Perceptions and practices among students, parents, and teachers of the Human Papillomavirus (HPV) Vaccination: A pilot feasibility study from Rural Kerala.

Abstract

India bears the world's highest cervical cancer burden, yet awareness and uptake of the effective HPV vaccine remain low. Although Kerala has initiated pilot HPV vaccination programmes, stakeholder knowledge, attitudes, and practices (KAP) are not well documented. This pilot study aimed to assess the feasibility of a KAP study and to identify gaps in the questionnaire, and refine study procedures (tool and process refinement) for a future large-scale analytical study. A cross-sectional pilot study was conducted in a school in Pulinkunnu, Kerala, among students aged 11-15 years, their parents, and teachers. A structured, validated questionnaire, developed in English, translated into Malayalam, was administered during school hours. Responses were entered into secure electronic spreadsheets. Descriptive statistics were used to summarise questionnaire responses and assess the feasibility, clarity, and performance of study items. As this pilot study was designed primarily to refine study procedures and measurement tools rather than test hypotheses, no inferential or multivariable analyses were performed. The pilot included 75 students and 20 teachers; no parents participated despite planned recruitment, highlighting an important feasibility challenge for the proposed full-scale study. Among participants, females constituted the majority. HPV-related knowledge was low across groups, with widespread misconceptions and limited awareness of vaccine availability and cervical cancer screening. Attitudes toward vaccination were mixed, marked by safety concerns and modest willingness to receive or recommend the vaccine. Practices reflected low prior awareness and uptake, with few respondents having heard of or received the HPV vaccine. This pilot revealed major gaps in HPV-related knowledge, attitudes, and practices among participating students and teachers, while also identifying important methodological challenges, particularly parental recruitment and questionnaire refinement. The findings support modifications to recruitment strategies, study procedures, and measurement tools before implementation of a larger analytical study.