In this study, both Korean and Chinese female college students showed a moderate level of intention to receive the HPV vaccine. The HPV vaccine intentions of Spanish nursing students increased from 4.14 out of 10 before a survey to 6.02 out of 10 post-survey and those of female college students in Lebanon increased from 5.24 out of 10 before a survey to 6.98 out of 10 post-survey , The results of these studies are similar to those of our study. The results of Korean female college students are similar to those of Han et al.  (27.47 out of 35 points), but they reflect an improvement compared to the findings of Kim  (25% of) and Lee  (3.88 out of 7 points). In prior studies of Chinese female college students, the proportion of expressing that they intended to receive HPV vaccination was 44% in the study of Gu et al.  and 55.2% in the study of Lin et al. but Chen et al. , who conducted a study among women aged 20, reported that the percentage of 35–35 with vaccination intention was as high as 83. That the percentage of vaccination, reporting intention varied largely among studies. Considering these levels of intention of HPV vaccination, it is necessary to make further efforts to enhance the intention of HPV vaccination among female college students, who are included in the secondary target population for HPV vaccination in both countries, and to ensure that intention to receive the HPV vaccine will lead to actual uptake of the HPV vaccine. In addition, in the case of China, where these vaccines were recently introduced, ongoing research on HPV vaccination needs to be conducted among female college students in various regions to obtain basic data.
Positive attitudes toward the HPV vaccine and HPV knowledge were identified as significant factors influencing intention of HPV vaccination in Korean female college students, while sexual experience, awareness of genital warts, positive attitudes, HPV knowledge, perceptions of the seriousness of HPV infection, and negative emotions toward HPV infection were identified as significant factors influencing intention of vaccination among Chinese female college students. Positive attitudes and HPV knowledge were common factors between both countries. This is consistent with the findings of previous studies that a more positive attitude toward the HPV vaccine and a higher level of HPV knowledge were associated with a higher level of intention of HPV vaccination [5, 15, 25, 26], In this regard, it should be noted that the level of HPV knowledge among Korean and Chinese female college students was very low in this study, with a mean score of less than 2 out of 8 points and a correct answer rate of less than 25% . This is a very low level, compared to the correct answer rates of 33.5–58.2% reported in previous studies [5, 8, 27],
In addition, only 23.1% of female college students in the two countries responded that they had heard of HPV, and only 17.8% reported that they had heard of genital warts. Since improving knowledge and awareness can induce changes in attitudes and perceptions, above all, it is necessary to actively implement educational programs that provide accurate knowledge in order to increase HPV vaccination rates. HPV vaccination campaign programs should include a variety of content to meet the needs of the target population and should include information appropriate for their knowledge levels, and it would be an effective strategy to deliver such interventions for college students through the internet and mass media considering their patterns of media consumption [5, 10], Healthcare providers play an important role in changing knowledge and attitudes about HPV vaccination by participating in educational programs, and concrete recommendations from them have a major influence on the decision to get vaccinated , In addition, since young adults, including college students, are the target population, promotional activities in the form of public service announcements at the national level should be conducted in addition to on-campus activities.
In Chinese female college students, perceptions of the seriousness of HPV infection and negative emotions toward HPV infection were found to have a significant effect on vaccination intention. This result is consistent with the results of prior studies that a higher level of perceived severity among health beliefs was correlated with a higher level of HPV vaccination intention [9, 29],
In this study, negative emotions regarding HPV infection were found to influence the intention to receive the HPV vaccine, but previous studies reported that emotions related to HPV infection, such as shame, anxiety, and depression, did not have an effect on intentions to be tested or vaccinated for HPV [19, 22], Thus, further studies are needed to determine the effects of negative emotions related to HPV infection, as an STI, on the performance of preventive health behaviours. In contrast to the findings of previous studies [5, 9], the results of the present study indicated that perceived susceptibility, which is the perception that “I can get cervical cancer or genital warts due to HPV”, did not have a significant impact on HPV vaccination intention. This result can be attributed to the low levels of HPV knowledge and awareness among the participants of this study. Perception of seriousness and negative emotions should be taken into consideration when designing interventions that improve HPV vaccination intentions.
In Chinese female college students, sexual experience was significantly related to HPV vaccination intention, but prior studies did not show a significant association between these variables [5, 9], Yet, regarding this difference in study findings, there are some limitations in explaining the statistical significance of the results because the percentage of reporting sexual experience among the total participants was low in both this study and previous studies. However, in both countries, college students are included in the age group with the highest prevalence of HPV infection [6, 7], In addition, it should be noted that among the participants of this study, only 4.4% of Chinese female college students reported having sexual experience, but 42% of them responded that they had experienced an STI. Therefore, to prevent HPV infection, there is an imperative need to implement an STI prevention program, including HPV vaccination.
This study had some limitations. First, since the present study examined variables at a single point in time, it should be considered that participants’ characteristics and social environment could have affected the results. Secondly, the participants of this study were selected by convenience sampling among students at a single university in Korea and China, respectively, and the reasons for non-participation were not analyzed; Therefore, the representativeness of the sample is limited. Additionally, typical forms of survey bias, such as inaccurate recall and social desirability, should be taken into account. Recall bias in this study is expected to have been minimal because the survey did not require participants to recall events from the distant past. However, since the study contained items on sensitive topics, such as smoking, alcohol drinking, sexual experience, and STI experience, social desirability bias may have affected participants’ responses. Nevertheless, the use of anonymous questionnaires is expected to have minimized this issue. Therefore, some caution should be taken in interpreting the study results. In particular, since HPV vaccines have been recently introduced into China and HPV vaccination has not yet been included in China’s national immunization program, basic data should be gathered by conducting research on vaccination in multiple regions. In addition, to effectively prevent cervical cancer in both countries, active research is required to identify the factors influencing the association between HPV vaccination intention and the likelihood of getting vaccinated against HPV.