HPV Aşısı Hakkında Bilgi, Tutum ve Davranışların Değerlendirilmesi: İzmir’de Pediatri ve Kadın Hastalıkları ve Doğum Asistanları Arasında Bir Anket Çalışması

Yıl 2024, , 137 - 146, 06.11.2024

Nebahat Ermiş , Derşan Onur , Anıl Er , İlker Günay

https://doi.org/10.46969/EZH.1555150

Öz

Amaç: Bu çalışmanın birincil amacı, İzmir, Türkiye’deki Kadın Hastalıkları ve Doğum (OB/GYN) ve pediatri asistanlarının HPV aşısı hakkındaki bilgi, tutum ve davranışlarını değerlendirmektir.
Gereç ve Yöntem: Bu kesitsel anket çalışması, Mayıs ve Temmuz 2019 tarihleri arasında İzmir, Türkiye’deki beş hastanede gerçekleştirildi. Veriler, 299 pediatri ve 126 OB/GYN asistanından çevrimiçi anket aracılığıyla elde edildi. İstatistiksel analizler SPSS® kullanılarak yapıldı.
Bulgular: Genel katılım oranı %72 idi. Asistanların sadece %25,2’si HPV aşısı hakkında yeterli bilgiye sahipti. OB/GYN asistanlarının bilgi puanları pediatri asistanlarına göre anlamlı derecede yüksekti (ortanca [IQR] = 9,4 [8,4-10,6] ve 8,4 [7,4-9,8], p=0,007). Asistanlar arasında aşılama oranı düşük olup, kadın asistanların aşılama oranı erkek asistanlara göre daha yüksekti (%13,6 ve %1,1, p<0,01). Asistanların %68,3’ü hem oğullarını hem de kızlarını aşılayacaklarını belirtirken, sadece %13,1’i hastalarına her zaman HPV aşısını tavsiye etmekteydi.
Sonuç: Çalışma, OB/GYN ve pediatri asistanlarının HPV aşısı hakkındaki bilgi ve aşılama oranlarının yetersiz olduğunu ortaya koymaktadır. Bu hekim gruplarına yönelik eğitim ve desteğin artırılması, HPV aşılama oranlarının iyileştirilmesi ve toplumda HPV ile ilişkili hastalıkların yaygınlığının azaltılması için önemlidir.

Anahtar Kelimeler

HPV aşısı, Pediatrist, Jinekolojist, Asistan, bilgi, tutum ve davranış

Evaluation of Knowledge, Attitudes, and Practices About HPV Vaccine: A Survey Study of Pediatric and Obstetrics and Gynecology Residents in İzmir, Türkiye

Öz

Purpose: The main objective of this study was to evaluate the knowledge, attitudes, and practices of obstetrics and gynecology (OB/GYN) and pediatric residents in Izmir, Turkey, regarding the HPV vaccination.
Materials and Methods: This cross-sectional survey study was conducted in five hospitals in Izmir, Turkey, between May and July 2019. The data for this study were obtained from 299 pediatric and 126 OB/GYN residents via an online web-based questionnaire. The statistical analyses were performed using SPSS®.
Results: The overall participation rate was 72%. Only 25.2% of the participating residents demonstrated adequate knowledge about the HPV vaccine. The OB/GYN residents had significantly higher knowledge scores than the pediatric residents (median [IQR] = 9.4 [8.4-10.6] vs. 8.4 [7.4-9.8], p=0.007). The vaccination rate among residents was low, with female residents having higher rates of vaccination than male residents (13.6% vs. 1.1%, p<0.01). While 68.3% of residents indicated that they would vaccinate both their sons and daughters, only 13.1% always recommended the HPV vaccine to their patients.
Conclusion: This study revealed that the knowledge and vaccination rates of OB/GYN and pediatric residents regarding the HPV vaccine are insufficient. Enhancing education and support for these physician groups is crucial for improving HPV vaccination rates and reducing the prevalence of HPV-related diseases in the population.

Anahtar Kelimeler

HPV vaccines, pediatrics, gynecologist, residency, health knowledge, attitudes, practice

Etik Beyan

The study was approved by the Clinical Research Ethics Committee of the University of Health Sciences Dr. Behçet Uz Childrenv’s Hospital (2019/351) in accordance with the ethical standards established in the 1964 Declaration of Helsinki and its subsequent amendments.

Destekleyen Kurum

None

Teşekkür

The authors thank all the participating healthcare providers from Tepecik Training and Research Hospital, Dr. Behçet Uz Pediatrics and Surgery Training and Research Hospital, Ege University, Dokuz Eylül University, and İzmir Katip Çelebi University.

Kaynakça

• Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49. https://doi.org/10.3322/caac.21660
• Altun Z. Çukurova bölgesindeki kadınlarda genital human papilloma virus infeksiyon prevalansı [dissertation]. Çukurova University; 2009.
• Bosch FX, de Sanjosé S. Chapter 1: Human papillomavirus and cervical cancer-burden and assessment of causality. J Natl Cancer Inst Monogr. 2003;2003(31):3-13. https://doi.org/10.1093/oxfordjournals.jncimonographs.a003479
• Bruni L, Barrionuevo-Rosas L, Albero G, et al. Human papillomavirus and related diseases in the world. Summary Report. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre); 2023. Available at: https://hpvcentre.net/statistics/reports/XWX.pdf (Accessed on March 10, 2023).
• Clark M, Jembere N, Kupets R. The impact of a universal human papilloma virus (HPV) vaccination program on lower genital tract dysplasia and genital warts. Prev Med. 2021;150:106641. https://doi.org/10.1016/j.ypmed.2021.106641
• Drolet M, Bénard É, Pérez N, Brisson M; HPV Vaccination Impact Study Group. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet. 2019;394(10197):497-509. https://doi.org/10.1016/S0140-6736(19)30298-3
• Kirnbauer R, Booy F, Cheng N, Lowy DR, Schiller JT. Papillomavirus L1 major capsid protein self-assembles into virus-like particles that are highly immunogenic. Proc Natl Acad Sci U S A. 1992;89(24):12180-4. https://doi.org/10.1073/pnas.89.24.12180
• Markowitz LE, Schiller JT. Human Papillomavirus Vaccines. J Infect Dis. 2021;224(12 Suppl 2):S367-78. https://doi.org/10.1093/infdis/jiaa621
• Lei J, Ploner A, Elfström KM, et al. HPV Vaccination and the Risk of Invasive Cervical Cancer. N Engl J Med. 2020;383(14):1340-8. https://doi.org/10.1056/NEJMoa1917338
• Shing JZ, Griffin MR, Chang RS, et al. Human Papillomavirus Vaccine Impact on Cervical Precancers in a Low-Vaccination Population. Am J Prev Med. 2022;62(3):395-403. https://doi.org/10.1016/j.amepre.2021.08.017
• FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007;356(19):1915-27. https://doi.org/10.1056/NEJMoa061741
• Joura EA, Giuliano AR, Iversen OE, et al. A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med. 2015;372(8):711-23. https://doi.org/10.1056/NEJMoa1405044
• Trim K, Nagji N, Elit L, Roy K. Parental Knowledge, Attitudes, and Behaviours towards Human Papillomavirus Vaccination for Their Children: A Systematic Review from 2001 to 2011. Obstet Gynecol Int. 2012;2012:921236. https://doi.org/10.1155/2012/921236
• Tolunay O, Celik U, Karaman SS, et al. Awareness and attitude relating to the human papilloma virus and its vaccines among pediatrics, obstetrics and gynecology specialists in Turkey. Asian Pac J Cancer Prev. 2014;15(24):10723-8. https://doi.org/10.7314/apjcp.2014.15.24.10723
• Uluocak T, Bekar M. Kadın sağlık çalışanlarının servikal kansere ilişkin bilgi ve tutumlarının belirlenmesi. Türk Jinekolojik Onkol Derg. 2012;15(2):50-7.
• Naki MM, Celik H, Api O, Toprak S, Ozerden E, Unal O. Awareness, knowledge and attitudes related to HPV infection and vaccine among non-obstetrician-gynecologist healthcare providers. J Turk Ger Gynecol Assoc. 2010;11(1):16-21.
• Allison MA, Hurley LP, Markowitz L, et al. Primary Care Physicians' Perspectives About HPV Vaccine. Pediatrics. 2016;137(2):e20152488. https://doi.org/10.1542/peds.2015-2488
• Hofstetter AM, Lappetito L, Stockwell MS, Rosenthal SL. Human Papillomavirus Vaccination of Adolescents with Chronic Medical Conditions: A National Survey of Pediatric Subspecialists. J Pediatr Adolesc Gynecol. 2017;30(1):88-95. https://doi.org/10.1016/j.jpag.2016.08.005
• Abi Jaoude J, Khair D, Dagher H, et al. Factors associated with Human Papilloma Virus (HPV) vaccine recommendation by physicians in Lebanon, a cross-sectional study. Vaccine. 2018;36(49):7562-7. https://doi.org/10.1016/j.vaccine.2018.10.065
• Rosen BL, Shepard A, Kahn JA. US Health Care Clinicians' Knowledge, Attitudes, and Practices Regarding Human Papillomavirus Vaccination: A Qualitative Systematic Review. Acad Pediatr. 2018;18(2S):S53-65. https://doi.org/10.1016/j.acap.2017.10.007
• Smolarczyk K, Pieta W, Majewski S. Assessment of the State of Knowledge about HPV Infection and HPV Vaccination among Polish Resident Doctors. Int J Environ Res Public Health. 2021;18(2):551. https://doi.org/10.3390/ijerph18020551
• Sharma A, Minh Duc NT, Luu Lam Thang T, et al. A Consensus-Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med. 2021;36(10):3179-87. https://doi.org/10.1007/s11606-021-06737-1
• Berkowitz Z, Malone M, Rodriguez J, Saraiya M. Providers' beliefs about the effectiveness of the HPV vaccine in preventing cancer and their recommended age groups for vaccination: Findings from a provider survey, 2012. Prev Med. 2015;81:405-11. https://doi.org/10.1016/j.ypmed.2015.10.007
• Hoque ME. Factors influencing the recommendation of the Human Papillomavirus vaccine by South African doctors working in a tertiary hospital. Afr Health Sci. 2016;16(2):567-75. https://doi.org/10.4314/ahs.v16i2.26
• Nikolic Z, Matejic B, Kesic V, Eric Marinkovic J, Jovic Vranes A. Factors influencing the recommendation of the human papillomavirus vaccine by Serbian pediatricians. J Pediatr Adolesc Gynecol. 2015;28(1):12-8. https://doi.org/10.1016/j.jpag.2014.01.107
• Riedesel JM, Rosenthal SL, Zimet GD, et al. Attitudes about human papillomavirus vaccine among family physicians. J Pediatr Adolesc Gynecol. 2005;18(6):391-8. https://doi.org/10.1016/j.jpag.2005.09.004
• Aldrich T, Becker D, García SG, Lara D. Mexican physicians' knowledge and attitudes about the human papillomavirus and cervical cancer: a national survey. Sex Transm Infect. 2005;81(2):135-41. https://doi.org/10.1136/sti.2003.008557
• Özçam H, Cimen G, Uzuncakmak C, Aydin S, Ozcan T, Boran B. Evaluation of the knowledge, attitude, and behavior of female health workers about breast cancer, cervical cancer, and routine screening tests. Istanb Med J. 2014;15(3):154-60. https://doi.org/10.5152/imj.2014.86548
• Güdücü N, Gönenç G, İşçi H, Yiğiter AB, Dünder İ. Awareness of human papilloma virus, cervical cancer and HPV vaccine in healthcare workers and students of medical and nursing schools. J Clin Exp Investig. 2012;3(3):318-25. https://doi.org/10.5799/ahinjs.01.2012.03.0171
• Leddy MA, Anderson BL, Gall S, Schulkin J. Obstetrician-gynecologists and the HPV vaccine: practice patterns, beliefs, and knowledge. J Pediatr Adolesc Gynecol. 2009;22(4):239-46. https://doi.org/10.1016/j.jpag.2008.09.002
• Yıldırım M, Düzovalı Ö, Kanık A, Kırık Ö. Knowledge and Attitudes of The Pediatricians in Turkey Regarding Human Papillomavirus (HPV) Vaccine. Çocuk Enfeksiyon Derg. 2009;3:62-8.
• Unlu A, Kalenderoglu MD, Ay H, et al. National survey study on the approaches of pediatricians, family physicians, medical oncologists and gynecologists to the HPV vaccine. J Oncol Sci. 2018;4(2):74-9. https://doi.org/10.1016/j.jons.2018.04.002
• Ozsurekci Y, Karadag Oncel E, Bayhan C, et al. Knowledge and attitudes about human papillomaviruses and immunization among Turkish pediatricians. Asian Pac J Cancer Prev. 2013;14(12):7325-9. https://doi.org/10.7314/apjcp.2013.14.12.7325
• Wong LP, Edib Z, Alias H, et al. A study of physicians' experiences with recommending HPV vaccines to adolescent boys. J Obstet Gynaecol. 2017;37(7):937-43. https://doi.org/10.1080/01443615.2017.1317239
• Collange F, Verger P, Launay O, Pulcini C. Knowledge, attitudes, beliefs and behaviors of general practitioners/family physicians toward their own vaccination: A systematic review. Hum Vaccin Immunother. 2016;12(5):1282-92. https://doi.org/10.1080/21645515.2015.1138024
• Kara Elitok G, Bulbul L, Altuntas SB, et al. Recommending immunizations to adolescents in Turkey: a study of the knowledge, attitude, and practices of physicians. Hum Vaccin Immunother. 2020;16(5):1132-8. https://doi.org/10.1080/21645515.2020.1715146
• Görkem Ü, Toğrul C, İnal HA, Özgü BS, Güngör T. Knowledge and attitudes of allied health personnel in university hospital related to Human Papilloma Virus and the vaccine. Turk Bull Hyg Exp Biol. 2015;72(4):303-10. https://doi.org/10.5505/TurkHijyen.2015.35556
• Gilkey MB, Mohan D, Janssen EM, McRee AL, Kornides ML, Bridges JFP. Exploring variation in parental worries about HPV vaccination: a latent-class analysis. Hum Vaccin Immunother. 2019;15(7-8):1745-51. https://doi.org/10.1080/21645515.2019.1574157
• Walling EB, Dodd S, Bobenhouse N, Reis EC, Sterkel R, Garbutt J. Implementation of Strategies to Improve Human Papillomavirus Vaccine Coverage: A Provider Survey. Am J Prev Med. 2019;56(1):74-83. https://doi.org/10.1016/j.amepre.2018.07.038