Document Type: Research Articles
Nossal Institute for Global Health, Melbourne School of Population and Global Health, Faculty of Medicine and Dentistry and Health Sciences, The University of Melbourne, Australia.
Center for Reproductive Health, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Indonesia.
Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Indonesia.
Background: Cervical cancer (CC) is a leading cause of cancer deaths among Indonesian women. Pilot prevention
programs, including human papillomavirus (HPV) vaccination for young adolescent girls, and cervical screening for
women, have been implemented. However, many communities are yet to receive these interventions, nor targeted
education regarding CC prevention. This study explored community readiness and acceptance of HPV vaccination
and CC screening, as well as knowledge and perceptions of HPV and CC, to determine facilitators and barriers to
upscaling CC prevention in rural Central Java. Methods: Qualitative data collection in October 2015 consisted of four
focus group discussions with married women and men, and 22 semi-structured interviews with married women. All
57 participants, 39 women and 15 men, lived in Purworejo Regency in rural Central Java. Results: Most participants
had no knowledge of HPV or the causal link between HPV and CC. However, most participants were supportive of
vaccinating their children against HPV. Most participants had heard of cervical cancer, although understandings of
symptoms and causes were very poor. Less than half of the women interviewed had undergone CC screening. Multiple
barriers to screening were reported, including: a dislike of pelvic exams; embarrassment at being screened by a male;
anxiety over the cost; fearing a positive result; and being asymptomatic and thus not perceiving the need for screening.
Conclusions: Extensive community education about HPV and CC, targeting women and men, adolescents, health
workers and teachers, is crucial to support the introduction of the HPV Demonstration Program and the upscaling of
CC screening. Low incomes among rural families underline the need for the HPV vaccine to be provided free within
the National Immunization Program, and for CC screening to be free at primary health clinics.