A Cross-Sectional Study of Knowledge, Attitudes, and Perceptions toward HPV Vaccination Among Undergraduate Students Studying in Sarawak, Malaysia

Abstract

Background: Cervical cancer remains a significant public health problem, particularly in low- and middle-income countries, and is mainly caused by persistent infection with high-risk human papillomavirus (HPV). Despite Malaysia’s national HPV vaccination program, gaps in knowledge, misconceptions, and suboptimal vaccine uptake persist even among university students. Objective: This study aimed to assess HPV-related knowledge, attitudes and perceptions toward HPV vaccination among undergraduate students studying in Sarawak, and to identify sociodemographic factors associated with knowledge levels. Results: A total of 382 undergraduate students participated, of whom 55% were unvaccinated against HPV. Overall, HPV knowledge was moderate, with students from health faculties demonstrating higher HPV knowledge compared with those from non-health faculties ([aOR] = 2.0, 95% CI: 1.1-3.5; p = 0.016); Indian participants had significantly higher odds of high HPV-related knowledge compared with Malay participants (adjOR = 2.7, 95% CI: 1.0–7.0; p = 0.043). Vaccinated students have significantly higher HPV-related knowledge compared with unvaccinated students (adjOR = 1.9, 95% CI: 1.2-3.0; p=0.007). Attitudes toward HPV vaccination were generally positive, although concerns regarding cost, safety, and social stigma remained. Conclusion: Undergraduate students demonstrated moderate knowledge and positive attitudes toward HPV vaccination; however, notable knowledge gaps and misconceptions persist, particularly among non-health students and those who were unvaccinated. Targeted educational strategies and improved access to reliable information are essential to strengthen HPV prevention efforts.