Document Type : Original Article
Authors
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
Abstract
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.
Keywords
Rawal LB, Alam K, et al. Wealth‑related inequalities of women’s
knowledge of cervical cancer screening and service utilisation
in 18 resource‑constrained countries: Evidence from a pooled
decomposition analysis. Int J Equity Health 2020;19:42.
2. PrestonSM, DarrowWW. Improving human papillomavirus‑related
knowledge and attitudes among ethnically diverse young adults.
Health Equity 2019;3:254‑63.
3. Hasanzadeh Mofrad M, Jedi L, Ahmadi S. The role of Human
Papilloma Virus (HPV) vaccines in prevention of Cervical Cancer,
review article. Iran J Obstet Gynecold Infertility 2016;19:22‑9.
4. de Sanjose S, Brotons M, LaMontagne DS, Bruni L. Human
papillomavirus vaccine disease impact beyond expectations. Curr
Opin Virol 2019;39:16‑22.
5. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer
J Clin 2016;66:7‑30.
6. Moscicki AB, Schiffman M, Franceschi S. The natural history of
human papillomavirus infection in relation to cervical cancer. In:
Human Papillomavirus Academic Press. Elsevier; 2020. p. 149‑60.
7. Park IU, Introcaso C, Dunne EF. Human papillomavirus and
genital warts: A review of the evidence for the 2015 centers for
disease control and prevention sexually transmitted diseases
treatment guidelines. Clin Infect Dis 2015;61 Suppl 8:S849‑55.
8. Jaberipour M, Samsami A, Sahraiian F, Kazerooni T, Hashemi M,
Ghaderi A, et al. Elevation of HPV‑18 and HPV‑16 DNA in the
plasma of patients with advanced cervical cancer. Asian Pac J Cancer Prev 2011;12:163‑7.
9. Seifi S, Asvadi Kermani I, Dolatkhah R, Asvadi Kermani A,
Sakhinia E, Asgarzadeh M, et al. Prevalence of oral human
papilloma virus in healthy individuals in East Azerbaijan province
of Iran. Iran J Public Health 2013;42:79‑85.
10. Muentes GD, García MA, Galárraga RI, Ollague K, Wachter CV,
Cabezas JC. Frequency and distribution of HPV genotypes in 800
genital samples of Ecuadorian men and women from the city of
Guayaquil. Rev Inst Med Trop Sao Paulo 2019;61:e41.
11. Torre LA, Siegel RL, Ward EM, Jemal A. Global cancer incidence
and mortality rates and trends – An update. Cancer Epidemiol
Biomarkers Prev 2016;25:16‑27.
12. Hamzehkhani MS, Zahiri M, Haghighizadeh MH,
Dehcheshmeh NF. Evaluating the quality of Iran’s package of
essential non‑communicable (IraPEN) disease in the eastern
health Center of Ahvaz: viewpoints of the referring patients. Arch
Pharm Pract. 2020;1:62.
13. Fakor F, Mahfouzi L, Dalil Heirati SF, Graili S. Knowledge
and attitudes of medical students about Human Papilloma
Virus (HPV) vaccination and associated factors. J Holis Nurs
Midwifery 2016;26:71‑9.
14. Pourkazemi A, Ghanbari A, Fakour F, Ghorbani S. Knowledge
and attitudes of medical students toward human papilloma virus
in Rasht, 2013. J Guilan Univ Med Sci 2017;25:1‑10.
15. Salehifar DL, Akbari Kamrani M. Knowledge about cervical
cancer, human papilloma virus and attitude towards acceptance
of vaccination among female students. J Payesh 2015;14:217‑226.
16. Rundle‑Thiele S, David P, Willmott T, Pang B, Eagle L, Hay R.
Social marketing theory development goals: An agenda to drive
change. J Mark Manag 2019;35:160‑81.
17. Glanz K, Burke LE, Rimer BK. Health behavior theories.
Philosophies and theories for advanced nursing practice.
2011:247‑70.
18. Ajzen I. The theory of planned behavior: Frequently asked
questions. Hum Behav Emerg Technol 2020;2:314‑24.
19. Catalano HP, Knowlden AP, Birch DA, Leeper JD, Paschal AM,
Usdan SL. Using the theory of planned behavior to predict
HPV vaccination intentions of college men. J Am Coll Health
2017;65:197‑207.
20. Taebi M, Riazi H, Keshavarz Z, Afrakhteh M. Knowledge and
attitude toward Human Papillomavirus and HPV vaccination
in Iranian population: A systematic review. Asian Pac J Cancer
Prev 2019;20:1945‑9.
21. Said S, Hassan H, Sarhan A. Effect of an educational intervention
on women’s knowledge and attitude regarding cervical cancer.
Am J Nurs Res 2018;6:59‑66.
22. Vasheghani F, Majlesi F, Mahmoudi M, Shojaeezadeh D. Effect
of educational intervention based on Health Belief Model on
knowledge and attitude about pap smear test among female
secondary school teachers in district 11 of Tehran. J Sch Public
Health Inst Public Health Res 2012;10:39‑46.
23. Mokarrami E, Jalili Z, Tavakoli Ghouchani H. The effect of
education based on the theory of planned behavior on preventive
behaviors of vaginitis in health ambassadors. Iran J Health Educ
Health Promot 2019;7:211‑9.
24. Moradi Z, Moradi P, Khani Jeihooni A, Dehghan A. Factors
associated with Pap smear implementation among women
referring to healthcare centers in Fasa, Iran: An application
of theory of planned behavior. J Educ Community Health
2017;4:51‑8.
25. Sargazi M, Mohseni M, Safar‑Navade M, Iran‑Pour A, Mirzaee M,
Jahani Y. Effect of an educational intervention based on the theory
of planned behavior on behaviors leading to early diagnosis of
breast cancer among women referred to health care centers in
Zahedan in 2013. Iran Q J Breast Dis 2014;7:45‑55.
26. Getahun T, Kaba M, Derseh BT. Intention to screen for cervical
cancer in Debre Berhan Town, Amhara Regional State, Ethiopia:
Application of theory of planned behavior. J Cancer Epidemiol
2020 MAR 19;20‑28.
27. Sabouri M, Shakibazadeh E, Mohebbi B, Tol A, Yaseri M, Babaee S.
Effectiveness of an educational intervention using theory of
planned behavior on health care empowerment among married
reproductive‑age women: A randomized controlled trial. J Educ
Health Promot 2020;9:293.
28. 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;16:4507.
29. Porter RM, Amin AB, Bednarczyk RA, Omer SB. Cancer‑salient
messaging for Human Papillomavirus vaccine uptake:
A randomized controlled trial. Vaccine 2018;36:2494‑500.
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