The effect of media exposure, health promotion, healthcare support, and knowledge on HPV vaccine intention among women of reproductive age 10.55131/jphd/2025/230207

Main Article Content

Agus Susanto
Dody Mulyanto
Heni Purwantiningrum

Abstract

Human Papillomavirus (HPV) infection poses a significant public health threat due to its strong association with cervical cancer, which remains a leading cause of cancer-related deaths among women globally. Despite the availability of an effective HPV vaccine, vaccination rates continue to be suboptimal in many regions. Understanding the influence of media exposure, health promotion efforts, healthcare support, and knowledge on HPV vaccine intentions is crucial for designing interventions aimed at increasing vaccine acceptance and mitigating HPV-related health risks. This cross-sectional study sought to examine these factors among women aged 20 to 40 in Tegal, Central Java, Indonesia, from July 2023 to January 2024. The study included 605 participants selected through simple random sampling. Data were collected using validated questionnaires to assess media exposure, health service support, HPV vaccine knowledge, and vaccination intentions. Descriptive statistics, chi-square tests, and multivariate logistic regression were applied to analyze the data and determine associations and predictors of vaccination intentions. Media exposure was not found to be significantly correlated with vaccination intention (p = 0.179). However, positive experiences with health promotion (p = 0.014), strong healthcare support (p < 0.001), and good knowledge of HPV (p < 0.001) were significantly associated with higher vaccination intentions. Logistic regression analysis identified health promotion (OR = 1.645), knowledge (OR = 3.797), and healthcare support (OR = 2.481) as significant predictors, underscoring their critical role in shaping health-related decisions. This study highlights the importance of health promotion, healthcare support, and increased knowledge in fostering positive attitudes towards HPV vaccination among women. The findings stress the need for targeted interventions aimed at enhancing health education, supporting healthcare providers, and raising public awareness to improve HPV vaccine uptake and ultimately reduce the incidence of cervical cancer.

Article Details

How to Cite
1.
Susanto A, Mulyanto D, Purwantiningrum H. The effect of media exposure, health promotion, healthcare support, and knowledge on HPV vaccine intention among women of reproductive age: 10.55131/jphd/2025/230207. J Public Hlth Dev [internet]. 2025 Apr. 30 [cited 2025 Dec. 25];23(2):87-102. available from: https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/272051
Section
Original Articles
Author Biographies

Agus Susanto, Politeknik Indonusa Surakarta, Surakarta, Central Java, Indonesia

Politeknik Indonusa Surakarta, Surakarta, Central Java, Indonesia

Dody Mulyanto, Politeknik Indonusa Surakarta, Surakarta, Central Java, Indonesia

Politeknik Indonusa Surakarta, Surakarta, Central Java, Indonesia

Heni Purwantiningrum, Politeknik Harapan Bersama, Tegal City, Central Java, Indonesia

Politeknik Harapan Bersama, Tegal City, Central Java, Indonesia

References

WHO. Human Papillomavirus (HPV) and Cervical Cancer. 2023. [Internet]. [Cited 2024 June 11]. Available from: https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer

WHO. Cervical cancer. 2024. [Internet]. [Cited 2024 June 19]. Available from: https://www.who.int/ news-room/fact-sheets/detail/cervical-cancer

World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem, World Health Organization. 2020. [Cited 2024 June 12]. Available from: https://www.who.int/ publications/i/item/9789240014107

Information Centre on HPV and Cancer (ICO/IARC). Indonesia Human Papillomavirus and Related Cancers, Fact Sheet 2023, ICO/IARC Inf Cent HPV Cancer. 2023. [Cited 2024 June 10]. Available from: https:// hpvcentre.net/statistics/reports/IDN_FS.pdf

Khatiwada M, Kartasasmita C, Mediani HS, Delprat C, Van Hal G, Dochez C. Knowledge, Attitude and Acceptability of the Human Papilloma Virus Vaccine and Vaccination Among University Students in Indonesia. Front Public Heal. 2021;9:616456.

Winarto H, Habiburrahman M, Dorothea M, Wijaya A, Nuryanto KH, Kusuma F, et al. Knowledge, attitudes, and practices among Indonesian urban communities regarding HPV infection, cervical cancer, and HPV vaccination. PLoS One. 2022;17:1–29. doi: 10.1371/journal.pone.0266139

Setiawan D, Andrijono, Hadinegoro SR, Meyta H, Sitohang RV, Tandy G, et al. Cervical cancer prevention in Indonesia: An updated clinical impact, cost-effectiveness and budget impact analysis. PLoS One. 2020;15(3): e0230359. doi: 10.1371/journal.pone. 0230359

Egbon M, Ojo T, Aliyu A, Bagudu ZS. Challenges and lessons from a school-based human papillomavirus (HPV) vaccination program for adolescent girls in a rural Nigerian community. BMC Public Health. 2022;22(1):4–11. doi: 10.1186/s12889-022-13975-3

Isaacson S, Adewumi K, Smith JS, Novak C, Oketch S, Huchko MJ. A Qualitative Exploration of Barriers to Treatment Among HPV-Positive Women in a Cervical Cancer Screening Study in Western Kenya. Oncologist. 2023;28(1):e9–18.

Kistiana S, Fajarningtiyas DN, Lukman S. Differentials in Reproductive Health Knowledge among Adolescents in Indonesia. Media Kesehat Masy Indones. 2023;19(1):19–29.

Li Y. Human papillomavirus infection and cervical cancer prevention in Indonesia. Proc. SPIE 12611, Second International Conference on Biological Engineering and Medical Science (ICBioMed 2022). 2023;126112B. doi: 10.1117/12.2670404

Hidayat YM, Reynaldi GN. 9vHPV (Nonavalent) Vaccine Policy in Indonesia. Indones J Obstet Gynecol. 2023;11(2):61–3.

Mutiar A, Wulandari T, Nurhayati N, Marfuah D, Noor Hayati S. Knowledge-related Human Papillomavirus Vaccination: A Study of Indonesian Women. J Keperawatan Komprehensif Compr Nurs J. 2023; 9(1):60-66.

Setiawan D, Postma MJ, Wilffert B, Off Page. HPV vaccination in Indonesia : a health-economic & comparative perspective. [Groningen]: University of Groningen, 2017.

Handayani S, Dewi RM, Wibowo HA, Dany F, Kipuw NL, Adelina R, et al. Cervical Cancer Risk Factor: HPV Infection Among Indonesian Urban Women. Advances in Health Sciences Research, 4th International Symposium on Health Research (ISHR 2019). 2020;22:452–5.

Wang Y, Chen Y, Bao S. The impact of exposure to HPV related information and injunctive norms on young women's intentions to receive the HPV vaccine in China: A structural equation model based on KAP theory. Front Public Health. 2023;10:1102590. doi: 10.3389/fpubh.2022.1102590

Zhang L, Yang J, Cao Y, Kang W. Sociocultural–psychological predictors influencing parents’ decision-making regarding HPV vaccination for their adolescent daughters in mainland China: An extended TPB model. Front Public Heal. 2023;10:1035658. doi: 10.3389/fpubh.2022.1035658

Guillaume D, Waheed D e. N, Schlieff M, Muralidharan K, Vorsters A, Limaye R. Key decision-making factors for human papillomavirus (HPV) vaccine program introduction in low-and-middle-income-countries: Global and national stakeholder perspectives. Hum Vaccin Immunother. 2022;18(7): 2150454. doi: 10.1080/21645515.2022. 2150454

Oketch SY, Ochomo EO, Orwa JA, Mayieka LM, Abdullahi LH. Communication strategies to improve human papillomavirus (HPV) immunisation uptake among adolescents in sub-Saharan Africa: A systematic review and meta-analysis. BMJ Open. 2023;13(4):e067164. doi: 10.1136/bmjopen-2022-067164

Krokidi E, Rao AP, Ambrosino E, Thomas PPM. The impact of health education interventions on HPV vaccination uptake, awareness, and acceptance among people under 30 years old in India: a literature review with systematic search. Front Reprod Heal. 2023;5:1151179. doi: 10.3389/ frph.2023.1151179

Escoffery C, Petagna C, Agnone C, Perez S, Saber LB, Ryan G, et al. A systematic review of interventions to promote HPV vaccination globally. BMC Public Health. 2023;23(1):1262. doi: 10.1186/s12889-023-15876-5.

Jorge V, Cheng-Chia C. Impact of social media messages on perceived risk and severity of adverse effects and regret of HPV vaccination: The moderating role of decision-making preference. J Clin Oncol. 2023; 10(16_suppl):10543–10543.

Wong C, Wang R, Xu X, Zhao Y. Exploring an Impact of Digital Media Platform on HPV Vaccination Intentions of College Women. ducation Psychol Public Media. 2023;2(1):316–24.

Thompson EL, Preston SM, Francis JKR, Rodriguez SA, Pruitt SL, Blackwell JM, et al. Social Media Perceptions and Internet Verification Skills Associated with Human Papillomavirus Vaccine Decision-Making among Parents of Children and Adolescents: Cross-sectional Survey. JMIR Pediatr Parent. 2022;5(3): e38297. doi: 10.2196/38297

Olga M. Influence of fear on anti-vaccine conspiracy theories and behaviour against vaccination. Rev Psicol la salud. 2023;11(1):179–92.

Igartua JJ, Rodríguez-Contreras L, Guerrero-Martín Í, Honorato-Vicente A. “It Happened to Me and It’s Serious”: Conditional Indirect Effects of Infection Severity Narrated in Testimonial Tweets on COVID-19 Prevention. Int J Environ Res Public Health. 2023;20(13):6254. doi: 10.3390/ijerph20136254

Ramgopal G, Bhartendra S. Cervical cancer and human papilloma virus vaccination: gap and barriers. Int J Community Med Public Heal. 2022;10(1):511–4.

Constable C, Ferguson K, Nicholson J, Quinn GP. Clinician communication strategies associated with increased uptake of the human papillomavirus (HPV) vaccine: A systematic review. CA Cancer J Clin. 2022;72(6):561–9.

de Araújo TM, Souza FO, Pinho PS, Werneck GL. Beliefs and Sociodemographic and Occupational Factors Associated with Vaccine Hesitancy among Health Workers. Vaccines (Basel). 2022;10(12):2013. doi: 10.3390/vaccines10122013

Dinkes Jawa Tengah. Profil Kesehatan Jawa Tengah, Jawa Tengah 2022. Dinas Kesehatan Pemerintahan. 2023.

Jobst LJ, Bader M, Moshagen M. A tutorial on assessing statistical power and determining sample size for structural equation models. Psychol Methods. 2021;28(1):207–21. doi: 10.1037/met0000423

Jhantasana C. Should A Rule of Thumb be used to Calculate PLS-SEM Sample Size. Asia Soc Issues. 2023;16(5): e254658.

Zhu X, Jacobson RM, MacLaughlin KL, Sauver JS, Griffin JM, Finney Rutten LJ. Parent-reported Barriers and Parental Beliefs Associated with Intentions to Obtain HPV Vaccination for Children in a Primary care Patient Population in Minnesota, USA. J Community Health. 2023;48(4):678–86. doi: 10.1007/s10900-023-01205-9

Luo Y, Liu T, Yang X, Lu M, Kou Z, Xu X. Human papillomavirus vaccination and contributing factors of vaccination intention among adolescents and young adults in China from a socio-ecological perspective: A cross-sectional study. Public Health Nurs. 2024;41(3):602–16. doi: 10.1111/phn.13315

Son Y, Ahn O. Factors Associated with Intention to Receive HPV Vaccination among Marriage-Immigrant Women. J Korea Acad Ind Coop Soc. 2021; 22(5):465–74.

Braveman P. Education Shapes Health and Health Disparities in Many Ways. In: The Social Determinants of Health and Health Disparities. New York: Oxford Academic. 2023.

Hardin RN, Russell KM, Flynn JS, Gammel HL, Eddinger JR, Schenck LA, et al. Factors Associated with Intention of Human Papillomavirus (HPV) Vaccine Initiation Among Females With and Without a History of Childhood Cancer. J Clin Psychol Med Settings. 2020;27(4):716-726. doi: 10.1007/s10880-019-09664-w

Le XTT, Nguyen PTN, Do TTT, Nguyen TH, Le HT, Nguyen CT, et al. Intention to pay for hpv vaccination among women of childbearing age in vietnam. Int J Environ Res Public Health. 2020;17(9):3144. doi: 10.3390/ijerph17093144

Mansfield LN, Onsomu EO, Merwin E, Hall NM, Harper-Harrison A. Association Between Parental HPV Knowledge and Intentions to Have Their Daughters Vaccinated. West J Nurs Res. 2018;40(4):481-501. doi: 10.1177/0193945916682953

Ratanasiripong NT, Sri-Umporn S, Kathalae D, Hanklang S, Ratanasiripong P. Human papillomavirus (HPV) vaccination and factors related to intention to obtain the vaccine among young college women in Thailand. J Heal Res. 2018; 32(2):142–51.

Otojareri KA, Isah M, Pius OO, Aliyu KM, Isah ZM, Shekwolo ZN. Effect of Access to Immunization Information on Vaccine Acceptance amongst Parents/Caregivers Visiting Health Facilities in Wushishi Local Government Area, Niger State. Texila Int J Public Heal. 2023;11(1):1–10.

Rubin J. Communication is key to sustainable vaccination programs. Acta Paediatr Int J Paediatr. 2023; 112(9):1838–9. doi: 10.1111/apa.16888

Ota Y, Nomura K, Fujita N, Suzuki T, Kamatsuka M, Sakata N, et al. Influence of LINE-Assisted Provision of Information about Human Papillomavirus and Cervical Cancer Prevention on HPV Vaccine Intention: A Randomized Controlled Trial. Vaccines. 2022;10(12):2005. doi: 10.3390/vaccines10122005

Villegas J, Chen C-C (Brian), Lee MJ. Impact of social media messages on perceived risk and severity of adverse effects and regret of HPV vaccination: The moderating role of decision-making preference. J Clin Oncol. 2023;41(16_suppl):10543–10543.

Hong SJ, Kim Y. Relationship of Exposure to Contradictory Information and Information Insufficiency to Decision-Making About HPV Vaccination Among South Korean College Women. J Health Commun. 2023;28(3):156–67. doi: 10.1080/10810730.2023.2191224

Passos MZ, da Silva-Filho AL, Brandão WC, Meinberg MF, Werneck RA. Evaluating the quality of HPV vaccine-related information on the Portuguese Internet. Hum Vaccines Immunother. 2022;18(6):2104571. doi: 10.1080/ 21645515.2022.2104571

Llavona-Ortiz JY, Spanos KE, Kraschnewski JL, D’Souza G, Myrick JG, Sznajder KK, et al. Associations Between Human Papillomavirus Vaccine Decisions and Exposure to Vaccine Information in Social Media. Cancer Control. 2022;29:10732748 221138404. doi: 10.1177/1073274822 1138404

Ekmez F, Ekmez M. Effects of information sources in HPV vaccine acceptance: prospective randomized trial. Postgrad Med. 2022;134(8):829–33. doi: 10.1080/00325481.2022. 2124791

Tran PL, Chirpaz E, Boukerrou M, Bertolotti A. PROM SSCOL-Impact of a Papillomavirus Vaccination Promotion Program in Middle Schools to Raise the Vaccinal Coverage on Reunion Island. Vaccines. 2022;10(11): 1923. doi: 10.3390/vaccines10111923

Yi Y, Xiu S, Shi N, Huang Y, Zhang S, Wang Q, et al. Perceptions and acceptability of HPV vaccination among parents of female adolescents 9–14 in China: A cross-sectional survey based on the theory of planned behavior. Hum Vaccin Immunother. 2023;19(2):2225994. doi: 10.1080/ 21645515.2023.2225994

Silvia S, Jason W, Beckstead. M, Naveed K, Ellen M, Daley D, et al. An approach to targeted promotion of HPV vaccination based on parental preferences for social media content. J Soc Mark. 2023;13(3):341–60.

Marshall S, Moore AC, Fleming A, Sahm LJ. A Video-Based Behavioral Intervention Associated with Improved HPV Knowledge and Intention to Vaccinate. Vaccines (Basel). 2022; 10(4):562. doi: 10.3390/vaccines 10040562

Bradley-Ewing A, Lee BR, Doctor JN, Meredith G, Goggin K, Myers A. A pilot intervention combining assessment and feedback with communication training and behavioral nudges to increase HPV vaccine uptake. Hum Vaccin Immunother. 2021;18(1): 1885968. doi: 10.1080/21645515. 2021.1885968

Hecht ML, BeLue R, Ray A, Hopfer S, Miller-Day M, Mckee F. HPV Vaccine Intent among Adult Women Receiving Care at Community Health Centers. J Cancer Educ. 2022;37(4):1186-1193. doi: 10.1007/s13187-020-01937-5

Balogun FM, Omotade OO. Facilitators and barriers of healthcare workers’ recommendation of HPV vaccine for adolescents in Nigeria: views through the lens of theoretical domains framework. BMC Health Serv Res. 2022;22(1):824. doi: 10.1186/s12913-022-08224-7

Silverthorne C, Daniels J, Thompson M, Robson JC, Ndosi M, Swales C, et al. Health professionals’ perspectives on psychological distress and meeting patients’ support needs in rheumatology care settings: A qualitative study. Musculoskeletal Care. 2023;21(2):537–44. doi: 10.1002/msc.1730

Laudi A. Identifying the Roles of Medical Providers when Addressing Barriers to HPV Vaccination Rates in Rural NE Clinics. J Obstet Gynecol Reprod Sci. 2022;6(1):01–7.

Horn S, Chapman GB, Chouhan K. Doctor recommendations and parents’ HPV vaccination intentions in Kenya: A randomized survey. Prev Med reports. 2022;25:101659. doi: 10.1016/ j.pmedr.2021.101659

Tsui J, Vincent A, Anuforo B, Btoush R, Crabtree BF. Understanding primary care physician perspectives on recommending HPV vaccination and addressing vaccine hesitancy. Hum Vaccin Immunother. 2021;17(7):1961–7. doi: 10.1080/21645515. 2020.1854603

Wu H, Tong X, Wang L, Huang Y, Zhang L. HPV vaccine information, knowledge, attitude, and recommendation intention among male college students in China. Hum Vaccines Immunother. 2023;19(2): 2228163. doi: 10.1080/21645515.2023. 2228163

Jin SW, Lee Y, Brandt HM. Human Papillomavirus (HPV) Vaccination Knowledge, Beliefs, and Hesitancy Associated with Stages of Parental Readiness for Adolescent HPV Vaccination: Implications for HPV Vaccination Promotion. Trop Med Infect Dis. 2023;8(5):251. doi: 10.3390/tropicalmed8050251