title: Knowledge, attitude, and uptake related to human papillomavirus vaccination among young women in Germany recruited via a social media site.
abstract: BACKGROUND
  Many industrialized countries have introduced human papillomavirus (HPV) vaccination of young women, but vaccine uptake often remains suboptimal. This study aimed to investigate whether a social media site like Facebook is an appropriate tool to assess knowledge, attitude and uptake related to HPV vaccination in young women in Germany.
  
  
  METHODS
  Between December 2012 and January 2013 two different targeting strategies were implemented on Facebook, providing a link to an online questionnaire. Advertisements were displayed to female Facebook users aged 18-25 years living in Germany. During the simple targeting strategy, advertisements comprised health-related images along with various short titles and text messages. During the focused strategy, advertisements were targeted to users who in addition had certain fashion brands or pop stars listed on their profiles. The targeting strategies were compared with respect to participant characteristics. Univariate and multivariate analyses were used to identify factors associated with HPV vaccine uptake.
  
  
  RESULTS
  A total of 1161 women participated. The two targeting strategies resulted in significant differences regarding educational status and migrant background. Overall, awareness of HPV was high, but only 53% received at least one vaccine dose. In multivariate analysis, HPV vaccine uptake was independently associated with a physician's recommendation and trust in vaccine effectiveness. Concerns of adverse effects were negatively associated with vaccine uptake.
  
  
  CONCLUSIONS
  Social network recruitment permits fast and convenient access to young people. Sample characteristics can be manipulated by adjusting targeting strategies. There is further need for promoting knowledge of HPV vaccination among young women. Physicians have a major role in the vaccination decision-making process of young women.
authors.affiliation: a Immunization Unit; Robert Koch Institute ; Berlin , Germany.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Remschmidt
authors.forename: Dietmar
authors.initials: D
authors.lastname: Walter
authors.forename: Patrick
authors.initials: P
authors.lastname: Schmich
authors.forename: Matthias
authors.initials: M
authors.lastname: Wetzstein
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Deleré
authors.forename: Ole
authors.initials: O
authors.lastname: Wichmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000329:Advertising; D001521:Behavior Therapy / Q000379:methods*; D003625:Data Collection / Q000379:methods*; D005260:Female; D005858:Germany; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D061108:Social Media; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: CI, confidence interval; HPV, human papillomavirus; OR, odds ratio; cross-sectional study; hr, high-risk; human papillomavirus; recruitment strategy; social media site; targeting advertisement; uptake; vaccine