Effect of an Educational Intervention on Knowledge of Human Papillomavirus Vaccination among Pre-University Students in Malaysia

  • Kwang, Ng Beng (Department of Obstetrics and Gynaecology, UKM Medical Centre) ;
  • Mahayudin, Tasneem (ASASIpintar, Pusat PERMATA) ;
  • Yien, Hii Ling (Department of Obstetrics and Gynaecology, UKM Medical Centre) ;
  • Abdul Karim, Abdul Kadir (Department of Obstetrics and Gynaecology, UKM Medical Centre) ;
  • Teik, Chew Kah (Department of Obstetrics and Gynaecology, UKM Medical Centre) ;
  • Shan, Lim Pei (Department of Obstetrics and Gynaecology, UKM Medical Centre)
  • Published : 2016.02.05


Background: Cervical cancer is the fourth most common cancer among women worldwide. Studies evaluating the effect of health education on knowledge and perception of cervical cancer have generated conflicting results. Thus, this study aimed to evaluate the effect of educational intervention towards knowledge of HPV vacccination for cervical cancer prevention among pre-university students in Malaysia. Materials and Methods: This was an experimental before and after study performed between October 2014 and March 2015. Five hundred and eighty students were randomly assigned into intervention and control groups. All were required to complete both pre-intervention and post-intervention questionnaires. Those in the intervention group were given an information leaflet to read before answering the post-intervention questionnaire. Results: Almost half (48.3%) of the students had poor knowledge, with a score less than 5, and only 51 (8.8%) exhibited good knowledge, with a score of 11 and above. After educational intervention, the number of students with poor knowledge was reduced to 177 (29.3%) and the number of students who exhibited good knowledge increased to 148 (25.5%). Students from the intervention group demonstrated significant higher total scores in knowledge regarding 'HPV infection and cervical cancer' (p=0.000) and 'HPV vaccination and cervical cancer prevention' (p=0.000) during post-intervention as compared to the control group. Conclusions: Knowledge on HPV infection and vaccination is low among pre-university students. Educational intervention in the form of information leaflets appears effective in creating awareness and improving knowledge.


Educational intervention;knowledge;HPV;vaccination;pre-university student;Malaysia


Supported by : UKM Research Ethics Committee


  1. Abiodun OA, Olu-Abiodun OO, Sotunsa JO, et al (2014). Impact of health education intervention on knowledge and perception of cervical cancer and cervical screening uptake among adult women in rural communities in Nigeria. BMC Public Health, 14, 814.
  2. Al-Darwish AA, Al-Naim AF, Al-Mulhim KS, et al (2014). 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, 15, 2529-32.
  3. 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.
  4. Arrossi S, Maceira V, Paolino M, et al (2012). Acceptability and uptake of HPV vaccine in Argentina before its inclusion in the immunization program: a population-based survey. Vaccine, 30, 2467-74.
  5. Baseman JG, Koutsky LA (2005). The epidemiology of human papillomavirus infections. J Clin Virol, 32, 16-24.
  6. Cassidy B, Braxter B, Charron-Prochownik D, et al (2014). A quality improvement initiative to increase HPV vaccine rates using an educational and reminder strategy with parents of preteen girls. J Pediatr Health Care, 28, 155-64.
  7. Chang IJ, Huang R, He W, et al (2013). Effects of an educationalintervention on HPV knowledge and vaccine attitudes among urban employed women and female undergraduate students in China: a cross-sectional study. BMC Public Health, 13, 916.
  8. Choi SY (2013). Development of an Educational Program to Prevent Cervical Cancer among Immigrants in Korea. Asian Pac J Cancer Prev, 14, 5345-9.
  9. Dodd RH, McCaffery KJ, Marlow LA, et al (2014). Knowledge of human papillomavirus (HPV) testing in the USA, the UK and Australia: an international survey. Sex Transm Infect, 90, 201-7.
  10. Ferlay J, Soerjomataram I, Ervik M, et al (2013). GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 11
  11. Foley OW, Birrer N, Rauh-Hain JA, et al (2015). Effect of educational intervention on cervical cancer prevention and screening in Hispanic women. J Community Health. [Epub ahead of print].
  12. Fu LY, Bonhomme LA, Cooper SC, et al (2014). Educational interventions to increase HPV vaccination acceptance: a systematic review. Vaccine, 32, 1901-20.
  13. Grabiel M, Reutzel TJ, Wang S, et al (2013). HPV and HPV vaccines: the knowledge levels, opinions, and behavior of parents. J Community Health, 38, 1015-21.
  14. Ito T, Takenoshita R, Narumoto K, et al (2014). A communitybased intervention in middle schools to improve HPV vaccination and cervical cancer screening in Japan. Asia Pac Fam Med, 13, 13.
  15. Kwan TT, Tam KF, Lee PW, et al (2011). The effect of schoolbased cervical cancer education on perceptions towards human papillomavirus vaccination among Hong Kong Chinese adolescent girls. Patient Educ Couns, 84, 118-22.
  16. Kwang NB, Yee CM, Shan LP, et al (2014). Knowledge, perception and attitude towards Human Papilloma Virus among pre-university students in Malaysia. Asian Pac J Cancer Prev, 15, 9117-23.
  17. Malaysia Cancer Statistics- Data and Figure (2007). The third report of national cancer registry. Ministry of Health Malaysia. [Online]
  18. Mccusker SM, Macqueen I, Lough G, et al (2013). Gaps in detailed knowledge of human papillomavirus (HPV) and the HPV vaccine among medical students in Scotland. BMC Public Health, 13, 264.
  19. Rashwan H, Lubis SH, Ni KA (2011). Knowledge of cervical cancer and acceptance of HPV vaccination among secondary school students in Sarawak, Malaysia. Asian Pac J Cancer Prev, 12, 1837-41.
  20. Reiter PL, Stubbs B, Panozzo CA, et al (2011). HPV and HPV vaccine education intervention: effects on parents, healthcare staff, and school staff. Cancer Epidemiol Biomarkers Prev, 20, 2354-61.
  21. Vanderpool RC, Casey BR, Crosby RA (2011). HPV-related risk perceptions and HPV vaccine uptake among a sample of young rural women. J Community Health, 36, 903-9.
  22. Wen Yi, Pan XF, Zhao ZM, et al (2014). Knowledge of Human papilloalomavirus (HPV) infection, cervical cancer, and HPV vaccine and its correlates among medical students in Southwest Chinal: a multicenter cross-sectional survey. Asian Pac J Cancer Prev, 15, 5773-9.
  23. Wong LP, Wong YL, Low WY, et al (2009). Knowledge and awareness of cervical cancer and screening among Malaysian women who have never had a Pap smear: a qualitative study. Singapore Med J, 50, 49-53.
  24. 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.
  25. World Health Organization (2007). Cervical cancer, human papillomavirus (HPV), and HPV vaccines - Key points for policy-makers and health professionals.

Cited by

  1. Awareness and Knowledge Levels of Turkish College Students about Human Papilloma Virus Infection and Vaccine Acceptance pp.1543-0154, 2016,