# Knowledge of human papillomavirus and self-sampling, including vaccination practices among female students in Free State, South Africa

## TL;DR

This study explores HPV knowledge, vaccination practices, and self-sampling awareness among female university students in South Africa, revealing significant gaps in awareness and vaccine uptake.

## Contribution

The study provides insights into HPV knowledge and vaccine hesitancy among South African female students, highlighting the need for targeted educational interventions.

## Key findings

- Only 9.7% of participants demonstrated good knowledge of HPV vaccination.
- 78.2% of participants were unaware of HPV self-sampling.
- Lack of information and safety concerns were the main barriers to HPV vaccine uptake.

## Abstract

Human papillomavirus (HPV)-related cancers, especially cervical cancer, remain highly prevalent in low- and middle-income countries, despite the availability of preventive measures such as vaccination and self-sampling screening, due to limited HPV awareness. The study aimed to assess the knowledge of HPV, HPV vaccination practices, and HPV self-sampling awareness and perceptions among female students at the University of the Free State in Bloemfontein, South Africa.

Data were collected from female university students through a self-administered questionnaire distributed via the secure web-based platform Research Electronic Data Capture (REDCap). HPV infection and vaccination knowledge were measured using a self-administered questionnaire. Knowledge was assessed by assigning one (1) point for each correct answer, while incorrect or “don't know” responses received a score of zero (0). A knowledge score above 75% was categorized as “good knowledge.” The data were analyzed using SAS version 9.4.

The study included 381 participants with a median age (interquartile range, IQR) of 23.0 (20–26) years. The findings showed that while 40.9% of participants had good knowledge of HPV infection, only 9.7% demonstrated good knowledge of HPV vaccination, and 13.3% had good overall knowledge. Only 13.4% of participants reported having received the HPV vaccine, while 19.1% expressed unwillingness to receive the vaccine. Barriers to vaccine uptake included lack of information about the HPV vaccine (46.0%) and safety concerns (46.0%). The majority (78.2%) were unaware of HPV self-sampling. Having heard about HPV self-sampling was predictive for HPV knowledge (OR: 2.684, 95% CI: 1.389–5.188, p = 0.003).

These findings suggest that while some participants are informed about HPV infection, the majority are not well-informed about HPV vaccination and are unaware of HPV self-sampling. Additionally, barriers to HPV vaccination persist. Targeted educational interventions are needed to address awareness and knowledge gaps and vaccine hesitancy. These interventions could significantly improve HPV and cervical cancer prevention outcomes.

The online version contains supplementary material available at 10.1007/s10552-025-02049-5.