The Cervical Cancer Paradox in Eastern Europe: How Knowledge and Institutional Trust Shape HPV Vaccination Attitudes in Romania.
This Romanian cross-sectional survey of adult female clinic patients reports low HPV vaccination uptake and positive associations of HPV knowledge and institutional trust with vaccination intention, while negative online content was not directly associated with intention.
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This Romanian cross-sectional survey of adult female clinic patients reports low HPV vaccination uptake and positive associations of HPV knowledge and institutional trust with vaccination intention, while negative online content was not directly associated with intention.
Research significance
The evidence supports correlations between knowledge, institutional trust, official information use, and favorable HPV vaccination attitudes; it can only be inferred—not concluded from this cross-sectional study—that trust-building, health-literacy initiatives or proactive opt-out vaccination systems could increase uptake and thereby improve long-term cervical cancer prevention.
Source abstract
BACKGROUND: Although cervical cancer is a highly preventable malignancy, Romania continues to report critical mortality rates. This paradox is largely attributable to the suboptimal implementation of clinical guidelines and a passive, "opt-in" administrative framework. This cross-sectional study investigates the cognitive and behavioural determinants-specifically, human papillomavirus (HPV) knowledge, institutional trust in healthcare systems, and digital misinformation exposure-that modulate female attitudes toward HPV immunisation. METHODS: An observational cross-sectional study was conducted between December 2025 and March 2026 across four obstetrics and gynaecology clinics. Data were collected via digital questionnaires administered to adult female patients aged 18 to 65 years. The assessment tool evaluated four primary domains: HPV knowledge, perceived vaccine safety, immunisation intention, and the degree of exposure to social media misinformation. RESULTS: The cohort demonstrated a substantially low vaccination rate (28.6%). Statistical analysis elucidated significant positive correlations between HPV knowledge, trust in health authorities, and vaccination intention. Furthermore, reliance on official information sources strongly correlated with perceived vaccine safety. Conversely, exposure to negative online content exhibited a weak negative association with knowledge levels, yet it did not directly influence vaccination intention. CONCLUSIONS: Health literacy and institutional trust emerge as fundamental pillars for HPV vaccine acceptance. To overcome patient vaccine hesitancy, the national healthcare system must initiate a strategic paradigm shift, prioritising the neutralization of digital misinformation and transitioning from a passive model to a proactive, "opt-out" infrastructure.