Document Type : Original Article


1 Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences

2 Department of Obstetrics and Gynecology, Women’s Health Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad

3 Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran


BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection 
and causes more than 90% of cervical cancers. The highest rate of infection occurs between the 
ages of 18 and 28. This study aimed to determine the effect of education based on the theory of 
planned behavior (TPB) on the intention of vaccination against HPV in female students.
MATERIALS AND METHODS: This controlled educational trial study was performed on 72 female 
students aged 18–26 years of Mashhad University of Medical Sciences by random assignment to 
intervention and control groups. For random assignment in the intervention and control groups, 
random blocking with four blocks was performed using a random number table with a ratio of 1:1. 
Data collection tools included demographic questionnaire, awareness about HPV vaccination, 
and TPB theory constructs. The control group was received the university routine training. The 
intervention group was received the virtual group training in four sessions, 60–90 min at weekly 
intervals and with educational content including TPB constructs on HPV vaccination with the 
method of lecture training, group discussion, questions and answers, and presentation of training 
package. Questionnaires were completed before, instantly, and 1 month after the educational 
intervention. Data were analyzed using the Chi‑square test, Fisher’s exact, t‑test, Mann–Whitney 
test, and Friedman test.
RESULTS: The mean age of students was 18.9 ± 1.1 years. The intervention and control groups 
were homogeneous in terms of demographic characteristics (P > 0.05). Before the intervention, 
the mean score of model constructs did not show a statistically significant difference between the 
two groups (P > 0.05), but after the intervention, in the intervention group, mean scores of attitude, 
subjective norms, perceived behavioral control, and behavioral intention in the intervention group 
was significantly higher than the control group (P < 0.001). In the intervention group, the difference 
in the mean score of HPV vaccination intention instantly (P < 0.001) and 1 month (P < 0.001) after 
the intervention significantly increased.
CONCLUSION: TPB‑based education was effective in increasing attitudes, subjective norms, and 
perceived behavioral control and the intention to vaccinate against HPV in the female students of 
Mashhad University of Medical Sciences. Therefore, it is suggested that the present educational 
intervention be widely used to educate female students.


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