Barriers, Attitudes and Clinical Approach of Lebanese Physicians Towards HPV Vaccination; A Cross- Sectional Study

Document Type: Research Articles


1 Faculty of Medicine, American University of Beirut, Beirut, Lebanon.

2 Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.

3 Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.


Objectives: HPV infection is associated with the development of cervical and oropharyngeal cancer. HPV vaccination
prevents cervical cancer, but is still not part of Lebanon’s routine vaccination schedule. As such, understanding physicians’
practice towards HPV vaccination is essential. Material and Methods: We conducted a cross-sectional study in Greater
Beirut, Lebanon to assess the barriers, attitudes and clinical approach of Lebanese physicians towards HPV vaccination.
We also aimed to analyze the factors associated with physicians’ barriers to HPV vaccination. Results: In total, 228
physicians completed the survey. Our results show that physicians and parents consider the cost of HPV vaccination to
be a main barrier (58.9% and 80.7% respectively). Also, parents tend to have concerns about vaccine safety (78.1%),
efficacy (68.6%), and lack education concerning HPV infection (81.8%). Furthermore, female physicians tend to
have fewer barriers when compared to male physicians (aOR = 0.39; p-value = 0.007). Additionally, physicians who
completed residency programs in the USA also showed fewer barriers when compared to physicians who completed
Lebanese residency programs (aOR = 0.24; p-value = 0.040). Finally, physicians with higher knowledge score have
fewer barriers when compared to those with lower knowledge scores (aOR = 0.42; p-value = 0.018). Conclusions:
Physician gender, residency program and level of knowledge play a role in HPV vaccine barriers and recommendation
in Lebanon. Future improvements in cost and awareness about HPV might improve vaccination rates. Creating uniform
practices towards HPV vaccine is warranted to improve patient care.


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