ORIGINAL ARTICLE Chinese medical students’ knowledge, attitude and practice towards human papillomavirus vaccination and their intention to recommend the vaccine Anthony Liu, 1 † Frederick K Ho , 1 † Lily KL Chan, 1 Joanne YW Ng, 1 Sophia L Li, 1 Godfrey CF Chan, 1 Ting Fan Leung 2 and Patrick Ip 1 1 Department of Paediatrics and Adolescent Medicine, The University of Hong Kong and 2 Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China Aim: The human papillomavirus (HPV) vaccine is effective in preventing cervical cancer, but its global uptake rate in vulnerable populations is unsatisfactory. Physician’s recommendation is an important determinant for vaccine uptake, but we have limited understanding on the contribut- ing factors of physician’s recommendation. This study investigated whether the knowledge, attitudes and vaccination status of medical students would affect their intention to recommend HPV vaccination. Methods: This is a population-representative survey of medical schools in Hong Kong. Results: Participants included 1022 Chinese medical students (46.9% of all in Hong Kong; 46.3% female). Better HPV-related knowledge and a more positive attitude towards HPV vaccination were important factors predicting vaccine uptake and intention to recommend. HPV vaccination status and intention to receive the vaccine were positively associated with intention to recommend among females. Conclusion: Better HPV-related medical education may be a feasible way to promote the HPV vaccine in regions without universal coverage. Medical students who have not received the HPV vaccine should also be encouraged to receive the vaccine. Key words: human papillomavirus vaccine; international child health; medical education. What is already known on this topic 1 Human papillomavirus (HPV) vaccine is effective in preventing cervical cancers. 2 Regions without universal HPV vaccination programmes, such as Hong Kong, have a very low uptake rate. 3 Physicians’ recommendation is an important predictor for HPV vaccine uptake. What this paper adds 1 The HPV-related knowledge and attitude is quite variable among medical students. 2 Their intention to recommend HPV vaccine is related to their own HPV-related knowledge and attitude and their own vaccina- tion status. 3 Better medical education may be useful to promote HPV vac- cines in regions without universal programmes. Cervical cancer is the third most common female cancer and a significant cause of death world-wide and in China. 1 Most, if not all, cervical cancers are caused by human papillomavirus (HPV) infection, so HPV vaccines were suggested to be an effective way in cervical cancer prevention. 2 In addition, HPV vaccines were also linked to significant decline in genital wart prevalence in Australia. 3 The implementation of school-based vaccination programmes in Australia, Spain, Norway and the UK has success- fully increased HPV vaccination coverage in those countries. 4–7 Hong Kong is the first place in China to license an HPV vac- cine, but a universal vaccination programme has yet to be imple- mented. A bivalent HPV vaccine was approved by the China Food and Drug Administration in late 2016, but it is not available on the market yet. 8,9 The vaccine is currently only available in private medical clinics of Hong Kong and costs around $100 USD per dose with a very low uptake rate (7.2%) among adolescent girls. 10 The major reasons for this low uptake at 2013 were the lack of relevant knowledge, inaccessibility, high cost, concerns about efficacy and safety and being too young. 10 Similar reasons, coupled with health beliefs and cultural factors, were identified in Chinese, Korean and other overseas studies. 11–14 More recently, studies found that doctors played a critical role in the uptake of vaccines in young women. Women in the USA whose doctors recommended HPV vaccination were four times more likely to receive the vaccine. 12 Nevertheless, factors Correspondence: Dr Patrick Ip, Department of Paediatrics and Adoles- cent Medicine, Queen Mary Hospital, The University of Hong Kong, Room 123, New Clinical Building, Hong Kong, China. Fax: +852 2255 4089; email: patricip@hku.hk †Joint first authors. Conflict of interest: None declared. Accepted for publication 30 July 2017. doi:10.1111/jpc.13693 Journal of Paediatrics and Child Health (2017) © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians) 1