Comparison of awareness, attitudes and knowledge on human papilloma virus vaccination in Singapore: 2019 versus 2013

Abstract Introduction: This study aimed to assess the changes in the awareness, attitudes and knowledge regarding human papillomavirus (HPV) vaccination among the local population. The secondary aims were to identify barriers and to evaluate the effectiveness of national HPV vaccination campaigns over a six-year period in Singapore. Methods: We conducted and compared two cross-sectional surveys in 2013 and 2019 among female participants attending a general gynaecology clinic. Results: A total of 597 participants completed the survey in 2013 and 2019. The participants were comparable in their race, marital status, educational level, occupation and monthly household income. Knowledge scores for cervical cancer and HPV infection showed significant improvement from 2013 to 2019. There was no significant difference in knowledge scores for HPV vaccination, which resulted in similar uptake of the HPV vaccine. Age, educational level and knowledge of HPV vaccine were significant predictors of acceptance of the HPV vaccine. The top two reasons for declining the HPV vaccine were the lack of knowledge and cost, as noted in the 2019 survey. Conclusion: The Singapore government’s efforts to improve cervical cancer awareness through national campaigns and policy changes have led to an improvement in knowledge of HPV infection. However, this has not translated into improvements in the vaccine acceptance rates. The decision for vaccine uptake is complex, and there are multiple factors to be addressed to ensure cost-effective implementation of the strategies. Our study highlights the need for effective dissemination of vaccine information, additional subsidies and consideration of a mandatory school-based vaccination programme.