Awareness, factual knowledge, attitudes, and acceptability of human papillomavirus vaccination among adult women in Palestine: a cross-sectional study.

Background: Human papillomavirus (HPV) is a major preventable cause of cervical cancer, yet awareness and uptake of HPV vaccination remain suboptimal in many settings. Evidence regarding women's HPV-related awareness, factual knowledge, and vaccine acceptability in Palestine remains limited. This study assessed awareness, factual knowledge, attitudes, self-reported uptake, willingness, and perceived barriers related to HPV infection and HPV vaccination among adult women in Palestine. Methods: A cross-sectional online survey was conducted between October 2025 and February 2026 among women aged ≥18 years residing in Palestine. The questionnaire assessed sociodemographic characteristics, HPV and HPV vaccine awareness, factual knowledge, attitudes, vaccine uptake, willingness to receive or recommend vaccination, and perceived barriers. A 12-item factual knowledge score was calculated, and higher factual knowledge was defined as ≥7 correct responses. Descriptive statistics, subgroup analyses, and multivariable logistic regression were performed. Results: Among 424 adult women included in the final analysis, 220 (51.9%) had heard of HPV and 146 (34.4%) had heard of the HPV vaccine. The mean factual knowledge score was 4.03 ± 2.72 out of 12, and 90 participants (21.2%) had higher factual knowledge. Self-reported HPV vaccine uptake was low (13.0%), whereas willingness to receive the vaccine was higher (55.2%). Lack of awareness (55.8%) and concern about vaccine safety (22.8%) were the most frequently reported barriers among unvaccinated women. In expanded adjusted analyses, prior HPV awareness, prior HPV vaccine awareness, and more supportive HPV-vaccination attitudes were independently associated with higher factual knowledge. Higher factual knowledge and supportive attitudes were associated with self-reported vaccine uptake, while willingness among unvaccinated women was most strongly associated with supportive vaccination attitudes. Conclusion: Adult women in Palestine demonstrated limited HPV-related awareness and low factual knowledge, together with low self-reported HPV vaccine uptake. The gap between willingness and uptake, combined with the predominance of awareness and safety concerns as reported barriers, suggests a need for culturally appropriate education, provider-led counseling, and improved access to reliable HPV vaccine information. Findings should be interpreted cautiously given the cross-sectional design and online convenience sampling.