Abstract
Background
Human papillomavirus (HPV) is a common sexually transmitted infection associated with most cervical cancers. Despite the effectiveness of HPV vaccines, awareness and knowledge about HPV and its vaccine remain low among women. In today’s digital world, obtaining information about HPV is also shifting. Cyberchondria, characterized by excessive online health-related information-seeking behavior, can affect health behaviors. This study explored the relationships between HPV awareness, vaccination status, and cyberchondria.
Methods
This descriptive and correlational study was conducted from June to December 2024 at a single educational and research hospital in Istanbul with women aged 18–49. The sample size was calculated using G*Power, which indicated a need for 328 participants; ultimately, 337 were included. Data were collected through the Descriptive Information Form, the HPV Awareness and Concern Level Scale (HPV-ACS), and the Short-Form of the Cyberchondria Severity Scale (CSS-12). Analyses were performed using SPSS 27.0 and included independent t-tests, one-way ANOVA, Pearson correlation, and multiple linear regression.
Results
The mean participant age was 33.4 years; 55.2% had a university education, 57.9% were unemployed, and 27.6% were married. Higher HPV awareness was observed among individuals with higher income, those vaccinated against HPV, and those who underwent co-testing. Participants who spent more than four hours a day online and frequently followed health-related publications reported greater HPV awareness. Cyberchondria severity was higher in individuals who occasionally followed health publications. Confusion during online health searches was experienced by 43% of participants. Among those avoiding hospital visits, 88.7% cited work obligations as the reason. Those who visited the hospital reported lower levels of cyberchondria severity. HPV awareness was negatively correlated with the need for reassurance in health-related matters but positively correlated with compulsive information-seeking behaviors.
Conclusions
HPV awareness was associated with income level, regular gynecological check-ups, vaccination, and co-testing. Frequent online health engagement not only increased awareness but also contributed to cyberchondria, especially compulsive behavior. While greater HPV knowledge decreased health-related anxiety, it also led to excessive online searching, potentially disrupting daily life. Enhancing reliable online health education may improve HPV awareness while reducing the negative impacts of cyberchondria.
Clinical trial registration
ClinicalTrials.gov Identifier: NCT06800456. Registered on January 29, 2024.
Keywords: Awareness, Cyberchondria, Human papillomavirus, HPV vaccines
Background
Human Papillomavirus (HPV) is a common sexually transmitted infection strongly associated with most cervical cancers. Prophylactic HPV vaccination is an effective preventive measure against these forms of cancer. Additionally, cervical cancer screenings are essential for the early detection and prevention of the disease. The World Health Organization (WHO) has outlined three fundamental strategies—vaccination, screening, and treatment—to eliminate cervical cancer by 2030 [1].
Primary preventive measures against HPV include reducing sexual risk factors and implementing prophylactic vaccination [2]. As of the end of 2023, the HPV vaccine has been incorporated into the national immunization programs of 143 countries [3]. Despite these global efforts, awareness of HPV testing and cervical screenings remains insufficient among women [4, 5]. Studies indicate that knowledge of HPV is low in many societies, [6] while misinformation about HPV and its vaccine can contribute to distrust toward these preventive measures [7]. Research has found that while many women are aware of HPV and its vaccine, only a small percentage have been vaccinated [8, 9]. Similarly, concerns about receiving a positive HPV test result, negative attitudes, and lack of knowledge may prevent women from participating in screening programs [10].
In the digital age, acquiring information about HPV has also evolved. Easy access to digital health resources allows individuals to gather more information about their health; however, it also encourages excessive and uncontrolled online health research. Cyberchondria is defined as a psychological condition characterized by an uncontrollable urge to collect health-related information, often associated with obsessive symptom monitoring and repetitive reassurance-seeking behaviors [11–13]. Anxiety and online health-seeking behaviors can create a reinforcing cycle—prolonged exposure to medical information online can unintentionally increase health-related anxiety, prompting individuals to seek constant medical consultations or attempt self-diagnosis [14]. Studies have shown a positive relationship between cyberchondria and health anxiety, with individuals experiencing high health anxiety spending more time online and showing increased anxiety levels following their searches [15–17]. This phenomenon may prevent individuals from accessing reliable sources of health information, further worsening misinformation about HPV and encouraging the spread of inaccurate or misleading content.
The primary barriers to screening and vaccination include fear of receiving a positive HPV test result, [18] lack of information about the vaccine, concerns about side effects, and the cost of the HPV vaccine [9]. Moreover, in today’s digital world, cyberchondria is a significant factor that may influence individuals’ health-related decisions. Research indicates that HPV-positive women tend to exhibit higher levels of cyberchondria [19]. Searching for health information online can expose individuals to exaggerated or misleading content, which may increase health-related anxiety or affect their vaccination decisions. Therefore, all healthcare professionals must understand cyberchondria and develop effective strategies to manage this condition.
To date, no study has investigated the relationship between cyberchondria severity, HPV awareness, and vaccination uptake among adult women. Thus, this study evaluates the associations between HPV awareness, vaccination status, and cyberchondria severity. This research aims to improve healthcare professionals’ public health knowledge and understanding while promoting more effective policies and interventions to guide individuals toward accurate digital health resources.
Methods
Study design and sampling method
This descriptive study employs a correlational design using relational analysis and regression methods. The study population included women aged 18–49 who visited an outpatient clinic at a Training and Research Hospital in Istanbul between June and December 2024.
Studies utilizing the CSS-12 were reviewed to determine the sample size, and a power analysis was conducted using the G*Power (3.1.9.7) program. A correlation hypothesis test was used in the statistical analyses. The effect size in the referenced study was noted as 0.196 [20]. Accordingly, a power of 0.95 was targeted, with an alpha level of 0.05. The study involved 337 participants.
Women who met the age criteria and had at least a primary school education, enabling them to complete the questionnaire, were included in the study. Women with a psychiatric disorder and those with conditions hindering effective communication were excluded. In addition, women whose most recent cervical screening showed HPV detected were excluded to prevent potential bias associated with prior disease experience, heightened health anxiety, or clinical follow-up processes that could influence both HPV awareness and cyberchondria levels. Women who previously had HPV detected but later tested HPV not detected were not excluded, in accordance with current terminology and understanding of HPV natural history.
Data collection tools
The data collection tools consist of the “Demographic Information Form,” the “HPV Awareness and Concern Scale for Women (HPV-ACS),” and the “Short-Form Cyberchondria Severity Scale (CSS-12). Permission was obtained from the authors who conducted these scales’ validity and reliability studies.
Demographic information form
This form, developed by the researchers per on the literature, contains 32 general questions regarding women’s sociodemographic characteristics, reproductive health, and health-seeking behaviors.
HPV awareness and concern scale for women (HPV-ACS)
The scale was developed by Yılmaz Esencan et al. (2023) [21] to measure HPV awareness and levels of concern. It consists of 19 items and three subdimensions. The minimum and maximum scores obtainable from the scale are 0 and 76, respectively. Higher total scores indicate a greater perception of HPV awareness. The scale comprises three subdimensions: health concern (items 7–14), concern about social exclusion (items 15–19), and awareness (items 1–6). It is evaluated using a 5-point Likert scale. Items 1, 2, 3, 4, 9, 10, 11, 12, 13, 14, 15, 16, 17, and 19 are rated as follows: 0 = Strongly Disagree, 1 = Disagree, 2 = Neutral, 3 = Agree, 4 = Strongly Agree. Items 5, 6, 7, 8, and 18 are scored inversely: 0 = Strongly Agree, 1 = Agree, 2 = Neutral, 3 = Disagree, 4 = Strongly Disagree. The Cronbach’s alpha coefficient for the scale is 0.905. [21] In this study, the Cronbach’s alpha coefficient was 0.748. This scale was selected because it is currently the only instrument specifically developed to assess HPV-related awareness and concern among women, making it conceptually well aligned with the aims of this study.
The short-form of the cyberchondria severity scale (CSS-12)
CSS-12 was developed by McElroy and Shevlin in 2014, comprising 12 items. Yam et al. (2021) confirmed its validity and reliability. [22] CSS-12 evaluates the severity of individuals’ online searches for illness symptoms. The scale comprises four subdimensions: excessiveness, distress, reassurance, and compulsion. It is rated on a 5-point Likert scale, with responses ranging from 1 (Never) to 5 (Always). The total score ranged from 5 to 60, with higher scores indicating a greater severity of cyberchondria. The overall Cronbach’s alpha coefficient for the scale is 0.89, with subdimension values of 0.83, 0.79, 0.70, and 0.80, respectively. [22] In this study, the overall Cronbach’s alpha coefficient was 0.805.
Data analysis
Data analysis was performed using IBM SPSS version 27.0. The normality of the distribution was examined using the skewness and kurtosis values. Independent t-tests, one-way ANOVA, Pearson correlation, and multiple linear regression analyses were performed for normally distributed data. Bonferroni correction was applied for the post hoc tests. The relationship between the numerical variables was assessed using the Spearman correlation test. Descriptive statistics are presented as n (%), mean ± standard deviation, and median (min-max). A significance level of p < 0.05 was considered significant.
Results
The mean age of the participants in this study was determined to be 33.37 ± 8.12. Among the participants, 55.2% were university graduates, 57.9% were unemployed, and 72.4% were single.
Specific sociodemographic characteristics of women were found to impact HPV-ACS and CSS-12 scale scores significantly. Participants with an income higher than their expenses had significantly higher HPV-ACS scores than those whose income was equal to their costs (p = 0.029). No significant correlation was found between age and scale scores (Table 1).
Table 1.
Sociodemographic characteristics of the women (n = 337)
| Characteristics | Mean ± SD | Min-max | HPV-ACS Score | Test & Significance | Post-Hoc | CSS-12 Score | Test & Significance | Post-Hoc | |
|---|---|---|---|---|---|---|---|---|---|
| Age (years) | 33.37 ± 8.12 | 18–49 |
r = 0.062 pc = 0.253 |
r= -0.022 pc = 0.683 |
|||||
| n | % | Mean ± SD | Mean ± SD | ||||||
| Education Level | Secondary school | 20 | 5.9 | 43.05 ± 7.41 | pb=0.191 | 33.40 ± 8.84 | pb=0.638 | ||
| High school | 93 | 27.6 | 40.66 ± 10.56 | 33.90 ± 6.91 | |||||
| University | 186 | 55.2 | 38.83 ± 9.27 | 32.98 ± 7.22 | |||||
| Master’s/PhD | 38 | 11.3 | 39.39 ± 10.91 | 32.23 ± 7.63 | |||||
| Employment Status | Part-time1 | 17 | 5.0 | 41.29 ± 8.52 | pb=0.067 | 30.94 ± 7.50 | pb=0.423 | ||
| Full-time2 | 125 | 37.1 | 38.05 ± 9.26 | 33.38 ± 7.08 | |||||
| Unemployed3 | 195 | 57.9 | 40.53 ± 10.09 | 33.24 ± 7.38 | |||||
| Marital Status | Married | 93 | 27.60 | 40.27 ± 11.57 | pa=0.468 | 32.86 ± 6.93 | pa=0.618 | ||
| Single | 244 | 72.40 | 39.41 ± 9.00 | 33.30 ± 7.41 | |||||
| Level of income | Income > Expenses1 | 77 | 22.80 | 42.20 ± 11.88 | pb=0.029 | 1–2 | 32.97 ± 7.90 | pb=0.576 | |
| Income = Expense2 | 203 | 60.20 | 38.73 ± 9.14 | 33.00 ± 6.83 | |||||
| Income < Expenses3 | 57 | 16.90 | 39.47 ± 8.23 | 34.10 ± 7.95 | |||||
| Presence of a Health Professional in the Family | Yes | 120 | 35.6 | 39.65 ± 8.67 | pa=0.997 | 33.98 ± 6.44 | pa=0.132 | ||
| No | 217 | 64.4 | 39.65 ± 10.35 | 32.73 ± 7.67 | |||||
SD Standard deviation, pa Independent Student T-test p, b One-way ANOVA, pcPearson Correlation
Bonferroni test was used for post hoc analysis
1.2.3.4.5.6: Used to indicate statistically significant differences between subgroups
* Multiple answers were allowed
Among the women participating in the study, 61.7% were in monogamous relationships. The rate of women receiving regular gynecological examinations was 47.8%, while 24.9% had undergone co-testing, and 8.6% had received the HPV vaccine. Most (82.4%) of the women who did not have gynecological examinations reported that they did not see it as necessary. In response to item 13 of the HPV-ACS scale, which states, “I can be vaccinated to protect myself from HPV,” 56.1% of participants were undecided.
Participants obtained information about reproductive and sexual health primarily from the media/internet (63.2%), healthcare professionals (57%), friends (32.3%), and mothers (23.4%). The rate of obtaining information from fathers was the lowest at 2.4%. Almost half of the participants, 48.4%, reported spending 2–3 h online daily, while 34.7% spent more than 4 h. The primary reasons for internet use were social media (87.8%), searching for information (70%), and watching videos (45.4%).
Among those experiencing health issues, 65.5% sought hospital care, while 88.7% of those who did not seek medical attention cited work commitments as the primary reason. The highest proportion of participants (42.4%) reported occasionally following health-related publications, while 8% indicated they never followed such publications. In the past year, 38.9% of participants underwent medical tests without a physician’s recommendation, and 32% used medication without consulting a doctor.
HPV-ACS scores were significantly higher among women who received reproductive health information from healthcare professionals (p = 0.045), underwent co-testing (p = 0.035), and received the HPV vaccine (p = 0.007). Increased internet usage was linked to higher HPV-ACS scores (p < 0.001). Participants who consistently followed health-related publications had significantly higher HPV-ACS and CSS-12 scores (p = 0.010, p = 0.024), while those who sought hospital care when facing a health issue had significantly lower CSS-12 scores (p = 0.008) (Table 2).
Table 2.
Health and internet usage characteristics of the women (n = 337)
| Characteristics | n | % | HPV-ACS Score | Test & Significance | Post-Hoc | CSS-12 Score | Test & Significance | Post-Hoc | |
|---|---|---|---|---|---|---|---|---|---|
| Monogamy Status | Yes | 208 | 61.7 | 40.06 ± 10.29 | pa=0.616 | 33.02 ± 7.20 | pa=0.329 | ||
| No | 129 | 38.3 | 38.99 ± 8.87 | 33.43 ± 7.41 | |||||
| Presence of Chronic Disease | Yes | 33 | 9.80 | 40.96 ± 12.55 | pa=0.521 | 32.60 ± 8.07 | pa=0.633 | ||
| No | 304 | 90.20 | 39.50 ± 9.43 | 33.24 ± 7.19 | |||||
| Regular Medication Use | Yes | 60 | 27.60 | 40.41 ± 10.86 | pa=0.505 | 31.51 ± 7.68 | pa=0.050 | ||
| No | 277 | 72.40 | 39.48 ± 9.53 | 33.54 ± 7.14 | |||||
| Undergoing Regular Gynecological Check-ups | Yes | 161 | 47.80 | 40.21 ± 10.11 | pa=0.311 | 32.89 ± 7.87 | pa=0.493 | ||
| No | 176 | 52.20 | 39.13 ± 9.44 | 33.44 ± 6.69 | |||||
| Reasons for Not Undergoing Gynecological Check-ups (n = 176) | Employment status1 | 12 | 6.80 | 45.83 ± 11.62 | pb=0.0.56 | 33.41 ± 4.66 | pb=0.491 | ||
| Family responsibilities2 | 2 | 1.10 | 46.50 ± 7.77 | 42.50 ± 10.60 | |||||
| Not considering it necessary3 | 145 | 82.40 | 38.82 ± 9.16 | 33.96 ± 6.94 | |||||
| Shame or fear of stigma4 | 13 | 7.40 | 36.46 ± 7.66 | 34.61 ± 3.22 | |||||
| Fear/Anxiety5 | 4 | 2.30 | 35.25 ± 12.20 | 33.25 ± 10.43 | |||||
| Undergone Co-testing | Yes | 84 | 24.90 | 42.03 ± 11.53 | p b =0.035 | 32.34 ± 8.04 | pb=0.308 | ||
| No | 244 | 72.40 | 38.84 ± 8.95 | 33.54 ± 6.87 | |||||
| Never heard of it | 9 | 2.70 | 39.44 ± 10.79 | 31.22 ± 10.04 | |||||
| HPV Vaccination Status | Yes | 29 | 8.60 | 44.31 ± 11.97 | p a =0.007 | 432.62 ± 10.11 | pa=0.752 | ||
| No | 308 | 91.40 | 39.21 ± 9.44 | 33.23 ± 6.96 | |||||
| Sources of Reproductive/Sexual Health Information* | Mother | 79 | 23.40 | 40.44 ± 11.25 | pa=0.412 | 33.32 ± 7.41 | pa=0.837 | ||
| Father | 8 | 2.40 | 42.00 ± 8.56 | pa=0.493 | 39.59 ± 9.80 | pa=0.823 | |||
| Sibling | 23 | 6.80 | 42.13 ± 9.31 | pa=0.208 | 29.82 ± 7.68 | p a =0.022 | |||
| Teacher | 76 | 22.60 | 39.35 ± 10.54 | pa=0.763 | 32.92 ± 7.38 | pa=0.724 | |||
| Friend | 109 | 32.30 | 40.05 ± 10.56 | pa=0.602 | 33.35 ± 7.42 | pa=0.758 | |||
| Media and internet | 213 | 63.20 | 40.40 ± 9.92 | pa=0.063 | 33.61 ± 7.54 | pa=0.147 | |||
| Artificial intelligence | 22 | 6.50 | 42.27 ± 8.80 | pa=0.072 | 34.59 ± 7.77 | pa=0.348 | |||
| Health professional | 192 | 57.00 | 40.57 ± 10.22 | p a =0.045 | 32.74 ± 7.47 | pa=0.206 | |||
| Average Daily Internet Usage | 1 h per day¹ | 49 | 14.50 | 33.89 ± 7.56 | p b <0.001 | 1–2, 1–3 | 34.06 ± 4.88 | pb=0.474 | |
| 2–3 h per day² | 163 | 48.40 | 40.03 ± 9.18 | 32.71 ± 7.85 | |||||
| More than 4 h per day³ | 117 | 34.70 | 41.76 ± 10.64 | 33.28 ± 7.46 | |||||
| 1–2 h every other day⁴ | 8 | 2.40 | 36.12 ± 6.08 | 35.87 ± 2.64 | |||||
| Purpose of Internet Use* | Seeking information | 256 | 76.0 | 40.0 ± 9.81 | pa=0.236 | 33.01 ± 7.31 | pa=0.459 | ||
| Social media | 296 | 87.8 | 39.39 ± 9.93 | pa=0.188 | 33.33 ± 7.16 | pa=0.310 | |||
| Watching videos | 153 | 45.4 | 40.07 ± 10.17 | pa=0.467 | 33.35 ± 7.17 | pa=0.693 | |||
| Topics Searched Online* | Health | 188 | 55.8 | 39.57 ± 10.40 | pa=0.878 | 33.56 ± 7.09 | pa=0.279 | ||
| Education | 197 | 58.5 | 39.56 ± 9.69 | pa=0.843 | 33.66 ± 7.15 | pa=0.148 | |||
| Current events | 291 | 86.4 | 39.64 ± 9.87 | pa=0.987 | 33.26 ± 7.25 | pa=0.581 | |||
| Visiting a Hospital When Experiencing a Health Problem | Does not visit | 221 | 65.6 | 40.03 ± 10.02 | pa=0.427 | 32.47 ± 7.74 | p a =0.008 | ||
| Visits | 116 | 34.4 | 38.93 ± 9.27 | 34.52 ± 6.09 | |||||
| Reasons for Not Visiting a Hospital When Experiencing a Health Problem (n = 221) | Financial issues | 3 | 1.40 | 34.00 ± 4.58 | pb=0.175 | 28.66 ± 11.50 | pb=0.157 | ||
| Work-related constraints | 196 | 88.70 | 40.37 ± 10.20 | 32.48 ± 7.86 | |||||
| Not considering it necessary | 10 | 4.50 | 39.90 ± 9.78 | 33.60 ± 5.68 | |||||
| Shame or fear of stigma | 4 | 1.80 | 28.75 ± 1.50 | 29.50 ± 7.93 | |||||
| Fear and/or anxiety | 8 | 3.60 | 39.87 ± 5.89 | 33.62 ± 6.36 | |||||
| Experiencing Confusion While Searching for Health Information Online | Yes | 57 | 16.90 | 41.98 ± 8.79 | pb=0.056 | 34.71 ± 6.34 | pb=0.193 | ||
| No | 189 | 56.10 | 39.73 ± 9.78 | 33.01 ± 7.62 | |||||
| Sometimes | 91 | 27.00 | 38.03 ± 10.10 | 32.57 ± 7.00 | |||||
| Following Health-Related Publications | Always¹ | 10 | 3.00 | 49.60 ± 10.82 | p b =0.010 | 1–3, 1–4 | 27.70 ± 10.17 | p b =0.024 | 1–3 |
| Frequently² | 57 | 16.90 | 40.64 ± 9.58 | 33.28 ± 8.35 | |||||
| Sometimes / Occasionally³ | 143 | 42.40 | 38.76 ± 9.37 | 33.95 ± 5.97 | |||||
| Rarely⁴ | 100 | 29.70 | 38.99 ± 9.73 | 33.31 ± 7.23 | |||||
| Never⁵ | 27 | 8.00 | 41.00 ± 10.34 | 30.44 ± 8.99 | |||||
| Following Health-Related TV Programs | Always¹ | 3 | 0.90 | 30.33 ± 1.52 | pb=0.419 | 29.00 ± 3.60 | pb=0.080 | ||
| Frequently² | 26 | 7.70 | 41.50 ± 10.20 | 34.30 ± 8.69 | |||||
| Sometimes / Occasionally³ | 133 | 39.50 | 38.33 ± 8.94 | 33.80 ± 6.15 | |||||
| Rarely⁴ | 131 | 38.90 | 40.16 ± 10.33 | 32.77 ± 7.47 | |||||
| Never⁵ | 44 | 13.10 | 41.65 ± 9.90 | 32.13 ± 8.87 | |||||
| Undergoing Tests Without Physician Recommendation in the Past Year | Yes | 131 | 38.9 | 40.88 ± 10.51 | pa=0.065 | 33.38 ± 7.25 | pa=0.676 | ||
| No | 206 | 61.1 | 38.86 ± 9.20 | 33.04 ± 7.29 | |||||
| Taking Medications Without Physician Recommendation in the Past Year | Yes | 108 | 32.0 | 39.51 ± 9.42 | pa=0.863 | 33.46 ± 7.84 | pa=0.626 | ||
| No | 229 | 68.0 | 39.71 ± 9.95 | 33.04 ± 7.00 | |||||
SD Standard deviation, pa Independent Student T-test, pb One-way ANOVA, pc Pearson Correlation
Bonferroni test was used for post hoc analysis
1.2.3.4.5.6: Used to indicate statistically significant differences between subgroups
* Multiple answers were allowed
The mean HPV awareness and concern level, as measured by the HPV-ACS scale, were 39.65 ± 9.77 (min:22.00, max:85.00). The mean scores for its subdimensions were: “health concern” 16.51 ± 3.81, “fear of social exclusion” 11.02 ± 6.17, and “Awareness” 12.11 ± 2.93.
The mean total score of CSS-12 was 33.18 ± 7.27 (min:12.00, max:56.00). The mean subdimension scores were: “excessiveness” 10.02 ± 2.39, “distress” 7.83 ± 2.51, “reassurance” 8.77 ± 2.57, and “compulsion” 6.54 ± 2.39 (Table 3).
Table 3.
Scores of the HPV-ACS and the CSS-12 among the women (n = 337)
| Mean ± SD | Min-max | |
|---|---|---|
| HPV-ACS | ||
| Health Concern | 16.51 ± 3.81 | 8.00–40.00 |
| Concern about Social Exclusion | 11.02 ± 6.17 | 2.00–25.00 |
| Awareness | 12.11 ± 2.93 | 4.00–30.00 |
| Total Score | 39.65 ± 9.77 | 22.00–85.00 |
| CSS-12 | ||
| Excessiveness | 10.02 ± 2.39 | 3.00–15.00 |
| Distress | 7.83 ± 2.51 | 3.00–15.00 |
| Reassurance | 8.77 ± 2.57 | 3.00–15.00 |
| Compulsion | 6.54 ± 2.39 | 3.00–15.00 |
| Total Score | 33.18 ± 7.27 | 12.00–56.00 |
SD Standard deviation
No significant relationship was found between the HPV-ACS and CSS-12 total scores (r = 739). However, a negative relationship was observed between the HPV-ACS total score and the “reassurance” subdimension of CSS-12 (p = 0.035), while a positive relationship was identified with the “compulsion” subdimension (p = 0.002).
The “health concern” and “fear of social exclusion” subdimensions of HPV-ACS were negatively correlated with the “compulsion” subdimension of CSS-12 (p = 0.025; p = 0.005). Additionally, a positive correlation was observed between “health concern” and the “reassurance” subdimension (p = 0. 031) (Table 4).
Table 4.
The relationship between the scores of the HPV-ACS and the CSS-12 among women (n = 337)
| HPV-ACS | ||||
|---|---|---|---|---|
| Health Concern | Concern about Social Exclusion | Awareness | Total Score | |
| CSS-12 | ||||
| Excessiveness |
r = 0.024 pc = 0.667 |
r = 0.072 pc = 0.185 |
r= -0.052 pc = 0.337 |
r = 0.039 pc = 0.473 |
| Distress |
r = 0.005 pc = 0.929 |
r= -0.053 pc = 0.335 |
r= -0.055 pc = 0.316 |
r= -0.055 pc = 0.316 |
| Reassurance |
r = 0.118 pc = 0.031 |
r = 0.084 pc = 0.123 |
r = 0.051 pc = 0.347 |
r = 0.115 pc = 0.035 |
| Compulsion |
r= -0.122 pc = 0.025 |
r= -0.152 pc = 0.005 |
r= -0.081 pc = 0.136 |
r= -0.168 pc = 0.002 |
| Total Score |
r = 0.011 pc = 0.839 |
r= -0.014 pc = 0.792 |
r= -0.045 pc = 0.413 |
r= -0.018 pc = 0.739 |
pc Pearson Correlation
According to the results of the regression analysis, individuals whose income surpassed their expenses had significantly lower HPV-ACS scores (B = − 3.474, p = 0.008). Similarly, participants who had neither undergone co-testing nor received the HPV vaccine also had significantly lower HPV-ACS scores (B = − 2.648, p = 0.018; B = − 5.096, p = 0.007).
As internet usage time increased, HPV-ACS scores also increased; a notable rise was noted among those who used the internet for 2–3 h daily (B = 6.139, p < 0.001), with an even more significant rise among those using it for more than four hours (B = 7.871, p < 0.001). The frequency of following health publications had a substantial impact on HPV-ACS scores. Compared to those who “always” followed such publications, individuals who followed them less frequently had significantly lower scores (p < 0.05).
Regarding CSS-12, participants who did not seek hospital care for health issues exhibited higher levels of cyberchondria (B = 2.051, p = 0.014). Additionally, participants who regularly followed health-related publications had higher CSS-12 scores, particularly those who interacted with them “occasionally” or “rarely” (p < 0.05). However, no significant association was observed among those who “never” followed such publications (B = 2.744, p = 0.304).
Durbin-Watson values (1.97–2.29) indicated no autocorrelation issues in all models. The explained variance rates (1.4%–6.2%) suggested that the effects of the independent variables were limited (Table 5).
Table 5.
Regression analysis of the HPV-ACS and the CSS-12 scores in relation to sociodemographic, health, and internet usage characteristics of women (n = 337)
| Dependent Variable | Independent Variable | Unstandardized Coefficient | Standardized Coefficient | t | p | VIF | F | Model (p) | Adjusted R2 | Durbin Watson | |
| B | Standard Error | Beta | |||||||||
| HPV-ACS |
Income Level (Constant) Income > Expenses |
42.208 | 1.105 | 38.190 | 0.000 | 3.59 | 0.029 | 0.015 | 2.29 | ||
| Income = Expense | -3.474 | 1.298 | -0.174 | -2.676 | 0.008 | 1.446 | |||||
| Income < Expenses | -2.734 | 1.695 | -0.105 | -1.613 | 0.108 | 1.446 | |||||
| Undergone Co-testing (Constant) | 44.359 | 2.044 | 21.698 | 0.000 | 5.67 | 0.018 | 0.014 | 2.29 | |||
| No | -2.648 | 1.111 | -0.129 | -2.383 | 0.018 | 1.000 | |||||
| HPV Vaccination Status (Constant) | 49.406 | 3.638 | 13.581 | 0.000 | 7.34 | 0.007 | 0.019 | 2.27 | |||
| No | -5.096 | 1.881 | -0.146 | -2.710 | 0.007 | 1.000 | |||||
| Average Daily Internet Usage (Constant) 1 h per day | 33.898 | 1.352 | 25.075 | 0.000 | 8.45 | < 0.001 | 0.062 | 2.24 | |||
| 2–3 h per day | 6.139 | 1.542 | 0.314 | 3.982 | 0.000 | 2.234 | |||||
| More than 4 h per day | 7.871 | 1.610 | 0.384 | 4.888 | 0.000 | 2.212 | |||||
| 1–2 h every other day | 2.227 | 3.608 | 0.035 | 0.617 | 0.538 | 1.136 | |||||
|
Following Health-Related Publications (Constant) Always |
49.600 | 3.048 | 16.274 | 0.000 | 3.36 | 0.010 | 0.027 | 1.97 | |||
| Frequently | -8.951 | 3.304 | -0.344 | -2.709 | 0.007 | 5.567 | |||||
| Sometimes / Occasionally | -10.831 | 3.153 | -0.549 | -3.436 | 0.001 | 8.808 | |||||
| Rarely | -10.610 | 3.197 | -0.497 | -3.319 | 0.001 | 7.736 | |||||
| Never | -8.600 | 3.568 | -0.239 | -2.410 | 0.016 | 3.404 | |||||
| CSS-12 | Visiting a Hospital When Experiencing a Health Problem (Constant) | 30.424 | 1.180 | 25.778 | 0.000 | 6.13 | 0.14 | 0.015 | 2.24 | ||
| Does not visit | 2.051 | 0.828 | 0.134 | 2.477 | 0.014 | 1.000 | |||||
|
Following Health-Related Publications (Constant) Always |
27.700 | 2.276 | 12.172 | 0.000 | 2.84 | 0.024 | 0.022 | 2.05 | |||
| Frequently | 5.581 | 2.467 | 0.288 | 2.262 | 0.024 | 5.567 | |||||
| Sometimes / Occasionally | 6.251 | 2.354 | 0.425 | 2.656 | 0.008 | 8.808 | |||||
| Rarely | 5.610 | 2.387 | 0.353 | 2.350 | 0.019 | 7.736 | |||||
| Never | 2.744 | 2.664 | 0.103 | 1.030 | 0.304 | 3.404 | |||||
*Bold values indicate statistically significant results (p < 0.05)
Discussion
This study examined the relationship between HPV awareness, vaccination status, and the severity of cyberchondria in adult women. The findings revealed that various sociodemographic and health-related factors influenced HPV awareness and levels of concern and showed significant associations with certain subdimensions of cyberchondria.
In the study, individuals whose income exceeded their expenses demonstrated higher HPV awareness than other groups. The literature similarly indicates that individuals with a higher socioeconomic status have greater HPV awareness [23–25]. Higher HPV awareness among participants with additional income may reflect differences in educational opportunities, access to preventive services, or health-seeking behaviors rather than income alone.
Nearly half the participants did not undergo regular gynecological examinations, indicating a lack of awareness of women’s health and inadequate preventive health behaviors. The literature similarly reports low examination rates (34.4% [26]; 41%[27]). Most women who did not have examinations considered them “unnecessary,” suggesting that asymptomatic health check-ups are often overlooked and that routine screenings, which aid in early detection, are insufficiently widespread.
The low rate of co-testing for HPV screening (24.9%) indicates a lack of awareness or access barriers. A similar trend is observed globally, with participation rates in cervical cancer screening programs ranging from 60% to 80% in developed countries but falling below 20% in low- and middle-income countries [1]. Although Türkiye has nationally adopted primary HPV-DNA–based cervical screening since 2014, participation in population-based screening remains low [28]. Previous studies reported Pap smear rates between 25.5% and 54.9%, indicating that many women still do not undergo routine screening despite the updated national program [29]. – [30] While at least a 70% participation rate is necessary for effective cervical cancer screening, Türkiye’s rate remains at just 20%. [31] These findings highlight the need to enhance awareness of HPV and cervical cancer screenings worldwide, remove access barriers, and strengthen health policies that promote regular screening.
Recent global analyses highlight the substantial burden and rising incidence trends of HPV-associated cancers worldwide [2]. Only 8.6% of participants have received the HPV vaccine. HPV vaccination rates vary significantly across countries, with a global average of 27% as of 2023 [3]. In the U.S., rates range between 6.2% and 31.1% [32, 33] while Türkiye reports low rates of between 1% and 6%. [9], [34] These findings highlight the necessity of increasing HPV vaccine awareness in Türkiye and the importance of adopting global vaccination strategies. Given that the HPV vaccine is an effective tool for preventing cervical cancer, these low rates are a significant public health concern.
Half the participants were undecided about getting vaccinated against HPV, suggesting that uncertainty and lack of information may influence vaccine hesitancy. Previous studies have found that low vaccination rates are associated with a lack of awareness, misinformation, and insufficient guidance from healthcare professionals [23, 32, 35] highlighting the importance of health education programs in reducing vaccine hesitancy.
The study’s findings indicate that women who obtained information from healthcare professionals and regularly followed health-related publications had higher HPV awareness scores. This underscores the importance of healthcare professionals and trustworthy sources in raising awareness [36]. As part of the broader healthcare team, healthcare professionals (including midwives and nurses, who often serve as first-contact providers in women’s health) can play an important role in supporting women’s digital health literacy. Guidance integrated into routine care may help reduce confusion caused by online health information and support informed decision-making regarding HPV vaccination and screening. However, the fact that the internet and media were preferred over healthcare professionals (63.2%) raises concerns about the reliability of health information available on digital platforms. This pattern may also reflect time constraints in clinical settings or limited opportunities for counselling, suggesting that some women may not receive adequate or accessible guidance about HPV and cervical cancer prevention from healthcare providers. Information found online and through social media is often not based on scientific evidence or may be misleading. This could result in misunderstandings about HPV and negative attitudes toward vaccination.
The association between internet usage duration and HPV awareness scores demonstrates the internet’s role in acquiring health information, while also exposing the risks of misinformation [37]. A total of 43% of participants reported experiencing confusion during online searches for health information. This finding highlights the importance of strengthening health literacy [38–40]. Health professionals may also incorporate moderated digital tools—such as brief evidence-based online educational content—to guide women toward reliable HPV information and reduce cyberchondria-related behaviors.
Compared to the study by Yıldırım et al. (2024), [41] the higher exclusion and health concern scores among participants suggest that increased HPV awareness may also result in greater anxiety. This paradox may reflect that being more informed heightens perceived susceptibility and triggers worry, especially when individuals encounter alarming or ambiguous information during online searches.
Many studies indicate that HPV awareness levels are low to moderate [9, 42, 43]. This study aligns with that trend, showing that HPV awareness is moderate and that presistent knowledge gaps about HPV require more comprehensive educational programs.
The study found that cyberchondria levels among women were moderate. This finding is consistent with a survey conducted in the same country [2]. Another study indicated that married women exhibited moderate levels of cyberchondria, while single women displayed lower levels; however, in this study, both groups showed moderate levels of cyberchondria [44]. In the study by Fang and Mushtaque (2024), [45] 18% of participants had low levels of cyberchondria, while 41% had moderate and 41% had high levels. These findings align with the results of the current study, indicating that moderate levels of cyberchondria are common among participants. Frequently searching for health information online due to health concerns suggests some cyberchondria behavior may develop. However, further research is needed to understand how cyberchondria levels vary among different sociodemographic groups.
Although no significant relationship was observed between total HPV-ACS and CSS-12 scores, a negative correlation emerged between the HPV awareness and the “reassurance” subdimension, whereas a positive correlation was found with the “compulsion” subdimension. The “reassurance” subdimension reflects individuals’ need for medical consultation after searching for health information online, while the “compulsion” subdimension reflects how these searches influence daily life [22, 46]. These findings suggest that as HPV awareness increases, women may feel less inclined to seek professional reassurance and instead engage more intensely in online information searching. This pattern may initially reflect proactive health-seeking behavior; however, if excessive or unregulated, it may shift toward maladaptive tendencies and disrupt daily activities. A significant portion of participants also delayed hospital care due to work commitments, which may further reinforce reliance on online information. This was more pronounced among employed women, highlighting the need for accessible health professional–led teleconsultation services (e.g., nurse- or midwife-led models) to support timely guidance and reduce reliance on unregulated online searches.While some of these associations may appear contradictory, they are expected given the multidimensional structure of cyberchondria: different subdimensions, such as reassurance seeking and compulsive searching, can operate in distinct and sometimes opposing directions.
Regression analysis revealed that HPV awareness was greater among individuals who had received the HPV vaccine, while it was lower among those who had not undergone co-testing. These findings suggest that HPV awareness is linked to health behaviors, suggesting that individuals with greater awareness are more likely to utilize preventive health services [47–50]. Similarly, the higher awareness scores among those who had received both the HPV vaccine and co-testing demonstrate that access to healthcare services improves awareness levels. In addition, women who had not received the HPV vaccine showed no meaningful variation in cyberchondria levels, suggesting that vaccination behavior itself is not directly shaped by cyberchondria severity but rather by awareness and access to preventive health services.
This study found that individuals who did not seek hospital care when facing health issues had higher cyberchondria levels. This suggests that limitations in accessing healthcare services or a tendency to self-manage health problems may trigger cyberchondria. Previous research has demonstrated that cyberchondria is directly associated with excessive health information-seeking behavior [51]. Additionally, individuals who followed health publications irregularly exhibited higher levels of cyberchondria, suggesting that incomplete or unreliable information could heighten anxiety [52]. The bidirectional relationship between cyberchondria and utilizing healthcare services suggests some individuals seek medical consultation in response to health anxiety, while others avoid it. [53]
Limitations
This study is limited by its focus on a single public hospital and a specific age group of women, potentially affecting the generalizability of the findings. However, conducting the study in a metropolitan city allowed for including participants from diverse cultural backgrounds. Future research should examine the factors influencing cyberchondria with more extensive and more diverse samples.
Conclusion
This study aimed to provide a new perspective by examining the relationships among HPV awareness, vaccination status, and cyberchondria. The findings indicate that HPV awareness and levels of concern are associated with individuals’ sociodemographic characteristics, internet usage habits, and sources of health information. Additionally, cyberchondria may influence healthcare utilization in different ways. While it may increase healthcare visits due to heightened health anxiety for some individuals, for others, it may lead to avoiding medical services due to excessive worry. Notably, HPV vaccination status showed no direct association with cyberchondria severity, suggesting that vaccine uptake is shaped more by awareness and preventive health behaviors than by digital health anxiety.
These results underscore the importance of healthcare professionals developing effective informational strategies to enhance HPV awareness and reduce cyberchondria. Future studies should further explore the relationship between HPV awareness and cyberchondria to address knowledge gaps in this area and evaluate the effectiveness of internet-based interventions. Verifying health information in digital environments, guiding individuals to reliable sources, and improving digital health literacy will significantly contribute to public health. Strengthening structured counselling and adopting targeted health communication strategies may be essential to address both HPV knowledge gaps and the potential effects of cyberchondria. Incorporating basic digital health-literacy support into routine care by healthcare professionals—including midwives and nurses—may further strengthen HPV awareness and reduce cyberchondria-related concerns. Additionally, studies with larger samples are recommended to better understand the impact of cyberchondria across different demographic groups.
Acknowledgements
We would like to thank all the women who participated in the study.
Abbreviations
- HPV
Human papillomavirus
- CSS-12
Short-form of the cyberchondria severity scale
- HPV-ACS
HPV awareness and concern scale for women
- WHO
World Health Organization
Authors’ contributions
MC and GÜS conceptualized and designed the study. MC and İNÖ collected the data. GÜS analyzed the data. MC and GÜS contributed to the writing of the manuscript. As the corresponding author, GÜS coordinated the submission and revision process. All authors reviewed and approved the final version of the manuscript.
Funding
None.
Data availability
The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
This study was approved by the Acıbadem University and Acıbadem Healthcare Institutions Medical Research Ethics Committee (Approval Date: 16.05.2024, Approval Number: 2024-8/311). Written informed consent was obtained from all participants before data collection. The study was conducted in accordance with the principles of the Declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Referrences
- 1.World Health Organization. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention. 2nd ed. Geneva: World Health Organization. 2021. ISBN: 978-92-4-003082-4; 978-92-4-003083-1. [PubMed]
- 2.Meng X, Yang B, Yin H, Chen J, Ma W, Xu Z, et al. Global burden and incidence trends in cancers associated with human papillomavirus infection: a population-based systematic study. Pathogens. 2025;14(9):880. 10.3390/pathogens14090880. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.World Health Organization. Immunization coverage: Key facts. Geneva: World Health Organization. 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/immunization-coverage
- 4.Escoffery C, Riehman K, Watson L, Priess AS, Borne MF, Halpin SN, et al. Facilitators and barriers to the implementation of the HPV vacs (vaccinate adolescents against cancers) program: a consolidated framework for implementation research analysis. Prev Chronic Dis. 2019;16:E85. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Patel H, Moss EL, Sherman SM. HPV primary cervical screening in england: women’s awareness and attitudes. Psychooncology. 2018;27(6):1559–64. [DOI] [PubMed] [Google Scholar]
- 6.Mousavi T, Rezapour M, Moosazadeh M, Ghaffari N, Nazari Z. The relationship between the level of knowledge about human papillomavirus and the level of anxiety and sexual satisfaction in women with a positive HPV test. J Mazandaran Univ Med Sci. 2023;33(2):329–34. [Google Scholar]
- 7.Muthukrishnan M, Loux T, Shacham E, Tiro JA, Arnold LD. Barriers to human papillomavirus (HPV) vaccination among young adults, aged 18–35. Prev Med Rep. 2022;29:101942. [DOI] [PMC free article] [PubMed]
- 8.Yıldız M, Demirhan A, Gökçay G, Polat F. The relationship between cyberchondria levels, attitudes towards menopause and menopausal complaints of women in the climacteric period: analysis with data mining. Womens Stud Int Forum. 2023;98:102701. [Google Scholar]
- 9.Amboree TL, McCutcheon S, Ali K, Gordon JS, Laz TH. Awareness of human papillomavirus and reported human papillomavirus vaccine uptake in a high-risk population. Prev Med Rep. 2022;28:101853. 10.1016/j.pmedr.2022.101853. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Shariati-Sarcheshme M, Mahdizdeh M, Tehrani H, Jamali J, Vahedian-Shahroodi M. Women’s perception of barriers and facilitators of cervical cancer pap smear screening: a qualitative study. BMJ Open. 2024;14(1):e072954. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Eşkisu M, Çam Z, Boysan M. Health-related cognitions and metacognitions indirectly contribute to the relationships between impulsivity, fear of COVID-19, and cyberchondria. J Rational-Emotive Cogn-Behav Ther. 2023. 10.1007/s10942-022-00495-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Zheng H, Kim HK, Sin SCJ, Theng YL. A theoretical model of cyberchondria development: antecedents and intermediate processes. Telemat Inf. 2021;63:101659. 10.1016/j.tele.2021.101659. [Google Scholar]
- 13.Starcevic V, Schimmenti A, Billieux J, Berle D. Cyberchondria in the time of the COVID-19 pandemic. Hum Behav Emerg Technol. 2021;3(1):53–62. 10.1002/hbe2.233. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Zanfir AG, Marian G. New psychopathologies in the digital age: orthorexia and cyberchondria. Psihiatru Ro. 2024;76(1):14–7.
- 15.Barke A, Bleichhardt G, Rief W, Doering BK. The cyberchondria severity scale (CSS): German validation and development of a short form. Int J Behav Med. 2016;23(5):595–605. [DOI] [PubMed] [Google Scholar]
- 16.Norr AM, Allan NP, Boffa JW, Raines AM, Schmidt NB. Validation of the cyberchondria severity scale (CSS): replication and extension with bifactor modeling. J Anxiety Disord. 2015;31:58–64. [DOI] [PubMed] [Google Scholar]
- 17.Baumgartner SE, Hartmann T. The role of health anxiety in online health information search. Cyberpsychol Behav Soc Netw. 2011;14(10):613–8. [DOI] [PubMed] [Google Scholar]
- 18.Hendry M, Pasterfield D, Lewis R, Clements A, Damery S, Neal RD, et al. Are women ready for the new cervical screening protocol in england? A systematic review and qualitative synthesis of views about human papillomavirus testing. Br J Cancer. 2012;107(2):243–54. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Turhan Çakır A. Cyberchondria levels in women with human papilloma virus. J Obstet Gynaecol Res. 2022;48(10):2610–4. [DOI] [PubMed] [Google Scholar]
- 20.Agrawal V, Khulbe Y, Singh A, Kar SK. The digital health dilemma: exploring cyberchondria, well-being, and smartphone addiction in medical and non-medical undergraduates. Indian J Psychiatry. 2024;66(3):256–62. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Yılmaz Esencan T, Demir Yıldırım A, Yıldız M. Human papillomavirus awareness and concern scale (HPV-ACS): A scale development study. Androloji Bülteni. 2023;25(4):239–45. 10.24898/tandro.2023.75875. [Google Scholar]
- 22.Yam FC, Korkmaz O, Griffiths MD. The association between fear of COVID-19 and smartphone addiction among individuals: the mediating and moderating role of cyberchondria severity. Curr Psychol. 2023;42(3):2377–90. [DOI] [PMC free article] [PubMed]
- 23.McBride KR, Singh S. Predictors of adults’ knowledge and awareness of HPV, HPV-associated cancers, and the HPV vaccine: implications for health education. Health Educ Behav. 2018;45(1):68–76. [DOI] [PubMed] [Google Scholar]
- 24.Rivera AF, Dussault JM, Oudin Doglioni D, Chyderiotis S, Sicsic J, Barret AS, et al. Sociodemographic determinants of HPV vaccine awareness, uptake, and intention among parents of adolescents in France 2021-22. Hum Vaccin Immunother. 2024;20(1):2381300. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Kim L, Hong Y, Abrar S, FitzGerald CA. Relationships between social media use, exposure to vaccine misinformation and online health information seeking behaviour. J Creat Commun. 2023;18(2):199–213. [Google Scholar]
- 26.Selçuk AK, Yanıkkerem E, Esmeray N. Factors associated with awareness of gynecological cancer among Turkish women: A descriptive and cross-sectional study. Mediterr Nurs Midwifery. 2024;4(2):129–38. [Google Scholar]
- 27.Toptaş Acar B, Gerçek Öter E, Şanlı Çolakoğlu H. Awareness of gynaecological cancer and factors affecting in women: a cross-sectional study. J Obstet Gynaecol. 2022;42(7):3193–8. [DOI] [PubMed] [Google Scholar]
- 28.Arslan HN, Oruc MA. Results from a cervical cancer screening program in Samsun, Turkey. BMC Womens Health. 2022;22(1):331. 10.1186/s12905-022-01916-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Yılmaz B, Hat BN, Yürekli Y, Oskay Ü. Knowledge and attitude of young adults on Hpv infection and Hpv vaccine: an analytical cross-sectional study. KOU Sag Bil Derg. 2021;7(2):138–48. [Google Scholar]
- 30.Polat A, Kalkım A. Sağlık inanç modeli bileşenleri Ile kadınların Serviks Kanseri ve pap smear Tarama testi Bilgilerinin ve Tarama testi davranışlarının incelenmesi. Izmir Democracy Univ Health Sci J. 2023;6(1):149–59. [Google Scholar]
- 31.Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. Türkiye kanser kontrol programı 2021. Ankara: Sağlık Bakanlığı. 2021. Available from: https://hsgm.saglik.gov.tr/depo/birimler/kanser-db/Dokumanlar/Raporlar/17.Agustos_2021_Kanser_Kontrol_Programi_versiyon-1.pdf
- 32.Allen JD, Abuelezam NN, Rose R, Isakoff K, Zimet G, Fontenot HB. HPV vaccine behaviors and intentions among a diverse sample of women aged 27–45 years: implications for shared clinical decision-making. BMC Public Health. 2024;24(1):2154. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Ellingson MK, Oliveira CR, Sheth SS, Sullivan EL, Torres A, Shapiro ED, et al. Patterns of recommended vaccine receipt among women ages 24–45 years: a cross-sectional analysis. BMC Public Health. 2021;21(1):1–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Koç Ö, Baltacı N, Yüksekol ÖD. Kadınların Serviks Kanseri taraması inançlarının HPV aşısına yönelik inançları Ile ilişkisi. Turk J Fam Med Prim Care. 2023;17(1):31–41. [Google Scholar]
- 35.Eisenhauer L, Hansen BR, Pandian V. Strategies to improve human papillomavirus vaccination rates among adolescents in family practice settings in the united states: a systematic review. J Clin Nurs. 2021;30(3–4):341–56. [DOI] [PubMed] [Google Scholar]
- 36.Thanasa E, Thanasa A, Kamaretsos E, Paraoulakis I, Balafa K, Gerokostas EE, et al. Awareness regarding human papilloma virus among health professionals and will to accept vaccination: a systematic review. Cureus. 2022;14(10):e30855. [DOI] [PMC free article] [PubMed]
- 37.Vega ES, Zepeda MF, Gutierrez EL, Martinez MDC, Gomez SJ, Caldera SD. Internet health information on patient’s decision-making: implications, opportunities and challenges. Med Res Arch. 2023;11(7.2):1–9.
- 38.Davies C, Burns K. Human papillomavirus (HPV) and HPV vaccine literacy in sexualities education. The Palgrave encyclopedia of sexuality education. Cham: Springer Int Publ; 2024. pp. 1–9. [Google Scholar]
- 39.Galvin AM, Garg A, Griner SB, Moore JD, Thompson EL. Health literacy correlates to HPV vaccination among US adults ages 27–45. J Cancer Educ. 2023;38(1):349–56. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Johnson RR, Cox DA, Deupree J. Assessment of health literacy in college-age females to reduce barriers to human papilloma virus vaccination. J Nurse Pract. 2022;18(7):715–8. [Google Scholar]
- 41.Thompson EL, Wheldon CW, Rosen BL, Maness SB, Kasting ML, Massey PM. Awareness and knowledge of HPV and HPV vaccination among adults ages 27–45 years. Vaccine. 2020;38(15):3143–8. 10.1016/j.vaccine.2020.01.053. [DOI] [PubMed] [Google Scholar]
- 42.Thompson EL, Wheldon CW, Rosen BL, Maness SB, Kasting ML, Massey PM. Awareness and knowledge of HPV and HPV vaccination among adults ages 27–45 years. Vaccine. 2020;38(15):3143–8. [DOI] [PubMed] [Google Scholar]
- 43.Hu S, Xu X, Zhang Y, Liu Y, Yang C, Wang Y, et al. A nationwide post-marketing survey of knowledge, attitude and practice toward human papillomavirus vaccine in general population: implications for vaccine roll-out in Mainland China. Vaccine. 2021;39(1):35–44. [DOI] [PubMed] [Google Scholar]
- 44.Potur İ, Islek Secen E. The relationship between e-Health literacy and cyberchondria severity with participation in cervical cancer screening. Ankara Med J. 2024;24(2):98–111.
- 45.Fang S, Mushtaque I. The moderating role of health literacy and health promoting behavior in the relationship among health anxiety, emotional regulation, and cyberchondria. Psychol Res Behav Manag. 2024;17:51–62. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 46.McElroy E, Shevlin M. The development and initial validation of the cyberchondria severity scale (CSS). J Anxiety Disord. 2014;28(2):259–65. 10.1016/j.janxdis.2013.12.007. [DOI] [PubMed] [Google Scholar]
- 47.Sarcheshme MS, Mahdizadeh M, Tehrani H, Vahedian-Shahroodi M. Exploring the barriers to pap smear test compliance: A qualitative study for improving cervical cancer screening in the primary health care. Health Promot Perspect. 2024;14(1):80. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 48.Schwendener CL, Kiener LM, Jafflin K, Rouached S, Juillerat A, Meier V et al. HPV vaccine awareness, knowledge and information sources among youth in switzerland: a mixed methods study. BMJ Open. 2022;12(1):e054419.Shariati-Sarcheshme, M. [DOI] [PMC free article] [PubMed]
- 49.Chen S, Mei C, Huang W, Liu P, Wang H, Lin W, et al. Human papillomavirus vaccination related knowledge, and recommendations among healthcare providers in Southern china: a cross-sectional survey. BMC Womens Health. 2022;22(1):169. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 50.Ashtarian H, Mirzabeigi E, Mahmoodi E, Khezeli M. Knowledge about cervical cancer and pap smear and the factors influencing the pap test screening among women. Int J Community Based Nurs Midwifery. 2017;5(2):188. [PMC free article] [PubMed] [Google Scholar]
- 51.Starcevic V, Berle D. Recent insights into cyberchondria. Curr Psychiatry Rep. 2020;22(11):56. 10.1007/s11920-020-01179-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 52.Xu RH, Chen C. The effect of coping strategies on the association between the infodemic-driven overuse of health care services and cyberchondria and anxiety: partial least squares modeling approach. J Med Internet Res. 2024;26:e53417. 10.2196/53417. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 53.Jungmann SM, Witthöft M. Health anxiety, cyberchondria, and coping in the current COVID-19 pandemic: which factors are related to coronavirus anxiety? J Anxiety Disord. 2020;73:102239. 10.1016/j.janxdis.2020.102239. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.