Knowledge of Human Papillomavirus Infection, Cervical Cancer and Willingness to pay for Cervical Cancer Vaccination among Ethnically Diverse Medical Students in Malaysia

  • Maharajan, Mari Kannan (Department of Pharmacy Practice, School of Pharmacy International Medical University) ;
  • Rajiah, Kingston (Department of Pharmacy Practice, School of Pharmacy International Medical University) ;
  • Num, Kelly Sze Fang (Department of Nutrition & Dietetics School of Health Sciences, International Medical University) ;
  • Yong, Ng Jin (School of Pharmacy International Medical University)
  • Published : 2015.09.02


The primary objective of this study was to assess the knowledge of medical students and determine variation between different cultural groups. A secondary aim was to find out the willingness to pay for cervical cancer vaccination and the relationships between knowledge and attitudes towards Human Papillomavirus vaccination. A cross-sectional survey was conducted in a private medical university between June 2014 and November 2014 using a convenient sampling method. A total of 305 respondents were recruited and interviewed with standard questionnaires for assessment of knowledge, attitudes and practice towards human papilloma virus and their willingness to pay for HPV vaccination. Knowledge regarding human papilloma virus, human papilloma virus vaccination, cervical cancer screening and cervical cancer risk factors was good. Across the sample, a majority (90%) of the pupils demonstrated a high degree of knowledge about cervical cancer and its vaccination. There were no significant differences between ethnicity and the participants' overall knowledge of HPV infection, Pap smear and cervical cancer vaccination. Some 88% of participants answered that HPV vaccine can prevent cervical cancer, while 81.5% of medical students said they would recommend HPV vaccination to the public although fewer expressed an intention to receive vaccination for themselves.


  1. Al-Dubai SA, Alshagga MA, Al-Naggar RA, et al (2010). Knowledge, attitudes and barriers for human papilloma virus (HPV) vaccines among Malaysian women. Asian Pac J Cancer Prev, 11, 887-92.
  2. Aljunid S, Zafar A, Saperi S, Amrizal M (2010). Burden of disease associated with cervical cancer in Malaysia and potential costs and consequences of HPV vaccination. Asian Pac J Cancer Prev, 11, 1551-9.
  3. Boehner CW, Howe SR, Bernstein DI, Rosenthal SL (2003). Viral sexually transmitted disease vaccine acceptability among college students. Sex Transm Dis, 30, 774-8
  4. Chow S, Soon R, Park J, et al (2010). Knowledge, attitudes, and communication around human papillomavirus (HPV) vaccination amongst urban Asian mothers and physicians. Vaccine, 28, 3809-17.
  5. Jenkins D (2008). A review of cross-protection against oncogenic HPV by an HPV-16/18 AS04-adjuvanted cervical cancer vaccine: importance of virological and clinical endpoints and implications for mass vaccination in cervical cancer prevention. Gynecol Oncol, 110, 18-25.
  6. Ezat SW, Hod R, Mustafa J, et al (2013). National HPV immunization programme: knowledge and acceptance of mothers attending an obstetrics clinic at a teaching hospital, Kuala Lumpur. Asian Pac J Cancer Prev, 14, 2991-9.
  7. Ezem BU (2007). Awareness and uptake of cervical cancer screening in Owerri, South-Eastern Nigeria. Ann Afr Med, 6, 94-8.
  8. Dochez C, Bogers JJ, Verhelst R, Rees H (2014). HPV vaccines to prevent cervical cancer and genital warts: an update. Vaccine, 32, 1595-601.
  9. Giede C, McFadden LL, Komonoski P, et al (2010). The acceptability of HPV vaccination among women attending the university of saskatchewan student health services. J Obstet Gynaecol Can, 32, 679-86.
  10. Holcomb B, Bailey JM, Crawford K, Ruffin MT 4th (2004). Adults' knowledge and behaviors related to human papillomavirus infection. J Am Board Fam Pract, 17, 26-31.
  11. Hopenhayn C, Christian A, Christian WJ, Schoenberg NE (2007). Human papillomavirus vaccine: knowledge and attitudes in two Appalachian Kentucky counties. Cancer Causes Control, 18, 627-34.
  12. Hoque ME, Ghuman S, Hal GV (2013). Human papillomavirus vaccination acceptability among female university students in South Africa. Asian Pac J Cancer Prev, 14, 4865-9.
  13. Jones M, Cook R (2008). Intent to receive an HPV vaccine among university men and women and implications for vaccine administration. J Am Coll Health, 57, 23-32.
  14. Kahn JA, Cooper HP, Vadaparampil ST, et al (2009). Human papillomavirus vaccine recommendations and agreement with mandated human papillomavirus vaccination for 11-to- 12-year-old girls: a statewide survey of Texas physicians. Cancer Epidemiol Biomarkers Prev, 18, 2325-32.
  15. Khoo CL, Teoh S, Rashid AK, et al (2011). Awareness of cervical cancer and HPV vaccination and its affordability among rural folks in Penang Malaysia. Asian Pac J Cancer Prev, 12, 1429-33.
  16. Kilic A, Seven M, Guvenc G, Akyuz A, Ciftci S (2012). Acceptance of human papillomavirus vaccine by adolescent girls and their parents in Turkey. Asian Pac J Cancer Prev, 13, 4267-72.
  17. Kondo M, Yamamura M, Hoshi SL, Okubo I (2010). Demand for pneumococcal vaccination under subsidy program for the elderly in Japan. BMC Health Serv Res, 12, 313.
  18. Kruiroongroj S, Chaikledkaew U, Thavorncharoensap M (2014). Knowledge, acceptance, and willingness to pay for human papilloma virus (HPV) vaccination among female parents in Thailand. Asian Pac J Cancer Prev, 15, 5469-74.
  19. Kwang NB, Yee CM, Shan LP, et al (2014). Knowledge, perception and attitude towards human papillomavirus among pre-university students in Malaysia. Asian Pac J Cancer Prev, 15, 9117-23.
  20. La Torre G, de Waure C, Chiaradia G, Mannocci A, Ricciardi W (2007). HPV vaccine efficacy in preventing persistent cervical HPV infection: a systematic review and metaanalysis. Vaccine, 25, 8352-8.
  21. Liao C, Liu J, Pwu R, et al (2009). Valuation of the economic benefits of human papillomavirus vaccine in Taiwan. Value Health, 12, 74-7.
  22. Madhivanan P, Srinivas V, Marlow L, et al (2014). Indian parents prefer vaccinating their daughters against HPV at older ages. Asian Pac J Cancer Prev, 15, 107-10.
  23. McClelland A, Liamputtong P (2006). Knowledge and acceptance of human papillomavirus vaccination: perspectives of young Australians living in Melbourne, Australia. Sex Health, 3, 95-101.
  24. National Health Morbidity Survey III (2008). The third national health and morbidity survey. Ministry of health, Kuala Lumpur. [ONLINE] Available at:
  25. Pulcini C, Massin S, Launay O, Verger P (2013). Factors associated with vaccination for hepatitis B, pertussis, seasonal and pandemic influenza among French general practitioners: a 2010 survey. Vaccine, 31, 3943-9.
  26. Rashwan H, Saat N, Manan D (2012). Knowledge, attitude and practice of malaysian medical and pharmacy students towards human papillomavirus vaccination. Asian Pac J Cancer Prev, 13, 2279-83.
  27. Saha A, Nag Chaudhury A, Bhowmik P, et al (2010). Awareness of cervical cancer among female students of premier colleges in Kolkata, India. Asian Pac J Cancer Prev, 11, 1085-90.
  28. Saidatul Norbaya Buang (2010), Introduction of national hpv immunization program: sharing malaysia experience presented at global meeting on cervical cancer prevention programme 29 Nov-2 Disember 2010.
  29. Saravanan C, Kingston R, Gin M (2014). Is Test Anxiety a Problem among Medical Students: A cross sectional study on outcome of test anxiety among medical students? Int J Psychol Stud, 6, 24-31.
  30. Shafei M, Zainon N, Zulkifli N, Ibrahim M (2014). Knowledge and perception on human papilloma virus infection and vaccination among medical students of a university in Malaysia. Procedia Soc Behav Sci, 116, 2707-10.
  31. Songthap A, Pitisuttithum P, Kaewkungwal J, et al (2009). Knowledge, attitudes, and acceptability of a human papillomavirus vaccine among healthcare providers. Southeast Asian J Trop Med Public Health, 40, 1048-56.
  32. Uzunlar, Ozyer, Bacser E, et al (2013). A survey on human papillomavirus awareness and acceptance of vaccination among nursing students in a tertiary hospital in Ankara, Turkey. Vaccine, 31, 2191-5.
  33. Wen Y, Pan XF, Zhao ZM, et al (2014). Knowledge of human papillomavirus (HPV) infection, cervical cancer, and HPV vaccine and its correlates among medical students in Southwest China: a multi-center cross-sectional survey. Asian Pac J Cancer Prev, 15, 5773-9.
  34. Wong LP (2011). Knowledge and attitudes about HPV infection, HPV vaccination, and cervical cancer among rural southeast Asian women. Int J Behav Med, 18, 105-11.
  35. Wong LP (2009). Physicians' experiences with HPV vaccine delivery: Evidence from developing country with multiethnic populations. Vaccine, 27, 1622-7.
  36. Yilmazel G, Duman NB (2014). Knowledge, attitudes and beliefs about cervical cancer and human papilloma virus vaccination with related factors in Turkish university students. Asian Pac J Cancer Prev, 15, 3699-704.
  37. Zhou L, Su Q, Xu Z, et al (2013). Seasonal influenza vaccination coverage rate of target groups in selected cities and provinces in china by season (2009/10 to 2011/12) PLoS One, 8, 3724.

Cited by

  1. A review of knowledge and attitudes of young people on cervical cancer and HPV vaccination pp.1613-2238, 2019,
  2. Health professionals’ willingness to pay and associated factors for human papilloma virus vaccination to prevent cervical cancer at College of Medicine and Health Sciences University of Gondar, Northwest Ethiopia vol.12, pp.1, 2019,