Background: The United States (US) continues to face a substantial burden of cervical cancer, which has been the focus of many policies and public health prevention agendas. Of the numerous risk factors associated with cervical cancer, human papillomavirus (HPV) infection remains the leading and most preventable cause of this chronic disease. Therefore, one major public health prevention strategy to decrease cervical cancer cases is HPV vaccination. Another screening tool that enables cervical cancer prevention and early intervention is the Pap smear, the primary method of screening for abnormal cervical cells. However, barriers such as social determinants of health and ineffective patient–provider communication hinder access to such critical preventive measures. The purpose of this study was to provide a comprehensive overview of the knowledge level of US female adults, aged 21–65 years, concerning HPV infection and cervical cancer prevention using the Health Information National Trends Survey (HINTS) database. Additionally, it assessed associations between patient–provider communication and the completion of Pap smear tests. Methods: Descriptive statistics were computed to explore the sociodemographic characteristics of female survey participants as well as to gather frequency and percentages of responses related to knowledge of HPV, awareness of the HPV vaccine, and history of Pap smear. Chi-squared tests were carried out to examine the associations between awareness of a cervical cancer vaccine or HPV shot and whether the participant has had a Pap smear, heard of the HPV vaccine, and knowledge of HPV’s association with cervical cancer. Next, binary logistic regression models were built to determine the size and direction of the association between patient–provider communication metrics and measures of (1) having had a Pap smear, (2) participant knowledge of HPV, (3) participant awareness of causality between HPV and cervical cancer, and (4) participant knowledge of HPV vaccine and cervical cancer prevention measures. Results: A substantial majority of participants (81.8%) reported having heard of HPV. Among them, 72.1% recognized that HPV could cause cervical cancer. Awareness of the HPV vaccine was reported by 88.1%, suggesting a relatively high reach of effective public health messaging. Regarding Pap tests, 43.3% of participants had undergone testing within the past year, but 12.6% had not been tested in over five years, and 3.6% have never been tested. Bivariate analysis using chi-squared tests revealed significant associations between participants’ history of Pap smears and their knowledge of HPV infection, its role in cervical cancer, and HPV vaccination as a prevention tool. Participants who had undergone a Pap test were more likely to have heard of HPV (p< 0.001), were knowledgeable of the HPV vaccine (p< 0.001), and were more aware of the HPV vaccine (p< 0.001). Participants reporting “never” for certain communication criteria significantly had an increased risk of having lower knowledge levels about the HPV vaccine and other cervical cancer prevention measures. They also had almost twice the risk of having lower knowledge levels about HPV prevention measures when reporting “never” (RR = 1.997, 95% CI (1.018–3.916) for “spending enough time with patients” compared to those selecting “always”. Additionally, participants responding “sometimes” (RR = 1.889, 95% CI (1.187–3.005) rather than “always” to feeling involved in healthcare decisions had a significantly higher risk of being unaware of the vaccine or other cervical cancer prevention measures. Conclusions: Strengthening provider communication and education skills not only encourages greater patient knowledge and adherence to preventative measures, such as HPV and cervical cancer screening, but also reduces disparities in healthcare stemming from limited health literacy.
背景：美国宫颈癌负担依然沉重，已成为多项政策与公共卫生预防议程的关注焦点。在众多宫颈癌相关风险因素中，人乳头瘤病毒（HPV）感染仍是该慢性疾病最主要且最可预防的致病原因。因此，HPV疫苗接种成为降低宫颈癌发病率的重要公共卫生预防策略。巴氏涂片作为筛查宫颈异常细胞的主要方法，是另一种实现宫颈癌预防与早期干预的筛查工具。然而，健康社会决定因素及医患沟通不畅等障碍阻碍了这些关键预防措施的可及性。本研究旨在通过健康信息全国趋势调查（HINTS）数据库，系统评估美国21-65岁成年女性对HPV感染与宫颈癌预防的认知水平，并探讨医患沟通与巴氏涂片检测完成情况之间的关联。 方法：通过描述性统计分析方法，探究女性调查参与者的社会人口学特征，并汇总HPV认知、HPV疫苗知晓度及巴氏涂片检测史的频率与百分比分布。采用卡方检验分析宫颈癌疫苗或HPV疫苗知晓度与以下变量的关联：参与者是否接受过巴氏涂片检测、是否知晓HPV疫苗、是否了解HPV与宫颈癌的因果关系。进一步构建二元逻辑回归模型，量化医患沟通指标与以下四类结局指标的关联强度与方向：（1）巴氏涂片检测史；（2）参与者HPV认知水平；（3）参与者对HPV与宫颈癌因果关系的认知；（4）参与者对HPV疫苗及宫颈癌预防措施的认知。 结果：绝大多数参与者（81.8%）表示知晓HPV，其中72.1%认识到HPV可导致宫颈癌。88.1%的参与者知晓HPV疫苗，提示公共卫生宣传覆盖面较广。关于巴氏涂片检测，43.3%的参与者在过去一年内接受过检测，但12.6%超过五年未检测，3.6%从未检测。卡方检验双变量分析显示，参与者的巴氏涂片检测史与其对HPV感染的认知、HPV在宫颈癌中的作用认知以及HPV疫苗作为预防工具的认知存在显著关联。接受过巴氏涂片检测的参与者更可能知晓HPV（p<0.001）、了解HPV疫苗（p<0.001）且对HPV疫苗认知度更高（p<0.001）。在特定医患沟通维度选择"从未"的参与者，其HPV疫苗及其他宫颈癌预防措施认知不足的风险显著增加。与选择"总是"的群体相比，在"为患者提供充足沟通时间"维度选择"从未"的参与者，其HPV预防措施认知不足的风险增加近两倍（RR=1.997，95%CI：1.018-3.916）。此外，在"参与医疗决策"维度选择"有时"而非"总是"的参与者，其不知晓疫苗或其他宫颈癌预防措施的风险显著更高（RR=1.889，95%CI：1.187-3.005）。 结论：加强医疗服务提供者的沟通与教育能力，不仅能提升患者对HPV及宫颈癌筛查等预防措施的认知与依从性，还能缓解因健康素养不足导致的医疗不平等现象。
肿瘤(癌症)患者之家