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*Corresponding Author: Ahmed Zahr Allayali, Associate Professor of Dermatology, College of medicine, Umm Al-Qura University, Al-Abdia Main Campus, Makkah, Saudi Arabia, ORCID: 0000-0001-6863-2774.
Citation: Ahmed M. Zahr Allayali, Shahad Bamerdah, Shumukh H. Alqahtani, Sarah M. Fageeh, Bushra M. Aldajani, et al, (2024), Knowledge, awareness, and perception towards Human Papilloma Virus vaccination among the general population in Makkah, Saudi Arabia: A cross-sectional study, Dermatology and Dermatitis, 9(4); DOI:10.31579/2578-8949/153
Copyright: © 2024, Ahmed ZahrAllayali. This is an open-access article distributed under the terms of The Creative Commons. Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 21 March 2024 | Accepted: 01 May 2024 | Published: 07 May 2024
Keywords: human papilloma virus; HPV vaccine; general population; knowledge awareness; perception
Background and aim: This cross-sectional study sought to assess knowledge, awareness, and perceptions about HPV vaccination among the general population in Makkah, Saudi Arabia, and identify factors influencing HPV vaccination decisions.
Materials and Methods: From May to April 2023 in Makkah, a descriptive cross-sectional study was carried out using random sampling techniques to select 501 participants for this research project. An online survey was distributed through social media platforms to collect the necessary data using structured questionnaires. Descriptive statistics and logistic regression models were then employed for data analysis.
Results: Most participants were female (78.1%), Saudi nationals (95.6%) and married (51.3%). Only 41.3% were familiar with HPV, and their awareness varied regarding its association with cervical cancer and genital warts. Among those informed about HPV, 72.0% were aware of the HPV vaccine, and about two-thirds believed it could prevent cervical cancer. Concerns regarding potential side effects were prevalent among participants. Factors associated with knowledge about HPV included employment in a health-related sector, pursuing a health specialty degree, and higher family income. Conversely, being married and older was associated with lower levels of awareness.
Conclusion: This study highlights a lack of knowledge and awareness regarding HPV infection and the HPV vaccine among the general population in Makkah, Saudi Arabia. Efforts should be made to improve education and awareness programs to increase knowledge about HPV and promote HPV vaccination. Targeted interventions addressing misconceptions and concerns about the vaccine could enhance vaccine acceptance and uptake among the population.
Human papillomavirus (HPV) is a non-enveloped DNA virus that predominately infects both the skin and mucous membranes. Head and neck squamous cell carcinoma and cervical cancer have been closely linked to specific HPV strains [1-3]. With over 100 different strains, approximately 30 to 40 types infect the genital tract. Most cases of cervical cancer are caused by two highly common viruses, HPV 16 and 18, while HPV 6 and 11 are associated with genital warts [1-3].
As the fourth most common type of cancer diagnosed globally and the fourth leading cause of cancer-related deaths among women, cervical cancer presents a serious threat to global health. [2]. Cervical cancer ranks ninth in Saudi Arabia among cancers that affect women between the ages of 15 and 44 [2]. The incidence of cervical cancer has been on the rise, with late-stage diagnoses complicating treatment and contributing to elevated morbidity and mortality rates [2, 4].
Efforts to control cervical cancer have been primarily focused on early detection through cervical screening tests, such as the Pap smear, and the development of vaccines targeting HPV strains [5]. Cervarix (bivalent) and Gardasil-4 (quadrivalent), two preventive HPV vaccines available since 2010, have been extensively distributed among females aged 11-26 in Saudi Arabia [1, 2] for the prevention of genital warts and associated cervical lesions such as precancerous and cancerous changes. Although HPV vaccines are available and effective, their uptake remains low in Saudi Arabia, posing a significant barrier to cervical cancer prevention [1]. Several studies conducted across Arab societies, including Jordan, Qatar, Iraq, and UAE, have documented a notable lack of awareness and understanding regarding HPV infection, its association with cervical cancer, and the benefits of HPV vaccination [3]. To address these knowledge gaps and enhance awareness, it is essential to understand the factors influencing individuals' decisions to accept or decline vaccination. Previous studies have explored the impact of socio-demographic factors, knowledge levels, attitudes, and sources of information on HPV vaccine acceptance [1, 3]. However, there is a lack of specific research assessing knowledge, awareness, and perceptions surrounding HPV vaccination among the general population in Makkah City, Saudi Arabia in 2022.
Makkah City stands out for HPV vaccination knowledge, awareness, and perception studies due to several reasons. As an important religious and cultural hub, it attracts millions of pilgrims annually for Hajj and Umrah pilgrimages. [2]. Consequently, collecting data from Makkah City reflects a diverse population from various regions of Saudi Arabia and international visitors. Understanding the knowledge and perceptions of this population is essential for tailored interventions that address cultural and religious factors influencing HPV vaccination decisions. Studies conducted at Makkah City’s Maternity and Children Hospital revealed surprisingly low awareness among participants regarding HPV vaccination and Pap smears despite high levels of awareness about cervical cancer [2]. The findings suggest a potential gap in communication and education provided by healthcare providers in Makkah City, emphasizing the significance of further investigating healthcare professionals' practices and recommendations related to HPV vaccination. Research conducted in Makkah City have uncovered an alarming lack of knowledge among female patients about HPV infection, cervical cancer, and the HPV vaccine [2]. Although awareness about cervical cancer is high, there remains a gap in understanding regarding how HPV infection influence contributes to cervical cancer development and the benefits of vaccination [2]. Therefore, it is essential to identify factors contributing to this lack of awareness and knowledge within the population of Makkah City and develop potential strategies for improvement [2]. By focusing on Makkah City, this research aims to gain an understanding of knowledge, awareness, and perceptions regarding HPV vaccination within its unique cultural and religious setting. Findings from this study can give rise to targeted interventions and health campaigns tailored specifically towards promoting HPV vaccine acceptance and reducing cervical cancer incidences. Addressing any existing gaps involves identifying prior studies conducted in Makkah City and developing effective strategies to ensure accurate information regarding vaccination reaching all individuals [2].
Therefore, this study aims to measure knowledge, awareness, and perceptions regarding HPV vaccination among the general population in Makkah City, Saudi Arabia, and explore factors influencing their decisions. By assessing current levels of awareness and recognizing specific reasons behind individuals' choices regarding vaccinations, targeted interventions, and health campaigns may be implemented to increase HPV vaccine uptake and acceptance.
A descriptive cross-sectional study was conducted in Makkah, Saudi Arabia, between May and April 2023. The minimum required sample size was calculated using the equation from a prior study [6]. Considering the general population in Makkah [7], a sample size of 385 participants was determined. To accommodate potential missing data, the sample size was increased by 10%. All adults aged 18 years and older residing in Makkah were eligible to participate, while exclusion criteria applied to individuals who did not speak Arabic. Participants were randomly selected using a simple random sampling technique. Data was collected through an online survey distributed via the Google Platform and shared across various social media channels. Initially, 515 participants initiated the online survey; however, 14 responses were excluded from the dataset. Consequently, the final sample consisted of 501 individuals who were included as study participants.
The questionnaire used in this study was structured and developed based on relevant literature [8,9]. Subsequently, its validity was assessed by three experts at Umm Al-Qura University, following which suggested modifications were incorporated. A pilot test of the survey was conducted among individuals (n=50) not involved in the study to evaluate item reliability. Initially prepared in English, the survey was translated independently into Arabic by two researchers. Expert linguists were then consulted to review the translated questionnaire and ensure its accuracy and consistency.
The questionnaire was structured into four primary sections, comprising a total of 24 questions. The first section included eight questions about the participants' socio-demographic characteristics, such as age, gender, nationality, education, marital status, income, occupation, and Pap smear history within the preceding three years. The second section comprised nine questions assessing participants' knowledge about HPV. The third section contained 13 questions evaluating participants' awareness of the HPV vaccine. Lastly, the fourth section included three questions gauging participants' acceptance of the HPV vaccine.
Ethics approval (HAPO-02-K-012-2022-06-1143) for this study was obtained from the Biomedical Ethics Committee at Umm Al-Qura University, Makkah, Saudi Arabia. Participation in the study was voluntary, and informed consent was obtained from all participants after providing a clear explanation of the study objectives. Strict confidentiality measures were implemented, and no personally identifiable information was collected.
The statistical analysis was conducted using RStudio (R Version 4.1.1). Descriptive statistics were used to summarize categorical variables, including frequencies and percentages. Univariate binary logistic regression models were employed to investigate factors associated with participants' knowledge of the HPV virus and its vaccine. The demographic characteristics of the participants served as independent variables, while the knowledge variables (categorized as “No” or “Yes”) were considered dependent variables. Subsequently, significantly associated factors were incorporated into multivariate logistic regression models to identify independent predictors of participants' knowledge. The results were presented as odds ratios (ORs) with corresponding 95% confidence intervals (95%CIs). Statistical significance was defined at a p-value of less than 0.05.
Demographic characteristics: Five hundred and one participants were included in the analysis, achieving a robust response rate of 97.3%. Most participants were female (78.2%) and of Saudi nationality (95.6%). The sample consisted of individuals across various age groups, with the highest representation falling within the 18-25 years range (39.7%). Most participants were married (51.3%) and held a bachelor’s degree (57.1%). Notably, unemployment was reported by 29.9% of the participants. Additionally, most females (82.4%) had not undergone a Pap smear test within the past three years (Table 1).
| Parameter | Category | N (%) |
| Gender | Male | 109 (21.8%) |
| Female | 392 (78.2%) | |
| Age | 18-25 years | 199 (39.7%) |
| 26-30 years | 55 (11.0%) | |
| 31-40 years | 105 (21.0%) | |
| More than 40 years | 142 (28.3%) | |
| Nationality | Non-Saudi | 22 (4.4%) |
| Saudi | 479 (95.6%) | |
| Marital status | Single | 224 (44.7%) |
| Married | 257 (51.3%) | |
| Divorced/widow | 20 (4.0%) | |
| Educational level | Illiterate | 0 (0.0%) |
| Below high school | 40 (8.0%) | |
| High school or diploma | 140 (27.9%) | |
| Bachelor’s degree | 286 (57.1%) | |
| Postgraduate degree | 35 (7.0%) | |
| Occupation | Student | 9 (1.8%) |
| Unemployed | 150 (29.9%) | |
| Work related to health sector | 28 (5.6%) | |
| Work not related to health sector | 119 (23.8%) | |
| Student in a health specialty | 70 (14.0%) | |
| Student in a non-health specialty | 70 (14.0%) | |
| Retired | 55 (11.0%) | |
| Perceived family income (SAR) | Less than 5000 | 104 (20.8%) |
| 5000 to 1000 | 181 (36.1%) | |
| More than 1000 | 216 (43.1%) | |
| Pap smear within the last 3 years* | Never | 323 (82.4%) |
| Yes, within the past 3 years | 39 (9.9%) | |
| Yes, more than 3 years ago | 30 (7.7%) |
Table 1: Demographic characteristics of the participants.
Knowledge about HPV: Among the participants, 41.3% (n=207) demonstrated familiarity with the HPV. Within this group, a substantial percentage acknowledged that unsafe sexual practices could increase the probability of HPV infection (71.0%) and that HPV can cause cervical cancer (69.6%) and genital warts (66.2%). Conversely, a notable proportion disagreed that HPV infection usually goes away without treatment (43.5%) and can affect both men and women (20.3%). A significant number of participants (55.6%) were unsure about the association of HPV with other genital cancers and the presence of symptoms (51.2%) (Table 2).
| Parameter | Category | N (%) |
| HPV is a virus that is sexually transmitted. | No | 20 (9.7%) |
| Yes | 128 (61.8%) | |
| Do not know | 59 (28.5%) | |
| HPV will usually go away on its own without treatment. | No | 90 (43.5%) |
| Yes | 26 (12.6%) | |
| Do not know | 91 (44.0%) | |
| HPV can cause cervical cancer | No | 2 (1.0%) |
| Yes | 144 (69.6%) | |
| Do not know | 61 (29.5%) | |
| HPV Infection can affect both men and women | No | 42 (20.2%) |
| Yes | 103 (49.8%) | |
| Do not know | 62 (30.0%) | |
| Unsafe sexual relationships can increase the probability of HPV infection | No | 6 (2.9%) |
| Yes | 147 (71.0%) | |
| Do not know | 54 (26.1%) | |
| Most people infected with HPV have no symptoms | No | 31 (15.0%) |
| Yes | 70 (33.8%) | |
| Do not know | 106 (51.2%) | |
| HPV causes genital warts | No | 7 (3.4%) |
| Yes | 137 (66.2%) | |
| Do not know | 63 (30.4%) | |
| HPV may cause other genital cancers (penis and anus) | No | 14 (6.8%) |
| Yes | 78 (37.7%) | |
| Do not know | 115 (55.6%) |
Table 2: Responses of the participants who were knowledgeable about the HPV virus (n=207).
Knowledge about the HPV vaccine: Among the 207 participants who demonstrated knowledge about the HPV virus (n=207), 72.0% (n=149) were aware of the HPV vaccine. Among these participants, 58.4% expressed the belief that only women should receive the HPV vaccine. A majority of participants (63.2%) acknowledged that the vaccine could prevent cervical cancer. However, fewer participants (20.6%) believed it could provide protection against all types of cervical cancer or be administered to women already infected with the HPV (17.6%). A substantial proportion of participants expressed uncertainty regarding whether the vaccine could cause HPV infection (43.6%) or induce side effects (46.3%). The primary concern reported was the potential side effects of the vaccine (39.6%). The optimal times for HPV vaccination were perceived to be before marriage (30.9%) and during school age (28.9%). The decision-making process for vaccination was mainly self-driven (54.4%), although a joint decision table 3).
| Parameter | Category | N (%) |
| Whom should be vaccinated with HPV vaccine | Men | 1 (0.7%) |
| Women | 87 (58.4%) | |
| Both genders | 49 (32.9%) | |
| Do not know | 12 (8.1%) | |
| Does HPV vaccine prevent cervical cancer? * | No | 16 (11.8%) |
| Yes | 86 (63.2%) | |
| Do not know | 34 (25.0%) | |
| Does HPV vaccine protect against all types of cervical cancer? * | No | 55 (40.4%) |
| Yes | 28 (20.6%) | |
| Do not know | 53 (39.0%) | |
| Does HPV vaccine decrease the chance of having changes in the Pap smear test? * | No | 13 (9.6%) |
| Yes | 54 (39.7%) | |
| Do not know | 69 (50.7%) | |
| Do females need to be screened for HPV before vaccinated? * | No | 32 (23.5%) |
| Yes | 49 (36.0%) | |
| Do not know | 55 (40.4%) | |
| Can the HPV be given to a woman having HPV infection? * | No | 28 (20.6%) |
| Yes | 24 (17.6%) | |
| Do not know | 84 (61.8%) | |
| Can HPV vaccine cause HPV infection? | No | 65 (43.6%) |
| Yes | 19 (12.8%) | |
| Do not know | 65 (43.6%) | |
| Can HPV vaccine cause side effects? | No | 30 (20.1%) |
| Yes | 50 (33.6%) | |
| Do not know | 69 (46.3%) | |
| What is your greatest concern about the HPV vaccine? | Side effects | 59 (39.6%) |
| Efficacy | 8 (5.4%) | |
| Cost | 15 (10.0%) | |
| Nothing | 67 (45.0%) | |
| What is the appropriate time to be vaccinated against HPV virus? | Preschool | 4 (2.7%) |
| School age | 43 (28.9%) | |
| Before marriage | 46 (30.9%) | |
| Any age | 23 (15.4%) | |
| I do not know | 33 (22.1%) | |
| Who should make the decision about HPV vaccination? | Person himself | 81 (54.4%) |
| Joint decision of parents and young person | 49 (32.9%) | |
| Only the parents | 6 (4.0%) | |
| I do not know | 13 (8.7%) |
Table 3: Responses of the participants who were knowledgeable about the HPV vaccine (n=149).
*The records have 13 missing values
Factors associated with participants' knowledge about the HPV and the vaccine: Univariate analysis identified that working in a health-related sector (OR = 8.75, 95% CI = 1.70-68.0, p = 0.016) and being a student in a health specialty (OR = 12.8, 95% CI = 2.77-92.5, p = 0.003) were significantly associated with higher levels of knowledge about the HPV. Conversely, married participants (OR = 0.64, 95% CI = 0.44-0.92, p = 0.017) and those aged over 40 years (OR = 0.51, 95% CI = 0.32-0.79, p = 0.003) exhibited lower levels of knowledge. In the multivariate analysis, only participants' occupations remained independently associated with knowledge, with individuals working in health-related sectors (OR = 7.83, 95% CI = 1.45-62.7, p = 0.026) and students in health specialties (OR = 10.3, 95% CI = 2.15-75.6, p = 0.007) demonstrating higher levels of knowledge about the HPV (Table 4).
| Parameter | Category | Univariate | Multivariate | ||||
| OR | 95% CI | p | OR | 95% CI | p | ||
| Gender | Male | — | — | ||||
| Female | 0.95 | 0.62, 1.47 | 0.832 | NA | NA | ||
| Age | 18-25 years | — | — | — | — | ||
| 26-30 years | 0.58 | 0.31, 1.07 | 0.084 | 0.62 | 0.28, 1.34 | 0.227 | |
| 31-40 years | 0.92 | 0.57, 1.48 | 0.737 | 1.33 | 0.62, 2.90 | 0.468 | |
| More than 40 years | 0.51 | 0.32, 0.79 | 0.003 | 0.92 | 0.40, 2.12 | 0.837 | |
| Nationality | Non-Saudi | — | — | ||||
| Saudi | 2.48 | 0.96, 7.64 | 0.079 | NA | NA | ||
| Marital status | Single | — | — | — | — | ||
| Married | 0.64 | 0.44, 0.92 | 0.017 | 0.86 | 0.45, 1.66 | 0.658 | |
| Divorced/widow | 0.36 | 0.12, 0.98 | 0.058 | 0.57 | 0.16, 1.80 | 0.356 | |
| Educational level | Below high school | — | — | ||||
| High school or diploma | 1 | 0.48, 2.13 | >0.999 | NA | NA | ||
| Bachelor’s degree | 1.50 | 0.76, 3.07 | 0.246 | ||||
| Postgraduate degree | 1.56 | 0.62, 4.01 | 0.346 | ||||
| Occupation | Student | — | — | — | — | ||
| Unemployed | 2.33 | 0.54, 16.0 | 0.301 | ||||
| Work related to health sector | 8.75 | 1.70, 68.0 | 0.016 | 7.83 | 1.45, 62.7 | 0.026 | |
| 2.16 | 0.47, 15.4 | 0.364 | |||||
| Work not related to health sector | 2.05 | ||||||
| Student in a health specialty | 12.8 | 2.77, 92.5 | 0.003 | 10.3 | 2.15, 75.6 | 0.007 | |
| 0.47, 14.2 | 0.383 | 1.70 | 0.35, 12.5 | 0.541 | |||
| Student in a non-health specialty | 0.80 | 0.17, 5.77 | 0.793 | 0.67 | 0.14, 4.91 | 0.642 | |
| Retired | 1.08 | 0.23, 7.87 | 0.926 | 0.97 | 0.18, 7.77 | 0.976 | |
| Perceived family income | Less than 5000 | — | — | — | — | ||
| 5000 – 10,000 | 1.46 | 0.88, 2.43 | 0.145 | 1.41 | 0.80, 2.49 | 0.232 | |
| More than 10,000 | 1.71 | 1.05, 2.81 | 0.032 | 1.76 | 1.00, 3.13 | 0.052 | |
| Pap smear within the last 3 years | Never | — | — | ||||
| Yes, within the past 3 years | 0.99 | 0.50, 1.94 | 0.986 | NA | NA | ||
| Yes, more than 3 years ago | 0.95 | 0.43, 2.02 | 0.9 | ||||
Table 4: Results of the regression analysis of factors associated with participants’ knowledge about the HPV virus.
In terms of knowledge about the HPV vaccine, older participants (> 40 years) showed lower levels of awareness about the vaccine (OR = 0.38, 95% CI = 0.17-0.82, p = 0.014). Conversely, those employed in health-related sectors (OR = 4.05, 95% CI = 1.20-18.7, p = 0.039) and students pursuing health specialties (OR = 4.20, 95% CI = 1.75-11.0, p = 0.002) demonstrated higher levels of knowledge. In the multivariate model, independent predictors of high knowledge included students pursuing a health specialty program (OR = 3.66, 95% CI = 1.24-11.3, p = 0.020) and employment in a health-related sector (OR = 4.68, 95% CI = 1.31-22.7, p = 0.029, Table 5).
| Parameter | Category | Univariate | Multivariate | ||||
| OR | 95% CI | p | OR | 95% CI | p | ||
| Gender | Male | — | — | — | — | ||
| Female | 1.33 | 0.64, 2.67 | 0.433 | NA | NA | ||
| Age | 18-25 years | — | — | — | — | ||
| 26-30 years | 0.43 | 0.15, 1.28 | 0.117 | 0.41 | 0.12, 1.49 | 0.169 | |
| 31-40 years | 0.61 | 0.27, 1.37 | 0.222 | 0.94 | 0.34, 2.57 | 0.897 | |
| More than 40 years | 0.38 | 0.17, 0.82 | 0.014 | 0.68 | 0.22, 2.10 | 0.498 | |
| Nationality | Non-Saudi | — | — | — | — | ||
| Saudi | 4.01 | 0.65, 31.0 | 0.134 | NA | NA | ||
| Marital status | Single | — | — | — | — | ||
| Married | 0.66 | 0.35, 1.23 | 0.192 | NA | NA | ||
| Divorced/widow | 0.2 | 0.03, 1.29 | 0.090 | ||||
| Educational level | Below high school | — | — | — | — | ||
| High school or diploma | 3.08 | 0.89, 10.9 | 0.074 | NA | NA | ||
| Bachelor’s degree | 2.76 | 0.89, 8.65 | 0.075 | ||||
| Postgraduate degree | 2.2 | 0.50, 10.3 | 0.299 | ||||
| Occupation | Unemployed | — | — | — | — | ||
| Student | NA | NA | 0.988 | NA | NA | 0.988 | |
| Work related to health sector | 4.05 | 1.20, 18.70 | 0.039 | 4.68 | 1.31, 22.7 | 0.029 | |
| Work not related to health sector | 2.14 | 0.93, 5.18 | 0.080 | 2.54 | 0.57, 6.47 | 0.430 | |
| Student in a | 4.2 | 1.75, | 0.00 | 3.66 | 1.24, | 0.02 | |
| health specialty | 0 | 11.0 | 2 | 11.3 | 0 | ||
| Student in a non-health specialty | 1.61 | 0.47, 6.47 | 0.469 | 1.36 | 0.35, 5.93 | 0.665 | |
| Retired | 0.61 | 0.18, 2.06 | 0.425 | 0.76 | 0.18, 3.04 | 0.693 | |
| Perceived family income | Less than 5000 | — | — | — | — | ||
| 5000 – 1000 | 2.39 | 1.00, 5.74 | 0.050 | NA | NA | ||
| More than 1000 | 1.84 | 0.81, 4.15 | 0.142 | ||||
| Pap smear within the last 3 years | Never | — | — | — | — | ||
| Yes, within the past 3 years | 1.55 | 0.47, 7.04 | 0.515 | NA | NA | ||
| Yes, more than 3 years ago | 0.5 | 0.15, 1.78 | 0.262 | ||||
Table 5: Results of the regression analysis of factors associated with participants’ knowledge about the HPV vaccine.
HPV vaccine acceptance among participants knowledgeable about the HPV vaccine (n=149), approximately half expressed willingness to receive the vaccine (54.4%). Additionally, 64.4% indicated they would recommend the vaccine to friends or relatives, 45.0% would recommend it to children or adolescents (Figure 1).
Figure 1: Percentage distribution of participants' responses regarding their acceptance of the HPV vaccine.
It is worth noting that 13 records had missing values in the analysis of responses related to the HPV vaccine (Table 3).
The study investigated the knowledge, awareness, and acceptance of HPV vaccination among the general population. Our findings reveal significant gaps in knowledge among participants [10]. In comparison with previous studies conducted in Saudi Arabia, our findings highlight inadequate knowledge about HPV [11, 12]. A similar study conducted in Makkah revealed limited knowledge and awareness about the virus, and a relatively low percentage of participants (18%) were aware that the HPV vaccine does not cause serious side effects, despite an overall positive inclination toward receiving the vaccine if offered free of charge [13]. Another study conducted in Jazan reported similar deficiencies in knowledge, with participants scoring an average of 1.99 out of 10 in assessing their HPV-related knowledge. Notably, 63% of participants in that study acknowledged the preventive benefits of the HPV vaccine against warts and cervical cancer, which aligns with our finding of 63.2% awareness regarding the vaccine's preventive efficacy [12]. However, discrepancies exist, as our study indicates a higher percentage of participants (71%) acknowledging the link between unsafe sexual practices and HPV infection compared to the Jazan study. These discrepancies might be attributed to differences in study populations or sample demographics [12].
Similarly, a study from the Eastern Province of Saudi Arabia found that levels of knowledge were low (28%), with limited awareness of HPV (42.2%) [14]. Notably, 25.2% of participants disagreed with the idea that HPV would naturally go away without treatment, and 64.9
This study offers invaluable insights into the knowledge, awareness, and perceptions regarding HPV vaccination among the general population in Makkah, Saudi Arabia. The findings reveal significant knowledge gaps regarding HPV infection and vaccination and substantial gaps in understanding between different groups. There is a pressing need to enhance educational and awareness initiatives concerning HPV to promote knowledge and encourage participation in vaccination campaigns. Moreover, this study identifies occupation, education level, and age as influential factors affecting the level of knowledge, emphasizing the necessity for targeted interventions and educational campaigns tailored to specific populations. Collaboration among healthcare providers, policymakers, and public health authorities is essential to formulate comprehensive strategies aimed at enhancing knowledge, debunking misconceptions, and increasing acceptance of vaccination. By increasing awareness and understanding of HPV and its preventive measures, the prevalence of HPV-related diseases in Makkah, Saudi Arabia, can be diminished while fostering improved overall health outcomes. Future research should evaluate the effectiveness of interventions while exploring cultural and religious influences on vaccination decisions to strengthen public health endeavors in this region.
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As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
