Review Analysis of community-based researches related to knowledge, awareness, attitude and behaviors towards HPV and HPV vaccine published in Turkey: A systematic review Özdemir et al. HPV and HPV vaccine Serpil Özdemir 1 , Rabia Akkaya 1 , Kazım Emre Karaşahin 2 1 Department of Public Health Nursing, Sağlık Bilimleri University Gülhane Faculty of Nursing, Ankara, Turkey 2 Department of Obstetrics and Gynecology, Sağlık Bilimleri University, Gülhane Training and Research Hospital, Ankara, Turkey Adress for Correspondence: Serpil Özdemir Phone: +90 533 451 85 04 e-mail: serpilozdemir327@gmail.com ORCID: orcid.org/0000-0003-0952-3337 DOI: 10.4274/jtgga.galenos.2019.2019.0071 Received: 16 April, 2019 Accepted: 29 July, 2019 Abstract HPV vaccine is a proven method for preventing HPV related cancers and genital warts, especially preventing cervical cancer. It is aimed to systematically review and synthesize conclusions in detail from the community- based researches published in Turkey between 2009 and 2019, which evaluate the knowledge, awareness, attitude and behaviors of individuals towards HPV and HPV. The systematic review is conducted based on PRISMA reporting method and includes community based, descriptive-cross sectional and cross sectional studies published between 2009 and 2019 years. In this systematic review, 5132 studies from six databases were scanned in total. It is determined that there are 23 studies which meet the eligibility criteria for this systematic review. In the reviewed studies it was determined that the rate of “Hearing of HPV before” was 3.8% at the lowest and 57.0 at the highest and the rate of “Hearing of HPV vaccine before” was 2.2% at the lowest and 74.7% at the highest. In the reviewed studies, it was reported that while parents’ willingness to have their daughters vaccinated with HPV vaccine varied between 14.4% and 68.0%, their willingness to have their sons vaccinated with HPV vaccine varied between 11.0% and 62.0%. In addition, it was reported that the lowest rate of vaccination with HPV vaccine among participants was 0.3% at the lowest and 6.0% at the highest. Consequently, it is considered that carrying out common, systematic and continuous health education programs aimed at both genders and including both parents, which will increase knowledge and awareness on HPV and vaccine, would provide positive attitude, will be effective in protecting from HPV related cancers. Keywords: Human papilloma virus, HPV vaccine, knowledge, awareness, attitude, public health Introduction Human Papilloma Virus (HPV) infection which is sexually transmitted to both male and female is a global epidemic (1-3). Approximately 75% of the sexually active individuals encounter HPV in some part of their lives (4). Thirteen known carcinogenic types of HPV, which have approximately 200 diagnosed types, may become cancerous by causing chronic and progressive infection (5). HPV related cancers are listed as cervical, vulvar, vaginal, anal, rectal, penile and oropharyngeal cancers (5,6). According to the data from surveillance program carried out by Centers for Disease Control and Prevention in the United States of America between 2008-2012; it is reported that 38.793 people on average were diagnosed with HPV related cancer and 59% of the people diagnosed with cancer were female and 41% were male (6). In the last five years in Turkey, the reported prevalences of cervical cancer, vulvar cancer, anal cancer and penile cancer were 16.09%, 1.82%, 1.09% and 0.16%, respectively (7). HPV vaccine is a proven method for preventing HPV related cancers and genital warts, especially preventing cervical cancer (8,9). It is reported that vaccines containing HPV16-18 types prevent 63% of all HPV related cancers; vaccines containing nine types of HPV (HPV6-11-16-18-31-33-45-52-58) provides protection from cervical, vulvar, vaginal and anal cancers by 90% (6,10). Throughout the world and in Turkey, HPV vaccines are recommended to individuals from both genders between 9-26 years of age and before first sexual experience (11,12). HPV vaccine safety of which is verified by European Medicines Agency (13) is included in national vaccination program in many countries, while it is not included in Turkey’s national vaccination schedule (13- 15). Uncorrected Proof