Assessing knowledge, attitudes and practices towards HPV vaccination among male healthcare professionals and students in Delhi National Capital Region: A mixed-method study

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While the burden of HPV (Human papillomavirus)-related infections among Indian women is well-documented, there is a need to understand HPV related dynamics among Indian men as well as an influencing factor in male reproductive health. This study aims to assess the knowledge, attitudes, and practices (KAP) related to HPV vaccination among male healthcare professionals in India. Methods A mixed-method survey was conducted from March 2022 to April 2023 among young male healthcare professionals from diverse backgrounds across public and private healthcare settings in the Delhi National Capital Region (NCR) region of India. In the quantitative arm, systematic random sampling was employed to recruit participants, with 299 complete responses recorded. For the qualitative arm, 37 participants were interviewed to gain an in-depth understanding of their perceptions of HPV infection and vaccination. Quantitative data were analysed using descriptive statistics (SPSS Version 30.0), and qualitative data analysis was done using manual transcription method employing the Grounded Theory Approach (GTA). Results The mean age of the participants in the quantitative arm was 24.6 years. The overall knowledge score towards HPV vaccination was 59%, with an attitude score of 89%. Although 83.9% of participants were willing to promote HPV vaccination among men in India, only 11.4% got vaccinated for HPV. The engagement in unsafe sexual practices was significantly associated with age (p-0.006), occupation (p-0.004), education (p < 0.001), and marital status of the participants (p-0.003). A significant association was also observed between marital status and the willingness to engage in HPV-related awareness within their personal networks (p < 0.001). In the qualitative arm, the mean age was 32.4 ± 6.2 years. Four themes were generated after thematic analysis:1) HPV seen as female-specific, 2) Awareness not translating into action, 3) Systemic silence and missed opportunities, and 4) Cost-consciousness despite awareness. Out of 37 interviewees, 27% had misconceptions towards HPV, 18.9% felt a lack of male-focused HPV vaccination drive, and 29.7% expressed affordability concerns towards getting HPV vaccination due to the high vaccine cost. Conclusion This study's findings lay the groundwork for more extensive research to understand the barriers and facilitators to HPV vaccination among men. Such research could inform targeted strategies to improve vaccination rates, reducing the burden of preventable HPV-related diseases thereby improving male reproductive health. KAP HPV Vaccine Healthcare India Introduction Cervical cancer remains a significant global health concern, particularly affecting women aged 15 to 44 years [1]. In India, the situation is particularly alarming, accounting for 123,907 new cases in the year 2023 with 77348 mortality cases [2]. The primary causative agent for cervical cancer is HPV. It has more than 200 different forms, and at least 40 of them are known to affect the genitals. Although the assessment of HPV burden has been concentrated on female populations, it is equally imperative to assess the prevalence and incidence of HPV among Indian men [3–5]. Penile cancer accounts for 6% of all cancers in Indian men, and oropharyngeal malignancies contribute to 30% of HPV-related cancers [6]. Male HPV infection affects not only penile, anal, and oropharyngeal cancers, but also leads to poor sperm quality, anti-sperm antibody production, embryonic developmental abnormalities, and adverse reproductive outcomes such as decreased fertilization rates, poor embryo quality, and increased pregnancy loss [7, 8]. The Men who have sex with men (MSM) population in India presents a unique challenge due to high-risk sexual practices and cultural stigmas [9]. Immunizing women alone does not provide enough protection against HPV infection in males. Most European countries as defined by the World Health Organization (WHO) have implemented HPV vaccinations for both men and women [10]. While HPV-related infections in Indian women constitute a considerable segment of the HPV burden within the Indian population, the prevalence of HPV and related diseases in Indian men is also a crucial factor in assessing the overall prevalence and incidence of HPV in the Indian hemisphere [9]. In India, HPV vaccines are available but not yet included in the national immunization program. The vaccines are primarily available in private hospitals upon request, limiting their accessibility. Despite global evidence supporting the effectiveness of HPV vaccination, its acceptability in India remains controversial due to factors like high cost, social stigma, and concerns about safety and efficacy [9]. A significant gap exists in the current discourse around HPV vaccination in India, particularly concerning men. Healthcare providers, including paramedical staff, play a crucial role in educating the population about disease prevention. Their knowledge, attitude, and recommendations significantly influence HPV vaccination acceptance among young males. In light of this context, our study aims to assess the knowledge, attitude, and practices of healthcare providers regarding HPV vaccination among young males in India. By identifying gaps and barriers in current practices, this study seeks to offer valuable insights to inform targeted interventions to improve HPV vaccination rates among male healthcare professionals. Materials & Methods Study Design, Population, and Inclusion Criteria The study employed a mixed-method design, and data collection lasted from March 2022 to April 2023. The target population consisted of male healthcare professionals and students of medical and health-related sciences (graduates, postgraduates, and PhDs) in the Delhi-NCR region. This specific demographic population was chosen because they are budding professionals who can make significant contributions to understanding and promoting the importance of vaccines. Eligibility criteria included being above 18 years of age, being a male healthcare professional, or being a student of medical and health allied sciences in the Delhi NCR region. Written informed consent was integrated into the Google Form and distributed to the participants before the initiation of the study. Sampling Technique and Data Collection Quantitative component For the quantitative study, participants were recruited using convenience sampling technique. Participants who met the inclusion criteria and were accessible to the research team were considered. Participants were approached based on their availability and willingness to participate and provided with virtual written informed consent via a Google Form. The recruitment process was done in medical institutions and hospitals across the Delhi-NCR region. The sample size was calculated using a single population proportion formula, resulting in 320 participants, considering 10% non-response rate. However, only 299 participants completed the questionnaire and were therefore included in the study analysis. Data collection was conducted through an online, self-reported, semi-structured questionnaire created using Google Forms. The questionnaire was disseminated via various virtual social media platforms, including WhatsApp, LinkedIn, and Instagram, to reach a broader audience within the target demographic. Several measures were taken to specifically target the demographic of male healthcare professionals and students in medical and health allied sciences. Social media platforms widely used by the target demographic, including WhatsApp, LinkedIn, and Instagram, were strategically chosen to reach a broad and diverse audience. Additionally, we leveraged professional and academic networks, including groups and forums specific to healthcare professionals and students, to disseminate the questionnaire within these networks, ensuring it reached individuals more likely to meet our inclusion criteria. The online questionnaire included screening questions to confirm eligibility, ensuring that only those who met the criteria could complete the survey. Electronic informed consent was integrated into the Google Form to ensure ethical compliance and verify that participants understood the study's purpose and their involvement. Qualitative component In the qualitative study, purposive sampling was used to recruit 40 participants from the same target demographics; however, participants recruited for the quantitative study were excluded from the qualitative part. The participants selected were diverse in terms of age, occupation, and experience within the healthcare sector. Out of 40 participants, 37 provided their consent to participate in the interview. Semi-structured interviews were conducted virtually using a secure video conferencing platform such as Google Meet for the participants’ convenience. Participants who met the eligibility criteria were purposefully enrolled through the same professional and digital networks used in the quantitative arm, including WhatsApp, LinkedIn, and Instagram. In addition, participants were also contacted via email and peer referrals who were willing to participate in the semi-structured interview process. The interviews in both processes were audio-recorded with prior permission to enable transcription and interpretation. Written informed consent and audio-recorded consent was taken from the enrolled participants before the interviews. The identities of the participants were anonymized, and manual thematic analysis was done to construct relevant themes. Assessment Tool and Measurement Process For the quantitative arm, a semi-structured questionnaire was designed, comprising four primary sections: socio-demographic information, knowledge, attitudes and practices-related questions pertaining to HPV. The questionnaire was designed after reviewing existing literature and under the supervision of medical health professionals as well as public health professionals with expertise in sexual health. The questionnaire was further validated by the experts in the related field. The scoring system included two types of questions based on the answer choices: binary (yes/no) and ternary (yes/no/do not know). Each correct or affirmative answers were given a score of 1, while incorrect, negative, or uncertain answers were assigned 0. A normalization procedure was then followed to ensure the interpretability of the scores. The scores were normalized by dividing the total points by the maximum possible score in each section and multiplying by 100 to obtain a final percentage score for each domain reflecting the relative knowledge, attitude and practice level toward HPV vaccination. For the qualitative arm, a semi-structured open-ended interview guide was designed to conduct in-depth interviews to explore the awareness, attitudes and contextual barriers about HPV vaccination among male healthcare professionals. The questionnaire was designed after reviewing relevant existing literature and expert suggestions to collect context-specific details associated with vaccine acceptability, perceptions of risk, social influences and institutional dynamics. The questionnaire was validated by the experts in the related field. Statistical Analysis Quantitative data were analysed using SPSS (Version 24). Descriptive statistics were used to summarize the socio-demographic characteristics and the KAP of the study population. Additionally, the Chi-square test was employed to assess associations between different variables. A p-value of < 0.05 was considered statistically significant. For the qualitative arm, data were manually transcribed verbatim to capture the participant’s narratives. GTA [11] was used for the inductive analysis of the transcripts, which allows themes to emerge from the data. The transcripts were independently coded by two researchers, followed by the thematic coding of subsequent interviews using jointly developed codes. Coding and analysis were done in parallel with data collection. The study protocol was approved by the Institutional Ethics Committee at Amity University, Noida (AUUP/IEC/FEB/2022/03). Informed consent was confirmed by the Institutional Review Board (IRB). Results In this study, the final sample comprised 299 respondents who completed the survey. Table 1 shows that most of the study's population was between 18–25 years old. According to their educational qualifications, most participants were Graduates (60%). The overall knowledge score among participants regarding HPV vaccination was 59%. Table 1 Socio-demographic characteristics of the participants from the quantitative part (n = 299) Socio-demographic variables Number (n-299) (%) Age (Years) 18–25 215 (71.9) 26–35 71 (23.7) 36–45 9 (3.0) 46 and above 4 (1.3) Occupation Government Job 18 (6.0) Private Job 40 (13.4) Self-employed 16 (5.4) Student 222 (74.2) Unemployed 3 (1.0) Religion Buddhist 3 (1.0) Christian 32 (10.7) Hindu 213 (71.2) Muslim 35 (11.7) Sikh 10 (3.3) Others* 6 (2.0) Education Ayurveda Yoga Unani Siddha Homeopathy (AYUSH) 10 (3.3 Bachelor in Pharmacology 10 (3.3) Bachelor in Dental Surgery (BDS) 59 (19.7) Bachelor in Physiotherapy (BPT) 37 (12.4) Bachelor of Science in Nursing 1 (0.3) Doctorate 7 (2.3) Bachelor of Medicine and Bachelor of Surgery (MBBS) 29 (9.7) Doctor of Medicine (MD) 11 (3.7) Master’s in dental surgery (MDS) 6 (2.0) Master in Hospital Administration (MHA) 6 (2.0) Master’s in Public Health (MPH) 17 (5.7) Master of Science (MS) 6 (2.0) Paramedics 65 (21.7) Others ** 34 (11.4) Post-graduate (MD,MS,MDS,MPH,MHA) 1 (0.3) Education Level Graduate 182 (60.9) Post-graduate 110 (36.8) Doctorate 7 (2.3) Place of Stay Hostel/Paying guest 146 (48.8) Other*** 42 (14.0) With parents/relatives 111 (37.1) Household income (INR) 50K-1.5 Lakhs 132 (44.1) 1.5 Lakhs − 2.5 Lakhs 45 (15.1) 3.5 Lakhs and above 122 (40.8) Marital status Married 38 (12.7) Other**** 5 (1.7) Unmarried 256 (85.6) *Religion- Others- Adivasi, Jainism, **Education- Others- Pharmacology, Optometry, Microbiology, Anatomy, etc., ***Place of stay-Others- With colleagues or friends, ****Marital status-Other-Divorced, Widowed. There was adequate knowledge about HPV (82%) and its transmission (98%) among the population, as shown in Table 2 . The positive attitude score towards HPV vaccination was 89%. Table 2 shows that there was a negative attitude towards the perception that only sexually active individuals should get vaccinated against HPV (55.5%). Most participants (55.9%) were sexually active and indulged in safe sex practices (70.9%). Sixty-eight per cent of the respondents had a positive approach towards educating young men and women about the risk factors associated with HPV (Table 2 ). Around 83.9% displayed a favourable inclination towards encouraging young men visiting their OPD/Clinic to get vaccinated against HPV. Only a small portion (11.4%) of the population was vaccinated against HPV. Table 2 Frequencies and percentages of Knowledge, Attitude and Practice regarding HPV vaccine among the participants from the quantitative part (n = 299) Questions Adequate Inadequate Knowledge Based Questions Adequate Knowledge N (%) Inadequate Knowledge N (%) 1. What HPV is? (Yes/No) 246 (82.3) 53 (17.7) 2. HPV infection transmission (Sexually/Droplet nuclei/Saliva/Blood transfusion) 296 (98.0) 6 (2.0) 3. Diseases caused by HPV. (Cancer/STDs/Heart disease/Kidney disease) 285 (95.3) 14 (4.7) 4. HPV causing diseases in men. (Yes/No) 270 (90.3) 29 (9.7) 5. Diseases it can cause in men. (Penal cancer/Anal cancer/Genital warts/Genital sores/kidney disease) 265 (94.0) 17 (6.0) 6. Men can be carriers for HPV infection. (Yes/No) 232 (77.6) 67 (22.4) 7. Gender-neutral HPV vaccine (Yes/No) 159 (53.2) 140 (46.8) 8. Available gender-neutral vaccines for HPV in India (Gardasil 9/ Cervarix/ Gardasil 4/Don’t know) 93 (31.1) 206 (68.9) 9. Ideal age for getting HPV vaccine (6–18 years/9–26 years/26 and above /None of the above) 156 (52.2) 143 (47.8) Attitude Based Questions Positive Attitude N (%) Negative Attitude N (%) 1. HPV can cause serious diseases. (Yes/No) 269 (90) 30 (10) 2. HPV is related to penile/ anal cancer. (Yes/No) 249 (83.3) 50 (16.7) 3. HPV vaccines can help prevent penile cancer and genital warts. (Yes/No) 251 (83.9) 48 (16.1) 4. Only sexually active individuals should get vaccinated against HPV. (Yes/No) 133 (44.5) 166 (55.5) 5. HPV vaccination should be mandatory for boys and girls before their first sexual intercourse. (Yes/No) 218 (72.9) 81 (27.1) 6. Partner's opinion is essential when you decide to get vaccinated against HPV. (Yes/No) 177 (59.2) 122 (40.8) 7. Willingness to get vaccinated against HPV infection. (Yes/No) 238 (79.6) 61 (20.4) 8. Willingness to know more about HPV infection and its vaccine. (Yes/No) 264 (88.3) 35 (11.7) 9. HPV vaccines should be a part of the immunization programme. (Yes/No) 263 (88) 36 (12) Practice Based Questions Adequate Practice N (%) Inadequate Practice N (%) 1. Sexually active (Yes/No) 167 (55.9) 132 (44.1) 2. Age at which you became sexually active o 15–25 o 26–35 o 36–45 298 (99.6) 1 (0.3) 3. Indulgence in safe sex practices (Yes/No) 212 (70.9) 87 (29.1) 4. Educate young men/women about the risk factors for HPV (Yes/No) 205 (68.6) 94 31.4) 5. Encourage young men visiting your OPD (clinic) to get vaccinated against HPV. (Yes/No) 251 (83.9) 48 (16.1) 6. Vaccinated against HPV (Yes/No) 34 (11.4) 265 (88.6) 7. Recommendation for vaccine o Doctor o Family/ Friends o Others o Not Vaccinated 34 (11.4) 265 (88.6) 8. What was the reason for not getting vaccinated? o Fear of side effects o Lack of knowledge o Vaccine not available o Others 244 (81.6) 55 (18.4) 9. Willingness to create awareness among family and friends. (Yes/No) 277 (92.6) 22 (7.4) Upon analyzing the association between knowledge, attitude, and practice related to HPV among men, socio-demographic characteristics, such as age and occupation, were significantly associated with having basic knowledge of HPV (age: p < 0.001, occupation: p < 0.027) (Table 3, Supplementary file). With respect to attitude-related questions, participants’ willingness to get vaccinated against HPV was significantly associated with age (p < 0.001) (Table 4, Supplementary file). The practice of encouraging young men to get vaccinated for HPV was significantly related to the age of the participant (p < 0.001) (Table 5, Supplementary file). Also, practice was found to be significantly associated with attitude towards HPV (< 0.001) (Table 6 ). Table 6 Association of practice scores with scores of knowledge as well as attitude assessment Practice based categories Knowledge Attitude Inadequate Average Adequate Positive Negative Bad Practice 55.6% 50.9% 16% 54.5% 19.5% Good Practice 44.4% 49.1% 84% 45.5% 80.5% P-value < 0.001 < 0.001 In the in-depth interview, 37 participants participated via a secure virtual platform. The mean age of the participants was 32.4 ± 6.2 years. (Table 7 ). Thematic analysis generated four themes were :1) HPV seen as female-specific, 2) Awareness not translating into action, 3) Systemic silence and missed opportunities, and 4) Cost-consciousness despite awareness (Table 8 ). Table 7 Socio-demographic characteristics of the participants from the qualitative part (n-37) Variable Category n-37 (%) Age (Years) (Mean ± SD: 32.4 ± 6.2) 18–25 12 (32.4) 26–35 15 (40.5) 36–45 6 (16.2) 46 and above 4 (10.8) Occupation Government Job 10 (27.0) Private Job 5 (13.5) Self-employed 3 (8.1) Student (UG/PG/Interns) 19 (51.4) Education (Stream) Bachelor of Medicine and Bachelor of Surgery (MBBS) 8 (21.6) Bachelor in Dental Surgery (BDS) 7 (18.9) Bachelor of Physiotherapy (BPT) 5 (13.5) Paramedics/AYUSH/Allied Health 10 (27.0) Others* 7 (18.9) Education Level Undergraduate 21 (56.8) Postgraduate 14 (37.8) Doctorate 2 (5.4) Marital Status Married 9 (24.3) Unmarried 28 (75.7) HPV Vaccination Status Vaccinated 0 (0.0) Not Vaccinated 37 (100.0) *Education- Others- Pharmacology, Optometry etc., UG- Undergraduate, PG-Postgraduate Table 8 Thematic Analysis overview showcasing themes, codes, and participants' representation (n-37) Theme Primary Code Secondary Code Participants (n = 37) % HPV seen as female-specific Knowledge of HPV & HPV Vaccine Misinformation 10 27 Knowledge Gap 6 16.2 Awareness not translating into action Knowledge–Action Gap Lack of perceived need for vaccination 9 24.3 Difficulty in communication with adolescent boys/men 8 21.6 Lack of male-focused vaccination drives 7 18.9 Systemic Silence and Missed Opportunities Institutional & Policy Silence Lack of educational campaigns for men/boys 8 21.6 Government/advertisement focusing only on women/girls 5 13.5 Cost-Consciousness despite Awareness Affordability Concerns High vaccine cost 11 29.7 Lack of government support/subsidies 6 16.2 1st theme: HPV seen as female-specific This theme expresses the perception that HPV mainly impacts women, especially in the context of cervical cancer. It emerged from the interviewees that most did not know about the risks HPV poses to men, such as genital warts, as well as penile, oropharyngeal and anal cancers. The majority expressed limited knowledge regarding male susceptibility to HPV. The interviewees expressed that predominantly the health-related government messages as well as policies revolve around HPV and Cervical cancer, which is why they are not very aware of HPV effects in the context of men. "I was thinking HPV only affects women and is related to cervical cancer. I had no idea that it affects men as well." — 22-year-old Undergraduate student, Participant 1 "We are surrounded by HPV along with cervical cancer, and the Indian government is also encouraging HPV vaccination against cervical cancer. I had no idea there was another side of it." — 28-year-old Postgraduate Student, Participant 3 2nd theme: Awareness not translating into action This theme highlights the significant knowledge-action gap, as none of the interviewees had received the HPV vaccination, despite some being aware of it. Some of the interviewees expressed awareness towards HPV among men and associated vaccination; however, they never thought about taking the vaccination for themselves. They reported not being worried about getting vaccinated as HPV vaccination for men was not felt essential at the moment. "I know that men too can take vaccination against HPV, but I never felt the need to have it for myself." — 32-year-old healthcare practitioner, Participant 5 "I have read and seen several articles that talk about vaccination of men for protection against HPV, but I have never seen any HPV vaccination drive for men in India." 28-year-old Postgraduate student, Participant 10 3rd theme: Systemic Silence and Missed Opportunities The interviewees expressed a lack of advocacy and orientation towards HPV vaccination in the context of men. Undergraduate and postgraduate interviewees stated that their institutions have not organised any HPV vaccination educational campaign related to men. Practising healthcare professionals reported a lack of governmental initiatives in advocating gender neutral HPV vaccination, as most of the vaccination drives are concentrating on girls and women. "I have never seen any HPV vaccination educational program for men in my college. That’s why I was never exposed to it” 22-year-old undergraduate student, Participant 15 " Today if we see the government initiatives or commercial ads, the focus is to prevent cervical cancer through HPV vaccination among girls. Maybe because of that the other genders felt it is not that necessary now.”— 35-year-old practising healthcare professional, participant 2 4th theme: Cost-Consciousness despite Awareness The interviewees expressed affordability as a barrier to getting vaccinated against HPV. The high price of the vaccine was a prominent deterrent even for those who were aware of HPV risks and the benefits of vaccination. The interviewees believed the vaccine was too expensive, particularly for students and those beginning their careers, as there is a lack of government vaccination programs or subsidies for boys and men. “The per-dose cost of the recent HPV vaccine is nearly 10,000 Rs. I cannot afford it right now as I am a student” — 25-year-old postgraduate student, Participant 20 "I am willing to get vaccinated, but it seems more like a luxury to get vaccinated unless it is subsidized." — 34-year-old practising healthcare professional, Participant 28 Discussion The quantitative component of our study revealed a decent overall knowledge score among the participants. This indicates a fair understanding among the participants regarding potential health risks associated with HPV infection. Our study reported a significant level of awareness among respondents about HPV causing diseases in men, highlighting the exposure of the virus's impact on both genders. Additionally, a notable proportion of the participants recognized that males may transmit HPV infection. This comprehension is vital in underscoring the significance of HPV immunization for both genders [12]. The overall knowledge score in our study suggests that educational campaigns, public health initiatives, and healthcare interventions aimed at disseminating information about HPV and its vaccine can effectively raise awareness among the population [13]. The study also reported that a positive attitude towards a partner's opinion is essential when deciding to get vaccinated against HPV, with the majority of the participants expressing this view. This underscores the importance of communication and shared decision-making within relationships regarding preventive healthcare measures [14]. A significant percentage of responders demonstrated a proactive approach in teaching young men and women of the risk factors linked to HPV. This conclusion underscores the participants' dedication to enhancing awareness and understanding of the virus, its transmission, and associated health hazards among the youth. In terms of healthcare practices, an encouraging majority of the participants expressed a favourable inclination towards encouraging young men visiting their outpatient department (OPD)/Clinic to get vaccinated against HPV. This suggests a proactive role of healthcare professionals in promoting HPV vaccination and prevention [15]. However, it is concerning that only a small portion of the population reported being vaccinated against HPV. This finding suggests a gap between the positive attitudes and actual uptake of the vaccine. Further investigation is required to explore the factors contributing to this low vaccination rate, such as access barriers, knowledge gaps, or vaccine hesitancy [16]. Among those who were vaccinated, it is noteworthy that the majority received a recommendation for vaccination, indicating the influential role of healthcare providers in promoting. Interventions aimed at increasing vaccine uptake, improving access to vaccination, and addressing vaccine hesitancy should be implemented to maximize the potential impact of HPV vaccination in reducing the burden of HPV-related diseases [17]. In the qualitative component, our result highlights a potential gap in knowledge regarding HPV among interviewed participants. In addition to the knowledge gap, there is misinformation towards HPV being perceived as a female-specific issue. This is an alarming situation, as students as well as budding healthcare professionals need to be sensitized to the HPV topic to be able to provide precautionary health information to the general population. This forms the rationale for conducting large-scale educational campaigns at the institutional level as well as at the population level sponsored by the government. The majority of the interviewees expressed gender-biased approach towards HPV prevention strategies and vaccination including but not limited to vaccination drives, educational seminars, campaigns and governmental current initiatives. Although India is progressing towards a gender-neutral HPV vaccination initiative; prioritizing girls/women for cervical cancer prevention as a primary focus has created a huge gap in the vaccination rate for men. This disparity is not only the result of existing gender bias in the healthcare delivery system but also long-existing emphasis on cervical cancer prevention, less understanding among men about the hazards of HPV, and logistical as well as societal obstacles. Studies have reported that HPV vaccination is helpful to males and is critical for developing herd immunity and avoiding HPV-related malignancies in men. In line with our study, disparity in HPV knowledge across gender in context of healthcare professionals has reported in other studies as well [18]. The interviewees also expressed cost-effectiveness as a prime factor in getting vaccination against HPV as the current cost is not affordable by all tiers of population. Several studies conducted in diverse locations of southern India reported similar findings [19–25]. As a result, unless vaccination is included in India's Universal vaccination Program, it will be financially expensive for majority of population [26]. Healthcare professionals also reported hesitancy to recommend vaccination in the absence of a defined program plan or official government support. Based on the study findings, a series of recommendations can be adopted to address the knowledge gap related to HPV and enhance the administration of gender-neutral HPV vaccination. To begin with, our study has projected that, although the quantitative component reflected a decent level of knowledge and attitude among the participants towards HPV and associated vaccination, the qualitative component has shown a substantial gap in understanding HPV and perception towards implementing HPV vaccination among the participants. educational campaigns targeting both the general population, particularly young adults, and healthcare professionals is crucial. These campaigns should aim to disseminate accurate information about HPV transmission, associated diseases, available vaccine options, and the importance of vaccination for both males and females. To ensure widespread availability and acceptance of HPV vaccination, incorporating it as a mandatory component in national immunization programs prior to individuals' first sexual intercourse is highly recommended. Healthcare professionals should play a vital role in advocating for and supporting HPV vaccination within these programs [27]. To address knowledge gaps and misconceptions, it is recommended to develop targeted interventions and educational resources for specific demographic groups, such as students and young adults. Providing clear and accurate information about the appropriate age range for vaccination, with the support and guidance of knowledgeable healthcare professionals, can ensure better comprehension and timely vaccination [28]. Lastly, promoting peer-to-peer education and community-driven initiatives with the guidance of healthcare professionals is highly valuable. Empowering individuals who have already been vaccinated to become advocates and educate their peers, family members, and community can effectively emphasize the importance of HPV vaccination and foster acceptance and understanding among various social circles [29]. Conclusions The majority of male healthcare professionals in the quantitative study reflected adequate knowledge and positive attitude towards promoting HPV vaccination. However, in the qualitative part, various challenges pertaining to HPV vaccination including misinformation, lack of governmental support, lack of sensitization as well as affordability came to surface. These mixed findings serve as the groundwork for more extensive studies aimed at understanding both the barriers and facilitators affecting HPV vaccination among men in the Indian subcontinent. Future research should focus on developing targeted approaches to address specific concerns. This includes disseminating accurate information about vaccine safety and effectiveness, debunking prevalent misconceptions, integrating HPV education in male reproductive health programs and emphasizing the benefits of HPV vaccination in preventing HPV-related diseases. Moreover, it is crucial to formulate strategies tailored to address and overcome barriers to vaccine acceptance. These strategies should account for geographic and socio-economic variables to ensure a comprehensive and effective vaccination program, benefiting all genders. Abbreviations HPV Human Papilloma Virus KAP Knowledge, Attitude and Practice NCR National Capital Region GTA Grounded Theory Approach MSM Men who have sex with men WHO World Health Organization IRB Institutional Review Board OPD Out Patient Department KNK Karuna Nidhi Kaur DN Dhruva Nandi AJ Alex Joseph SS Shazina Saeed SC Shanta Chandrasekaran Declarations Ethics approval and consent to participate Ethical approval was obtained from the institutional ethics board prior to the initiation of the study, and informed consent was obtained from each participant before data collection. The study has adhered to the Declaration of Helsinki. Consent for publication Not applicable Availability of data and materials Data and materials will be available upon request to the corresponding author. Competing interests Authors declare no competing interests. Funding Nil Authors' contributions KNK and DN conceptualized, initiated the study, and wrote the manuscript. SC provided the methodology and reviewed the manuscript. AJ carried out statistical analysis and interpreted all data, and SS reviewed and carried out overall editing of the manuscript. AJ and SS both supervised and administered the study. Acknowledgements The authors would like to thank all the male health professionals who agreed to take part in the study. The authors would also like to thank Arunima Koul and Kanika Arora from the Laboratory of Disease Dynamics & Molecular Epidemiology at Amity Institute of Public Health, Amity University, Noida, India, for their assistance in collecting the data samples. 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Indian Journal of Youth and Adolescent Health. 2022 Nov 23;09(03):1–2. Rahangdale L, Mungo C, O’Connor S, Chibwesha CJ, Brewer NT. Human papillomavirus vaccination and cervical cancer risk. BMJ. 2022 Dec 15;379:e070115. Tie YC, Birks M, Francis K. Grounded Theory research: a Design Framework for Novice Researchers. SAGE Open Medicine [Internet]. 2019;7(1):1–8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6318722/ He W, Pan H, Lin B, Zhong X. Analysis of HPV Vaccination Willingness amongst HIV-Negative Men Who Have Sex with Men in China. Vaccines. 2021 Sep 24;9(10):1069. Widjaja VN. Awareness, Knowledge and Attitudes of Human Papillomavirus (HPV) among Private University Students- Malaysia Perspective. Asian Pacific Journal of Cancer Prevention. 2019 Jul 1;20(7):2045–50. Grad R, Légaré F, Bell NR, Dickinson JA, Singh H, Moore AE, et al. Shared decision making in preventive health care: what it is; what it is not. Can Fam Physician. 2017 Sept 1;63(9):682-4. Cheung T, Lau JTF, Wang JZ, Mo P, Siu CK, Chan RTH, et al. The Acceptability of HPV Vaccines and Perceptions of Vaccination against HPV among Physicians and Nurses in Hong Kong. International Journal of Environmental Research and Public Health. 2019 May 14;16(10):1700. Seok Won Jin, Lee Y, Lee S, Jin H, Brandt HM. Factors Associated with College Students’ Human Papillomavirus (HPV) Vaccination and Preferred Strategies for Catch-Up Vaccine Promotion: A Mixed-Methods Study. Vaccines. 2023 Jun 20;11(6):1124–4. Krokidi E, Rao AP, Ambrosino E, Pierre. The impact of health education interventions on HPV vaccination uptake, awareness, and acceptance among people under 30 years old in India: a literature review with systematic search. Frontiers in Reproductive Health [Internet]. 2023 May 5;5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10198780/ Leung SOA, Akinwunmi B, Elias KM, Feldman S. Educating healthcare providers to increase Human Papillomavirus (HPV) vaccination rates: A Qualitative Systematic Review. Vaccine: X. 2019 Dec;3:100037. Shetty S, Shetty V, Badiger S, Shetty AK. An exploratory study of undergraduate healthcare student perspectives regarding human papillomavirus and vaccine intent in India. Women’s Health. 2021 Jan;17:174550652110553. Chellapandian P, Myneni S, Ravikumar D, Padmanaban P, James KM, Kunasekaran VM, et al. Knowledge on cervical cancer and perceived barriers to the uptake of HPV vaccination among health professionals. BMC Women’s Health. 2021 Feb 12;21(1). Canon C, Effoe V, Shetty V, Shetty AK. Knowledge and Attitudes Towards Human Papillomavirus (HPV) Among Academic and Community Physicians in Mangalore, India. Journal of Cancer Education. 2016 Feb 16;32(2):382–91. Jacob M, Mawar N, Menezes L, Kaipilyawar S, Gandhi S, Khan I, et al. Assessing the Environment for Introduction of Human Papillomavirus Vaccine in India~!2009-10-20~!2010-02-02~!2010-04-06~! The Open Vaccine Journal. 2010 May 4;3(1):96–107. Madhivanan P, Krupp K, Yashodha MN, Marlow L, Klausner JD, Reingold AL. Attitudes toward HPV vaccination among parents of adolescent girls in Mysore, India. Vaccine. 2009 Aug;27(38):5203–8. Pandey D, Vanya V, Bhagat S, VS B, Shetty J. Awareness and Attitude towards Human Papillomavirus (HPV) Vaccine among Medical Students in a Premier Medical School in India. Wu JT, editor. PLoS ONE. 2012 Jul 31;7(7):e40619. Swarnapriya K, Kavitha D, Reddy GMM. Knowledge, Attitude and Practices Regarding HPV Vaccination Among Medical and Para Medical in Students, India a Cross Sectional Study. Asian Pacific Journal of Cancer Prevention. 2016 Jan 11;16(18):8473–7. Krupp K, Marlow LAV, Kielmann K, Doddaiah N, Mysore S, Reingold AL, et al. Factors Associated With Intention-to-Recommend Human Papillomavirus Vaccination Among Physicians in Mysore, India. Journal of Adolescent Health. 2010 Apr;46(4):379–84. National implementation of HPV vaccination programs in low-resource countries: Lessons, challenges, and future prospects. Preventive Medicine [Internet]. 2021 Mar 1;144:106335. Available from: https://www.sciencedirect.com/science/article/pii/S0091743520303662# Tuckerman J, Kaufman J, Danchin M. Effective Approaches to Combat Vaccine Hesitancy. The Pediatric Infectious Disease Journal [Internet]. 2022 May 1;41(5). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8997018/ Kaufman J, Ryan R, Walsh L, Horey D, Leask J, Robinson P, et al. Face-to-face Interventions for Informing or Educating Parents about Early Childhood Vaccination. Cochrane Database of Systematic Reviews [Internet]. 2018 May 8;5(5). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494431/ Additional Declarations No competing interests reported. Supplementary Files peerj101542peerj101542TablesHPVvaccineSupplementary28102024.docx Legend of table 3, 4 & 5 has been mentioned in the supplementary file along with the table. Cite Share Download PDF Status: Under Review Version 1 posted Editor invited by journal 09 Mar, 2026 Reviewers agreed at journal 25 Jan, 2026 Reviewers agreed at journal 15 Dec, 2025 Reviewers agreed at journal 09 Dec, 2025 Reviewers invited by journal 08 Dec, 2025 Editor assigned by journal 06 Nov, 2025 Submission checks completed at journal 06 Nov, 2025 First submitted to journal 06 Nov, 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. 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20:07:37","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":88931,"visible":true,"origin":"","legend":"","description":"","filename":"764ff6d49f46493d8734e5dd6408322c1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7975577/v1/0f7031782963481eae62bb92.xml"},{"id":98429338,"identity":"3beb49f7-3e42-4f4c-9f2d-b205bb97a29c","added_by":"auto","created_at":"2025-12-17 16:43:14","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103774,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7975577/v1/0a768bc3902525b7336baca1.html"},{"id":98444776,"identity":"9fe05e32-8cd9-488f-9c0f-5483319bde3a","added_by":"auto","created_at":"2025-12-17 17:17:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1021440,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7975577/v1/8674c822-3f52-4ee7-a150-f2acac40ab5e.pdf"},{"id":98099562,"identity":"ccb07c24-738d-485c-9354-f7578e78186b","added_by":"auto","created_at":"2025-12-12 20:07:37","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":51813,"visible":true,"origin":"","legend":"\u003cp\u003eLegend of table 3, 4 \u0026amp; 5 has been mentioned in the supplementary file along with the table.\u003c/p\u003e","description":"","filename":"peerj101542peerj101542TablesHPVvaccineSupplementary28102024.docx","url":"https://assets-eu.researchsquare.com/files/rs-7975577/v1/33a4cb352781570c1eaaae73.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessing knowledge, attitudes and practices towards HPV vaccination among male healthcare professionals and students in Delhi National Capital Region: A mixed-method study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCervical cancer remains a significant global health concern, particularly affecting women aged 15 to 44 years [1]. In India, the situation is particularly alarming, accounting for 123,907 new cases in the year 2023 with 77348 mortality cases [2]. The primary causative agent for cervical cancer is HPV. It has more than 200 different forms, and at least 40 of them are known to affect the genitals. Although the assessment of HPV burden has been concentrated on female populations, it is equally imperative to assess the prevalence and incidence of HPV among Indian men [3\u0026ndash;5]. Penile cancer accounts for 6% of all cancers in Indian men, and oropharyngeal malignancies contribute to 30% of HPV-related cancers [6]. Male HPV infection affects not only penile, anal, and oropharyngeal cancers, but also leads to poor sperm quality, anti-sperm antibody production, embryonic developmental abnormalities, and adverse reproductive outcomes such as decreased fertilization rates, poor embryo quality, and increased pregnancy loss [7, 8].\u003c/p\u003e\u003cp\u003eThe Men who have sex with men (MSM) population in India presents a unique challenge due to high-risk sexual practices and cultural stigmas [9]. Immunizing women alone does not provide enough protection against HPV infection in males. Most European countries as defined by the World Health Organization (WHO) have implemented HPV vaccinations for both men and women [10]. While HPV-related infections in Indian women constitute a considerable segment of the HPV burden within the Indian population, the prevalence of HPV and related diseases in Indian men is also a crucial factor in assessing the overall prevalence and incidence of HPV in the Indian hemisphere [9].\u003c/p\u003e\u003cp\u003eIn India, HPV vaccines are available but not yet included in the national immunization program. The vaccines are primarily available in private hospitals upon request, limiting their accessibility. Despite global evidence supporting the effectiveness of HPV vaccination, its acceptability in India remains controversial due to factors like high cost, social stigma, and concerns about safety and efficacy [9]. A significant gap exists in the current discourse around HPV vaccination in India, particularly concerning men. Healthcare providers, including paramedical staff, play a crucial role in educating the population about disease prevention. Their knowledge, attitude, and recommendations significantly influence HPV vaccination acceptance among young males. In light of this context, our study aims to assess the knowledge, attitude, and practices of healthcare providers regarding HPV vaccination among young males in India. By identifying gaps and barriers in current practices, this study seeks to offer valuable insights to inform targeted interventions to improve HPV vaccination rates among male healthcare professionals.\u003c/p\u003e"},{"header":"Materials \u0026 Methods","content":"\u003cp\u003eStudy Design, Population, and Inclusion Criteria\u003c/p\u003e\u003cp\u003eThe study employed a mixed-method design, and data collection lasted from March 2022 to April 2023. The target population consisted of male healthcare professionals and students of medical and health-related sciences (graduates, postgraduates, and PhDs) in the Delhi-NCR region. This specific demographic population was chosen because they are budding professionals who can make significant contributions to understanding and promoting the importance of vaccines. Eligibility criteria included being above 18 years of age, being a male healthcare professional, or being a student of medical and health allied sciences in the Delhi NCR region. Written informed consent was integrated into the Google Form and distributed to the participants before the initiation of the study.\u003c/p\u003e\u003cp\u003eSampling Technique and Data Collection\u003c/p\u003e\u003cp\u003eQuantitative component\u003c/p\u003e\u003cp\u003eFor the quantitative study, participants were recruited using convenience sampling technique. Participants who met the inclusion criteria and were accessible to the research team were considered. Participants were approached based on their availability and willingness to participate and provided with virtual written informed consent via a Google Form. The recruitment process was done in medical institutions and hospitals across the Delhi-NCR region. The sample size was calculated using a single population proportion formula, resulting in 320 participants, considering 10% non-response rate. However, only 299 participants completed the questionnaire and were therefore included in the study analysis. Data collection was conducted through an online, self-reported, semi-structured questionnaire created using Google Forms. The questionnaire was disseminated via various virtual social media platforms, including WhatsApp, LinkedIn, and Instagram, to reach a broader audience within the target demographic.\u003c/p\u003e\u003cp\u003eSeveral measures were taken to specifically target the demographic of male healthcare professionals and students in medical and health allied sciences. Social media platforms widely used by the target demographic, including WhatsApp, LinkedIn, and Instagram, were strategically chosen to reach a broad and diverse audience. Additionally, we leveraged professional and academic networks, including groups and forums specific to healthcare professionals and students, to disseminate the questionnaire within these networks, ensuring it reached individuals more likely to meet our inclusion criteria. The online questionnaire included screening questions to confirm eligibility, ensuring that only those who met the criteria could complete the survey. Electronic informed consent was integrated into the Google Form to ensure ethical compliance and verify that participants understood the study's purpose and their involvement.\u003c/p\u003e\u003cp\u003eQualitative component\u003c/p\u003e\u003cp\u003eIn the qualitative study, purposive sampling was used to recruit 40 participants from the same target demographics; however, participants recruited for the quantitative study were excluded from the qualitative part. The participants selected were diverse in terms of age, occupation, and experience within the healthcare sector. Out of 40 participants, 37 provided their consent to participate in the interview. Semi-structured interviews were conducted virtually using a secure video conferencing platform such as Google Meet for the participants\u0026rsquo; convenience. Participants who met the eligibility criteria were purposefully enrolled through the same professional and digital networks used in the quantitative arm, including WhatsApp, LinkedIn, and Instagram. In addition, participants were also contacted via email and peer referrals who were willing to participate in the semi-structured interview process. The interviews in both processes were audio-recorded with prior permission to enable transcription and interpretation. Written informed consent and audio-recorded consent was taken from the enrolled participants before the interviews. The identities of the participants were anonymized, and manual thematic analysis was done to construct relevant themes.\u003c/p\u003e\u003cp\u003eAssessment Tool and Measurement Process\u003c/p\u003e\u003cp\u003eFor the quantitative arm, a semi-structured questionnaire was designed, comprising four primary sections: socio-demographic information, knowledge, attitudes and practices-related questions pertaining to HPV. The questionnaire was designed after reviewing existing literature and under the supervision of medical health professionals as well as public health professionals with expertise in sexual health. The questionnaire was further validated by the experts in the related field. The scoring system included two types of questions based on the answer choices: binary (yes/no) and ternary (yes/no/do not know). Each correct or affirmative answers were given a score of 1, while incorrect, negative, or uncertain answers were assigned 0. A normalization procedure was then followed to ensure the interpretability of the scores. The scores were normalized by dividing the total points by the maximum possible score in each section and multiplying by 100 to obtain a final percentage score for each domain reflecting the relative knowledge, attitude and practice level toward HPV vaccination.\u003c/p\u003e\u003cp\u003eFor the qualitative arm, a semi-structured open-ended interview guide was designed to conduct in-depth interviews to explore the awareness, attitudes and contextual barriers about HPV vaccination among male healthcare professionals. The questionnaire was designed after reviewing relevant existing literature and expert suggestions to collect context-specific details associated with vaccine acceptability, perceptions of risk, social influences and institutional dynamics. The questionnaire was validated by the experts in the related field.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eQuantitative data were analysed using SPSS (Version 24). Descriptive statistics were used to summarize the socio-demographic characteristics and the KAP of the study population. Additionally, the Chi-square test was employed to assess associations between different variables. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. For the qualitative arm, data were manually transcribed verbatim to capture the participant\u0026rsquo;s narratives. GTA [11] was used for the inductive analysis of the transcripts, which allows themes to emerge from the data. The transcripts were independently coded by two researchers, followed by the thematic coding of subsequent interviews using jointly developed codes. Coding and analysis were done in parallel with data collection. The study protocol was approved by the Institutional Ethics Committee at Amity University, Noida (AUUP/IEC/FEB/2022/03). Informed consent was confirmed by the Institutional Review Board (IRB).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn this study, the final sample comprised 299 respondents who completed the survey. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows that most of the study's population was between 18\u0026ndash;25 years old. According to their educational qualifications, most participants were Graduates (60%). The overall knowledge score among participants regarding HPV vaccination was 59%.\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\u003eSocio-demographic characteristics of the participants from the quantitative part (n\u0026thinsp;=\u0026thinsp;299)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSocio-demographic variables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber (n-299) (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eAge (Years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e215 (71.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e71 (23.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (3.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4 (1.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGovernment Job\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18 (6.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrivate Job\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40 (13.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16 (5.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e222 (74.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (1.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBuddhist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (1.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChristian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32 (10.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHindu\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e213 (71.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMuslim\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35 (11.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSikh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (3.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6 (2.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"14\" rowspan=\"15\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAyurveda Yoga Unani Siddha Homeopathy (AYUSH)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (3.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor in Pharmacology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (3.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor in Dental Surgery (BDS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59 (19.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor in Physiotherapy (BPT)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37 (12.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor of Science in Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (0.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDoctorate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7 (2.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor of Medicine and Bachelor of Surgery (MBBS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29 (9.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDoctor of Medicine (MD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11 (3.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaster\u0026rsquo;s in dental surgery (MDS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6 (2.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaster in Hospital Administration (MHA)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6 (2.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaster\u0026rsquo;s in Public Health (MPH)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17 (5.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaster of Science (MS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6 (2.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eParamedics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65 (21.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003cb\u003e**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34 (11.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePost-graduate (MD,MS,MDS,MPH,MHA)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (0.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eEducation Level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e182 (60.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePost-graduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e110 (36.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDoctorate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7 (2.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003ePlace of Stay\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHostel/Paying guest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e146 (48.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42 (14.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWith parents/relatives\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e111 (37.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eHousehold income (INR)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50K-1.5 Lakhs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e132 (44.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.5 Lakhs \u0026minus;\u0026thinsp;2.5 Lakhs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45 (15.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.5 Lakhs and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e122 (40.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38 (12.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther****\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5 (1.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e256 (85.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e*Religion- Others- Adivasi, Jainism, **Education- Others- Pharmacology, Optometry, Microbiology, Anatomy, etc., ***Place of stay-Others- With colleagues or friends, ****Marital status-Other-Divorced, Widowed.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThere was adequate knowledge about HPV (82%) and its transmission (98%) among the population, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The positive attitude score towards HPV vaccination was 89%. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that there was a negative attitude towards the perception that only sexually active individuals should get vaccinated against HPV (55.5%). Most participants (55.9%) were sexually active and indulged in safe sex practices (70.9%). Sixty-eight per cent of the respondents had a positive approach towards educating young men and women about the risk factors associated with HPV (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Around 83.9% displayed a favourable inclination towards encouraging young men visiting their OPD/Clinic to get vaccinated against HPV. Only a small portion (11.4%) of the population was vaccinated against HPV.\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\u003eFrequencies and percentages of Knowledge, Attitude and Practice regarding HPV vaccine among the participants from the quantitative part (n\u0026thinsp;=\u0026thinsp;299)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdequate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInadequate\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnowledge Based Questions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdequate Knowledge\u003c/p\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInadequate Knowledge\u003c/p\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. What HPV is?\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e246 (82.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53 (17.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. HPV infection transmission\u003c/p\u003e\u003cp\u003e(Sexually/Droplet nuclei/Saliva/Blood\u003c/p\u003e\u003cp\u003etransfusion)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e296 (98.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (2.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Diseases caused by HPV.\u003c/p\u003e\u003cp\u003e(Cancer/STDs/Heart disease/Kidney\u003c/p\u003e\u003cp\u003edisease)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e285 (95.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (4.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. HPV causing diseases in men.\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e270 (90.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29 (9.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. Diseases it can cause in men.\u003c/p\u003e\u003cp\u003e(Penal cancer/Anal cancer/Genital\u003c/p\u003e\u003cp\u003ewarts/Genital sores/kidney disease)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e265 (94.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (6.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. Men can be carriers for HPV infection.\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e232 (77.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67 (22.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7. Gender-neutral HPV vaccine\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e159 (53.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e140 (46.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8. Available gender-neutral vaccines for HPV in India\u003c/p\u003e\u003cp\u003e(Gardasil 9/ Cervarix/ Gardasil 4/Don\u0026rsquo;t know)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e93 (31.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e206 (68.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9. Ideal age for getting HPV vaccine\u003c/p\u003e\u003cp\u003e(6\u0026ndash;18 years/9\u0026ndash;26 years/26 and above\u003c/p\u003e\u003cp\u003e/None of the above)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e156 (52.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e143 (47.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAttitude Based Questions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePositive Attitude\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eNegative Attitude\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. HPV can cause serious diseases.\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e269 (90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. HPV is related to penile/ anal cancer.\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e249 (83.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50 (16.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. HPV vaccines can help prevent penile cancer and genital warts.\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e251 (83.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48 (16.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Only sexually active individuals should get vaccinated against HPV.\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e133 (44.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e166 (55.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. HPV vaccination should be mandatory for boys and girls before their first sexual intercourse.\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e218 (72.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81 (27.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. Partner's opinion is essential when you decide to get vaccinated against HPV.\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e177 (59.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e122 (40.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7. Willingness to get vaccinated against HPV infection.\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e238 (79.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61 (20.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8. Willingness to know more about HPV infection and its vaccine.\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e264 (88.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35 (11.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9. HPV vaccines should be a part of the immunization programme.\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e263 (88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (12)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePractice Based Questions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eAdequate Practice\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eInadequate Practice\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Sexually active\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e167 (55.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e132 (44.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Age at which you became sexually active\u003c/p\u003e\u003cp\u003eo 15\u0026ndash;25\u003c/p\u003e\u003cp\u003eo 26\u0026ndash;35\u003c/p\u003e\u003cp\u003eo 36\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e298 (99.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Indulgence in safe sex practices\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e212 (70.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e87 (29.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Educate young men/women about the risk factors for HPV\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e205 (68.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94 31.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. Encourage young men visiting your OPD (clinic) to get vaccinated against HPV.\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e251 (83.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48 (16.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. Vaccinated against HPV\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34 (11.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e265 (88.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7. Recommendation for vaccine\u003c/p\u003e\u003cp\u003eo Doctor\u003c/p\u003e\u003cp\u003eo Family/ Friends\u003c/p\u003e\u003cp\u003eo Others\u003c/p\u003e\u003cp\u003eo Not Vaccinated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34 (11.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e265 (88.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8. What was the reason for not getting vaccinated?\u003c/p\u003e\u003cp\u003eo Fear of side effects\u003c/p\u003e\u003cp\u003eo Lack of knowledge\u003c/p\u003e\u003cp\u003eo Vaccine not available\u003c/p\u003e\u003cp\u003eo Others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e244 (81.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55 (18.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9. Willingness to create awareness among family and friends.\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e277 (92.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (7.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eUpon analyzing the association between knowledge, attitude, and practice related to HPV among men, socio-demographic characteristics, such as age and occupation, were significantly associated with having basic knowledge of HPV (age: p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, occupation: p\u0026thinsp;\u0026lt;\u0026thinsp;0.027) (Table\u0026nbsp;3, Supplementary file). With respect to attitude-related questions, participants\u0026rsquo; willingness to get vaccinated against HPV was significantly associated with age (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;4, Supplementary file). The practice of encouraging young men to get vaccinated for HPV was significantly related to the age of the participant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;5, Supplementary file). Also, practice was found to be significantly associated with attitude towards HPV (\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e6\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 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation of practice scores with scores of knowledge as well as attitude assessment\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=\"left\" 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\u003ePractice based categories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eKnowledge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eAttitude\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInadequate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAverage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdequate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePositive\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNegative\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBad Practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.9%\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\u003e54.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e19.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood Practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e80.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn the in-depth interview, 37 participants participated via a secure virtual platform. The mean age of the participants was 32.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2 years. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e7\u003c/span\u003e). Thematic analysis generated four themes were :1) HPV seen as female-specific, 2) Awareness not translating into action, 3) Systemic silence and missed opportunities, and 4) Cost-consciousness despite awareness (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-demographic characteristics of the participants from the qualitative part (n-37)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en-37 (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (Years)\u003c/p\u003e\u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD: 32.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (32.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (40.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (16.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (10.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGovernment Job\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (27.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrivate Job\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (13.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (8.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudent (UG/PG/Interns)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (51.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation (Stream)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor of Medicine and Bachelor of Surgery (MBBS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (21.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor in Dental Surgery (BDS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (18.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor of Physiotherapy (BPT)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (13.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eParamedics/AYUSH/Allied Health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (27.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (18.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUndergraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (56.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePostgraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (37.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDoctorate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (5.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (24.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (75.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHPV Vaccination Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVaccinated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot Vaccinated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (100.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003e*Education- Others- Pharmacology, Optometry etc., UG- Undergraduate, PG-Postgraduate\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThematic Analysis overview showcasing themes, codes, and participants' representation (n-37)\u003c/p\u003e\u003c/div\u003e\u003c/caption\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\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary Code\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSecondary Code\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eParticipants (n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHPV seen as female-specific\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eKnowledge of HPV \u0026amp; HPV Vaccine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMisinformation\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\u003e27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKnowledge Gap\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\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAwareness not translating into action\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eKnowledge\u0026ndash;Action Gap\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLack of perceived need for vaccination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDifficulty in communication with adolescent boys/men\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\u003e21.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLack of male-focused vaccination drives\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\u003e18.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSystemic Silence and Missed Opportunities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eInstitutional \u0026amp; Policy Silence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLack of educational campaigns for men/boys\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\u003e21.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGovernment/advertisement focusing only on women/girls\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\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCost-Consciousness despite Awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAffordability Concerns\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHigh vaccine cost\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\u003e29.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLack of government support/subsidies\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\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e1st theme: HPV seen as female-specific\u003c/p\u003e\u003cp\u003eThis theme expresses the perception that HPV mainly impacts women, especially in the context of cervical cancer. It emerged from the interviewees that most did not know about the risks HPV poses to men, such as genital warts, as well as penile, oropharyngeal and anal cancers. The majority expressed limited knowledge regarding male susceptibility to HPV. The interviewees expressed that predominantly the health-related government messages as well as policies revolve around HPV and Cervical cancer, which is why they are not very aware of HPV effects in the context of men.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I was thinking HPV only affects women and is related to cervical cancer. I had no idea that it affects men as well.\" \u0026mdash; 22-year-old Undergraduate student, Participant 1\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"We are surrounded by HPV along with cervical cancer, and the Indian government is also encouraging HPV vaccination against cervical cancer. I had no idea there was another side of it.\" \u0026mdash; 28-year-old Postgraduate Student, Participant 3\u003c/em\u003e\u003c/p\u003e\u003cp\u003e2nd theme: Awareness not translating into action\u003c/p\u003e\u003cp\u003eThis theme highlights the significant knowledge-action gap, as none of the interviewees had received the HPV vaccination, despite some being aware of it. Some of the interviewees expressed awareness towards HPV among men and associated vaccination; however, they never thought about taking the vaccination for themselves. They reported not being worried about getting vaccinated as HPV vaccination for men was not felt essential at the moment.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I know that men too can take vaccination against HPV, but I never felt the need to have it for myself.\" \u0026mdash; 32-year-old healthcare practitioner, Participant 5\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I have read and seen several articles that talk about vaccination of men for protection against HPV, but I have never seen any HPV vaccination drive for men in India.\" 28-year-old Postgraduate student, Participant 10\u003c/em\u003e\u003c/p\u003e\u003cp\u003e3rd theme: Systemic Silence and Missed Opportunities\u003c/p\u003e\u003cp\u003eThe interviewees expressed a lack of advocacy and orientation towards HPV vaccination in the context of men. Undergraduate and postgraduate interviewees stated that their institutions have not organised any HPV vaccination educational campaign related to men. Practising healthcare professionals reported a lack of governmental initiatives in advocating gender neutral HPV vaccination, as most of the vaccination drives are concentrating on girls and women.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I have never seen any HPV vaccination educational program for men in my college. That\u0026rsquo;s why I was never exposed to it\u0026rdquo; 22-year-old undergraduate student, Participant 15\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\"\u003cem\u003eToday if we see the government initiatives or commercial ads, the focus is to prevent cervical cancer through HPV vaccination among girls. Maybe because of that the other genders felt it is not that necessary now.\u0026rdquo;\u0026mdash; 35-year-old practising healthcare professional, participant 2\u003c/em\u003e\u003c/p\u003e\u003cp\u003e4th theme: Cost-Consciousness despite Awareness\u003c/p\u003e\u003cp\u003eThe interviewees expressed affordability as a barrier to getting vaccinated against HPV. The high price of the vaccine was a prominent deterrent even for those who were aware of HPV risks and the benefits of vaccination. The interviewees believed the vaccine was too expensive, particularly for students and those beginning their careers, as there is a lack of government vaccination programs or subsidies for boys and men.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The per-dose cost of the recent HPV vaccine is nearly 10,000 Rs. I cannot afford it right now as I am a student\u0026rdquo; \u0026mdash; 25-year-old postgraduate student, Participant 20\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I am willing to get vaccinated, but it seems more like a luxury to get vaccinated unless it is subsidized.\" \u0026mdash; 34-year-old practising healthcare professional, Participant 28\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe quantitative component of our study revealed a decent overall knowledge score among the participants. This indicates a fair understanding among the participants regarding potential health risks associated with HPV infection. Our study reported a significant level of awareness among respondents about HPV causing diseases in men, highlighting the exposure of the virus's impact on both genders. Additionally, a notable proportion of the participants recognized that males may transmit HPV infection. This comprehension is vital in underscoring the significance of HPV immunization for both genders [12]. The overall knowledge score in our study suggests that educational campaigns, public health initiatives, and healthcare interventions aimed at disseminating information about HPV and its vaccine can effectively raise awareness among the population [13]. The study also reported that a positive attitude towards a partner's opinion is essential when deciding to get vaccinated against HPV, with the majority of the participants expressing this view. This underscores the importance of communication and shared decision-making within relationships regarding preventive healthcare measures [14].\u003c/p\u003e\u003cp\u003eA significant percentage of responders demonstrated a proactive approach in teaching young men and women of the risk factors linked to HPV. This conclusion underscores the participants' dedication to enhancing awareness and understanding of the virus, its transmission, and associated health hazards among the youth. In terms of healthcare practices, an encouraging majority of the participants expressed a favourable inclination towards encouraging young men visiting their outpatient department (OPD)/Clinic to get vaccinated against HPV. This suggests a proactive role of healthcare professionals in promoting HPV vaccination and prevention [15]. However, it is concerning that only a small portion of the population reported being vaccinated against HPV. This finding suggests a gap between the positive attitudes and actual uptake of the vaccine. Further investigation is required to explore the factors contributing to this low vaccination rate, such as access barriers, knowledge gaps, or vaccine hesitancy [16]. Among those who were vaccinated, it is noteworthy that the majority received a recommendation for vaccination, indicating the influential role of healthcare providers in promoting. Interventions aimed at increasing vaccine uptake, improving access to vaccination, and addressing vaccine hesitancy should be implemented to maximize the potential impact of HPV vaccination in reducing the burden of HPV-related diseases [17].\u003c/p\u003e\u003cp\u003eIn the qualitative component, our result highlights a potential gap in knowledge regarding HPV among interviewed participants. In addition to the knowledge gap, there is misinformation towards HPV being perceived as a female-specific issue. This is an alarming situation, as students as well as budding healthcare professionals need to be sensitized to the HPV topic to be able to provide precautionary health information to the general population. This forms the rationale for conducting large-scale educational campaigns at the institutional level as well as at the population level sponsored by the government. The majority of the interviewees expressed gender-biased approach towards HPV prevention strategies and vaccination including but not limited to vaccination drives, educational seminars, campaigns and governmental current initiatives. Although India is progressing towards a gender-neutral HPV vaccination initiative; prioritizing girls/women for cervical cancer prevention as a primary focus has created a huge gap in the vaccination rate for men. This disparity is not only the result of existing gender bias in the healthcare delivery system but also long-existing emphasis on cervical cancer prevention, less understanding among men about the hazards of HPV, and logistical as well as societal obstacles. Studies have reported that HPV vaccination is helpful to males and is critical for developing herd immunity and avoiding HPV-related malignancies in men. In line with our study, disparity in HPV knowledge across gender in context of healthcare professionals has reported in other studies as well [18]. The interviewees also expressed cost-effectiveness as a prime factor in getting vaccination against HPV as the current cost is not affordable by all tiers of population. Several studies conducted in diverse locations of southern India reported similar findings [19\u0026ndash;25]. As a result, unless vaccination is included in India's Universal vaccination Program, it will be financially expensive for majority of population [26]. Healthcare professionals also reported hesitancy to recommend vaccination in the absence of a defined program plan or official government support.\u003c/p\u003e\u003cp\u003eBased on the study findings, a series of recommendations can be adopted to address the knowledge gap related to HPV and enhance the administration of gender-neutral HPV vaccination. To begin with, our study has projected that, although the quantitative component reflected a decent level of knowledge and attitude among the participants towards HPV and associated vaccination, the qualitative component has shown a substantial gap in understanding HPV and perception towards implementing HPV vaccination among the participants. educational campaigns targeting both the general population, particularly young adults, and healthcare professionals is crucial. These campaigns should aim to disseminate accurate information about HPV transmission, associated diseases, available vaccine options, and the importance of vaccination for both males and females. To ensure widespread availability and acceptance of HPV vaccination, incorporating it as a mandatory component in national immunization programs prior to individuals' first sexual intercourse is highly recommended. Healthcare professionals should play a vital role in advocating for and supporting HPV vaccination within these programs [27]. To address knowledge gaps and misconceptions, it is recommended to develop targeted interventions and educational resources for specific demographic groups, such as students and young adults. Providing clear and accurate information about the appropriate age range for vaccination, with the support and guidance of knowledgeable healthcare professionals, can ensure better comprehension and timely vaccination [28]. Lastly, promoting peer-to-peer education and community-driven initiatives with the guidance of healthcare professionals is highly valuable. Empowering individuals who have already been vaccinated to become advocates and educate their peers, family members, and community can effectively emphasize the importance of HPV vaccination and foster acceptance and understanding among various social circles [29].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe majority of male healthcare professionals in the quantitative study reflected adequate knowledge and positive attitude towards promoting HPV vaccination. However, in the qualitative part, various challenges pertaining to HPV vaccination including misinformation, lack of governmental support, lack of sensitization as well as affordability came to surface. These mixed findings serve as the groundwork for more extensive studies aimed at understanding both the barriers and facilitators affecting HPV vaccination among men in the Indian subcontinent. Future research should focus on developing targeted approaches to address specific concerns. This includes disseminating accurate information about vaccine safety and effectiveness, debunking prevalent misconceptions, integrating HPV education in male reproductive health programs and emphasizing the benefits of HPV vaccination in preventing HPV-related diseases. Moreover, it is crucial to formulate strategies tailored to address and overcome barriers to vaccine acceptance. These strategies should account for geographic and socio-economic variables to ensure a comprehensive and effective vaccination program, benefiting all genders.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHPV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHuman Papilloma Virus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKAP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKnowledge, Attitude and Practice\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNCR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNational Capital Region\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGTA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGrounded Theory Approach\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMSM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMen who have sex with men\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIRB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInstitutional Review Board\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOPD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOut Patient Department\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKNK\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKaruna Nidhi Kaur\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDhruva Nandi\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAJ\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAlex Joseph\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eShazina Saeed\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eShanta Chandrasekaran\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the institutional ethics board prior to the initiation of the study, and informed consent was obtained from each participant before data collection. The study has adhered to the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eData and materials will be available upon request to the corresponding author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eAuthors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNil\u003c/p\u003e\n\u003cp\u003eAuthors' contributions\u003c/p\u003e\n\u003cp\u003eKNK and DN conceptualized, initiated the study, and wrote the manuscript. SC provided the methodology and reviewed the manuscript. AJ carried out statistical analysis and interpreted all data, and SS reviewed and carried out overall editing of the manuscript. AJ and SS both supervised and administered the study.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the male health professionals who agreed to take part in the study. The authors would also like to thank Arunima Koul and Kanika Arora from the Laboratory of Disease Dynamics \u0026amp; Molecular Epidemiology at Amity Institute of Public Health, Amity University, Noida, India, for their assistance in collecting the data samples.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eArbyn M, Weiderpass E, Bruni L, de Sanjos\u0026eacute; S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. The Lancet Global Health [Internet]. 2019 Dec;8(2). Available from: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30482-6/fulltext\u003c/li\u003e\n \u003cli\u003eGlobal Cancer Observatory. Global Cancer Observatory [Internet]. Iarc.fr. 2020. Available from: https://gco.iarc.fr/\u003c/li\u003e\n \u003cli\u003eLyu Z, Feng X, Li N, Zhao W, Wei L, Chen Y, et al. Human papillomavirus in semen and the risk for male infertility: a systematic review and meta-analysis. BMC Infectious Diseases. 2017 Nov 9;17(1).\u003c/li\u003e\n \u003cli\u003eGraham Sheila V. The human papillomavirus replication cycle, and its links to cancer progression: a comprehensive review. Clinical Science [Internet]. 2017 Aug 10;131(17):2201\u0026ndash;21. Available from: https://portlandpress.com/clinsci/article/131/17/2201/71573/The-human-papillomavirus-replication-cycle-and-its\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGheit T. Mucosal and Cutaneous Human Papillomavirus Infections and Cancer Biology. Frontiers in Oncology [Internet]. 2019 May 8;9(355). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517478/\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCDC. Men who have sex with men (MSM) [Internet]. www.cdc.gov. 2021. Available from: https://www.cdc.gov/std/treatment-guidelines/msm.htm\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSucato A, Michela Butt\u0026agrave;, Bosco L, Leonardo Di Gregorio, Perino A, Capra G. Human Papillomavirus and Male Infertility: What Do We Know? International Journal of Molecular Sciences [Internet]. 2023 Dec 16;24(24):17562\u0026ndash;2. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10744208/\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Chenafi-Adham S, Boussetta-Charfi O, Pillet S, Bourlet T. Impact of Human Papillomavirus (HPV) on Male and Female Fertility. Pathogens [Internet]. 2024 Dec 7 [cited 2025 Feb 22];13(12):1076. Available from: https://www.mdpi.com/2076-0817/13/12/1076?utm_source=chatgpt.com\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSaeed S. HPV Gender Neutral Vaccine in India: A Long Way Ahead. Indian Journal of Youth and Adolescent Health. 2022 Nov 23;09(03):1\u0026ndash;2.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRahangdale L, Mungo C, O\u0026rsquo;Connor S, Chibwesha CJ, Brewer NT. Human papillomavirus vaccination and cervical cancer risk. BMJ. 2022 Dec 15;379:e070115.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTie YC, Birks M, Francis K. Grounded Theory research: a Design Framework for Novice Researchers. SAGE Open Medicine [Internet]. 2019;7(1):1\u0026ndash;8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6318722/\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHe W, Pan H, Lin B, Zhong X. Analysis of HPV Vaccination Willingness amongst HIV-Negative Men Who Have Sex with Men in China. Vaccines. 2021 Sep 24;9(10):1069.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWidjaja VN. Awareness, Knowledge and Attitudes of Human Papillomavirus (HPV) among Private University Students- Malaysia Perspective. 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Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494431/\u0026nbsp;\u003c/li\u003e\n\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-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"KAP, HPV, Vaccine, Healthcare, India","lastPublishedDoi":"10.21203/rs.3.rs-7975577/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7975577/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e\u003cp\u003eCervical cancer poses a significant health risk to women globally and in India. While the burden of HPV (Human papillomavirus)-related infections among Indian women is well-documented, there is a need to understand HPV related dynamics among Indian men as well as an influencing factor in male reproductive health. This study aims to assess the knowledge, attitudes, and practices (KAP) related to HPV vaccination among male healthcare professionals in India.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA mixed-method survey was conducted from March 2022 to April 2023 among young male healthcare professionals from diverse backgrounds across public and private healthcare settings in the Delhi National Capital Region (NCR) region of India. In the quantitative arm, systematic random sampling was employed to recruit participants, with 299 complete responses recorded. For the qualitative arm, 37 participants were interviewed to gain an in-depth understanding of their perceptions of HPV infection and vaccination. Quantitative data were analysed using descriptive statistics (SPSS Version 30.0), and qualitative data analysis was done using manual transcription method employing the Grounded Theory Approach (GTA).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe mean age of the participants in the quantitative arm was 24.6 years. The overall knowledge score towards HPV vaccination was 59%, with an attitude score of 89%. Although 83.9% of participants were willing to promote HPV vaccination among men in India, only 11.4% got vaccinated for HPV. The engagement in unsafe sexual practices was significantly associated with age (p-0.006), occupation (p-0.004), education (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and marital status of the participants (p-0.003). A significant association was also observed between marital status and the willingness to engage in HPV-related awareness within their personal networks (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the qualitative arm, the mean age was 32.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2 years. Four themes were generated after thematic analysis:1) HPV seen as female-specific, 2) Awareness not translating into action, 3) Systemic silence and missed opportunities, and 4) Cost-consciousness despite awareness. Out of 37 interviewees, 27% had misconceptions towards HPV, 18.9% felt a lack of male-focused HPV vaccination drive, and 29.7% expressed affordability concerns towards getting HPV vaccination due to the high vaccine cost.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study's findings lay the groundwork for more extensive research to understand the barriers and facilitators to HPV vaccination among men. Such research could inform targeted strategies to improve vaccination rates, reducing the burden of preventable HPV-related diseases thereby improving male reproductive health.\u003c/p\u003e","manuscriptTitle":"Assessing knowledge, attitudes and practices towards HPV vaccination among male healthcare professionals and students in Delhi National Capital Region: A mixed-method study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-12 20:07:32","doi":"10.21203/rs.3.rs-7975577/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvited","content":"","date":"2026-03-09T17:23:05+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"223282064931002474556936881696006761779","date":"2026-01-26T01:47:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"30568343246512622091038975423138769260","date":"2025-12-15T15:01:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"203792309550363431653327989352006139942","date":"2025-12-09T07:38:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-08T21:50:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-06T12:24:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-06T05:14:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-11-06T05:11:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0e3a969b-3236-489f-b7a9-b818b11f9cbe","owner":[],"postedDate":"December 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-12T20:07:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-12 20:07:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7975577","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7975577","identity":"rs-7975577","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}