Improving family physicians’ knowledge and practices on non-routine childhood vaccines (meningococcal, rotavirus, HPV): a two-phase intervention study from primary care in Türkiye

Improving family physicians’ knowledge and practices on non-routine childhood vaccines (meningococcal, rotavirus, HPV): a two-phase intervention study from primary care in Türkiye | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Improving family physicians’ knowledge and practices on non-routine childhood vaccines (meningococcal, rotavirus, HPV): a two-phase intervention study from primary care in Türkiye Özge KILINÇ, Ufuk ÜNLÜ This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8343237/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Introduction In Türkiye, meningococcal, rotavirus, and HPV vaccines are not included in the national schedule. We aimed to assess whether a face-to-face educational intervention could improve physicians’ knowledge about these vaccines and influence their subsequent counselling and recommendation practices. Methods We used a two-phase intervention with pre/post assessment and a 4–6-week follow-up among family physicians. In Phase 1, participants received an in-person training on meningococcal, rotavirus, and HPV vaccines, and their knowledge was evaluated using identical true/false tests administered before and after the session. Phase 2, conducted 4–6 weeks later, measured changes in physicians’ self-reported frequency of providing recommendations about these vaccines, and whether they or their first-degree relatives had received any of the vaccines after the training. Differences in paired proportions were analyzed using McNemar’s test (p < 0.05). Results Ninety-one physicians completed Phase-1; 70 from the same cohort completed Phase-2. After training, correct responses increased across multiple items: e.g., “Rotavirus vaccine is live” 89.0%→100% (p = 0.002); “Only humans are reservoir for meningococcal infection” 50.6%→96.7% (p < 0.001); “Meningococcal vaccine cannot be co-administered” (false) 70.3%→96.7% (p < 0.001). Phase-2 showed more proactive practice: for HPV, 52.9% reported recommending “upon family request” and 27.1% “at every visit”; for rotavirus these were 37.1% and 35.7%, respectively. Overall, 52.9% reported having administered one of the three vaccines to themselves or first-degree relatives after training; 62.2% rated the training’s influence on that decision as 10/10. Conclusion A targeted educational session produced meaningful gains in vaccine knowledge and was associated with more frequent counselling/recommendation behaviours in primary care. primary care family physicians HPV rotavirus meningococcal continuing professional development vaccine counselling Introduction Vaccination is one of the most effective strategies for protecting human health and preventing infectious diseases, offering both cost-effectiveness and a strong safety profile. Numerous studies have shown that increasing global vaccination rates substantially reduces the burden of preventable diseases ( 1 ). Many countries implement a national vaccination schedule in a systematic manner, guided by the recommendations of international authorities such as the World Health Organization (WHO). In Türkiye, the national immunization program is overseen by the Ministry of Health and currently includes vaccines against hepatitis A and B, poliomyelitis, measles, rubella, mumps, tuberculosis, diphtheria, pertussis, tetanus, varicella, as well as conjugated pneumococcal and Haemophilus influenzae type B infections ( 2 ). In addition to these routine vaccines, other licensed vaccines—such as meningococcal, rotavirus, and human papillomavirus (HPV) vaccines—are available in Türkiye, although they are not part of the national immunization schedule. Families may receive counseling about these vaccines, and those who provide consent and purchase them can have their children vaccinated in healthcare facilities. Rotavirus is the most common cause of severe acute gastroenteritis in young children ( 3 , 4 ). Prior to widespread vaccine implementation, rotavirus infection was estimated to cause approximately 440,000 deaths, 2 million hospitalizations, and 25 million outpatient visits annually among children under five years of age worldwide ( 5 ). HPV infection, a sexually transmitted disease, leads to anogenital and oropharyngeal diseases in both men and women. Persistent infection with high-risk HPV genotypes is a major contributor to cervical cancer, with HPV-16 and HPV-18 accounting for approximately 70% of cases globally ( 6 ). Meningococcal disease, particularly meningococcal meningitis, remains one of the most severe infections affecting individuals and communities. Neisseria meningitidis commonly affects healthy young individuals and may lead to death within hours of symptom onset ( 7 ). Although the efficacy and protective effects of these three optional vaccines have been well demonstrated in the literature, they must be purchased by families in Türkiye, and their administration and follow-up predominantly occur in primary care settings. Therefore, family physicians’ knowledge, attitudes, and practices regarding these vaccines are critical. This interventional study aimed to evaluate the impact of an educational program on family physicians’ knowledge, attitudes, and practices concerning optional childhood vaccinations in the province of Tokat. The intervention consisted of a structured training session on non-schedule pediatric vaccines, followed by pre-test and post-test assessments to measure changes in knowledge. Additionally, a follow-up survey conducted 4–6 weeks after the training evaluated physicians’ counseling practices and their propensity to recommend these vaccines to families. By examining these changes, the study sought to determine whether targeted education could enhance clinical practice and increase awareness among primary care physicians. We anticipate that the findings will contribute meaningful evidence to the literature and support improvements in vaccination counseling within primary care settings. Materials and Methods StudyDesign This research was designed as a cross-sectional analytical intervention study evaluating family physicians’ knowledge, attitudes, and behaviors regarding optional childhood vaccinations. The study was conducted between May 1, 2024, and August 1, 2024. Study Population The study population consisted of all family physicians actively working in the province of Tokat (n = 211). No sampling method was used. Physicians who agreed to participate were included, whereas those who declined or submitted incomplete questionnaire data were excluded. Intervention (Educational Program) The study was conducted in two phases. In the first phase, a structured educational session titled “Childhood Vaccinations Not Included in the Routine Immunization Program” was delivered in conference halls designated by the Tokat Provincial Directorate of Health. The training provided detailed information about meningococcal, rotavirus, and HPV vaccines. All sessions were conducted by the same trainer and lasted approximately one hour. These sessions were held in official institutional halls outside routine working hours. To assess learning outcomes, identical pre-test and post-test forms were administered during the session. These agree/disagree questionnaires evaluated participants’ knowledge of meningococcal, rotavirus, and HPV vaccines and were developed by the researchers based on a literature review. Data Collection Tools In the second phase, conducted 4–6 weeks after the training, an online Behavior and Attitude Form—also developed through a literature review—was administered. To avoid response bias, participants were not informed in advance that a follow-up assessment would be conducted. The questionnaire examined whether participants’ frequency of informing families about, or recommending, each of the three vaccines had changed. Response options were “no change” or “more frequent.” Those reporting increased frequency were additionally asked whether this occurred: at the family’s request, during every patient visit, or by proactively contacting families via telephone. Participants were also asked whether they or any of their first-degree relatives had received any of these vaccines following the training. If yes, they were to indicate which vaccine was administered and to rate the influence of the training on their decision using a 0–10 scale. Statistical Analysis Descriptive statistics were used to summarize participants’ baseline characteristics. Categorical variables were presented as frequencies and percentages. Differences between pre-test and post-test scores were evaluated using the McNemar test. A p-value of < 0.05 was considered statistically significant. All analyses were performed using IBM SPSS Statistics version 20 (SPSS Inc., IBM Company, Somers, NY). Results A total of 91 physicians participated in the first phase of the study, while 70 participated in the second phase. A comparison of pre-test and post-test responses showed a statistically significant increase in accuracy rates for all items (p < 0.005). Regarding rotavirus-related items, complete improvement was observed in the post-test for several questions. All participants correctly identified that the rotavirus vaccine is a live vaccine, that rotavirus is the leading cause of hospitalization due to gastroenteritis, and that there is no specific treatment for rotavirus gastroenteritis—despite incorrect responses being present in the pre-test. Substantial improvements were also noted in knowledge about the management of vomiting following rotavirus vaccination and the availability of multiple rotavirus vaccine types in Türkiye. The percentages of correct and incorrect responses are presented in Table 1 . Table 1 Percentages of correct and incorrect answers to questions regarding rotavirus infection question pretest post test p agree disagree agree disagree The rotavirus vaccine is a live vaccine. 89%* 11% 100%* 0 0.002 The most common cause of gastroenteritis requiring hospitalization is rotavirus gastroenteritis. 84.6%* 15.4% 100%* 0 < 0.001 There is no specific treatment for rotavirus gastroenteritis. 91.2%* 8.8% 100%* 0 0.008 There should be at least a 4-week interval between rotavirus vaccine doses. 83.5%* 16.5% 96.7%* 3.3% 0.002 If the child vomits within 10 minutes after rotavirus vaccination, the vaccine should be repeated. 52.7% 47.3%* 4.4% 95.6%* < 0.001 The earliest rotavirus vaccine can be administered is when the baby is 4 weeks old. 36.3%* 63.7% 51.7%* 48.3% 0.003 There is only one type of rotavirus vaccine in our country. 41.8% 58.2% * 1.1% 98.9%* < 0.001 Rotavirus vaccine is not administered to children with immune deficiency or suspected immunodeficiency. 69.2%* 30.8% 85.7%* 14.3% 0.001 *defines correct answer. HPV-related items also demonstrated significant improvement. Post-test accuracy rates were markedly higher than pre-test rates across all questions, as shown in Table 2 . Table 2 Percentages of correct and incorrect answers to questions regarding HPV infection question pretest post test p agree disagree agree disagree HPV vaccine can be administered to both girls and boys. 71.4%* 28.6% 98.9%* 1.1% < 0.001 When HPV vaccines are administered between the ages of 9 and 14, a higher rate of antibody response occurs compared to older ages. 86.8%* 13.2% 98.9%* 1.1% 0.001 HPV vaccine is recommended in two doses for girls aged 9–14 and three doses for those aged 15 and older. 80.2%* 19.8% 96.7%* 3.3% < 0.001 *defines right answer. The greatest improvement was observed in items related to meningococcal infections. All questions showed statistically significant differences (p < 0.001), and in the post-test, all participants responded correctly to both meningococcal-specific knowledge items. Percentages of correct and incorrect responses are shown in Table 3 . Table 3 Percentages of correct and incorrect answers to questions regarding meningococcal infections question pretest post test p agree disagree agree disagree Most meningococcal diseases occur in healthy individuals with no previously identified risk factors. 56%* 44% 89%* 11 < 0.001 Meningococcal vaccine is included in the national vaccination programme. 36.3% 63.7%* 14.3% 85.7%* < 0.001 70% of deaths from meningococcal infection occur in children under 5 years of age. 78%* 22% 100%* 0 < 0.001 Meningococcal infections are most commonly seen in children under 1 year of age in our country. 67%* 33% 98.9%* 1.1% < 0.001 Humans are the only reservoir for meningococcal infections. 50.5%* 49.5% 96.7%* 3.3% < 0.001 There is only one type of meningococcal vaccine in our country. 23.1% 76.9%* 0 100%* < 0.001 Meningococcal vaccine cannot be administered with other childhood vaccines. 29.7% 70.3% * 3.3% 96.7%* < 0.001 *defines correct answer. In the second phase of the study, changes in physicians’ vaccine recommendation behaviors were evaluated. After the training, 51.4% of physicians reported more frequently recommending the rotavirus vaccine, 37.1% reported increased recommendations for HPV, and 41.4% for meningococcal vaccines—either during visits or via phone contact. In response to whether they had received any of the vaccines themselves or administered them to first-degree relatives after the training, 37 physicians answered yes, while 33 answered no. Among these vaccines, the rotavirus vaccine was the most frequently administered. The evaluation of the perceived impact of the training showed that the study’s primary aim was achieved: 94.6% of participants reported that the training influenced their vaccination-related decisions. The variables examined in the second phase are summarized in Table 4. Table 4: Distribution of variables examined in the second phase variables status n % Recommending Rotavirus vaccination after the training not changed 26 37,1 as the family requests information 8 11,4 during all visits 25 35,7 via phone contact 11 15,7 Recommending Meningococcal vaccines after the training not changed 31 44,3 as the family requests information 10 14,3 during all visits 21 30,0 via phone contact 8 11,4 Recommending HPV vaccines after the training not changed 37 52,9 as the family requests information 7 10,0 during all visits 19 27,1 via phone contact 7 10,0 Have you ever had any of these vaccines administered to yourself or your first-degree relatives after the training? Yes 37 52,9 No 33 47,1 If your answer to the above question is yes, please select the vaccine you have applied HPV 15 40,5 Meningokok 6 16,2 Rotavirüs 16 43,2 If you have been vaccinated, please rate the impact of the education on your decision between 0 and 10. (0: no effect / 10: very effective) 0 point 2 5.4 5 points 1 2.7 7 points 3 8.1 8 points 5 13.5 9 points 3 8.1 10 points 23 62.2 Discussion Our study showed that a brief face-to-face training program for family physicians significantly increased knowledge about rotavirus, HPV, and meningococcal vaccines, and also resulted in a significant improvement in information-giving and recommendation behaviors at 4–6 weeks follow-up. Improvements were also observed in frequently confused areas such as "included in the national schedule" and "cannot be administered with other vaccines" (all p < 0.001). At the behavioral level, the majority of physicians reported making more frequent recommendations to families after the training. Furthermore, 52.9% of physicians reported administering a specific vaccine to themselves or a first-degree relative, and 62.2% reported that the training had a "10/10" impact on their decision, suggesting that the brief training sessions were effectively translated into practical action. The high and increasing accuracy rates observed in our study are consistent with findings reported both nationally and internationally. In a study conducted in Nigeria, 85.7% of healthcare workers identified rotavirus as the leading cause ( 8 ). In our sample, the accuracy rate for this question increased from 84.6% in the pretest to 100% after training. We believe this improvement demonstrates that fundamental epidemiological knowledge in primary care can be effectively reinforced through brief training interventions. Knowledge regarding the vaccination schedule—such as dose intervals and appropriate steps following post-vaccination vomiting—also increased significantly after the training. In Adana, knowledge of the “interval of ≥ 4 weeks between doses” was reported as 75.47% ( 9 ). In our study, the correct response rate for this item rose from 83.5% to 96.7%, indicating that, while pretest knowledge aligned with existing literature, post-training gains reflected heightened awareness of appropriate vaccination timing. The item concerning “the earliest age at which the first dose can be administered” was the most challenging in the pretest (36.3%). Although post-training accuracy improved, the increase was less pronounced compared with other items. The substantial improvement in knowledge regarding vaccine diversity (Rotarix/RotaTeq) in our study (58.24% → 98.9%) is likewise consistent with prior research, in which family physicians reported awareness of the two available vaccine types in the range of 82%–85%. ( 9 ) The item stating that “the HPV vaccine can be administered to both girls and boys” showed one of the strongest improvements in knowledge following the training, increasing from 71.43% to 98.9%. Knowledge gaps and hesitations regarding the recommendation of HPV vaccination for boys in primary care have been well documented in the literature. In Anderson et al., only 20% of participants correctly identified that the vaccine is effective and recommended for boys ( 10 ). Similarly, Duval et al. reported that 93.6% of family physicians primarily associated HPV vaccination with “girls before sexual activity” ( 11 ). Evidence from Türkiye reflects comparable concerns; one study found that knowledge regarding the applicability of the vaccine to both boys and girls aged 9–18 was only 42.5%. ( 12 ). In this context, the substantial improvement observed in our study suggests that misconceptions related to HPV vaccination in boys can be effectively corrected through brief, targeted educational interventions. The findings related to meningococcal disease demonstrated substantial and consistent improvements following the training. The proportion of participants correctly identifying that the meningococcal vaccine is included in the national immunization schedule increased from 63.7% to 85.7% (p < 0.001), although 14.3% still responded incorrectly. In comparison, Tanrıkulu et al. reported a correct response rate of 91.2% among 102 participants in Adana. ( 13 ) While our post-training improvement is notable, the residual error highlights the need for continuous updates in medical knowledge, especially for family physicians who are most frequently responsible for vaccine administration. Knowledge regarding disease burden also improved markedly. Correct responses to the item stating that 70% of meningococcal deaths occur in children under five increased from 78.0% to 100% (p < 0.001). Similarly, we noticed that awareness that meningococcal disease is most common in children under one year rose from 67% to 98.9% (p < 0.001). Tanrıkulu et al. noted that in developing countries, meningococcal infection is most frequent in children under two, whereas in developed countries it occurs more commonly after age ten, with a correct response rate of 76.5%. ( 13 ) These findings suggest that our results align with existing evidence. Substantial gains were also observed in understanding transmission and coadministration principles. Correct responses to “humans are the only reservoir for meningococcal infection” increased from 50.6% to 96.7% (p < 0.001), whereas Tanrıkulu et al. reported 85% correct responses. ( 13 ) Similarly, the proportion correctly identifying that meningococcal vaccines may be coadministered with other vaccines rose from 70.3% to 96.7% (p < 0.001), consistent with the findings of Kolcu (71.9%). ( 14 ) Awareness of coadministration safety is particularly important given the crowded childhood immunization schedule and the inclusion of optional vaccines. Knowledge of meningococcal vaccines availability improved significantly. While 76.9% correctly stated in the pretest that only a single type of meningococcal vaccine is available in Türkiye, this increased to 100% after training (p < 0.001). Achieving full accuracy across all participants underscores the effectiveness of the educational intervention and reinforces the need for regular in-service training to maintain updated knowledge among primary care physicians. Overall, statistically significant improvements were observed across all meningococcal-related items, demonstrating that targeted training can successfully address knowledge gaps and enhance readiness for vaccine-preventable disease management in primary care settings. In the 4–6 weeks following the education program, physicians reported providing information and recommendations to families more frequently for all three vaccines. Counseling patterns indicated that “as the family requests” remained the most common approach, followed by “at every visit”. For rotavirus, the distribution of information provision was 15.7/45.7/28.6/10.0; for meningococcal, 14.3/48.6/28.6/8.6; and for HPV, 11.4/45.7/27.1/15.7. Regarding vaccine recommendations, distributions were 11.4/37.1/35.7/15.7 for rotavirus, 14.3/44.3/30.0/11.4 for meningococcal, and 10.0/52.9/27.1/10.0 for HPV. These findings suggest that proactive counseling at each visit has gained ground, while demand-driven advice remains prevalent. This behavioral improvement aligns with physicians’ self-reported impact of the education and personal/relative vaccination: 52.9% reported administering at least one vaccine for themselves or immediate family, and 62.2% rated the education as a “10/10” factor influencing their decisions. These results indicate that short, targeted educational interventions can enhance not only knowledge but also practical counseling and recommendation behaviors. In the Turkish context, the administration of vaccines not included in the national immunization schedule—such as HPV, rotavirus, and meningococcal vaccines—largely depends on physician guidance and family initiative. Previous studies have shown that insufficient knowledge limits recommendation and uptake; for example, Kolcu reported that 44.5% of family physicians did not recommend the rotavirus vaccine, primarily due to lack of sufficient information, with similar trends observed for meningococcal vaccination. ( 14 ) Our findings suggest that targeted training can quickly address these knowledge gaps, as evidenced by the increased proportion of “information/advice at every visit” after the program. Moreover, the substantial use of telephone counseling (e.g., HPV information provided at 15.7%) indicates that remote communication channels are being utilized more frequently, which may help overcome access barriers for vaccines requiring specialized procurement. The strength of this study is that the intervention focused directly on practical issues (dose intervals, co-administration, post-vomiting approach, etc.) and captured its effects on behavior with a short follow-up. This study was conducted as an intervention study in which HPV, meningococcal, and rotavirus vaccines were analyzed together, and attitudes and behaviors were assessed in the second phase using pretest-posttest methods. Based on the literature review, it can be said that this is the only study of this type conducted on this topic in our country in all these aspects. However, the predominance of the sample size from a single province/FHC and the use of self-reported behavioral measures may limit generalizability and precision. Furthermore, because the follow-up period in the second phase was 4–6 weeks, long-term conclusions about the maintenance of the effect cannot be drawn. Conclusion In our study, the questions family physicians most frequently answered incorrectly before our training were generally about fundamental points related to the timeframe, vaccine use forms available on the market, and the timing of vaccine administration. The importance of the knowledge level of family physicians, who are the primary vaccine administerers, on these topics is evident. After our training, we observed that incorrect answers were replaced by correct answers with significant percentages. This result demonstrates the value and necessity of periodic in-service training for healthcare providers. Educational and up-to-date formats in healthcare delivery are an important component of continuing medical education. We recommend increasing the frequency and availability of such training and seminars. Considering the data obtained from the second phase of our study, we can predict that vaccination rates in the community will also improve in line with the training provided. In conclusion, our study has highlighted the limited knowledge and experience of primary care physicians regarding vaccines not included in the national vaccination calendar. The primary duty of family physicians is to provide preventive and preventative healthcare. In light of this information, keeping physicians' knowledge up-to-date will contribute to gaining self-confidence and increasing vaccine application rates, thus strengthening social immunization. Abbreviations Human papilloma Virus (HPV) World Health Organization (WHO) Declarations Ethics approval and consent to participate Ethical approval was obtained from the Tokat Gaziosmanpaşa University Health Research and Training Hospital Clinical Research Ethics Committee (Approval date: 22 March 2024; Decision No: 24-KAEK-0722360). The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Written informed consent was obtained from all participants prior to their participation in the study. Consent for publication Not applicable. Funding The authors received no specific funding for this study. Availability of data and materials This study is based on the medical specialization thesis of Özge Kılınç. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Author contributions Özge KILINÇ and Ufuk ÜNLÜ contributed to the study conception and design. Data collection was performed by Özge KILINÇ. Data analysis and interpretation were carried out by Özge KILINÇ and Ufuk ÜNLÜ. The first draft of the manuscript was written by Özge KILINÇ. Ufuk ÜNLÜ contributed to critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript and agreed to be accountable for all aspects of the work. Acknowledgments The authors would like to thank the units of the Tokat Provincial Directorate of Health for their support and cooperation during the conduct of this study. 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Vaccination against human papillomavirus: a baseline survey of Canadian clinicians' knowledge, attitudes and beliefs. Vaccine. 2007;25(45):7841–7. Aydın B. Evaluation of family physicians’ knowledge, attitudes and behaviours regarding HPV vaccination [thesis]. Ankara: Yıldırım Beyazıt University, Faculty of Medicine; 2019. Tanrikulu A, Tunay M, Tekayak HV. Comparison of Knowledge Levels and Attitudes of Family Medicine Assistants About Meningococcal Infection and Vaccines Before and After Education. J Eur Med Sci. 2025;5(3):56–62. 10.4274/jeurmed.galenos.2025.68077 . Kolcu H. Evaluation of family physicians and family medicine residents’ knowledge, attitudes and behaviours regarding HPV, meningococcal and rotavirus vaccines [thesis]. Samsun: Ondokuz Mayıs University, Faculty of Medicine; 2019. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 27 Jan, 2026 Reviewers agreed at journal 19 Jan, 2026 Reviewers invited by journal 14 Jan, 2026 Editor invited by journal 19 Dec, 2025 Editor assigned by journal 16 Dec, 2025 Submission checks completed at journal 16 Dec, 2025 First submitted to journal 12 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Numerous studies have shown that increasing global vaccination rates substantially reduces the burden of preventable diseases (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Many countries implement a national vaccination schedule in a systematic manner, guided by the recommendations of international authorities such as the World Health Organization (WHO). In T\u0026uuml;rkiye, the national immunization program is overseen by the Ministry of Health and currently includes vaccines against hepatitis A and B, poliomyelitis, measles, rubella, mumps, tuberculosis, diphtheria, pertussis, tetanus, varicella, as well as conjugated pneumococcal and \u003cem\u003eHaemophilus influenzae\u003c/em\u003e type B infections (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition to these routine vaccines, other licensed vaccines\u0026mdash;such as meningococcal, rotavirus, and human papillomavirus (HPV) vaccines\u0026mdash;are available in T\u0026uuml;rkiye, although they are not part of the national immunization schedule. Families may receive counseling about these vaccines, and those who provide consent and purchase them can have their children vaccinated in healthcare facilities.\u003c/p\u003e \u003cp\u003eRotavirus is the most common cause of severe acute gastroenteritis in young children (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Prior to widespread vaccine implementation, rotavirus infection was estimated to cause approximately 440,000 deaths, 2\u0026nbsp;million hospitalizations, and 25\u0026nbsp;million outpatient visits annually among children under five years of age worldwide (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHPV infection, a sexually transmitted disease, leads to anogenital and oropharyngeal diseases in both men and women. Persistent infection with high-risk HPV genotypes is a major contributor to cervical cancer, with HPV-16 and HPV-18 accounting for approximately 70% of cases globally (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Meningococcal disease, particularly meningococcal meningitis, remains one of the most severe infections affecting individuals and communities. \u003cem\u003eNeisseria meningitidis\u003c/em\u003e commonly affects healthy young individuals and may lead to death within hours of symptom onset (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Although the efficacy and protective effects of these three optional vaccines have been well demonstrated in the literature, they must be purchased by families in T\u0026uuml;rkiye, and their administration and follow-up predominantly occur in primary care settings. Therefore, family physicians\u0026rsquo; knowledge, attitudes, and practices regarding these vaccines are critical.\u003c/p\u003e \u003cp\u003eThis interventional study aimed to evaluate the impact of an educational program on family physicians\u0026rsquo; knowledge, attitudes, and practices concerning optional childhood vaccinations in the province of Tokat. The intervention consisted of a structured training session on non-schedule pediatric vaccines, followed by pre-test and post-test assessments to measure changes in knowledge. Additionally, a follow-up survey conducted 4\u0026ndash;6 weeks after the training evaluated physicians\u0026rsquo; counseling practices and their propensity to recommend these vaccines to families. By examining these changes, the study sought to determine whether targeted education could enhance clinical practice and increase awareness among primary care physicians. We anticipate that the findings will contribute meaningful evidence to the literature and support improvements in vaccination counseling within primary care settings.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudyDesign\u003c/h2\u003e \u003cp\u003eThis research was designed as a cross-sectional analytical intervention study evaluating family physicians\u0026rsquo; knowledge, attitudes, and behaviors regarding optional childhood vaccinations. The study was conducted between May 1, 2024, and August 1, 2024.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe study population consisted of all family physicians actively working in the province of Tokat (n\u0026thinsp;=\u0026thinsp;211). No sampling method was used. Physicians who agreed to participate were included, whereas those who declined or submitted incomplete questionnaire data were excluded.\u003c/p\u003e\n\u003ch3\u003eIntervention (Educational Program)\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in two phases.\u003c/p\u003e \u003cp\u003eIn the first phase, a structured educational session titled \u003cem\u003e\u0026ldquo;Childhood Vaccinations Not Included in the Routine Immunization Program\u0026rdquo;\u003c/em\u003e was delivered in conference halls designated by the Tokat Provincial Directorate of Health. The training provided detailed information about meningococcal, rotavirus, and HPV vaccines. All sessions were conducted by the same trainer and lasted approximately one hour. These sessions were held in official institutional halls outside routine working hours.\u003c/p\u003e \u003cp\u003eTo assess learning outcomes, identical pre-test and post-test forms were administered during the session. These agree/disagree questionnaires evaluated participants\u0026rsquo; knowledge of meningococcal, rotavirus, and HPV vaccines and were developed by the researchers based on a literature review.\u003c/p\u003e\n\u003ch3\u003eData Collection Tools\u003c/h3\u003e\n\u003cp\u003eIn the second phase, conducted 4\u0026ndash;6 weeks after the training, an online Behavior and Attitude Form\u0026mdash;also developed through a literature review\u0026mdash;was administered. To avoid response bias, participants were not informed in advance that a follow-up assessment would be conducted.\u003c/p\u003e \u003cp\u003eThe questionnaire examined whether participants\u0026rsquo; frequency of informing families about, or recommending, each of the three vaccines had changed. Response options were \u0026ldquo;no change\u0026rdquo; or \u0026ldquo;more frequent.\u0026rdquo; Those reporting increased frequency were additionally asked whether this occurred:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eat the family\u0026rsquo;s request,\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eduring every patient visit, or\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eby proactively contacting families via telephone.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eParticipants were also asked whether they or any of their first-degree relatives had received any of these vaccines following the training. If yes, they were to indicate which vaccine was administered and to rate the influence of the training on their decision using a 0\u0026ndash;10 scale.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used to summarize participants\u0026rsquo; baseline characteristics. Categorical variables were presented as frequencies and percentages. Differences between pre-test and post-test scores were evaluated using the McNemar test. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. All analyses were performed using IBM SPSS Statistics version 20 (SPSS Inc., IBM Company, Somers, NY).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 91 physicians participated in the first phase of the study, while 70 participated in the second phase. A comparison of pre-test and post-test responses showed a statistically significant increase in accuracy rates for all items (p\u0026thinsp;\u0026lt;\u0026thinsp;0.005).\u003c/p\u003e \u003cp\u003eRegarding rotavirus-related items, complete improvement was observed in the post-test for several questions. All participants correctly identified that the rotavirus vaccine is a live vaccine, that rotavirus is the leading cause of hospitalization due to gastroenteritis, and that there is no specific treatment for rotavirus gastroenteritis\u0026mdash;despite incorrect responses being present in the pre-test. Substantial improvements were also noted in knowledge about the management of vomiting following rotavirus vaccination and the availability of multiple rotavirus vaccine types in T\u0026uuml;rkiye. The percentages of correct and incorrect responses are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentages of correct and incorrect answers to questions regarding rotavirus infection\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003equestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003epretest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003epost test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003edisagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003edisagree\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe rotavirus vaccine is a live vaccine.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe most common cause of gastroenteritis requiring hospitalization is rotavirus gastroenteritis.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84.6%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThere is no specific treatment for rotavirus gastroenteritis.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91.2%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThere should be at least a 4-week interval between rotavirus vaccine doses.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83.5%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96.7%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf the child vomits within 10 minutes after rotavirus vaccination, the vaccine should be repeated.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.3%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95.6%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe earliest rotavirus vaccine can be administered is when the baby is 4 weeks old.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.3%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.7%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThere is only one type of rotavirus vaccine in our country.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.2% *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98.9%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRotavirus vaccine is not administered to children with immune deficiency or suspected immunodeficiency.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69.2%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.7%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*defines correct answer.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHPV-related items also demonstrated significant improvement. Post-test accuracy rates were markedly higher than pre-test rates across all questions, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentages of correct and incorrect answers to questions regarding HPV infection\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003equestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003epretest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003epost test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003edisagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003edisagree\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHPV vaccine can be administered to both girls and boys.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71.4%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e98.9%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen HPV vaccines are administered between the ages of 9 and 14, a higher rate of antibody response occurs compared to older ages.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86.8%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e98.9%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHPV vaccine is recommended in two doses for girls aged 9\u0026ndash;14 and three doses for those aged 15 and older.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80.2%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96.7%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*defines right answer.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe greatest improvement was observed in items related to meningococcal infections. All questions showed statistically significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and in the post-test, all participants responded correctly to both meningococcal-specific knowledge items. Percentages of correct and incorrect responses are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentages of correct and incorrect answers to questions regarding meningococcal infections\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003equestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003epretest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003epost test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003edisagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003edisagree\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMost meningococcal diseases occur in healthy individuals with no previously identified risk factors.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeningococcal vaccine is included in the national vaccination programme.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.7%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85.7%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70% of deaths from meningococcal infection occur in children under 5 years of age.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeningococcal infections are most commonly seen in children under 1 year of age in our country.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.9%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHumans are the only reservoir for meningococcal infections.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.5%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96.7%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThere is only one type of meningococcal vaccine in our country.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.9%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeningococcal vaccine cannot be administered with other childhood vaccines.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.3% *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96.7%*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*defines correct answer.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the second phase of the study, changes in physicians\u0026rsquo; vaccine recommendation behaviors were evaluated. After the training, 51.4% of physicians reported more frequently recommending the rotavirus vaccine, 37.1% reported increased recommendations for HPV, and 41.4% for meningococcal vaccines\u0026mdash;either during visits or via phone contact. In response to whether they had received any of the vaccines themselves or administered them to first-degree relatives after the training, 37 physicians answered yes, while 33 answered no. Among these vaccines, the rotavirus vaccine was the most frequently administered.\u003c/p\u003e \u003cp\u003eThe evaluation of the perceived impact of the training showed that the study\u0026rsquo;s primary aim was achieved: 94.6% of participants reported that the training influenced their vaccination-related decisions. The variables examined in the second phase are summarized in Table\u0026nbsp;4.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eTable\u0026nbsp;4: Distribution of variables examined in the second phase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003evariables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003estatus\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eRecommending Rotavirus vaccination after the training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003enot changed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37,1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eas the family requests information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11,4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eduring all visits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35,7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003evia phone contact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15,7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eRecommending Meningococcal vaccines after the training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003enot changed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44,3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eas the family requests information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14,3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eduring all visits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003evia phone contact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11,4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eRecommending HPV vaccines after the training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003enot changed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52,9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eas the family requests information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eduring all visits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27,1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003evia phone contact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHave you ever had any of these vaccines administered to yourself or your first-degree relatives after the training?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52,9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47,1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIf your answer to the above question is yes, please select the vaccine you have applied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHPV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMeningokok\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16,2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eRotavir\u0026uuml;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43,2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eIf you have been vaccinated, please rate the impact of the education on your decision between 0 and 10.\u003c/p\u003e \u003cp\u003e(0: no effect / 10: very effective)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0 point\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e5 points\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e7 points\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e8 points\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e9 points\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e10 points\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e62.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study showed that a brief face-to-face training program for family physicians significantly increased knowledge about rotavirus, HPV, and meningococcal vaccines, and also resulted in a significant improvement in information-giving and recommendation behaviors at 4\u0026ndash;6 weeks follow-up. Improvements were also observed in frequently confused areas such as \"included in the national schedule\" and \"cannot be administered with other vaccines\" (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). At the behavioral level, the majority of physicians reported making more frequent recommendations to families after the training. Furthermore, 52.9% of physicians reported administering a specific vaccine to themselves or a first-degree relative, and 62.2% reported that the training had a \"10/10\" impact on their decision, suggesting that the brief training sessions were effectively translated into practical action.\u003c/p\u003e \u003cp\u003eThe high and increasing accuracy rates observed in our study are consistent with findings reported both nationally and internationally. In a study conducted in Nigeria, 85.7% of healthcare workers identified rotavirus as the leading cause (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In our sample, the accuracy rate for this question increased from 84.6% in the pretest to 100% after training. We believe this improvement demonstrates that fundamental epidemiological knowledge in primary care can be effectively reinforced through brief training interventions.\u003c/p\u003e \u003cp\u003eKnowledge regarding the vaccination schedule\u0026mdash;such as dose intervals and appropriate steps following post-vaccination vomiting\u0026mdash;also increased significantly after the training. In Adana, knowledge of the \u0026ldquo;interval of \u0026ge;\u0026thinsp;4 weeks between doses\u0026rdquo; was reported as 75.47% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In our study, the correct response rate for this item rose from 83.5% to 96.7%, indicating that, while pretest knowledge aligned with existing literature, post-training gains reflected heightened awareness of appropriate vaccination timing.\u003c/p\u003e \u003cp\u003eThe item concerning \u0026ldquo;the earliest age at which the first dose can be administered\u0026rdquo; was the most challenging in the pretest (36.3%). Although post-training accuracy improved, the increase was less pronounced compared with other items. The substantial improvement in knowledge regarding vaccine diversity (Rotarix/RotaTeq) in our study (58.24% \u0026rarr; 98.9%) is likewise consistent with prior research, in which family physicians reported awareness of the two available vaccine types in the range of 82%\u0026ndash;85%. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe item stating that \u0026ldquo;the HPV vaccine can be administered to both girls and boys\u0026rdquo; showed one of the strongest improvements in knowledge following the training, increasing from 71.43% to 98.9%. Knowledge gaps and hesitations regarding the recommendation of HPV vaccination for boys in primary care have been well documented in the literature. In Anderson et al., only 20% of participants correctly identified that the vaccine is effective and recommended for boys (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Similarly, Duval et al. reported that 93.6% of family physicians primarily associated HPV vaccination with \u0026ldquo;girls before sexual activity\u0026rdquo; (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Evidence from T\u0026uuml;rkiye reflects comparable concerns; one study found that knowledge regarding the applicability of the vaccine to both boys and girls aged 9\u0026ndash;18 was only 42.5%. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In this context, the substantial improvement observed in our study suggests that misconceptions related to HPV vaccination in boys can be effectively corrected through brief, targeted educational interventions.\u003c/p\u003e \u003cp\u003eThe findings related to meningococcal disease demonstrated substantial and consistent improvements following the training. The proportion of participants correctly identifying that the meningococcal vaccine is included in the national immunization schedule increased from 63.7% to 85.7% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), although 14.3% still responded incorrectly. In comparison, Tanrıkulu et al. reported a correct response rate of 91.2% among 102 participants in Adana. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) While our post-training improvement is notable, the residual error highlights the need for continuous updates in medical knowledge, especially for family physicians who are most frequently responsible for vaccine administration.\u003c/p\u003e \u003cp\u003eKnowledge regarding disease burden also improved markedly. Correct responses to the item stating that 70% of meningococcal deaths occur in children under five increased from 78.0% to 100% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, we noticed that awareness that meningococcal disease is most common in children under one year rose from 67% to 98.9% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Tanrıkulu et al. noted that in developing countries, meningococcal infection is most frequent in children under two, whereas in developed countries it occurs more commonly after age ten, with a correct response rate of 76.5%. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) These findings suggest that our results align with existing evidence.\u003c/p\u003e \u003cp\u003eSubstantial gains were also observed in understanding transmission and coadministration principles. Correct responses to \u0026ldquo;humans are the only reservoir for meningococcal infection\u0026rdquo; increased from 50.6% to 96.7% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas Tanrıkulu et al. reported 85% correct responses. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) Similarly, the proportion correctly identifying that meningococcal vaccines may be coadministered with other vaccines rose from 70.3% to 96.7% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), consistent with the findings of Kolcu (71.9%). (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) Awareness of coadministration safety is particularly important given the crowded childhood immunization schedule and the inclusion of optional vaccines.\u003c/p\u003e \u003cp\u003eKnowledge of meningococcal vaccines availability improved significantly. While 76.9% correctly stated in the pretest that only a single type of meningococcal vaccine is available in T\u0026uuml;rkiye, this increased to 100% after training (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Achieving full accuracy across all participants underscores the effectiveness of the educational intervention and reinforces the need for regular in-service training to maintain updated knowledge among primary care physicians. Overall, statistically significant improvements were observed across all meningococcal-related items, demonstrating that targeted training can successfully address knowledge gaps and enhance readiness for vaccine-preventable disease management in primary care settings.\u003c/p\u003e \u003cp\u003eIn the 4\u0026ndash;6 weeks following the education program, physicians reported providing information and recommendations to families more frequently for all three vaccines. Counseling patterns indicated that \u0026ldquo;as the family requests\u0026rdquo; remained the most common approach, followed by \u0026ldquo;at every visit\u0026rdquo;. For rotavirus, the distribution of information provision was 15.7/45.7/28.6/10.0; for meningococcal, 14.3/48.6/28.6/8.6; and for HPV, 11.4/45.7/27.1/15.7. Regarding vaccine recommendations, distributions were 11.4/37.1/35.7/15.7 for rotavirus, 14.3/44.3/30.0/11.4 for meningococcal, and 10.0/52.9/27.1/10.0 for HPV. These findings suggest that proactive counseling at each visit has gained ground, while demand-driven advice remains prevalent.\u003c/p\u003e \u003cp\u003eThis behavioral improvement aligns with physicians\u0026rsquo; self-reported impact of the education and personal/relative vaccination: 52.9% reported administering at least one vaccine for themselves or immediate family, and 62.2% rated the education as a \u0026ldquo;10/10\u0026rdquo; factor influencing their decisions. These results indicate that short, targeted educational interventions can enhance not only knowledge but also practical counseling and recommendation behaviors.\u003c/p\u003e \u003cp\u003eIn the Turkish context, the administration of vaccines not included in the national immunization schedule\u0026mdash;such as HPV, rotavirus, and meningococcal vaccines\u0026mdash;largely depends on physician guidance and family initiative. Previous studies have shown that insufficient knowledge limits recommendation and uptake; for example, Kolcu reported that 44.5% of family physicians did not recommend the rotavirus vaccine, primarily due to lack of sufficient information, with similar trends observed for meningococcal vaccination. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) Our findings suggest that targeted training can quickly address these knowledge gaps, as evidenced by the increased proportion of \u0026ldquo;information/advice at every visit\u0026rdquo; after the program. Moreover, the substantial use of telephone counseling (e.g., HPV information provided at 15.7%) indicates that remote communication channels are being utilized more frequently, which may help overcome access barriers for vaccines requiring specialized procurement.\u003c/p\u003e \u003cp\u003eThe strength of this study is that the intervention focused directly on practical issues (dose intervals, co-administration, post-vomiting approach, etc.) and captured its effects on behavior with a short follow-up. This study was conducted as an intervention study in which HPV, meningococcal, and rotavirus vaccines were analyzed together, and attitudes and behaviors were assessed in the second phase using pretest-posttest methods. Based on the literature review, it can be said that this is the only study of this type conducted on this topic in our country in all these aspects. However, the predominance of the sample size from a single province/FHC and the use of self-reported behavioral measures may limit generalizability and precision. Furthermore, because the follow-up period in the second phase was 4\u0026ndash;6 weeks, long-term conclusions about the maintenance of the effect cannot be drawn.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn our study, the questions family physicians most frequently answered incorrectly before our training were generally about fundamental points related to the timeframe, vaccine use forms available on the market, and the timing of vaccine administration. The importance of the knowledge level of family physicians, who are the primary vaccine administerers, on these topics is evident. After our training, we observed that incorrect answers were replaced by correct answers with significant percentages. This result demonstrates the value and necessity of periodic in-service training for healthcare providers. Educational and up-to-date formats in healthcare delivery are an important component of continuing medical education. We recommend increasing the frequency and availability of such training and seminars. Considering the data obtained from the second phase of our study, we can predict that vaccination rates in the community will also improve in line with the training provided.\u003c/p\u003e \u003cp\u003eIn conclusion, our study has highlighted the limited knowledge and experience of primary care physicians regarding vaccines not included in the national vaccination calendar. The primary duty of family physicians is to provide preventive and preventative healthcare. In light of this information, keeping physicians' knowledge up-to-date will contribute to gaining self-confidence and increasing vaccine application rates, thus strengthening social immunization.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul\u003e\n \u003cli\u003eHuman papilloma Virus (HPV)\u003c/li\u003e\n \u003cli\u003eWorld Health Organization (WHO)\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Tokat Gaziosmanpaşa University Health Research and Training Hospital Clinical Research Ethics Committee (Approval date: 22 March 2024; Decision No: 24-KAEK-0722360). The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Written informed consent was obtained from all participants prior to their participation in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no specific funding for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is based on the medical specialization thesis of \u0026Ouml;zge Kılın\u0026ccedil;. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthor contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026Ouml;zge KILIN\u0026Ccedil; and Ufuk \u0026Uuml;NL\u0026Uuml; contributed to the study conception and design. Data collection was performed by \u0026Ouml;zge KILIN\u0026Ccedil;. Data analysis and interpretation were carried out by \u0026Ouml;zge KILIN\u0026Ccedil; and Ufuk \u0026Uuml;NL\u0026Uuml;. The first draft of the manuscript was written by \u0026Ouml;zge KILIN\u0026Ccedil;. Ufuk \u0026Uuml;NL\u0026Uuml; contributed to critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgments\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the units of the Tokat Provincial Directorate of Health for their support and cooperation during the conduct of this study. We also sincerely thank all participants for their voluntary participation and valuable contributions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBoccalini S. Value of Vaccinations: A Fundamental Public Health Priority to Be Fully Evaluated. Vaccines (Basel). 2025;13(5):479. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/vaccines13050479\u003c/span\u003e\u003cspan address=\"10.3390/vaccines13050479\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRepublic of T\u0026uuml;rkiye Ministry of Health Childhood Vaccination Schedule. [Online]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://hsgm.saglik.gov.tr/tr/asi-takvimi.html/\u003c/span\u003e\u003cspan address=\"https://hsgm.saglik.gov.tr/tr/asi-takvimi.html/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed 26.11.2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCortese MM, Parashar UD, Centers for Disease Control and Prevention (CDC). Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2009;58(RR\u0026ndash;2):1\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Rotavirus vaccines. WHO position paper - January 2013. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/WHO-WER9628\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/WHO-WER9628\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed 26.11.2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParashar UD, Hummelman EG, Bresee JS, et al. Global illness and deaths caused by rotavirus disease in children. Emerg Infect Dis. 2003;9:565.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStanley M. Pathology and epidemiology of HPV infection in females. Gynecol Oncol. 2010;117(2 Suppl):S5\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ygyno.2010.01.024\u003c/span\u003e\u003cspan address=\"10.1016/j.ygyno.2010.01.024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePace D, Pollard AJ. Meningococcal disease: clinical presentation and sequelae. Vaccine. 2012;30(30 Suppl 2):B3\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTagbo B, Ughasoro M, Omotowo B, Eneh C, Uwaezuoke N. Knowledge of Rotavirus Disease among Health Care Providers and Their Acceptance of Rotavirus Vaccines in South-East, Nigeria. J Vaccines Vaccin. 2013;S1:1\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarataş S, Tunay M. Evaluation of family medicine residents knowledge levels, attitudes and behaviors about rotavirus infection and vaccines. J Eur Med Sci. 2024;5(2):45\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnderson S, Isaac A, Jeffery CC, Robinson JL, Isaac DM, Korownyk C, Biron VL, Seikaly H. Practices regarding human Papillomavirus counseling and vaccination in head and neck cancer: a Canadian physician questionnaire. J Otolaryngol Head Neck Surg. 2017;46(1):61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuval B, Gilca V, McNeil S, Dobson S, Money D, Gemmill IM, Sauvageau C, Lavoie F, Ouakki M. Vaccination against human papillomavirus: a baseline survey of Canadian clinicians' knowledge, attitudes and beliefs. Vaccine. 2007;25(45):7841\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAydın B. Evaluation of family physicians\u0026rsquo; knowledge, attitudes and behaviours regarding HPV vaccination [thesis]. Ankara: Yıldırım Beyazıt University, Faculty of Medicine; 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTanrikulu A, Tunay M, Tekayak HV. Comparison of Knowledge Levels and Attitudes of Family Medicine Assistants About Meningococcal Infection and Vaccines Before and After Education. J Eur Med Sci. 2025;5(3):56\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4274/jeurmed.galenos.2025.68077\u003c/span\u003e\u003cspan address=\"10.4274/jeurmed.galenos.2025.68077\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKolcu H. Evaluation of family physicians and family medicine residents\u0026rsquo; knowledge, attitudes and behaviours regarding HPV, meningococcal and rotavirus vaccines [thesis]. Samsun: Ondokuz Mayıs University, Faculty of Medicine; 2019.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"primary care, family physicians, HPV, rotavirus, meningococcal, continuing professional development, vaccine counselling","lastPublishedDoi":"10.21203/rs.3.rs-8343237/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8343237/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn Türkiye, meningococcal, rotavirus, and HPV vaccines are not included in the national schedule. We aimed to assess whether a face-to-face educational intervention could improve physicians’ knowledge about these vaccines and influence their subsequent counselling and recommendation practices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used a two-phase intervention with pre/post assessment and a 4–6-week follow-up among family physicians. In Phase 1, participants received an in-person training on meningococcal, rotavirus, and HPV vaccines, and their knowledge was evaluated using identical true/false tests administered before and after the session. Phase 2, conducted 4–6 weeks later, measured changes in physicians’ self-reported frequency of providing recommendations about these vaccines, and whether they or their first-degree relatives had received any of the vaccines after the training. Differences in paired proportions were analyzed using McNemar’s test (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNinety-one physicians completed Phase-1; 70 from the same cohort completed Phase-2. After training, correct responses increased across multiple items: e.g., “Rotavirus vaccine is live” 89.0%→100% (p = 0.002); “Only humans are reservoir for meningococcal infection” 50.6%→96.7% (p \u0026lt; 0.001); “Meningococcal vaccine cannot be co-administered” (false) 70.3%→96.7% (p \u0026lt; 0.001). Phase-2 showed more proactive practice: for HPV, 52.9% reported recommending “upon family request” and 27.1% “at every visit”; for rotavirus these were 37.1% and 35.7%, respectively. Overall, 52.9% reported having administered one of the three vaccines to themselves or first-degree relatives after training; 62.2% rated the training’s influence on that decision as 10/10.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA targeted educational session produced meaningful gains in vaccine knowledge and was associated with more frequent counselling/recommendation behaviours in primary care.\u003c/p\u003e","manuscriptTitle":"Improving family physicians’ knowledge and practices on non-routine childhood vaccines (meningococcal, rotavirus, HPV): a two-phase intervention study from primary care in Türkiye","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-16 14:11:17","doi":"10.21203/rs.3.rs-8343237/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-27T10:20:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"40430098907878808920072474172536709564","date":"2026-01-19T10:39:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-14T10:40:52+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-19T08:47:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-17T03:29:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-17T03:25:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2025-12-12T07:47:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6d9e3d31-5fe6-4aae-aaeb-9c0040f019b3","owner":[],"postedDate":"January 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-16T14:11:17+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-16 14:11:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8343237","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8343237","identity":"rs-8343237","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}