, Gungor T, Var T, Kavak E, Yucel M, Uzunlar O. 
Knowledge about HPV, relation between HPV and cervix cancer 
and acceptance of HPV vaccine in women in eastern region of 
Turkey. J Gynecol Oncol 2013;24:7‑13.
26. Alsaad MA, Shamsuddin K, Fadzil F. Knowledge towards HPV 
infection and HPV vaccines among Syrian mothers. Asian Pac J 
Cancer Prev 2012;13:879‑83.
27. Al Khudairi H, Abu‑Zaid A, Alomar O, Salem H. Public awareness 
and knowledge of pap smear as a screening test for cervical cancer 
among Saudi population in Riyadh City. Cureus 2017;9:e984.
28. Dhaher EA. Knowledge, attitudes and practices of women in the 
southern region of Saudi Arabia regarding cervical cancer and 
the pap smear test. Asian Pac J Cancer Prev 2019;20:1177‑84.
29. Holcomb B, Bailey JM, Crawford K, Ruffin MT 4th. Adults’ 
knowledge and behaviors related to human papillomavirus 
infection. J Am Board Fam Pract 2004;17:26‑31.
30. Rajiah K, Maharajan MK, Chin NS, Num KS. Awareness and 
acceptance of human papillomavirus vaccination among health 
sciences students in Malaysia. Virusdisease 2015;26:297‑303.
31. Al‑Dubai SA, Alshagga MA, Al‑Naggar RA, Al‑Jashamy K, 
Baobaid MF, Tuang CP, et al. Knowledge, attitudes and barriers 
for human papilloma virus (HPV) vaccines among Malaysian 
women. Asian Pac J Cancer Prev 2010;11:887‑92.
32. Kamzol W, Jaglarz K, Tomaszewski KA, Puskulluoglu M, 
Krzemieniecki K. Assessment of knowledge about cervical cancer 
and its prevention among female students aged 17‑26 years. Eur 
J Obstet Gynecol Reprod Biol 2013;166:196‑203.
33. Notara V, Soultatou P, Tselika A. Lay knowledge of HPV infection 
and the vaccine against HPV in Greece. Health Sci J 2012;6:270‑9.
34. Kietpeerakool C, Phianmongkhol Y, Jitvatcharanun K, 
Siriratwatakul U, Srisomboon J. Knowledge, awareness, and 
attitudes of female sex workers toward HPV infection, cervical 
cancer, and cervical smears in Thailand. Int J Gynaecol Obstet 
2009;107:216‑9.
35. Kahn JA, Rosenthal SL, Hamann T, Bernstein DI. Attitudes about 
human papillomavirus vaccine in young women. Int J STD AIDS 
2003;14:300‑6.
36. Sait KH. Knowledge, attitudes, and practices regarding cervical 
cancer screening among physicians in the Western Region of 
Saudi Arabia. Saudi Med J 2011;32:1155‑60.
37. Amarin ZO, Badria LF, Obeidat BR. Attitudes and beliefs about 
cervical smear testing in ever‑married Jordanian women. East 
Mediterr Health J 2008;14:389‑97.
38. Ravichandran K, Al‑Hamdan NA, Mohamed G. Knowledge, 
attitude, and behavior among Saudis toward cancer preventive 
practice. J Family Community Med 2011;18:135‑42.
39. Villanueva S, Mosteiro‑Miguéns DG, Domínguez‑Martís EM, 
López‑Ares D, Novío S. Knowledge, attitudes, and intentions 
towards human papillomavirus vaccination among nursing 
students in Spain. Int J Environ Res Public Health 2019;16:E4507.
40. Ozsurekci Y, Karadag Oncel E, Bayhan C, Celik M, 
Ozkaya‑Parlakay A, Arvas M, et al. Knowledge and attitudes 
about human papillomaviruses and immunization among Turkish 
pediatricians. Asian Pac J Cancer Prev 2013;14:7325‑9.
41. Ling WY, Razali SM, Ren CK, Omar SZ. Does the success of a 
school‑based HPV vaccine programme depend on teachers’ 
knowledge and religion? ‑ A survey in a multicultural society. 
Asian Pac J Cancer Prev 2012;13:4651‑4.
42. Sauvageau C, Duval B, Gilca V, Lavoie F, Ouakki M. Human 
papilloma virus vaccine and cervical cancer screening acceptability 
among adults in Quebec, Canada. BMC Public Health 2007;7:304.
43. Burhan M, Rahman NA, Haque M. Knowledge and attitude 
regarding cervical cancer and its prevention among young female 
adults in Kuantan, Malaysia. J Edu Health Promot 2021;10:332.
44. Samami E, Seyedi‑Andi SJ, Bayat B, Shojaeizadeh D, Tori NA. The 
effect of educational intervention based on the health belief model 
on knowledge, attitude, and function of women about Pap smear 
test at Iranian health centers: A randomized controlled clinical 
trial. J Educ Health Promot 2021;10:22.
45. Lenselink CH, Schmeink CE, Melchers WJ, Massuger LF, 
Hendriks JC, van Hamont D, et al. Young adults and 
acceptance of the human papillomavirus vaccine. Public Health 
2008;122:1295‑301.
46. Wong LP, Sam IC. Ethnically diverse female university students’ 
knowledge and attitudes toward human papillomavirus (HPV), 
HPV vaccination and cervical cancer. Eur J Obstet Gynecol Reprod 
Biol 2010;148:90‑5.
47. Ortashi O, Raheel H, Shalal M, Osman N. Awareness and 
knowledge about human papillomavirus infection and 
vaccination among women in UAE. Asian Pac J Cancer Prev 
2013;14:6077‑80.
48. Thulaseedharan JV, Frie KG, Sankaranarayanan R. Challenges 
of health promotion and education strategies to prevent cervical 
cancer in India: A systematic review. J Educ Health Promot 
2019;8:216.