Patient-Reported Outcome Measures to Inform HPV Vaccination Strategies in University Students

Abstract

Introduction

Patient-reported outcome measures (PROMs) are essential tools to inform improvements in healthcare quality, to determine what matters to individuals in care and to guide clinical and prevention decision-making. Timely vaccination of university students is a cost-effective strategy to reduce infection rates and the burden of Human Papillomavirus (HPV)-associated consequences including various types of cancer. In fact, a recent meta-analysis found that university students exhibit limited awareness of HPV and vaccination, with about half willing to be vaccinated.

Objectives

The present study aims to assess university students’ knowledge, attitudes, and perceptions regarding HPV infection and HPV vaccination, as well as the factors influencing vaccine uptake and vaccination intention. The study seeks to identify the sociodemographic, behavioral and psychosocial determinants associated with both actual vaccination adherence and future vaccination intentions. By providing a comprehensive understanding of the drivers and barriers to HPV vaccine acceptance among university students, the findings are expected to support the development of targeted educational and public health interventions aimed at improving HPV vaccination coverage in this population.

Methods

A cross-sectional observational study was conducted on a sample of students at the University of Catania enrolled during the three open days conducted at the University of Catania to promote HPV vaccination in students, during the years 2025 and 2026. A structurated questionnaire was administered to collect sociodemographic and behavioral information as well as to assess participants' knowledge and attitudes. The data were analyzed using descriptive statistics, logistic regression, and clustering to identify behavioral determinants and profiles.

Results

A total of 270 students (mean age 22.1 years ± 3.16), 69,5 female, were enrolled. A marked gender difference in HPV vaccination coverage was shown with approximately 66% of female students having received the vaccine compared with only about 33% of male students. A total of 75% of vaccinated individuals came from families with at least a high school diploma or university degree. Knowledge of the HPV-cervical cancer link exceeded 90%, while knowledge relating to other HPV associated pathologies were at around 40-45%. Logistic regression analysis identified trust in the vaccine and health authorities as the main predictors of vaccination intention, while low risk perception and confidence in natural immunity represented barriers. This model showed good predictive power (accuracy 73%; AUC 0.78). Cluster analysis identified three distinct student profiles: a group characterized by positive attitudes toward vaccination and high levels of knowledge, a group that was well-informed but hesitant, and a third group consisting of skeptical and poorly informed individuals.

Conclusions

PROMs are useful tools to explore students’ self-reported awareness of HPV-related diseases, perceived susceptibility and severity, beliefs about vaccine effectiveness and safety, and willingness to receive or recommend HPV vaccination. Results of the present study emphasize the importance of developing targeted, evidence-based interventions, including personalized educational initiatives and multidisciplinary collaborations, to reduce disparities and enhance vaccine uptake among university students.