Online Exclusive Article

Knowledge and Beliefs About Cervical Cancer and Human Papillomavirus Among Taiwanese Undergraduate Women

Yu-Yun Hsu

Ya-Min Cheng

Keng-Fu Hsu

Susan Jane Fetzer

Cheng-Yang Chou

cervix neoplasms, papillomavirus
ONF 2011, 38(4), E297-E304. DOI: 10.1188/11.ONF.E297-E304

Purpose/Objectives: To assess knowledge and attitudes regarding cervical cancer and human papillomavirus (HPV) among undergraduate women in Taiwan.

Design: A descriptive cross-sectional design.

Setting: Five universities in southern Taiwan.

Sample: 953 undergraduate women aged 17-36 years.

Methods: The self-administered HPV Belief questionnaire was used to collect data on knowledge and beliefs regarding cervical cancer, Pap testing, and HPV.

Main Research Variables: Knowledge, beliefs, cervical cancer, Pap testing, HPV, likelihood of cervical cancer, and HPV infection.

Findings: Seventy percent of participants agreed that cervical cancer could be prevented and was a severe disease, and 80% knew the purpose of Pap testing. Forty-nine percent were aware of HPV. Undergraduate women with an awareness of HPV were more likely to be older, studying a health-related major, have a higher class standing, have a personal history of gynecologic visits, and have had a Pap test. Neither family history of gynecologic cancer nor sexual experience predicted HPV awareness, although sexual experience had a significant association with the knowledge and beliefs of cervical cancer. Most of the undergraduate women believed themselves unlikely to acquire cervical cancer or HPV infection.

Conclusions: Undergraduate women in Taiwan have limited knowledge of cervical cancer and HPV. Awareness of the likelihood of HPV infection is low among undergraduate women, even those who are sexually active.

Implications for Nursing: Educational campaigns focusing on cervical cancer screening and HPV infection are needed, particularly for sexually active undergraduate women.

Jump to a section


    American Cancer Society. (2010). Cervical cancer. Retrieved from
    Bosch, F.X., & de Sanjosé, S. (2007). The epidemiology of human papillomavirus infection and cervical cancer. Disease Markers, 23, 213-227.
    Bosch, F.X., Lorincz, A., Muñoz, N., Meijer, C.J., & Shah, K.V. (2002). The causal relation between human papillomavirus and cervical cancer. Journal of Clinical Pathology, 55, 244-265. doi:10.1136/jcp.55.4.244
    Brown, D.R., Shew, M.L., Qadadri, B., Neptune, N., Vargas, M., Tu, W., … Fortenberry, J.D. (2005). A longitudinal study of genital human papillomavirus infection in a cohort of closely followed adolescent women. Journal of Infectious Diseases, 191, 182-192. doi:10.1086/426867
    Burak, L.J., & Meyer, M. (1997). Using the Health Belief Model to examine and predict college women's cervical cancer screening beliefs and behavior. Health Care for Women International, 18, 251-262. doi:10.1080/07399339709516279
    Bureau of Health Promotion, Department of Health, ROC Taiwan. (2010). Taiwan cancer registry. Retrieved from
    Chen, H.C., You, S.L., Hsieth, C.Y., Schiffman, M., Lin, C.Y., Pan, M.H., … Chen, C.J. (2011). Prevalence of genotype-specific human papillomavirus infection and cervical neoplasia in Taiwan: A community-based survey of 10,602 women. International Journal of Cancer, 128, 1192-1203.
    Cothran, M.M., & White, J.P. (2002). Adolescent behavior and sexually transmitted diseases: The dilemma of human papillomavirus. Health Care for Women International, 23, 306-319.
    Food and Drug Administration, ROC Taiwan. (2011). Drug information. Retrieved from
    Gerend, M.A., & Magloire, Z.F. (2008). Awareness, knowledge, and beliefs about human papillomavirus in a racially diverse sample of young adults. Journal of Adolescent Health, 42, 237-242. doi:10.1016/j.jadohealth.2007.08.022
    Harper, D.M., & Paavonen, J. (2008). Age for HPV vaccination. Vaccine, 26(Suppl. 1), A7-A11. doi:10.1016/j.vaccine.2008.01.013
    Hsu, Y.Y., Fetzer, S.J., Hsu, K.F., Chang, Y.Y., Huang, C.P., & Chou, C.Y. (2009). Intention to obtain human papillomavirus vaccination among Taiwanese undergraduate women. Sexually Transmitted Diseases, 36, 686-692. doi:10.1097/OLQ.0b013e3181ad28d3
    Ingledue, K., Cottrell, R., & Bernard, A. (2004). College women's knowledge, perceptions, and preventive behaviors regarding human papillomavirus infection and cervical cancer. American Journal of Health Studies, 19, 28-34.
    Jain, N., Euler, G.L., Shefer, A., Lu, P., Yankey, D., & Markowitz, L. (2009). Human papillomavirus (HPV) awareness and vaccination initiation among women in the United States, National Immunization Survey-Adult 2007. Preventive Medicine, 48, 426-431.
    Jeng, C.J., Ko, M.L., Ling, Q.D., Shen, J., Lin, H.W., Tzeng, C.R., … Chen, S.C. (2005). Prevalence of cervical human papillomavirus in Taiwanese women. Clinical and Investigative Medicine, 28, 261-266.
    Klug, S.J., Hukelmann, M., & Blettner, M. (2008). Knowledge about infection with human papillomavirus: A systematic review. Preventive Medicine, 46, 87-98. doi:10.1016/j.ypmed.2007.09.003
    La Torre, G., de Waure, C., Chiaradia, G., Mannocci, A., & Ricciardi, W. (2007). HPV vaccine efficacy in preventing persistent cervical HPV infection: A systematic review and meta-analysis. Vaccine, 25, 8352-8358. doi:10.1016/j.vaccine.2007.09.027
    Lee-Lin, F., Pett, M., Menon, U., Lee, S., Nail, L., Mooney, K., … Itano, J. (2007). Cervical cancer beliefs and Pap test screening practices among Chinese American immigrants. Oncology Nursing Forum, 34, 1203-1209. doi:10.1188/07.ONF.1203-1209
    Lindley, L.L., Brandt, H.M., Annang, L., Barnett, C.L., Hardin, J.W., & Burcin, M. (2009). Receipt of routine gynecological examinations among sexually active female college students in the United States. Journal of Women's Health, 18, 1195-1200. doi:10.1089/jwh.2008.1205
    Lopez, R., & McMahan, S. (2007). College women's perception and knowledge of human papillomavirus (HPV) and cervical cancer. Californian Journal of Health Promotion, 5, 12-25.
    McIntosh, J., Sturpe, D.A., & Khanna, N. (2008). Human papillomavirus vaccine and cervical cancer prevention: practice and policy implications for pharmacists. Journal of the American Pharmacists Association, 48(1), E1-E13. doi:10.1331/JAPhA/2008.07032
    Rosenstock, I.M., Strecher, V.J., & Becker, M.H. (1988). Social learning theory and the Health Belief Model. Health Education Quarterly, 15, 175-183.
    Rosenstock, I.M., Strecher, V.J., & Becker, M.H. (1994). The Health Belief Model and HIV risk behavior change. In R.J. DiClemente, & J.L. Peterson (Eds.), Preventing AIDS: Theories and methods of behavioral interventions (pp. 5-24). New York, NY: Plenum Press.
    Sandfort, J.R., & Pleasant, A. (2009). Knowledge, attitudes, and informational behaviors of college students in regard to the human papillomavirus. Journal of American College Health, 58, 141-149. doi:10.1080/07448480903221368
    Saraiya, M., Martinez, G., Glaser, K., & Kulasingam, S. (2009). Pap testing and sexual activity among young women in the United States. Obstetrics and Gynecology, 114, 1213-1219. doi:10.1097/AOG.0b013e3181be3db4
    Saules, K.K., Vannest, N.O., Mehringer, A.M., Pomerleau, C.S., Lee, K., Opipari, A.W., Jr., … Snedecor, S.M. (2007). Actual versus perceived risk of cervical cancer among college women smokers. Journal of American College Health, 55, 207-213. doi:10.3200/JACH.55.4.207-213
    Schiffman, M., & Kjaer, S.K. (2003). Chapter 2: Natural history of anogenital human papillomavirus infection and neoplasia. Monographs, 2003(31), 14-19.
    Shew, M.L., & Fortenberry, J.D. (2005). HPV infection in adolescents: Natural history, complications, and indicators for viral typing. Seminars in Pediatric Infectious Diseases, 16, 168-174. doi:10.1053/j.spid.2005.04.005
    Taiwan Cooperative Oncology Group. (2007). Clinical guideline for gynecologic cancer. Taipei, Taiwan: National Health Research Institute.
    Tay, S.K., Ngan, H.Y., Chu, T.Y., Cheung, A.N., & Tay, E.H. (2008). Epidemiology of human papillomavirus infection and cervical cancer and future perspectives in Hong Kong, Singapore and Taiwan. Vaccine, 26(Suppl. 12), M60-M70. doi:10.1016/j.vaccine.2008.05.042
    Tsui, J., & Tanjasiri, S.P. (2008). Cervical cancer screening among Thai women in Northern California. Journal of Women's Health, 17, 393-401. doi:10.1089/jwh.2007.0427
    U.S. Centers for Disease Control and Prevention. (2011a). HPV and men: Fact sheet. Retrieved from
    U.S. Centers for Disease Control and Prevention. (2011b). HPV vaccine monitoring. Retrieved from
    Warman, J. (2010). Cervical cancer screening in young women: Saving lives with prevention and detection. Oncology Nursing Forum, 37, 33-38. doi:10.1188/10.ONF.33-38
    World Health Organization. (2010). WHO/ICO Information Centre on human papillomavirus (HPV) and cervical cancer. Retrieved from