HPV Knowledge and Associated Factors: Implication for Reducing Cervical Cancer Burden in the Hmong American Community

Background/Purpose: The Human Papillomavirus (HPV), a sexually transmitted disease, is known to be responsible for almost all cervical cancer cases (The Henry J. Kaiser Family Foundation, 2015). Previous studies show that increased HPV knowledge increases the likelihood of getting vaccinated against the disease (Licht et al., 2010; Tiro, Meissner, Kobrin, & Chollette, 2007). Certain minority and ethnic communities, however, continue to experience low vaccination rates despite a higher cervical cancer burden (Do et al., 2009; Gelman, Nikolajski, Schwarz, & Borrero, 2011; Nomura & Rahman, 2014). Hmong Americans (HA), a growing Asian American population, appear to be at risk. The cervical cancer incidence rate among HA women is three times higher than other Asian/Pacific Islanders (API) and more than four times higher than Non-Hispanic Whites (NHW) (Yang, Mills, & Riordan, 2004). Despite such alarming statistics, there is limited research focusing on HPV knowledge, vaccination uptake, and its associated factors in the HA community. Therefore the objectives of this study is to investigate: 1) the level of HPV knowledge; 2) initiation of the HPV vaccination and completion rates; and 3) factors associated with HPV literacy in HA community.  Andersen’s behavioral model of health services utilization, with its three components of predisposing, enabling and need factors, was used as the theoretical framework for this study (Andersen, 1995).

Methods: This study was conducted among HAs living in the Twin Cities metropolitan area in Minnesota. A self-administered paper and online health survey was conducted in the HA community, resulting in 192 participants who completed the survey.   

Results: Participants had a mean score of 4.76 (SD=1.67) for the 7-item questionnaire measuring HPV knowledge. The HPV vaccination initiation rate for 121 female participants was 46.3 percent (n=56) with 15 participants reporting having had a shot within the past year. Among the female participants who reported being vaccinated, a total of 32 participants (26.4%) completed the recommended three doses of the HPV vaccination. Multiple regression analysis showed that HA participants’ level of education (B=.229; β=.185; p<.05), number of doctor visits (B=.225; β=.188; p<.05), and cervical cancer screening literacy (B=.210; β=.173; p<.05) were significantly associated with HPV knowledge.

Conclusion/Implications: Results show that HAs were generally knowledgeable about HPV and HPV vaccination, yet more than half of the female participants were not vaccinated and only one quarter had completed the three doses. Participants’ level of education, number of doctor visits, and cervical cancer screening literacy were found to be significantly associated with HPV knowledge.  It is, therefore, important for health care providers to educate their HA patients about HPV and cervical cancer prevention to decrease the cervical cancer burden in this high-risk population.