High intention, low uptake: HPV vaccination knowledge, attitudes, and behavior among women attending a tertiary gynecology clinic in Turkey.

BACKGROUND: HPV vaccination prevents cervical cancer, yet uptake remains variable, particularly where it is not publicly funded. We assessed HPV knowledge, attitudes, and vaccination behavior - including stated intention, actual uptake, and reasons for non-vaccination - among women attending a gynecology clinic in Istanbul, Turkey.

METHODS: This cross-sectional study enrolled 305 women aged ≥ 18 years at the gynecology clinic of Yeditepe University Hospital between January and April 2026. A structured questionnaire assessed sociodemographics, HPV and vaccine knowledge (scored 0-10 and 0-6), attitudes (seven 5-point Likert items), and vaccination history. Acceptance was defined as agreement with willingness to vaccinate; uptake as self-reported prior vaccination. Multivariable logistic regression identified factors independently associated with each outcome.

RESULTS: Mean age was 38.1 ± 10.6 years; 68.5% had university education and 17.4% were healthcare workers. Mean HPV knowledge score was 7.25 ± 1.65, with notable gaps: 36.7% knew HPV is not exclusive to women, 57.4% knew condoms do not fully prevent transmission, and 60.0% understood infection is often asymptomatic. While 86.6% intended to vaccinate, actual uptake was 38.7% - an intention-uptake gap of 47.9% points. Cost was the most cited reason among unvaccinated women (71.0%). Education, knowledge, and preventive gynecological care were not independently associated with uptake; healthcare-worker status was the only independent predictor (aOR 2.01, 95% CI 1.07-3.80; p = 0.030).

CONCLUSION: HPV vaccine acceptance was high but uptake was substantially lower, with cost the most frequent barrier. These findings highlight the intention-uptake gap and specific knowledge deficits relevant for future research.