Judith Henninger MPH 2009
Human papillomavirus (HPV) is one of the most common sexually transmitted infections and nearly all cervical cancers are causally related to infections by HPV. Gardasil, a quadrivalent HPV vaccine, has recently been placed on the New Zealand immunisation schedule. This announcement has stimulated widespread media attention focusing on the pros and cons of HPV vaccination of pre-adolescents and adolescents. General practitioners (GP) and Practice nurses (PN) perform the majority of cervical screening in Christchurch and will also have a key role in promoting or discouraging uptake of HPV immunisation. Therefore it is essential that they are accurately informed in order to provide patients with the information and counseling necessary to meet the challenges of HPV management and prevention.
The objectives of this study were to examine Christchurch GP and PN general knowledge about HPV and HPV immunisation, identify their attitudes and practices about HPV and HPV immunisation, to discover what information they consider important and to whom they turn for information to guide their HPV-related practices.
A self-administered, anonymous questionnaire was distributed to 396 GPs and PNs practicing in Christchurch who attended peer-led small group meetings sponsored by Pegasus IPA from 5 May – 21 May, 2008. The overall participation rate was 39%. Data analysis was conducted and reported using the EpiInfo Complex-sample analysis programme and comparisons were made between provider specialties.
Christchurch GPs and PNs know that HPV is a very common STI and that it is necessary for the development of cervical cancer. Importantly, they are also aware the cervical screening will need to continue, even after immunisation against HPV. However, a significant proportion of these providers are less aware of differences between viral types included in the HPV vaccines relative to their disease outcomes or understand that most HPV infections do not require medical intervention. It is possible that these inconsistencies in knowledge may impact HPV management and patient counseling messages. While GPs and PNs alike are confident that their patients will comply with their recommendations about cervical screening and HPV vaccination, PNs were more likely than GPs to report discomfort discussing sexual behaviour with adolescents. They also favour immunisation for younger females over older females and are more likely to indicate that HPV vaccination may lead to increased risk-taking sexual behaviour. The Independent Provider Association (IPA) was reported to be the most valuable source of new information about HPV and HPV vaccines by both GPs and PNs. While GPs indicated the need for more information about evidence-based HPV facts, PNs reported that they would like more training about HPV counseling and psychosocial issues related to HPV.
This study has identified areas where HPV knowledge can be improved upon among Christchurch GPs and PNs. It has also discovered significant differences between GPs and PNs in their attitudes about adolescent sexual behaviour and communication challenges pertaining to HPV- related issues. Also, importantly, a difference in intention to recommend the HPV vaccine to adolescents by age between the two provider specialties was identified. The findings of this study may be useful for guiding the development of training, education and communication tools so that GPs and PNs are able to confidently discuss HPV and HPV vaccines with their patients. The findings of this study can also be used to inform programmes and policies which will improve general knowledge about HPV, direct the planning and policy of vaccine delivery, and inform public relations efforts.