Knowledge and Perceptions of Human Papillomavirus Infection and Vaccination Among Adolescents in French Rural Family Homes: A Mixed-Methods Study.

BACKGROUND/OBJECTIVES: Human papillomavirus (HPV) causes several cancers in both females and males. In France, HPV vaccination coverage among adolescents remains suboptimal, particularly among boys, and knowledge about HPV infection and vaccination is limited. This study assessed HPV-related knowledge, attitudes, and vaccination uptake among adolescents attending Rural Family Homes (RFHs). METHODS: A sequential mixed-methods study was conducted between September 2023 and June 2024 among 895 adolescents aged 15-19 years attending 19 RFHs in France. Participants completed an anonymous self-administered questionnaire assessing sociodemographic characteristics, general vaccination knowledge, HPV-related knowledge, vaccination status, and determinants of vaccine uptake. Focus groups involving 59 adolescents explored perceptions of, barriers to, and information needs regarding HPV vaccination. Quantitative data were analyzed using chi-square tests and multivariable logistic regression; qualitative data were analyzed thematically. RESULTS: Overall, 44% of participants had received at least one HPV vaccine dose and 31% received at least two doses. Coverage was significantly higher among girls than boys (55% vs. 28%, p < 0.001). Only 35% demonstrated adequate HPV-related knowledge. Parents and general practitioners were the main information sources. Vaccination uptake was associated with favorable subjective norms, female sex, and the belief that vaccination reduces cancer risk. Qualitative findings revealed persistent misconceptions about HPV-related risks, particularly among boys, and a substantial need for reliable information. CONCLUSIONS: Adolescents attending RFHs showed limited HPV-related knowledge and suboptimal vaccination coverage, particularly boys. Parental support and healthcare professional recommendations were associated with vaccine uptake. Targeted educational interventions and catch-up vaccination strategies among this population are needed to improve coverage and reduce the burden of HPV-related diseases.