Knowledge, attitudes and intentions of general practitioners and practice nurses and Christchurch and HPV and HPV vaccines

Background: Human papillomavirus (HPV) is a very common sexually transmitted infection (STI) and nearly all cervical cancers are causally related to infections by HPV. Gardasil®, a quadrivalent HPV vaccine, is now on the New Zealand immunization 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 immunization. Therefore, it is essential that they are accurately informed in order to provide patients with information and counseling necessary to meet the challenges of HPV management and prevention. Objectives: The objectives of this study were to examine Christchurch GP and PN general knowledge about HPV and HPV immunization, identify their attitudes and intentions about HPV and HPV immunization, to discover what information they consider important and to whom they turn for information to guide their HPV-related practices. Methods: 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 Health Independent Provider Association (IPA) from 5 May 21 May, 2008. Data analysis was conducted and reported using the Epiinfo Complex-sample analysis program and comparisons were made between provider specialties. Results: The overall participation rate was 39%. Christchurch GPs and PNs know that HPV is a very common sexually transmitted infection (STI) and that it is necessary for the development of cervical cancer. Importantly, they are also aware that cervical screening will need to continue, even after immunization against HPV. This study found that some providers may be unaware of differences between viral types included in the HPV vaccines relative to disease outcomes and some may not understand that most HPV infections do not require medical intervention. While both GPs and PNs are confident that their patients will comply with recommendations about cervical screening and HPV vaccination, GPs were more likely than PNs to report being comfortable discussing sexual behavior with adolescents. PNs intend to recommend immunization for older female adolescents over younger females and are more likely to indicate that HPV vaccination may lead to an increase in risky sexual behavior than GPs. The Independent Provider Association (IP A) 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. Conclusions: This study has identified an overall good level of HPV knowledge and has identified areas where 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 behavior and communication challenges pertaining to HPV-related issues. In addition, 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 materials and communication tools which will enhance GPs and PNs capacity to discuss HPV and HPV vaccines with their patients. The findings of this study may also be used to inform programs and policies which will improve general knowledge about HPV, direct the planning and policy of vaccine delivery, and inform public relation efforts.