Lack of Perception for HPV: A Literature Review

This literature review explores the lack of perception and awareness about Human Papillomavirus (HPV) and its impact on cervical cancer. It discusses various research studies and highlights the need for education and awareness programs to prevent the spread of HPV.

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Name of the student:
Name of the University:
Author’s note

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Introduction:
Human Papillomavirus (HPV) has primarily effective symptoms that are the warts on the
genital organs of human. These warts can be very dangerous as the warts caused by the HPV
leads to cancer and it is a contagious disease as well. Though there is presence of vaccine to
prevent this virus infecting the human body however, the lack of knowledge or perception about
the disease cause numerous deaths in under developed regions of the world. Almost 7.5% of
female deaths occurred in 2018 as result of cervical cancer which developed by the HPV attack
and almost 85% of these deaths and the occurrence of cervical cancers happened to be found in
the low income countries (Who.int, 2019). The following proposal is focused on the literature
review of the lack of perception for HPV.
Literature review:
Review of research papers can give an idea regarding the significance of conducting
research on this topic. Assoumou et al. (2015), surveyed in the region of Libreville, Gabon
among the random females counting to 452 aged above 16 years and the survey was focused on
the lack of awareness and knowledge about the cervical cancer and the prevention of HPV. They
used the logistic regression analysis to determine the effects of the demographic characters
which can be the cause of the lack of awareness in the region. The survey resulted in the
knowledge development about the factor that only 8% of theses respondents have the knowledge
about HPV and 91.6% of the women heard about cervical cancer. However, the results also
showed that among these 91.6% of the women only 65.1% had done cervical screening test and
others had shown a perception that it is an unimportant disease and also the fear of finding about
a critical disease also inhibited the screening tests among them. These results highlighted that a

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very poor knowledge about HPV is one of the factors that increased the number of the diseased
people in the region of Gabon. Schmotzer and Reding (2013), highlighted that cervical cancer is
one of the leading cause of women death in US and their findings were about knowledge and
beliefs about the HPV virus prevention or vaccination process. They surveyed among 202
nursing students including Hispanic and non-Hispanic ones and 28.9% have received the HPV
vaccination whereas only 27.3% of the Hispanic students had intended to receive the vaccine.
Thus it can be seen on the basis of the result that the beliefs of the multi-cultural people pose a
barriers in the knowledge and the awareness about HPV. The Hispanic people among all these
respondents had very lesser knowledge which is almost nil in this context.
Based on the results of the survey of Radecki et al. (2016), it is seen that knowledge
about the HPV virus and the vaccination of this foreign agent in the body lesser among the
people of the US and somewhat average in the white people. The survey among 296 people
showed that only 50.3% of the people had the knowledge of the HPV virus and 32.1% of the
respondents heard about the HPV vaccines. This result when analysed by the help of the
benchmark of the Health Information National Trends Survey (HINTS) the authors found that
the knowledge about HPV is very low among the multi-cultured people of US. All these surveys
and responses found that the lack of awareness about the disease and the cause of the disease
leads to the death of a numerous people in different regions of the world especially in the multi-
cultured community and also in the under developed region of the world population (Who.int,
2019). Mojahed et al. (2013) opined that the lack of knowledge about the HPV infection and the
sexual transition of this virus leading to the cervical cancer among the women needed to be
changed and the nurses, patients and also the young and adolescent people of the communities by
means of health education about the HPV virus and the vaccination of this virus. However, their

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survey among 357 health care nurses highlighted that only 36.7% nurse among them have the
knowledge about the HPV infection and 41.2% showed the intension about taking the
vaccination in terms of the preventive measures for the cervical cancer. However, the lack of the
awareness and the knowledge of this critical disease pose a critical concern for the society as all
the above discussed surveys have shown a negative response in terms of the knowledge and the
preventive policies of the disease. The HPV infection is also a sexually transmitted infection that
can affect and cause cervical cancer in other human bodies thus the prevention of this disease is a
mandate in present days.
Manoel et al. (2017) highlighted the factors that the knowledge and awareness about the
HPV infection is a critical condition among the community health agents in order to deliver the
proper knowledge about the disease among the community they are responsible for. However,
their study among 124 Brazilian community health agents showed that they had heard about the
HPV infection and only 25% of them have the knowledge about the HPV testing and 72.6% of
them answered about the disease which showed their knowledge is very poor about the factor.
They also stated that who answered more than 70% words in right manner are younger than the
others. Thus it can be said that the knowledge and awareness about HPV needed to be spread
among the community health agents properly as they are the responsible person to educate the
people of the community about the effects and the preventive ways for the disease.
All these surveys and the literature showed that the gap in the awareness and knowledge
spreading program among the less developed regions of the world. However, the literatures lack
the factors which could be used in the education program about the HPV virus and the
vaccination of the infection.

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Research question, research purpose and hypothesis:
The research question that will guide the research process is as follows:
How risk perception related to human papillomavirus influence uptake of HPV vaccine and
transmission of HPV infection in young women?
The main purpose of the research is to:
 To analyse the link between risk perception and HPV vaccine uptake among young
women
 To evaluate the impact of lack of knowledge about HPV infection on the development of
cervical cancer
 To recommend changes needed to increase awareness about HPV and HPV vaccination
among young women in the community
The research hypothesis is that awareness related to risk will predict increase in HPV vaccine
uptake.
Participants and focus of the research:
In this research topic the main targeted participants are the young women of different
communities especially the women from communities and colleges.
The main focus of the research is to evaluate the amount of preventive knowledge about
the HPV infection among the young women of the underdeveloped communities. The impact of
the lesser knowledge about the disease on the life of these women and the awareness program
which would be recommended for the knowledge development about the disease would also be
evaluated in the research program.

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Methods to answer the research question:
Here in this research program, mixed method research design using the quantitative and
the qualitative data collection method would be used for the data collection about the above
mentioned topic. It involves collection and analysis of data using both qualitative and
quantitative research methods. The main rationale behind choosing mixed method is that it will
favour making valid conclusion about the research topic and gain in-depth knowledge related to
the research question. It can help to uncover relationship between variables through quantitative
research and interpreting meaning using qualitative research method (Schoonenboom & Johnson,
2017). Quantitative data collection method includes the close-ended information collection and it
would be gained from surveys and the statistical data would mostly help gathering information
about the awareness of the society about the HPV infection and vaccination. However, the
qualitative data would be collected from the open-ended interviews and would be helpful in the
knowledge gathering process about the attitude, behaviour and the belief about this topic on the
minds of the women respondents.
Research method chosen:
The literature review and gaps in past research shows that the main cause behind increase
in cervical cancer is the infection by HPV and lack of HPV knowledge and its transmission
among young women. Hence, the main rationale behind exploring the risk perception related to
HPV is to determine how the risk perception influences uptake of HPV vaccine and rate of
transmission of infection among young women. Based on the chosen research question, mixed
method research design is considered best to answer the research question as will help to explore

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qualitative (attitude and beliefs) data as well as quantitative (rate of transmission of HPV
infection) data related to the research topic.
There are many types of mixed method research design such as explanatory sequential,
convergent, exploratory sequential or complex mixed method designs. The mixed method design
that has been chosen for this research includes sequential exploratory research design. It consists
of two phases involving collection of qualitative data first followed by collection and analysis of
quantitative data. Hence, the first step will be to conduct a verbal survey with research
participants regarding the risk perception related to HPV and then collect and interpret
quantitative data related HPV vaccination status among research participants. Sequential
exploratory research design will help to fill in the gaps identified in past research and give
answer to the research question.
Timing, weighting, mixing and theorizing strategies:
Based on the review of research question, it has been identified that the risk perception
part of the research question will require collection of qualitative data whereas the rate of
vaccine uptake and rate of infection will require collection of quantitative data. Hence, to answer
the research question, two types of research tools are needed. The first will involve interview
questionnaire tool to explore risk perception of HPV among participants and the second will
involve online survey questionnaire related to HPV vaccine uptake and concerns.
Timing: The qualitative and quantitative data collection will be gathered sequentially starting
with qualitative data collection and then quantitative data collection. In case of qualitative data
collection, interview will be conducted with each research participants. After the interview
process is completed, the quantitative data collection process will start. This will involve

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distribution of survey questionnaire via email to all research participants and ensuring
completion of the survey by 2 weeks.
Weighting and mixing: Weight attribution involves the level of priority given to qualitative or
quantitative data in a research. As the research involves collection of both quantitative data and
qualitative data, each type of these data has special weightage. Firstly, qualitative data is
importance because it will help to explore opinion about the topic from the research participants
(Brannen, 2017). This will help to determine whether changes in attitude and knowledge related
to HPV is needed or not. Secondly, the significance of collection quantitative data in this review
is that it will to collect scores on percentage of HPV vaccine uptake and determine whether
additional considerations are needed to increase coverage of HPV vaccine or not (Hammersley,
2017). Another uniqueness of the study is that the two forms of the data will not be
independently analysed. Instead, the qualitative and quantitative data will be connected and
integrated to establish link between risk perception and HPV vaccine uptake. The key advantage
of integrating data is that it allows for a deeper understanding of the phenomenon of interest and
the main purpose of integration is to fuse the quantitative and qualitative data and product
information that support each other manually (Almalki, 2016).
Theorizing: For a mixed method study, a theoretical perspective should also guide the research
project. However, no theoretical view guides this search process as the research strategy chosen
is sequential exploratory (Almalki, 2016).
Research methods:
Sample recruitment: Purposive sampling method will be used to recruit young women from
college and community based organizations in Canada. The main purpose behind choosing

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women is the high risk of cervical cancer death in women (Schmotzer & Reding, 2013). Hence,
taking female sample group would help to explore whether the association between risk
perception and HPV vaccine uptake among women. The key advantage of purposive sampling
method is that it helps to take a sample group from which the findings can be generalized for the
target population of interest (Etikan, Musa & Alkassim, 2016). The age group of participants will
include between 18 years to 35 years.
Data collection: The cross sectional survey approach will be used for data collection which
means collecting data from research participants one point at a time (Brannen, 2017) . Hence, all
data will not be collected at on exact phase. It will take some time for completion of interview
questainnnaire followed by interpretation and analysis. The data collection will consist of two
phase. The first phase will involved qualitative data collection using interview questionnaire to
identify knowledge, attitude and beliefs related to knowledge of risk factors of HPV and the
importance of HPV vaccination. The interview questionnaire will collect data related to
vaccination status, educational level, perception related to risk factors of HPV and life time risk
of cervical cancer for unvaccinated women. The main interview question that will guide the
interview includes the following:
 What do you know about HPV infection?
 Do you know the consequences and risk factor of HPV infection?
 Are you aware about the benefit of HPV vaccine in reducing cancer risk? Explain
 What information do you want regarding HPV vaccination?
Secondly, the quantitative phase will involve developing online survey questionnaire on
uptake of HPV vaccine and concerns related to HPV vaccination among the research

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participants. The qualitative and quantitative data will be further interpreted to find out whether
the relation between the risk perception related to HPV and the uptake of vaccination. This will
help to identify whether awareness and knowledge about risk is associated with increase in HPV
uptake and reduction in HPV infection and transmission or not. This will help to identify the
strategies needed to achieve optimal coverage of vaccines and reduce risk of risky sexual activity
among youths that lead to increased cancer risks in America.
The online survey questionnaire will be distributed to the research participants via email
and data will be collected regarding percentage of vaccine uptake in females and the concerns
regarding the use of vaccines. The perceived susceptibility issues will be identified based on
statement in which participants will have to give yes or no response. Some examples of these
statements will be as follows:
 HPV would be a serious threat to my health
 I would need HPV if have multiple sexual partners
 I would need HPV if I smoked
 The HPV can cause other health related problems
 I am worried my friends would know I have taken the HPV vaccine
 HPV vaccine is safe
The percentage of response received in relation to each statement will help to predict the rate
of uptake and the link between risk perception and increase in concerns related to HPV
vaccine.
Data analysis:

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The analyses of the data will be conduction using SPSS. Descriptive statistics and
independent t-test will help to characterise and compare participant’s response and examine the
links between HPV risk perception and uptake of HPV vaccines. The quantitative and qualitative
data will also be compared to analyse the link between HPV risk perception and concerns related
to HPV vaccine among research participants. The strategy will be applied for data analysis
includes thematic approach that involves organization of research findings as per themes or
common patterns identified in research. This will help to explore different types of risk
perception, rate of HPV uptake and risk of transmission of infection (Braun et al., 2019).
Ethical consideration:
To fulfil the ethical requirements of research, the approval for research will be taken
from the Ethics Review Committee of Canada and the facilitators of the college and Community
based organizations. The approval form will give details regarding the research topic, purpose of
research, research methodology and key research benefits. In addition, informed consent will be
also be taken from research participants regarding participation in research. They will be taken in
the study only when they are give consent for participants. This will ensure no ethical conflict
occur during the search process.
References:

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Almalki, S. (2016). Integrating Quantitative and Qualitative Data in Mixed Methods Research--
Challenges and Benefits. Journal of Education and Learning, 5(3), 288-296.
Assoumou, S. Z., Mabika, B. M., Mbiguino, A. N., Mouallif, M., Khattabi, A., & Ennaji, M. M.
(2015). Awareness and knowledge regarding of cervical cancer, Pap smear screening and
human papillomavirus infection in Gabonese women. BMC women's health, 15(1), 37.
Brannen, J. (2017). Mixing methods: Qualitative and quantitative research. Routledge.
Braun, V., Clarke, V., Hayfield, N., & Terry, G. (2019). Thematic analysis. Handbook of
Research Methods in Health Social Sciences, 843-860.
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and
purposive sampling. American journal of theoretical and applied statistics, 5(1), 1-4.
Hammersley, M. (2017). Deconstructing the qualitative-quantitative divide 1. In Mixing
methods: Qualitative and quantitative research (pp. 39-55). Routledge.
Manoel, A. L., Rodrigues, A. B., Piva, E. Z., Warpechowski, T. P., & Schuelter-Trevisol, F.
(2017). Avaliação do conhecimento sobre o vírus do papiloma humano (HPV) e sua
vacinação entre agentes comunitários de saúde na cidade de Tubarão, Santa Catarina, em
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Mojahed, S., Zarchi, M. K., Bokaie, M., & Salimi, T. (2013). Attitude and knowledge of Iranian
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M., ... & Colón‐Otero, G. (2016). Awareness and knowledge of Human Papillomavirus

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Schmotzer, G. L., & Reding, K. W. (2013). Knowledge and beliefs regarding human
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Who.int. (2019). Human papillomavirus (HPV) and cervical cancer. Retrieved from
https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-
cervical-cancer