Focus Group Study of Chinese International Students’ Knowledge and Beliefs About HPV Vaccination, Before and After Reading an Informational Pamphlet About Gardasil®


An increasing need for Human Papillomavirus (HPV) vaccines in China remains unmet in the mainland and the knowledge and intentions of Chinese youth regarding vaccination is unknown. In the fall of 2013, 44 Chinese international students (CIS) attending a university in the United States Midwest participated in 10 focus group discussions (five female and five male). Result showed that participants have limited awareness and knowledge about HPV infection and vaccination, participants erroneously believed that the causes of cervical cancer are abortion and miscarriage. Participants rely heavily on informal sources such as Chinese-based social media platforms and personal social networks for information on sexually transmitted infections. Sexual cultures and behaviors are perceived differently between CIS born in the 1990s and 1980s. Interestingly, participants’ perceived stigma about HPV infection decreased with improving knowledge level during group discussions. In conclusion, HPV vaccine should be further promoted alongside sex education among CIS.

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Fig. 1


  1. 1.

    Hu SY, Hong Y, Zhao FH, Lewkowitz AK, Chen F, Zhang WH, Pan QJ, Zhang X, Fei C, Li H, Qiao YL. Prevalence of HPV infection and cervical intraepithelial neoplasia and attitudes towards HPV vaccination among Chinese women aged 18–25 in Jiangsu Province. Chin J Cancer Res. 2011;23(1):25–32.

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.

    PubMed  Google Scholar 

  3. 3.

    Zhao FH, Tiggelaar SM, Hu SY, Xu LN, Hong Y, Niyazi M, Gao XH, Ju LR, Zhang LQ, Feng XX, Duan XZ, Song XL, Wang J, Yang Y, Li CQ, Liu JH, Liu JH, Lu YB, Li L, Zhou Q, Liu JF, Zhao N, Schmidt JE, Qiao YL. A multi-center survey of age of sexual debut and sexual behavior in Chinese women: suggestions for optimal age of human papillomavirus vaccination in China. Cancer Epidemiol. 2012;36(4):384–90.

    PubMed  PubMed Central  Google Scholar 

  4. 4.

    Agosti JM, Goldie SJ. Introducing HPV vaccine in the developing countries: key challenges and issues. N Engl J Med. 2007;356(19):1908–10.

    CAS  PubMed  Google Scholar 

  5. 5.

    Gu C, Chan CWH, Twinn S. How sexual history and knowledge of cervical cancer and screening influence Chinese women’s screening behavior in mainland China. Cancer Nurs. 2010;33(6):445–53.

    PubMed  Google Scholar 

  6. 6.

    Zhao FH, Hu SY, Zhang SW, Chen WQ, Qiao YL. Cervical cancer mortality in 2004–2005 and changes during last 30 years in China. Zhonghua Yu Fang Yi Xue Za Zhi. 2010;44(5):408–12.

    PubMed  Google Scholar 

  7. 7.

    CDC. Teen Vaccination Coverage. National Immunization Survey (NIS)-Teen. 2011. Accessed 23 Aug 2015.

  8. 8.

    Keam SJ, Harper DM. Human papillomavirus types 16 and 18 vaccine (recombinant, AS04 adjuvanted, adsorbed) [Cervarix]: profile report. BioDrugs. 2008;22(3):205–8.

    PubMed  Google Scholar 

  9. 9.

    Cancer Foundation of China. 13th Annual Meeting of National Cervical Cancer Consortium and Symposium of Cervical Cancer Prevention. Accessed on 07 Nov 2015.

  10. 10.

    Li J, Li LK, Ma JF, Wei LH, Niyazi M, Li CQ, Xu AD, Wang JB, Liang H, Belinson J, Qiao YL. Knowledge and attitudes about human papillomavirus (HPV) and HPV vaccines among women living in metropolitan and rural regions of China. Vaccine. 2009;27(8):1210–5.

    PubMed  Google Scholar 

  11. 11.

    Hsu YY, Fetzer SJ, Hsu KF, Chang YY, Huang CP, Chou CY. Intention to obtain human papillomavirus vaccination among Taiwanese undergraduate women. Sex Transm Dis. 2009;36(11):686–92.

    PubMed  Google Scholar 

  12. 12.

    Kwan TT, Chan KK, Yip AM, Tam KF, Cheung AN, Lo SS, Lee PW, Ngan HY. Acceptability of human papillomavirus vaccination among Chinese women: concerns and implications. BJOG. 2009;2–9116(4):501–10.

    Google Scholar 

  13. 13.

    Lee PW, Kwan TT, Tam KF, Chan KK, Young PM, Lo SS, Cheung AN, Ngan HY. Beliefs about cervical cancer and human papillomavirus (HPV) and acceptability of HPV vaccination among Chinese women in Hong Kong. Prev Med. 2007;45(2–3):130–4.

    PubMed  Google Scholar 

  14. 14.

    Nguyen GT, Chen B, Chan M. Pap testing, awareness, and acceptability of a human papillomavirus (HPV) vaccine among Chinese American women. J Immigr Minor Health. 2012;14(5):803–8.

    PubMed  Google Scholar 

  15. 15.

    Jeng CJ, Lin H, Wang LR. The effect of HPV infection on a couple’s relationship: a qualitative study in Taiwan. Taiwan J Obstet Gynecol. 2010;49(4):407–12.

    PubMed  Google Scholar 

  16. 16.

    Lin H, Jeng CJ, Wang LR. Psychological responses of women infected with cervical human papillomavirus: a qualitative study in Taiwan. Taiwan J Obstet Gynecol. 2011;50(2):154–8.

    PubMed  Google Scholar 

  17. 17.

    Institute of International Education. Fast Facts Open Doors 2014. Access on Sep 5th, 2015.

  18. 18.

    Wang DC, Mallinckrodt B. Acculturation, attachment, and psychosocial adjustment of Chinese/Taiwanese international students. J Couns Psychol. 2006;53(4):422–33.

    Google Scholar 

  19. 19.

    Wei M, Heppner PP, Mallen MJ, Ku TY, Liao KYH, Wu TF. Acculturative stress, perfectionism, years in the United States, and depression among Chinese international students. J Couns Psychol. 2007;54(4):385–94.

    Google Scholar 

  20. 20.

    Ye J. Traditional and online support networks in the cross-cultural adaptation of Chinese international students in the United States. J Comput-Mediat Commun. 2006;11(3):863–76.

    Google Scholar 

  21. 21.

    Yeh CJ, Inose M. International students’ reported English fluency, social support satisfaction, and social connectedness as predictors of acculturative stress. Couns Psychol Q. 2003;16(1):15–28.

    Google Scholar 

  22. 22.

    Tung WC, Lu M, Cook DM. HIV/AIDS knowledge and attitudes among Chinese college students in the US. J Immigr Minor Health. 2012;15(4):788–95.

    Google Scholar 

  23. 23.

    Huang K, Uba L. Premarital sexual behavior among Chinese college students in the United States. Arch Sex Behav. 1992;21(3):227–40.

    CAS  PubMed  Google Scholar 

  24. 24.

    Chan CY, Lam CH, Lam DY, Lee LY, Ng KK, Wong ML. A qualitative study on HPV vaccination from a nursing perspective in HongKong. Asian Pac J Cancer Prev. 2011;12(10):2539–45.

    CAS  PubMed  Google Scholar 

  25. 25.

    Kwan TT, Chan KK, Yip AM, Tam KF, Cheung AN, Young PM, Lee PW, Ngan HY. Barriers and facilitators to human papillomavirus vaccination among Chinese adolescent girls in Hong Kong: a qualitative-quantitative study. Sex Transm Infect. 2008;84(3):227–32.

    CAS  PubMed  Google Scholar 

  26. 26.

    Hsu YY, Hsu KF, Cheng YM, Fetzer SJ, Chou CY. Health beliefs of Taiwanese women seeking HPV vaccination. Vaccine. 2010;28(25):4224–8.

    PubMed  Google Scholar 

  27. 27.

    Marlow LA, Waller J, Evans RE, Wardle J. Predictors of interest in HPV vaccination: a study of British adolescents. Vaccine. 2009;27(18):2483–8.

    PubMed  Google Scholar 

  28. 28.

    Marlow LAV, Waller J, Wardle J. Parental attitudes to pre-pubertal HPV vaccination. Vaccine. 2007;25(11):1945–52.

    PubMed  Google Scholar 

  29. 29.

    Olshen E, Woods ER, Austin SB, Luskin M, Bauchner H. Parental acceptance of the human papillomavirus vaccine. J Adolesc Health. 2005;37(3):248–51.

    PubMed  Google Scholar 

  30. 30.

    Zimet GD. Improving adolescent health: focus on HPV vaccine acceptance. J Adolesc Health. 2005;37(6):S17–23.

    PubMed  Google Scholar 

  31. 31.

    Higgins LT, Sun C. Gender, social background and sexual attitudes among Chinese students. Cult Health Sex. 2007;9(1):31–42.

    PubMed  Google Scholar 

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The Judy K. Black Scholarship from the Department of Health and Kinesiology, Purdue University, funded the data collection of this study.

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Correspondence to Haijuan Gao.

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The first author declares that he/she has no conflict of interest. The second author declares that he/she has no conflict of interest. The third author declares that he/she has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All individual participants included in the study provided informed consent.

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Gao, H., Okoror, T.A. & Hyner, G.C. Focus Group Study of Chinese International Students’ Knowledge and Beliefs About HPV Vaccination, Before and After Reading an Informational Pamphlet About Gardasil® . J Immigrant Minority Health 18, 1085–1092 (2016).

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  • HPV vaccination
  • Chinese international students
  • Cervical cancer
  • HPV infection