Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 16 nº 1 - Jan/Mar - 2019

Original Article Imprimir 

Páginas 46 a 59


Internet and HPV: A possibility for health education among adolescents?

Internet y HPV: ¿Una posibilidad para educación en salud entre adolescentes?

Internet e HPV: Uma possibilidade para educação em saúde entre adolescentes?

Autores: Carolina Arnaut dos Santos1; Flávia Zandonadi Santos de Carvalho2; Mariana Soares Passos3; Lucas Franca Garcia4; Regiane da Silva Macuch5; Marcelo Picinin Bernuci6

1. Master student in Promoção da Health Promotion by the Postgraduate Program in Health Promotion of the University Center of Maringá (UniCesumar). Graduation in Nursing at the University Center of Maringá (UniCesumar). Maringá, PR, Brazil
2. Graduation in Medicine by the University Center of Maringá (UniCesumar). Scholarship of Scientific Initiation of CNPq. Maringá, PR, Brazil
3. Graduation in Medicine by the University Center of Maringá (UniCesumar). Scholarship of Scientific Initiation of CNPq. Maringá, PR, Brazil
4. Doctor in Medical Sciences and Bioethics from the Federal University of Rio Grande do Sul (UFRGS). Porto Alegre, RS, Brazil. Postdoctoral fellow of the Postgraduate Program in Health Promotion of the University Center of Maringá (UniCesumar). Maringá, PR, Brazil
5. Doctor in Education Sciences from the University of Porto, Portugal. Professor of the Postgraduate Program in Health Promotion and the Graduate Program in Knowledge Management in the Organizations of the University Center of Maringá (UniCesumar). Maringá, PR, Brazil
6. Doctor in Physiology from the Medical School of Ribeirão Preto, University of São Paulo (FMRP-USP). Post-Doctorate from the Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP). Ribeirão Preto, SP, Brazil. Scholarship Producer of the Cesumar Institute of Science, Technology and Innovation (ICETI). Professor of the Postgraduate Program in Health Promotion of the University Center of Maringá (UniCesumar). Maringá, PR, Brazil

Marcelo Picinin Bernuci
Programa de Pós-Graduação em Promoção da Saúde, Centro Universitário de Maringá (UniCesumar)
Av. Guedner, 1610
Maringá, PR, Brasil. CEP: 87050-390
marcelo.bernuci@unicesumar.edu.br

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Keywords: Adolescent; Social Networking; Health Promotion; Human papillomavirus 6.
Palabra Clave: Adolescente; Red Social; Promoción de Salud; Papiloma virus Humano 6.
Descritores: Adolescente; Rede Social; Promoção da Saúde; Papillomavirus Humano 6.

Abstract:
OBJECTIVE: Analyze the pattern of Internet use by girls of the 9th year of Elementary School, with the intention of using it in favor of actions to control HPV transmission.
METHODS: A cross-sectional study that analyzed the level of digital literacy and knowledge about HPV, through a questionnaire applied to 230 female students in 9 schools in the public network of Maringá.
RESULTS: The mean age of participants was 14 years. Most of the interviewees knew that HPV is a virus that can be transmitted sexually. 74% had heard of HPV at the health clinic. 97% have a cell phone, and this is more commonly used to access the internet, and the most used social networks are Facebook, WhatsApp and Youtube.
CONCLUSION: Because of the large number of users of digital media, especially social networks, this could be an important mean of spreading awareness and education about HPV prevention, especially among young people, which is the focus of the primary prevention program, consisting of vaccination.

Resumen:
OBJETIVO: Analizar el estándar de utilización de internet por niñas del 9º año de Enseñanza Fundamental, con la intención de usarlo a favor de las acciones de control de transmisión de HPV.
MÉTODOS: Estudio transversal que analizó el nivel de alfabetización digital y de conocimiento sobre HPV, por medio de cuestionario aplicado a 230 estudiantes del sexo femenino de nueve escuelas de la red pública de Maringá.
RESULTADOS: La media de edad de las participantes fue de 14 años. La mayoría de las entrevistadas sabía que el HPV es un virus que puede ser transmitido sexualmente. El 74% ya había oído hablar del HPV en el centro de salud. El 97% posee celular, y ese es el medio más utilizado para acceder a internet, siendo las redes sociales más utilizadas Facebook, WhatsApp u Youtube.
CONCLUSIÓN: Por la gran cantidad de usuarias de medios digitales, principalmente redes sociales, ese podría ser un medio importante de propagar la concientización y educación sobre prevención del HPV, principalmente entre jóvenes, que es el foco del programa de prevención primaria constituido por la vacunación.

Resumo:
OBJETIVO: Analisar o padrão de utilização da internet por meninas do 9º ano do Ensino Fundamental, com a intenção de usá-lo a favor das ações de controle da transmissão do HPV.
MÉTODOS: Estudo transversal que analisou o nível de alfabetização digital e de conhecimento sobre o HPV, por meio de questionário aplicado a 230 estudantes do sexo feminino de nove escolas da rede pública de Maringá.
RESULTADOS: A média de idade das participantes foi de 14 anos. A maioria das entrevistadas sabia que o HPV é um vírus que pode ser transmitido sexualmente. 74% já havia ouvido falar do HPV no posto de saúde. 97% possui celular, e esse é meio mais utilizado para acessar internet, e as redes sociais mais utilizadas são Facebook, WhatsApp e Youtube.
CONCLUSÃO: Pela grande quantidade de usuárias de meios digitais, principalmente redes sociais, esse poderia ser um meio importante de propagar a conscientização e educação sobre a prevenção do HPV, principalmente entre jovens, que é o foco do programa de prevenção primária, constituído pela vacinação.

INTRODUCTION

Adherence to Human Papillomavirus (HPV) vaccination among adolescents is critical in the management of cervical cancer (CCU), the most common malignancy in women in underdeveloped countries1. In Brazil, the implementation of the quadrivalent anti-HPV vaccine by the Unified Health System (SUS) is recent, available in 2014 for girls aged 11 to 13 years old with a vaccination schedule of three doses at 0, 6 and 60 months2. In 2017, the Ministry of Health (MS) initiated the implementation of HPV vaccination also for boys from 12 to 13 years old, as well as extending the age range for vaccination of girls from nine to 14 years3.

In fact, the vaccination data for the year 2014 indicated that almost half of the Brazilian municipalities presented low vaccination coverage against HPV4. Although the coverage in 2015 for the first dose of vaccine has exceeded 70%, the values didn´t reach 60% for the second dose5. According to the MS, the sporadic cases of post-vaccination psychogenic reaction that were widely reported in the media , especially in online social networks (RSO), and caused both parents and adolescents to be concerned about vaccine safety, explaining the reduction in vaccination coverage of the second dose6.

Many studies have identified factors that contribute to poor adherence to HPV vaccination. Lack of vaccine knowledge, lack of awareness, and lack of provider referral represent the main barriers to vaccination against HPV7-10. In this scenario, the development of mobilizing strategies based on health education may emerge as an adjunct to efforts to reduce barriers to adherence to HPV vaccination campaigns.

Due to the technological and cultural changes, the internet has now become a significant tool in obtaining knowledge, information and training for users. In fact, some institutions and public agencies already use RSOs to disseminate health information and to relate to the population, publicizing actions, campaigns and programs11,12. In addition, numerous studies have identified RSO as an important tool for the propagation of healthy life habits13-17, suggesting its use in health promotion strategies.

Thus, identifying adolescents' perceptions of the relationship between HPV and CCU, identifying the means by which they received information on this subject, and describing the pattern of Internet use and RSO by them can foster pertinent discussions on the feasibility of use of the Internet in strengthening the control actions of HPV infection among adolescents. Thus, we aim in this study to analyze the pattern of use of the Internet and other information and communication technologies (ICT) by girls in the 9th grade of Elementary School, with the intention of using it in favor of the design of health education interventions aimed at strengthening actions to control HPV transmission.


METHODOLOGY

Kind of study

A cross - sectional descriptive study was carried out with a quantitative approach and developed in nine of the 28 State schools of the Municipality of Maringá.

Place of study

The study was carried out in the public schools of the state network of Maringá. At the time of the study's development, there were 28 schools in the municipality, of which nine were selected according to the grade obtained in the Brazil Test. This test is carried out by the Ministry of Education and aims to evaluate schools through specific questionnaires intended for students. The schools were divided into levels 2, 3 and 4, according to the grade obtained in Portuguese and Mathematics.

Sampling

Stratified random sampling of conglomerates was used, since the adolescents were enrolled in the different schools of the state network. The total number of students enrolled in the 9th year of 2016 was 2971, and since it wasn´t possible to identify the exact number of girls enrolled, since the available data were relative to the total number of students, a statistical average was then calculated from the total number of students in the 9th grade. The sample was calculated considering the level of significance and the maximum error allowed between the estimation and the real value of the parameter in this way, it was verified the need to apply the questionnaire to at least 226 adolescents in order to estimate the factors of interest. Thus, it was also estimated that the number of participating schools should be nine, to understand the total number of students needed. A total of 300 Free and Informed Consent Terms (TCLEs) were delivered, but 70 girls didn´t bring the TCLEs on the date scheduled for the collection, and the questionnaire was applied to 230 adolescents.

Data collection

Data collection was carried out in three phases between August and October 2016. In the first phase, the first contact with the pedagogical coordinators of the schools was carried out to explain the research and request authorization. In the second phase the contact with the adolescents was made to expose the research and to schedule the date of collection, the TCLE was also delivered to bring them on the scheduled date for the collection, which didn´t exceed 10 days. The third phase consisted of the application of the questionnaire, in which the adolescents who had the ICF signed by the person in charge were sent to another room to respond to it.

Data analysis

The results were analyzed through the descriptive analysis to obtain frequency tables to trace the sociodemographic profile, HPV knowledge profile and access profile to information and communication technologies by adolescents, with the aid of the R Development Core Team).

Ethical aspects

The study was approved by the Committee of Ethics in Research with Human Beings of the University Center Cesumar, under number 37086014.3.0000.5539 and under the authorization of the State Nucleus of Education of Maringá.


RESULTS

Characterization of the population

The distribution of data regarding the characterization of the sociodemographic profile of adolescents and their parents is shown in Table 1. It was observed that almost half of the adolescents who participated in the survey (47%) were 14 years old and only 6% were older to 16 years. About a third of them reported having a family income of more than two minimum wages, while 41% didn´t know the family income. 26% of the students indicated that they do not know the degree of education of the father and a total of 33% answered that the father has complete or incomplete elementary education. Regarding the mother, 15% of them didn´t know what their schooling was, while 31% indicated that the mother has complete or incomplete elementary education and another 31% have completed or incomplete secondary education. It was verified that half of the students (50%) belong to the catholic religion and 41% to the evangelical one.




Perception of HPV transmission and its relation to CCU

Table 2 presents the data regarding adolescents' perception of HPV transmission and its relation to cancer. It was observed that the vast majority of girls (85%) answered that HPV is a virus. 96% of them reported that transmission of HPV occurs during sexual intercourse, 57% and 48% said that those who can get HPV are people who have sex without a condom and only women, respectively. When asked about the diseases that HPV can cause, only 5% of the adolescents pointed to liver cancer and 29% to penile cancer, while 68% and 43% responded that HPV can cause ovarian cancer and genital warts, respectively. Still, 88% of girls pointed out that HPV can cause CCU and only 20% responded to throat and mouth cancer. 94% of girls pointed out that HPV can turn into cancer and 97% believe there is a link between HPV and sexual intercourse.






Description of sources of HPV and CCU information

Only 1% of the study participants said they had not heard about HPV before. The most cited media they have heard of were the health and TV station, cited by 74% and 60% of all girls, respectively. When questioned if they had already heard about the importance of taking preventive tests, 9% answered negatively, and the most cited were the health and TV station, cited by 68% and 43% of the students, respectively.

Description of the use profile of Information and Communication Technology (ICT)

Tables 4 and 5 shows the distribution of data regarding the characterization of the adolescents' digital behavior profile. It wasn´ted that just over half of the interviewees (55%) have a personal computer, 97% of whom do not need computer help and 48% of the interviewees have used computers for more than five years.






It has also been observed that more than 90% of teenagers access the internet most of the time through paid Wi-Fi. The cell phone is the device most used by 94% of respondents to access the internet and 46% of them do not have a fixed time in which they use the internet every day.

A total of 82% of girls have e-mail, and more than half (53%) almost never access e-mail.

97% of the interviewees have cell phones and a good part have been using it for more than five years (42%), with the most common brand being Samsung (47%). A total of 94% of the girls participating in the survey have a cell phone with access to the Internet, and they use the device more frequently to access the internet and make calls (96% and 58% respectively).

Only one among the 230 adolescents pointed out that they do not have social networks. On the other hand, more than 90% of them use Facebook, Whatsapp and/or Youtube. Still, 97% and 83% of the girls pointed out that they use the Internet to enter social networks and/or do research, respectively. Almost half of the interviewees (48%) use Messenger video as a resource to communicate over video over the internet. Finally, the most frequent technological equipment, other than those already mentioned, that the interviewees have is the pen drive (73%), followed by the digital camera (47%).


DISCUSSION

The transmission of HPV and its relation to CCU infection are extremely relevant factors to be discussed in a sexually active population, especially in younger populations, since they have a high prevalence rate of HPV infection18,19. However, the adolescent population's perception of HPV and its relation to CCU is still insufficient20,21 and is limited almost exclusively to issues related to the transmission and development of HPV-associated diseases22. This fact is shown as such in our study, in which the majority of the adolescents surveyed knew what HPV was and its relation to the CCU, but 48% of them related the HPV transmission to the female only.

Unfortunately adherence to CCU prevention campaigns, especially vaccination against HPV by younger populations, is still a challenge, since the decision to take the vaccine requires a certain level of information from this population and their families. Through our study, it was possible to understand the quality of information about HPV and its relation with the CCU of the adolescent population, and to verify by what means this population obtained this information. It was also possible to identify the ICT use profile of the adolescents surveyed. And in the light of the results presented, we found evidence that ICTs are extremely used by this population in their daily lives, and this fact reinforced the idea of the use of ICT in the elaboration of strategies that provide accessible and reliable information on the transmission of HPV and prevention of CCU.

The mean age of the adolescents participating in our study was 14 years. This corroborates our proposal to investigate the perception of CCU control actions in the target population of vaccination campaigns against HPV23. Although about half of the adolescents didn´t know the family income and schooling level of their parents, those who responded to this questioning pointed out that the income is higher than two minimum wages and the schooling degree of the complete fundamental type. These data suggest that the population investigated in the present study shares similar sociodemographic similarities with the majority of the Brazilian families that depend on health care that is almost exclusive to SUS24.

Since information and knowledge play an important role in adherence to the HPV25 vaccine, the development of strategies that use tools focused on the young population is of fundamental importance for the promotion of the health of this population. The Internet is accessed by more than 100 million Brazilians, with the cellular telephone being the most used device for individual internet access26, which is in line with our results, which indicated that just over half of the adolescents who participated in the present study have computer, however almost all have cell phone with internet access. On the other hand, of the 230 adolescents surveyed, only one pointed out that they didn´t use social networks like Facebook and Whatsapp, which demonstrated the potential of RSO as an information vehicle for this population, which, with a large public and innumerable possibilities of use, can be used in various ways, with a focus on promoting the sexual health of the population27.

One of the most powerful communication tools of the 21st century is social media, which includes tools and web applications designed to facilitate online interaction and instant information sharing among users28. Its role is diverse: it helps people to communicate, discuss topics of interest and share their common interests, as well as provides the freedom to express their emotions and opinions. However, even if there is a need for new strategies that reach the adolescent population, the origin of this information and degree of quality and veracity must be considered. The evaluation of existing Youtube videos on HPV has identified that most have been in favor of the HPV vaccine, however videos with negative content have a higher number of views29.

The adolescents surveyed in our study responded that they obtained information about HPV and HPV vaccine through television and health posts. Unquestionably these information vehicles are of great value to the community. However, the potential of ICT use, especially among the adolescent population, increases each year, and has already been shown to be beneficial for increasing knowledge about STDs and reducing risk behavior27. The fact that the internet has been widely used for health research29,30 and that social networks are being used by patients to share personal information about their diseases29,31 reinforces the hypothesis of using ICT as a tool to be used for empowerment in with adolescents.

In view of the fact that levels of health education and awareness increase the immunization rates of a population32 and in this way, every effort to improve health information contributes to the needs of the population33, our study corroborates with relevant information on the adolescents' perception about the topic HPV and CCU and how they can be mobilized by ICTs to realize their knowledge on the subject. This information may indicate possible tools for creating new strategies that target the adolescent population. It is therefore imperative to create policies that promote correct information for the adolescent population and their families. Moreover, health professionals should be aware that their influence and information motivate individuals in making decisions about their health.


CONCLUSION

We conclude that the vast majority of adolescents know what HPV is, its form of transmission and health consequences, among them CCU. It was also possible to demonstrate that the medium that offered the most enlightenment about the virus to the target population was the Health Posts, where the young women also heard about the importance of preventive exams. In relation to the use of ICT, most of them have access to the Internet and do so through cellular devices, where they use the device mainly for access to RSO, among them, the most used are Facebook, Whatsapp and Youtube.

In this way, we understand that such technological means have the potential to offer health literacy, especially among young people and adolescents, since this age group uses digital means widely and can become protagonists in the awareness about HPV, CCU and its prevention, including due to to the fact that the primary prevention of this disease is vaccination.


THANKS

The data of this article were part of the Universal Project of the National Council of Scientific and Technological Development (CNPq), coordinated by the author Marcelo Picinin Bernuci - Project Number: 455495/2014-9.


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