Knowledge, Attitude and Practice Towards Human Papillomavirus Infection and Vaccination Among Undergraduate Medical Students and Interns: An Institution-Based Cross-Sectional Study

Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide and is strongly associated with cervical cancer, which remains a significant cause of morbidity and mortality among women, particularly in developing countries. Persistent infection with high-risk HPV genotypes is implicated in the pathogenesis of nearly all cases of cervical cancer, as well as other anogenital and oropharyngeal cancers.¹ Prophylactic HPV vaccines have demonstrated high efficacy in preventing HPV infection and associated precancerous lesions when administered before exposure to the virus.² Despite the proven effectiveness and safety of these vaccines, HPV vaccination coverage remains low in many regions, including India, due to lack of awareness, misconceptions, sociocultural barriers, and vaccine hesitancy.³ Medical students and interns represent future healthcare providers who will play a key role in counselling patients, recommending vaccination, and implementing preventive strategies. Their knowledge, attitude, and practices regarding HPV infection and vaccination can significantly influence public acceptance and uptake of the vaccine. Assessing these parameters is essential to identify gaps and guide educational interventions. The present study was undertaken to assess the knowledge, attitude, and practices towards HPV infection and vaccination among undergraduate medical students and interns at Tezpur Medical College and Hospital.

MATERIALS AND METHODS

An institution-based cross-sectional study was conducted at Tezpur Medical College and Hospital of Sonitpur district of Assam. The study population included undergraduate medical students from 1st year to 4th year MBBS and interns enrolled during the study period, from 1^st November, 2025 to 30^th November,2025. Inclusion criteria included all undergraduate students and interns who gave consent. Exclusion criteria included: (1) undergraduate students who were absent during the period of study and (2) those who were unwilling to participate. All eligible students and interns were invited to participate (n = 653). These included 125 first-year students, 128 second-year students, 123 third-year students, 133 fourth-year students, and 144 interns. Participation was voluntary. Data were collected using a structured, self-administered questionnaire developed after reviewing relevant literature. The questionnaire consisted of four sections: sociodemographic characteristics, knowledge regarding HPV infection and vaccination, attitude towards HPV vaccination, and practices related to HPV vaccination. The tool was pre-tested and modified for clarity. The questionnaire was distributed electronically after obtaining informed consent. A total of 272 participants completed the questionnaire and were included in the final analysis, yielding a response rate of 41.6%. Data were entered into Microsoft Excel and analysed using descriptive statistics. Results were expressed as frequencies and percentages. Ethical approval for the study was obtained from the Institutional Ethics Committee of Tezpur Medical College and Hospital. Confidentiality and anonymity of the participants were maintained.

RESULT AND DISCUSSION

Of the 653 undergraduate medical students and interns eligible to participate in the study, 272 completed the questionnaire, resulting in a response rate of 41.6%. The breakdown of participants by academic year is shown in Table 1. Most participants were in their third year MBBS (40.1%), followed by second year (18.8%), fourth year (15.4%), interns (14.7%), and first year (11.0%). The inclusion of students from all academic years enabled a holistic assessment of knowledge, attitude, and practices at various points of medical education.

TABLE 1: DISTRIBUTION OF STUDY PARTICIPANTS ACCORDING TO ACADEMIC YEAR (N = 272)

Knowledge Regarding HPV Infection and Vaccination

The participants' knowledge of HPV infections was adequate. 93.0% of the participants, identified the link between chronic HPV infections and cervical cancer. This is consistent with the global research with the causal link between high-risk HPV types and cervical cancer, as observed in the Global Cancer Statistics 2018, GLOBACON, by Bray et al. (2018)¹. Healthcare students in India also reported similar awareness according to Pandey et al. (2012)? and Mehta et al. (2013)?, implying that the awareness of cervical cancer and sexually transmitted infections is sufficiently covered in the undergraduate teaching curriculum. Nonetheless, participants showed lack of knowledge in several areas. 59.2% identified that HPV infections may cause cancer in men. Pandey et al. (2012)? and Patel et al. (2017)? have identified similar gaps in HPV knowledge. This lack of understanding may reduce the argument for gender inclusive vaccination programs. Future healthcare providers need to know that both men and women are at risk of HPV-related anogenital and oropharyngeal cancers. 78.7% of participants recognized HPV types 16 and 18 as major oncogenic strains and demonstrated a fair understanding of the virology involved. However, there were knowledge gaps concerning the vaccine schedule and eligibility criteria, indicating that there are gaps in understanding the practical aspects of immunization, demonstrating the need for more targeted teaching modules.

TABLE 2: KNOWLEDGE REGARDING HPV INFECTION AND VACCINATION AMONG PARTICIPANTS (N = 272)

Attitude Towards HPV Vaccination

Most of the participants had a positive attitude towards the HPV vaccination. 10 out of 11 participants stated that the HPV vaccination is a recommended way to prevent cervical cancer and should be suggested to patients, by their physicians. This agrees with findings from Mehta et al. (2013)? and Chawla et al. (2016)?, who also found supporters of the HPV vaccination as a preventive measure, from the medical students and healthcare professionals that they studied. Greater than 95.2% of participants are in support of giving the HPV vaccination, free of charge, or at a subsidized price. This adds to the understanding of the impact that financial barriers have on the uptake of the HPV vaccination in India, as stated in the publications by Sankaranarayanan et al. (2019)³ and Bruni et al. (2016)?. In addition to this, 83.8% of the participants said that they perceive the cost to be a large barrier, which adds to the importance of policy changes regarding this issue. 85.3% of the participants agreed that males should also be vaccinated. This shows changing views on the gender neutral vaccination practice as HPV virus is implicated in oropharyngeal and anogenital cancers. In the context of increasing worldwide recommendations, this is essential.

TABLE 3: ATTITUDE TOWARDS HPV VACCINATION (N = 272)

Practices Related to HPV Vaccination

Despite satisfactory knowledge and favourable attitudes, actual vaccination uptake was low. Only 13.6% of participants reported having received the HPV vaccine. This discrepancy between knowledge and practice has been consistently observed in previous studies among medical students and healthcare workers, including those by Chawla et al. (2016)? and Holman et al. (2014)¹?. Among unvaccinated participants, the most frequently cited barriers were cost (71.1%), lack of adequate information (60.4%), perceived low personal risk (41.7%), and uncertainty regarding eligibility (32.3%). Similar structural and perceptual barriers have been described by Sankaranarayanan et al. (2019)³ and Holman et al. (2014)¹?. These findings suggest that limited access and insufficient practical awareness, rather than negative attitudes, are the primary obstacles to vaccine uptake. Encouragingly, 94.1% of participants expressed willingness to receive vaccination if provided free or at subsidized rates. This indicates that institutional vaccination programs could substantially improve coverage among medical students. Furthermore, 65.4% reported counselling others regarding HPV vaccination, and 89.3% stated that they include HPV advice during patient counselling. While these figures reflect professional responsibility, the low personal vaccination rate highlights a need for self-implementation of preventive practices.

TABLE 4: PRACTICES RELATED TO HPV VACCINATION (N = 272)

FIG. 1: HPV VACCINATION STATUS AMONG PARTICIPANTS (N = 272).

 his figure depicts the proportion of undergraduate medical students and interns who had received the HPV vaccine. Only 13.6% reported being vaccinated, while 86.4% were not vaccinated, indicating a substantial gap between awareness and vaccination uptake.

TABLE 5: REASONS FOR NON-VACCINATION AGAINST HPV (MULTIPLE RESPONSES ALLOWED, N = 235)

FIG. 2: REASONS FOR NON-VACCINATION AGAINST HPV (N = 235).