Research Article: Perceptions of nurses on human papillomavirus vaccinations in the Republic of Korea

Date Published: February 6, 2019

Publisher: Public Library of Science

Author(s): Hae Won Kim, Hyang Yuol Lee, Seong Eun Kim, Hye Young Ahn, Yeon Hee Kim, Young Jin Lee, Italo Francesco Angelillo.


In June 2016, the Republic of Korea included free human papillomavirus (HPV) vaccinations for all 12-year-old girls in its national immunization program.

This study investigated perceptions of nurses on HPV vaccination and their intent to vaccinate preteens at the best ages.

Recruited for the survey were 514 health teachers (181, 35.2%), public health nurses (168, 32.7%), and clinical nurses (165, 32.1%). Factor-analysis was conducted to validate the Vaccine-Hesitancy Scale for Korean nurses. Related variables associated with vaccine-acceptance were examined using the Kruskal–Wallis test and Spearman’s rho coefficients, due to lack of normalization.

Factor-analysis results showed that two factors of positive acceptance (7 items) and negative acceptance (3 items) accounted for 67.46% of the total variance, and explained 47.4% and 20.1%, respectively. Nurses who positively accepted HPV vaccine differed significantly in agreement to vaccinate girls or boys. For the proper vaccination age, a significant difference emerged between answers for girls and vaccine-acceptance scores, whereas no difference emerged between answers for boys and the scores. The vaccinated status of respondents significantly related to higher HPV vaccine acceptance, although age, religion, marital status, education, and working duration did not.

This study showed that vaccine-acceptance levels reflect nurses’ attitudes and opinions about HPV vaccination for girls and boys.

Partial Text

The World Health Organization (WHO) raised vaccine-hesitancy—the hesitancy, delay, or refusal of vaccinations—as a global emerging concern, despite the availability of vaccination services [1–3]. Vaccine-hesitancy is present when vaccine-acceptance is lower than expected and is a country-specific phenomenon varying across time, place, and vaccines [3, 4]. Human papillomavirus (HPV) vaccine has been known as a cost-effective primary intervention to protect adolescents of both sexes from HPV infection and prevent several types of HPV-associated diseases such as genital warts and HPV-attributable (cervical/oropharyngeal/vulvar/vaginal/anal/penile) cancers [5–7]. However, a relatively lower uptake was found for the vaccine [8–10] among adolescent boys than girls in the United States [9, 11, 12]. HPV vaccination is most effective when given before one’s sexual debut (11–13 years), whereas vaccine uptake is clearly dependent on parental decisions for their children [12]. Vaccine safety was a major concern perceived by hesitant and antivaccine parents [13].

This was the first study to unveil nurses’ perceptions of HPV vaccination and intentions toward HPV vaccination among Korean nurses, using the Vaccine-Hesitancy Scale developed by Larson et al. [2]. The strength of this study was in recruiting three types of nurses—clinical nurses, public health nurses, and health teachers—who are caring for adolescent populations in the Republic of Korea. To design clinical or community-based interventions to increase the overall rates of HPV vaccinations in Korea, the most critical evidence was understanding actual healthcare providers’ attitudes; especially their hesitancy toward HPV vaccinations.

In this study, we developed a Korean version of the Vaccine-Hesitancy Scale related to the HPV vaccine, validated by nurses in Korea. This study showed that vaccine-acceptance levels of HPV vaccination among nurses significantly align with nurses’ attitudes and opinions about HPV vaccination for girls and boys.




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