Deema I. Fallatah ¹ Mohammad A. Khalil ² Samar Abd ElHafeez ³ Salma Gouda ⁴ Huda M. Alshanbari ⁵ Dr. Maaweya Awadalla ⁶ Mamoun Ahram ⁷ Bandar Alosaimi ^6*

• ¹ Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
• ² Department of Basic Medical Sciences, Faculty of Medicine, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
• ³ Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria, Alexandria, Egypt
• ⁴ Ministry of Health and Population (Egypt), Minya, Minya, Egypt
• ⁵ Department of Mathematical Sciences, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
• ⁶ Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
• ⁷ Department of Physiology and Biochemistry, School of Medicine, The University of Jordan, Aljubeiha, Amman, Jordan

Cervical cancer is a highly prevalent disease among women worldwide. However, the advent of a vaccine against HPV, the main cause of the disease, has prevented its spread. The acceptability of the HPV vaccine to different sectors of the Saudi community has yet to be clarified. Since parents and teachers are major influencers in the decision-making process of vaccination for HPV, this study aimed to assess the knowledge and attitudes of teachers and parents toward cervical cancer, HPV, and the HPV vaccine, and unraveled the factors that would influence recommending the vaccine. A cross-sectional study was done among 927 individuals (373 teachers and 356 parents). A newly developed validated questionnaire was used to collect data on knowledge, attitude, and factors influencing cervical cancer, HPV, and HPV vaccine. The relationship between different factors with knowledge and attitude was assessed using univariate and multivariate analysis. Females were 94% of the study participants, with a median (Interquartile range) age of 38 (31-44) years, 12.2% were teachers, 38.7% were parents and 49.1% were parents and teachers. The majority (78.5%) were married, and 75.6% had at least one child. Among those with children, 88.6% had at least one girl, and among those with girls, 72.2% had at least one girl aged between 10-18 years. The total median (IQR) knowledge score was 9 ((-5)- (-26)) and the total median (IQR) attitude score was 49 (43-56). The knowledge score significantly increased by receiving postgraduate education, working in the health or education sectors, knowing someone diagnosed with cervical cancer, having girls in the age group of 10-18 years, reading about medical issues, or having previously heard about the HPV vaccine. The attitude score significantly increased by a high knowledge score and decreased if the person has previously been diagnosed with cervical cancer. Physician’s recommendations and the amount of information on the HPV vaccine, opinions about vaccines in general, and government decrees are the main factors influencing the decision on HPV vaccine Uptake. This study emphasizes the role of healthcare providers, awareness of cervical cancer, HPV and its vaccine, and social status, in favoring vaccine uptake in Saudi.