Knowledge, Attitudes, and Perceptions of Human Papillomavirus and HPV Vaccination Among Adults in Armenia
Vahe Badalyan (1,*), Kristina Arutyunyan (2,3)
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Yerevan State Medical University after Mkhitar Heratsi, 2 Koryun St, Yerevan 0025, Armenia, vahe2002badalyan@gmail.com
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International Healthcare Organization, Los Angeles, CA, USA
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University of California, Los Angeles, 330 De Neve Drive, Los Angeles, CA 90095, USA
*Corresponding author.
Published: September 2026
DOI: https://doi.org/10.58417/TLQH1151
Abstract
Background: The human papillomavirus (HPV) is the principal etiologic agent of cervical
cancer, with HPV vaccination becoming an important component of cervical cancer prevention.
Armenia introduced HPV vaccination into its National Immunization Program in 2017 but uptake
has remained below the World Health Organization (WHO) elimination target. Misinformation and
vaccine hesitancy have been identified as important barriers.
Methods: A cross-sectional, anonymous online survey was conducted among adults aged 18
years and older in Armenia using convenience sampling. The survey was a 13-question survey in
Google Forms shared to university students and community members and conducted by students of
Yerevan State Medical University and the International Healthcare Organization. The questionnaire
consisted of dichotomous, multiple-response, and open-ended questions about demographics, HPV
knowledge, awareness of and attitudes toward the HPV vaccine, perceived barriers, and trusted
sources of information, with 163 responses analyzed by descriptive statistics.
Results: The sample was mostly female (94.5%) and urban (95.7%). Of 162 valid responses,
92.6% had heard of HPV before. Of all 163 participants, 82.8% were aware of HPV as a cause of
cervical cancer and 74.8% were aware of the HPV vaccine. Of 162 valid responses, 50.0% would be
willing to take the vaccine or vaccinate their daughter if the vaccine was safe and available and
43.2% were unsure. The most commonly identified barriers were safety concerns and lack of
information. Only 33.1% reported complete trust in information on HPV vaccine provided by
healthcare professionals, while 54.6% reported partial trust.
Conclusions: In this convenience sample, HPV awareness was relatively high but uncertainty
about vaccination and concerns about safety and information were common. Findings support
targeted, evidence-based communication, stronger engagement with healthcare providers and
further research in more representative Armenian populations.
Keywords: Human Papillomavirus (HPV); HPV vaccination; vaccine hesitancy; Armenia; Knowledge, Attitudes, and Perceptions (KAP)
Introduction
Human papillomavirus (HPV) is the most common sexually transmitted viral infection
worldwide and is the principal cause of cervical cancer. Although most HPV infections are transient
and cleared spontaneously by the immune system, persistent infection with high-risk HPV
genotypes, particularly HPV-16 and HPV-18, is responsible for the vast majority of cervical cancer
cases. HPV is also associated with other anogenital malignancies, including anal, vulvar, vaginal,
and penile cancers, as well as oropharyngeal cancer and benign conditions such as genital warts.
Despite the availability of highly effective prophylactic vaccines, HPV infection remains a major
global public health challenge (1).
The World Health Organization (WHO) recognizes cervical cancer as one of the few
cancers that can be eliminated as a public health problem through comprehensive prevention
strategies. The WHO Global Strategy for the Elimination of Cervical Cancer is based on the
90-70-90 targets, wherein 90% of girls are fully vaccinated against HPV by age 15, 70% of women
are screened by ages 35 and 45, and 90% of women with precancerous lesions or invasive cancers
receive appropriate treatment (2). However, vaccination coverage remains below target in many
countries because of limited public awareness, vaccine hesitancy, misinformation, inequitable
access to vaccination services, and inconsistent recommendations from healthcare providers (2,3).
In Armenia, HPV vaccination was introduced into the National Immunization Program in
2017. According to the WHO, HPV vaccination coverage among the primary target population was
8% in 2018, and increased to 26% by 2023. This, however, remains below the WHO target of 90%
coverage (4). Vaccine uptake has remained lower than desired, largely because of vaccine hesitancy
and misinformation among both the public and healthcare professionals (4).
Previous studies in Armenia have also identified challenges related to HPV vaccination.
One such study was focused on physicians in Yerevan, the capital of Armenia, and found physicians
had gaps in knowledge regarding HPV vaccination, suggesting that additional training may help
improve understanding and confidence in vaccination programs (5). Another, more recent study
among unvaccinated women in Armenia also identified a measurable burden of high-risk HPV
infection, further emphasizing the importance of vaccination and screening in the country (6).
Understanding public knowledge, attitudes, perceptions, and barriers regarding HPV
infection and HPV vaccination is essential for developing targeted educational strategies and
evidence-based public health interventions aimed at increasing vaccine acceptance and reducing the
burden of HPV-related diseases (1).
The present study aimed to evaluate knowledge, attitudes, and perceptions regarding HPV
infection and HPV vaccination among adults participating in the convenience sample in Armenia
and to identify the main barriers associated with HPV vaccine acceptance.
Materials and Methods
This study utilized a cross-sectional approach to conduct an assessment of knowledge,
attitudes and perceptions regarding HPV and HPV vaccination among adults in Armenia.
Participants were eligible to participate in the study if they were 18 years of age or older, and
voluntarily completed the anonymous online questionnaire. The survey was conducted from June
27, 2026 to July 4, 2026.
The questionnaire consisted of 13 questions and was created for this study using Google
forms by students from Yerevan State Medical University and the International Healthcare
Organization (IHO). Participants were asked questions regarding their understanding of HPV and
vaccination, their attitudes toward receiving the vaccination, the importance of cervical cancer
screening, and ways to improve the understanding citizens have about HPV vaccination and cervical
cancer. The survey included yes/no, multiple select, and open-ended questions.
Students from Yerevan State Medical University in Yerevan, Armenia, along with students
from the International Healthcare Organization (IHO) distributed the survey to students at Yerevan
State Medical University, and community members, throughout Armenia using convenience
sampling. Distribution of the survey was done by students, who shared the link through social
media and other messaging platforms.
A total of 163 responses were received and analyzed. The survey responses were analyzed
using descriptive statistics, and frequencies and percentages were calculated for each survey
question. Percentages were calculated using the number of valid responses for each question. For
multiple select questions, participants could select more than one response; therefore percentages
may sum to more than 100%.
This paper was designated as exempt from IRB approval by the Institutional Review
Board (IRB), since no identifying information was taken, the participants remained anonymous, no
invasive interventions were done, the study was completely optional, and all participants expressed
informed consent prior to participation.
Results
A total of 163 participants completed the online questionnaire. The majority of
participants were female (154, 94.5%), while males represented a small proportion of the study
population (9, 5.5%). Participants were aged 18 years and older. The largest age group was 35–44
years (58, 35.6%), followed by 18–24 years (36, 22.1%), 45 years and older (36, 22.1%), and 25–34
years (33, 20.2%). Most respondents resided in urban areas (156, 95.7%), whereas only 7 (4.3%)
lived in rural areas.
Of the 162 valid responses, 150 respondents (92.6%) reported that they had previously
heard of human papillomavirus (HPV). A total of 135 participants (82.8%) correctly identified that
HPV is associated with cervical cancer. The percentages reported for participants who did not know
or were uncertain of the association between HPV and cervical cancer accounted for the remaining
28 individuals, with 23 individuals (14.1%) reporting they did not know and 5 individuals (3.1%)
who were unsure.
Overall, 122 respondents (74.8%) were aware that a vaccine is available to prevent HPV
infection, whereas 41 (25.2%) were not aware of its availability. Of the 162 participants who
responded to the willingness question, 81 (50.0%) stated that they would be willing to receive the
HPV vaccine, or vaccinate their daughter, if they knew the vaccine was safe and available. In
contrast, 70 individuals (43.2%) were uncertain, while 11 (6.8%) reported that they would not
choose vaccination even if it were safe and available.
The question addressing barriers had 156 valid responses and allowed participants to
select more than one response. When calculated using the full study sample (N=163), the most
frequently reported barriers to HPV vaccination included concerns about vaccine safety (86,
52.8%), lack of information about HPV vaccination (71, 43.6%), the absence of a recommendation
from a healthcare provider (17, 10.4%), and high cost (3, 1.8%).
Participants identified healthcare professionals, the internet, and social media as sources
of information regarding HPV and HPV vaccination. When asked whether they trusted information
about HPV vaccination provided by healthcare professionals, 54 individuals (33.1%) answered
"yes," 89 individuals (54.6%) reported partial trust, and 20 individuals (12.3%) answered "no."
Discussion
The current study investigated knowledge, attitudes and perceptions of HPV infection and
vaccination among adults participating in a convenience sample in Armenia. While most
participants were aware of HPV and its link to cervical cancer, the findings suggest that awareness
alone may not be sufficient to improve vaccine uptake. Notably, while nearly three-quarters of
participants were aware that an HPV vaccine exists, only half indicated a willingness to be
vaccinated or vaccinate their daughter, with a substantial portion of respondents remaining uncertain
about vaccination. The gap between awareness and acceptance represents an important challenge
for public health efforts, suggesting that knowledge of HPV alone does not necessarily translate into
confidence in vaccination.
The most commonly reported barriers to vaccination were concerns about safety and lack
of information. Similar findings have been reported in previous studies where safety concerns,
misinformation and lack of access to reliable health information have consistently been identified as
significant factors contributing to HPV vaccine hesitancy worldwide (7). Extensive evidence
supports the safety and efficacy of HPV vaccination (8). However, misconceptions continue to
influence public perception of vaccination and become a barrier to vaccine uptake (7). Given that
HPV vaccination has already been incorporated into Armenia's national immunization program,
these findings suggest that concerns related to confidence, education, and communication may
remain important barriers to vaccine acceptance. These results suggest that strategies to improve
public knowledge of HPV vaccination should focus not only on increasing awareness but also on
addressing common misconceptions and providing clear, evidence-based information.
Healthcare professionals were identified as an important source of information among
participants, however the level of trust must be interpreted with caution. Only 33.1% of participants
reported full trust in the information they received about HPV vaccination from their healthcare
professional, while 54.6% reported partial trust. Many respondents identified healthcare
professionals as one of their primary sources of information and reported some level of trust in the
advice they received. In addition, participants felt that stronger physician recommendations and
more public education would help to increase vaccination rates. Together, these findings emphasize
the important role of healthcare professionals in shaping decisions about vaccination. Discussions
between patients and trusted providers are valuable opportunities to answer questions, address
concerns and correct misinformation, all of which may help to improve vaccine confidence (5).
The internet and social media were also frequently cited sources of information. Although
both provide access to health information, they must be considered separately. The internet includes
sources for healthcare through health organization websites, and search engines. Social media, on
the other hand, allows information to be readily spread through user-generated content. These
platforms have expanded access to health information, but have also facilitated the spread of
misinformation (9). This could, in part, explain why several participants were still reluctant to
receive the vaccine despite their knowledge of HPV and its association with cervical cancer.
Expanding evidence-based educational campaigns across both healthcare and digital settings may
therefore provide an opportunity to improve public understanding and counter misinformation (10).
The value of broader educational efforts was also recognized by participants. Many
participants believed that raising public awareness, strengthening physician recommendations and
expanding educational campaigns would improve HPV vaccine acceptance in Armenia. These
answers suggest that more than just vaccine availability will likely be necessary to improve
vaccination rates. Educational programs that foster trust, improve health literacy, and provide
consistent messaging from healthcare professionals may be equally important in strengthening
public confidence (10). Such efforts are also in alignment with the World Health Organization’s strategy
of eliminating cervical cancer by increasing HPV vaccination coverage worldwide (2,8).
Although limitations to the current study exist, this study offers important insights into
factors that may influence acceptance of HPV vaccine in Armenia. This study, therefore, contributes
additional evidence regarding HPV awareness, vaccine attitudes, and perceived barriers among
adults participating in this sample. The findings point to a range of barriers which can be addressed
through targeted public health interventions, notably increasing access to reliable information and
improving communication between health professionals and the public. Future research involving
larger and more representative populations, including participants from rural communities and a
more balanced representation of men and women, would help build on these findings and further
inform national vaccination strategies. These studies could evaluate whether interventions such as
healthcare provider education, patient counseling, or targeted digital education campaigns improve
HPV vaccine knowledge, confidence and acceptance.
Limitations
These findings should be understood with several limitations in mind. The study utilized a
convenience sample through an anonymous online questionnaire, which may limit the
generalizability of the findings. Individuals with internet access or greater interest in health-related
topics may have been more likely to participate. Furthermore, the sample was predominantly female
and urban, which limits the extent to which these findings can be generalized to the wider Armenian
population. In addition, some survey items had missing responses, resulting in different
denominators across analyses. Finally, the cross-sectional design only captures the participants’
views at a single point in time and does not allow for conclusions regarding causal relationships
between knowledge, attitudes and vaccine acceptance.
Another limitation is the relatively small amount of published research examining HPV
knowledge, attitudes, and vaccine acceptance among adults in Armenia. Although previous studies
have examined HPV-related topics in selected Armenian populations, the limited availability of
directly comparable studies restricted the extent to which the present findings could be compared
with previous research conducted within Armenia.
Conclusion
Overall, the findings indicate that raising awareness alone is not sufficient to boost HPV
vaccination coverage among participants of this study. Improving confidence in HPV vaccination
may require addressing concerns about vaccine safety, reducing the spread of misinformation, and
supporting healthcare professionals to give accurate, evidence-based recommendations.
Strengthening these efforts could help increase vaccine uptake and support ongoing efforts to
reduce the burden of cervical cancer and other HPV-related diseases.
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How to Cite: Badalyan, V. and K. Arutyunyan. "Knowledge, Attitudes, and Perceptions of Human Papillomavirus and HPV Vaccination Among Adults in Armenia." Journal of Healthcare Solutions, vol. 4, no. 3, 2026.