Assessing knowledge, attitudes, and barriers toward HPV cervical cancer and vaccination among female university students in Bangladesh

Human papillomavirus (HPV) is a leading cause of genital warts and cervical cancer (CC), which was reported as the second most common malignancy among women in Bangladesh in 2020. While vaccination against HPV stands out as the most effective strategy for preventing CC, however, misconceptions about its safety, effectiveness, and benefits may impact its prevalence. This study aimed to evaluate the knowledge of HPV infection, CC, and vaccination, as well as the attitudes and willingness to receive the vaccine among female university students in Bangladesh. A cross-sectional survey was conducted to collect primary data from 800 university students through face-to-face interviews. A well-structured questionnaire was administered to collect data on socio-demographic characteristics, knowledge of HPV infection, CC, and vaccination, as well as attitudes and willingness regarding vaccination. Multivariable logistic regression was used to identify factors influencing knowledge about HPV infection and CC. Moreover, Structural Equation Modeling (SEM) explored direct and indirect pathways affecting knowledge, attitudes, and willingness, validated by goodness-of-fit indices. Students with sexual health education demonstrated higher awareness of HPV infection and cervical cancer, with 23.4% having good knowledge, compared to only 11.0% without such education. Difficulty accessing healthcare increased the odds of poor knowledge in the unadjusted model (COR: 1.72. 95% CI: 1.01-2.93), whereas students from Khulna had higher odds (AOR: 4.45, 95% CI: 1.24-15.88). Moreover, 44.8% of participants recognized that the HPV vaccine prevents cervical cancer, and 64.7% were unsure of its effectiveness. The SEM highlights that attitude is the strongest predictor of vaccination willingness (0.61), while HPV vaccination knowledge has a moderate impact (0.46). University female students have limited knowledge about HPV, CC, and vaccination, yet they are willing to receive the HPV vaccine. This highlights the need for the government to implement educational initiatives and health counseling to increase awareness and empower informed health decisions.