연구 목적 : 본 연구는 여대생들을 대상으로 HPV 관련 지식, 백신접종태도, 건강신념 및 감염예방행위의도 간의 관계를 파악하고 HPV 관련 감염예방행위의도에 미치는 영향요인을 분석하여 여대생의 HPV 관련 감염예방행위의도를 증진시키기 위한 효율적 중재전략 개발에 도움이 되고자 한다.

연구방법 : 본 연구는 B광역시, G시 대학교에 재학 중인 여학생을 대상으로 하였으며 연구의 목적을 설명한 후 연구의 취지를 이해하여 연구 참여 에 동의하고 서면동의서를 작성한 120명을 대상으로 하였다. 자료수집기간 은 2016년 6월 1일부터 6월 30일까지 실시하였으며 수집된 자료는 SPSS 23.0 program을 이용하여 분석하였다. 대상자의 일반적 특성은 빈도와 백분율, 평균과 표준편차로 분석하였고 HPV 관련 지식, 백신접종태도, 건강신념, 감염예방행위의도의 정도는 평균과 표준편차로 분석하였다. 일반적 특성에 따른 HPV 관련 지식, 백신접종태도, 건강신념, 감염예방행위의도의 차이분석은 t-test와 ANOVA로 분석하고 사후검정은 Scheffe test로 분석하였다. 네 변수간의 관계는 피어슨의 적률상관계수 (Pearson correlation coefficient)로, 영향요인은 단계적 다중회귀분석 (Stepwise multiple regression)으로 분석하였다.

연구결과: 본 연구의 결과는 다음과 같다.

1. 대상자의 HPV 관련 지식은 평균 4.74점이었고 HPV 관련 백신접종태도는 평균 3.19점으로 하위영역별로 안전성 염려는 평균 2.79점, 필요성 인식은 평균 3.02점, 예방의 중요성은 평균 3.63점, 성적 위험행위는 평균 3.47점이었다. 건강신념은 평균 2.67점 이었고 하위영역별로 지각된 민감성은 1.93점, 지각된 심각성은 2.73점, 지각된 유익성은 2.90점, 지각된 장애성은 2.90점이었다. HPV 관련 감염예방행위의도는 평균 2.41점이었다.

2. 대상자의 일반적 특성에 따른 HPV 관련 지식은 연령(F=9.14, p<.001), 학년(F=10.34, p<.001), 전공(t=6.68, p<.001), 자궁경부암 인지여부(t=2.17, p =.032), 가족 중 자궁경부암 진단여부(t=2.84, p=.012), HPV 인지여부(t=7.71, p<.001), HPV 교육경험(t=4.22, p<.001), HPV 백신접종여부(t=2.58, p=.013)에서 통계적으로 유의한 차이를 나타냈다.

3. 대상자의 일반적 특성에 따른 HPV 관련 백신접종태도는 HPV 백신접종여부(t=3.15, p=.002)에서 통계적으로 유의한 차이를 나타냈다. 하위영역별로 안전성 염려에 차이를 보인 특성은 전공(t=-2.11, p=.037), 피임경험(t=2.10, p=.038)이었다. 필요성 인식에 차이를 보인 특성은 학년(F=3.76, p=.026), 전공(t=2.36, p=.020), 자궁경부암 인지(t=2.49, p=.014), 가족 중 자궁경부암 진단여부(t=2.10, p=.038), HPV 인지여부(t=3.59, p<.001), HPV 교육경험(t=2.60, p=.011), HPV 백신접종여부(t=4.39, p<.001)등 이었다. 예방의 중요성에 차이를 보인 특성은 음주경험(t=2.26, p=.025), HPV 교육경험(t=2.03, p=.045), HPV 백신접종여부(t=2.64, p=.011)에서 유의한 차이를 나타냈다.
4. 대상자의 일반적 특성에 따른 HPV 관련 건강신념은 연령(F=3.60, p=.030), 전공(t=2.43, p=.017), HPV 인지여부(t=2.90, p=.004), HPV 백신접종여부(t=2.17, p=.035)등에서 통계적으로 유의한 차이를 나타냈다. 하위영역 중 지각된 민감성에 차이를 보인 특성은 없었고, 지각된 심각성은 전공(t= 3.10, p=.002), HPV 인지여부(t=3.38, p=.001), HPV 교육경험(t=2.29, p=.024), HPV 백신접종여부(t=3.38, p=.001)등에서 유의한 차이를 나타냈다. 지각된 유익성은 학년(F=3.87, p=.024), 전공(t=2.51, p=.014), HPV 인지여부(t=3.39, p=.019), HPV 백신접종여부(t=2.16, p=.032)등에서 유의한 차이를 나타냈다. 지각된 장애성은 연령(F=3.16, p=.046), 자궁경부암 인지여부(t=-2.21, p=.029)에서 유의한 차이를 나타냈다.

5. 대상자의 일반적 특성에 따른 HPV 관련 감염예방행위의도는 전공(t=2.07, p=.041)과 흡연여부(t=2.53, p=.013)에서 통계적으로 유의한 차이를 나타냈다.

6. 대상자의 HPV 관련 감염예방행위의도는 HPV 관련 지식(r=.025, p=.005), HPV 관련 백신접종태도(r=.33, p<.001), HPV 관련 건강신념(r=.23, p=.012)과 정적 상관관계가 있는 것으로 나타났다. 또한, HPV 관련 지식과 HPV 관련 백신접종태도(r=.28, p=.002), HPV 관련 지식과 HPV 관련 건강신념(r=.40, p<.001)간에는 정적상관이 있었지만, HPV 관련 백신접종태도와 HPV 관련 건강신념(r=.01, p=.936)간에는 뚜렷한 상관이 없는 것으로 나타났다.

7. 대상자의 HPV 관련 감염예방행위의도에 영향을 미치는 요인은 HPV 관련 백신접종태도의 필요성 인식(β=.25, p=.005)과 HPV 관련 건강신념의 지각된 유익성(β=.24, p=.008), 흡연경험여부(β=-.22, p=.010)이었다. HPV 관련 백신접종태도의 필요성 인식, 건강신념의 지각된 유익성, 흡연경험 여부를 포함한 전체 설명력은 총 19.0%이었으며 가장 큰 영향을 미치는 요인은 HPV 관련 백신접종태도의 필요성 인식이었다.

결론 : 이상의 결과를 보면 여대생의 HPV 관련 감염예방행위의도에 영향을 미치는 요인은 HPV 관련 백신접종태도의 필요성 인식, HPV 관련 건강신념의 지각된 유익성, 흡연여부로 나타났으며 가장 큰 영향을 미치는 요인은 HPV 관련 백신접종태도로 확인되었다. 이를 토대로 HPV 관련 감염의 위험성이 높은 여대생을 대상으로 HPV 관련 감염예방행위의도를 증진시키기 위한 중재전략 개발에 도움이 될 것으로 기대한다.

중심단어: 인유두종 바이러스 백신접종, 자궁경부암, 지식, 태도, 의도

Purpose : This study is a descriptive research carried out to identify the effects of HPV-related knowledge, attitude to HPV vaccination and health beliefs on infection preventive behavior and intention targeting female university students, and aims to help develop efficient mediation strategies to improve the HPV-related infection preventive behavior and intention of female university students by analyzing those factors that influence HPV-related infection preventive behavior and intention.

Methods : The subjects of this study were female students at universities located in B metropolitan city and G city. 120 female university students who agreed to participate in the study and gave their written consent after the purpose of this study was explained to them were selected. The data collection was carried out from June 1, 2016 to June 30, 2016. The general characteristics of the subject were analyzed based on frequency, percentage, mean and standard deviation, and the level of HPV-related knowledge, attitude to HPV vaccination, HPV-related health beliefs and infection preventive behavior and intention was analyzed based on the mean and standard deviation. Also, the difference in the HPV- related knowledge, attitude to HPV vaccination and health beliefs on infection preventive behavior and intention was analyzed using the t-test and ANOVA, and a post-hoc test was carried out using the Scheffe test. The relationship between these 4 variables was analyzed using the Pearson correlation coefficient and the influential factors were analyzed using stepwise multiple regression.

Results: The results of this study are as follows.

1. The mean score of the subject''s HPV-related knowledge and attitude to HPV vaccination was 4.74 points and 3.19 points respectively and, according to the sub-domain, the mean score of safety concern, recognition of necessity, importance of prevention and sexual risk behavior was 2.79 points, 3.02 points, 3.63 points and 3.47 points respectively. The mean score of health beliefs was 2.67 points, and according to the sub-domain, the mean score of perceived sensitivity, perceived seriousness, perceived benefits and perceived disability was 1.93 points, 2.73 points, 2.90 points and 2.90 points respectively. The mean score of infection preventive behavior and intention was 2.41 points.

2. The HPV-related knowledge among the general characteristics of the subjects showed a statistically significant difference according to age (F=9.14, p<.001), school year (F=10.34, p<.001), major (t=6.68, p<.001), perception of cervical cancer (t=2.17, p=.032), diagnosis of cervical cancer among family members (t=2.84, p=.012), perception of HPV (t= 7.71, p<.001), experience of HPV education (t=4.22, p<.001) and rece-ption of HPV vaccination (t=2.58, p=.013).

3. The overall attitude to HPV vaccination among the general characteristics of the subjects showed a statistically significant difference according to the reception of HPV vaccination (t=3.15, p=.002). According to the sub-domain, the characteristics showing a difference in safety concern included major (t=-2.11, p=.037) and contraceptive experience (t=2.10, p=.038). The characteristics showing a difference in the recognition of necessity included school year (F=3.76, p=.026), major (t=2.36, p=.020), perception of cervical cancer (t=2.49, p=.014), diagnosis of cervical cancer among family members (t=2.10, p=.038), perception of HPV (t=3.59, p<.001), experience of HPV education (t=2.60, p=.011) and reception of HPV vaccination (t=4.39, p<.001). The importance of prevention showed a significant difference according to alcohol intake experience (t=2.26, p=.025), experience of HPV education (t=2.03, p=.045) and reception of HPV vaccination (t=2.64, p=.011).
4. The HPV-related health beliefs among the general characteristics of the subjects showed a significant difference according to age (F=3.60, p=.030), major (t=2.43, p=.017), perception of HPV (t=2.90, p=.004) and reception of HPV vaccination (t=2.17, p=.035). There was no characteristic among the sub-domain that showed a difference in perceived sensitivity, and the characteristics showing a difference in the perceived seriousness included major (t=3.10, p=.002), perception of HPV (t=3.38, p=.001), experience of HPV education (t=2.29, p=.024) and reception of HPV vaccination (t=3.38, p=.001). The characteristic showing a difference in the perceived benefits included school year (F=3.87, p=.024), major (t=2.51, p=.014), perception of cervical cancer (t=3.39, p=.019), and reception of HPV vaccination (t=2.16, p=.032). The characteristics showing a significant difference in the perceived disability included age (F=3.16, p=.046) and perception of cervical cancer(t=-2.21, p=.029).

5. The HPV-related infection preventive behavior and intention among the general characteristics of the subjects showed a significant difference according to major (t=2.07, p=.041) and smoking (t=2.53, p=.013).

6. The subject''s HPV-related infection preventive behavior and intention had a positive correlation with HPV-related knowledge (r=.025, p=.005), attitude to HPV vaccination (r=.33, p<.001) and HPV -related health beliefs (r=.23, p=.012). Also, there was a positive correlation between HPV-related knowledge and attitude to HPV vaccination (r=.28, p=.002), and HPV-related knowledge and HPV- related health beliefs (r=.40, p<.001), but there was no clear correlation between attitude to HPV vaccination and HPV-related health beliefs (r=.01, p=.936).

7. The influential factors on the subject''s HPV-related infection preventive behavior and intention included attitude to HPV vaccination (β=.35, p<.001) and experience of smoking (β=-.25, p=.003), HPV-related health beliefs (β=.21, p=.010). In other words, if the subjects have a more positive attitude to HPV vaccination, do not smoke, and have a higher score with regard to HPV-related health beliefs, their infection preventive behavior and intention becomes higher, and the whole explanation power including attitude to HPV vaccination, existence of smoking experience and HPV- related health belief was 19.0%.

Conclusions : It was identified through this study that the factors that influence female university students'' HPV infection preventive behavior and intention included the perception of the need for HPV-related vaccination, perceived benefit of HPV-related health beliefs and smoking status, and the factor that exerted the greatest influence was attitude towards HPV vaccination. These findings will contribute to the development of mediation strategies to improve HPV infection preventive behavior intention of female university students who have a high risk of HPV infection.

Keyword : HPV vaccination, Cervical cancer, Knowledge, Attitude, Intention