Doubt Runs Deeper Than Facts: What Kazakh Women Really Think About the HPV Vaccine

When Kazakhstan relaunched its national HPV vaccination programme in September 2024, health officials hoped that a decade of silence would be followed by renewed public confidence. A new cross-sectional study from Astana suggests that the reality is far more complicated. Among 221 adult women attending a single primary care centre in the Kazakh capital, researchers from Astana Medical University and the Ministry of Healthcare found that attitudes toward the HPV vaccine split into two largely independent psychological dimensions: perceived effectiveness and safety concern. The two were only weakly correlated, meaning that a woman can believe the vaccine prevents cancer while simultaneously fearing long-term harm. This multidimensional structure, published in Frontiers in Global Women’s Health, carries direct implications for how the renewed programme should communicate with the public.

The study’s timing is significant. Kazakhstan first piloted HPV vaccination in four regions during 2013 and 2014, but the effort collapsed amid low uptake, widespread parental refusal, negative media coverage, and persistent safety narratives. The national programme was relaunched in September 2024 for eleven-year-old girls, with catch-up vaccination for those aged twelve to thirteen and parental informed consent required. In May 2026, voluntary vaccination was extended to girls aged fourteen to seventeen. The researchers designed their survey to capture public sentiment in this renewed context, drawing on a validated bilingual questionnaire originally developed in France and previously adapted for Kazakh populations.

Participants completed an electronic questionnaire between 17 January and 28 February 2026, recruited through QR codes displayed in fourteen gynaecology offices at the City Center for Primary Health Care in Astana. The sample skewed young and educated: the largest age groups were eighteen to twenty-four (26.7 percent) and thirty-five to forty-four (25.3 percent), 73.3 percent held higher education, and 40.7 percent were healthcare workers. Nearly all participants (95.0 percent) had heard of the HPV vaccine, and 85.1 percent had actively searched for information about it. Despite this high engagement, factual knowledge remained strikingly low.

On a twelve-item knowledge test, the mean score was just 4.95 out of 12, with a standard deviation of 3.84. ‘Don’t know’ responses exceeded 40 percent for ten of the twelve items, indicating widespread uncertainty rather than confidently held false beliefs. Only 19.9 percent correctly recognised that cervical cancer can still occur after HPV vaccination, and just 29.9 percent knew the vaccine protects against genital warts. Even the highest-scoring item, recognition that HPV infection may remain unnoticed for years, was answered correctly by only 64.7 percent of respondents. These gaps matter because HPV is a necessary cause of nearly all cervical cancers, which accounted for approximately 660,000 new cases and 350,000 deaths worldwide in 2022.

Trust in information sources varied dramatically. Scientific researchers earned the highest mean trust score (3.47 on a five-point scale), followed by healthcare workers (3.29). Alternative media and social networks scored lowest at 2.36, with traditional media close behind at 2.48. This hierarchy suggests that clinicians and researchers remain the most credible voices in the Kazakh information environment, even as digital platforms dominate actual information-seeking behaviour.

To move beyond simple attitude measurement, the researchers applied exploratory psychometric analysis to sixteen perception items. Using polychoric correlations, parallel analysis, and principal-axis factor analysis with oblimin rotation, they identified a two-factor structure. One factor captured perceived effectiveness alongside social endorsement and service facilitation; the other reflected safety- and age-related concern. From this structure, the team derived two preliminary composite measures: a five-item safety concern scale (mean 2.34, Cronbach’s alpha 0.868, McDonald’s omega 0.901) and a three-item perceived effectiveness scale (mean 3.20, alpha 0.922, omega 0.948). Critically, the two scores correlated only weakly (Spearman’s rho 0.129, p = 0.055), confirming that believing in a vaccine’s benefit does not preclude harbouring safety fears.

Knowledge and trust shaped these dimensions in distinct ways. Higher HPV knowledge was inversely associated with safety concern (rho = -0.284, p < 0.001) and positively associated with perceived effectiveness (rho = 0.393, p < 0.001). In multivariable robust regression, each additional correct knowledge answer predicted a 0.061-point increase in perceived effectiveness (95% CI 0.010 to 0.111). But the strongest independent correlate of perceived effectiveness was professional and scientific trust: each one-point increase was associated with a 0.297-point higher effectiveness score (95% CI 0.114 to 0.480). Institutional trust, media trust, and anecdotal experience showed no independent association with effectiveness.

Safety concern told a different story. In a model accounting for 44.6 percent of outcome variance, three contextual beliefs emerged as significant predictors: spillover from COVID-19 vaccine controversies (B = 0.190, 95% CI 0.043 to 0.337), distrust attributed to Kazakhstan’s earlier HPV vaccination programme (B = 0.197, 95% CI 0.047 to 0.347), and preference for natural immunity (B = 0.137, 95% CI 0.040 to 0.234). Healthcare workers reported modestly lower adjusted concern than other participants (B = -0.225, 95% CI -0.449 to -0.001). Notably, the association between knowledge and safety concern was attenuated after contextual beliefs were included (B = -0.023, p = 0.269), suggesting that safety fears are driven more by narrative and historical context than by factual gaps alone.

The most striking finding came from a secondary exploratory analysis. Forty-nine participants (22.2 percent) reported refusal or intention to refuse HPV vaccination for a daughter. The strongest predictor of this response was knowing someone believed to have become seriously ill after vaccination, which raised the odds more than sevenfold (adjusted odds ratio 7.42, 95% CI 2.60 to 21.16). Having children was also associated with higher odds (aOR 3.71, 95% CI 1.40 to 9.81). The researchers caution that this outcome combines actual refusal among women with daughters and prospective intention among those without, so it cannot be interpreted as verified historical refusal prevalence. Nevertheless, the magnitude of the anecdotal-narrative effect underscores how personal stories, even when causally unverified, can override statistical safety data in vaccination decisions.

The findings carry clear programme-level implications. First, communication materials should address effectiveness and safety separately, since belief in benefit does not eliminate concern. Second, healthcare workers require standardised communication training and rapid access to evidence-based answers, because professional-scientific trust is a key asset and recent meta-analytic evidence shows that clinician communication training improves HPV vaccination uptake. Third, the history of the earlier national programme should be acknowledged directly through transparent safety surveillance rather than dismissed. Fourth, preference for natural immunity deserves targeted counter-messaging that contrasts the predictable protection of vaccination with the uncertain and potentially carcinogenic consequences of natural HPV infection. Finally, programme evaluation should measure actual first-dose and series-completion outcomes rather than attitudes alone. The study’s limitations, including convenience sampling at a single centre, a cross-sectional design that cannot establish causality, and preliminary psychometric measures requiring external validation, temper these conclusions. Yet the core message is unambiguous: in a post-COVID information environment marked by cross-vaccine narrative spillover, rebuilding confidence in HPV vaccination demands not just more facts, but a fundamentally different kind of conversation between clinicians, scientists, and the communities they serve.

Subject of Research: HPV vaccine knowledge, trust, and multidimensional perceptions among women attending primary care in Astana, Kazakhstan

Article Title: Knowledge, trust, and multidimensional perceptions of human papillomavirus vaccination among women attending a single primary care centre in Astana, Kazakhstan: a cross-sectional study

Article References: Umbetzhanova, A., Kusniyeva, A., Derbissalina, G., Abduldayeva, A., Safonov, N., & Koikov, V. (2026). Knowledge, trust, and multidimensional perceptions of human papillomavirus vaccination among women attending a single primary care centre in Astana, Kazakhstan: a cross-sectional study. Frontiers in Global Women's Health, 7, Article 1960252. https://doi.org/10.3389/fgwh.2026.1960252

Image Credits: AI Generated

DOI: 10.3389/fgwh.2026.1960252

Keywords: HPV vaccination, vaccine hesitancy, Kazakhstan, vaccine safety, vaccine confidence, cervical cancer, COVID-19 spillover, health communication, primary care, psychometrics, women's health, public trust