The Knowledge–Uptake Gap in HPV Vaccination Among Medical Students: A Mixed Methods Study from North India

Abstract

Background: HPV vaccination is an effective way to prevent cervical cancer, but vaccine uptake among medical students in India remains low despite good awareness. We aimed to assess HPV-related knowledge, vaccine awareness, attitudes and vaccination uptake among undergraduate medical students, and to understand why many informed students still remain unvaccinated. Methods: We conducted a convergent mixed-methods cross-sectional study among MBBS students at a medical college in North India. A questionnaire was used to assess knowledge, awareness, attitudes, vaccination status and barriers to vaccination. Of about 600 eligible students, 285 completed the survey. We also conducted a focus group discussion with nine final-year students to explore personal, social and practical reasons behind vaccination decisions. Quantitative data were analysed using descriptive statistics and logistic regression, while qualitative data were analysed thematically. Results: Knowledge and attitude were generally good. Most students had heard of HPV (96.1%), knew that HPV infection is vaccinepreventable (93.3%), and considered vaccination necessary for medical students (88.1%). However, only 29.8% had received at least one dose and 20.4% were fully vaccinated. Female students were more likely to be vaccinated (aOR 1.97, 95% CI 1.12–3.46; p=0.018). Knowledge, vaccine-awareness and attitude scores were not independently associated with uptake. The focus group showed that family influence, cost, low perceived personal risk, delay, and the gap between knowing and acting were important reasons for non-vaccination. Conclusion: Good knowledge alone did not lead to vaccination. Easier access, clear medical advice and lower financial barriers may improve vaccine uptake among medical students.