Currently submitted to: JMIR Public Health and Surveillance
Date Submitted: Jun 12, 2026
Open Peer Review Period: Jun 15, 2026 - Aug 10, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Impact of A Culturally Tailored Educational Intervention on Human Papillomavirus Knowledge and Vaccination Intentions Among Women in Saudi Arabia: A Quasi-Experimental Design
ABSTRACT
Background:
Human Papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. Despite the availability of effective vaccines, uptake remains suboptimal in many settings, including Saudi Arabia, where cultural sensitivities, limited awareness, and vaccine hesitancy have been documented. Educational interventions grounded in behavioral theory, such as the Information Motivation Behavioral Skills (IMB) model, can help address informational and motivational barriers to HPV vaccination
Objective:
This study was to evaluate the impact of an educational intervention in improving HPV vaccination decision-making among women in Northern Saudi Arabia.
Methods:
A quasi-experimental design (pretest-posttest with a control group) was used among women attending primary healthcare centers in the Northern Border Region of Saudi Arabia. Participants completed surveys at baseline (T1), one week post-intervention (T2), and three-month follow-up (T3), assessing HPV-related knowledge, health awareness, attitudes, and vaccination intentions. The educational intervention consisted of a culturally adapted, evidence-based, 45-minute interactive group session delivered in primary healthcare centers.
Results:
Study retention was excellent (97.7%; 380/389). At three month follow up, intervention participants demonstrated medium to large effect size improvements compared with controls: knowledge (adjusted β = 0.84, 95% CI 0.53–1.15, p < 0.001; Cohen’s d = 0.61, medium effect), health awareness (β = 0.88, 95% CI 0.53–1.23, p < 0.001; d = 0.65, medium effect), attitudes (β = 0.70, 95% CI 0.42–0.98, p < 0.001; d = 0.52, medium effect), and vaccination intentions (β = 0.86, 95% CI 0.60–1.12, p < 0.001; d = 0.83, large effect). Exploratory subgroup analyses found no significant effect modification by age, education, or health literacy (all interaction p > 0.10), suggesting consistent intervention effects across demographic characteristics.
Conclusions:
This culturally educational intervention was effective in improving HPV-related knowledge, attitudes, health awareness, and vaccination intentions among women in Northern Saudi Arabia. Given the well–documented intention–behavior gap in vaccination uptake, future research should incorporate verified vaccine initiation and completion outcomes, along with longer follow-up, to assess whether enhanced intentions translate into actual vaccine uptake
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