Beyond Nominal Awareness: Mapping the Literacy to Action Chasm in Adolescent HPV Vaccination Across Sub-Himalayan India

Beyond Nominal Awareness: Mapping the Literacy to Action Chasm in Adolescent HPV Vaccination Across Sub-Himalayan India A School-Based Cross-Sectional Study in Bilaspur and Shimla Districts, Himachal Pradesh Dr. Debankur Chakraborty, Dr. Vanshika S. ABSTRACT Background: Cervical cancer is a major cause of death among Indian women, even though the HPV vaccine and routine screening can prevent it. Himachal Pradesh launched a state-funded HPV vaccination drive in early 2026. This study looks at what adolescent schoolgirls know about cervical cancer, whether they understand the vaccine, and what influences their choices. Methods: We surveyed 516 female students across seven schools (five government and two private) in Bilaspur and Shimla districts of Himachal Pradesh between May and July 2026 (93.8% response rate). The survey covered knowledge of cervical cancer, HPV, vaccine benefits, vaccination status, fears about infertility, and willingness to get vaccinated if advised by a doctor. Results: While 71.9% (371/516) of girls had heard of cervical cancer, only 47.3% (244/516) knew it begins in the cervix or lower uterus, 76.0% (392/516) knew no symptoms, and only 27.5% (142/516) recognized that it can be prevented (p<0.001). Similarly, 61.6% (318/516) had heard of the HPV vaccine, but only 41.9% (216/516) had heard of HPV itself (p<0.001), and only 50.0% (258/516) knew the vaccine prevents infection. Only 12.8% (66/516) had received at least one dose, and just two girls (0.4%) had finished all required doses. When asked if they would get vaccinated on a doctor's advice, 45.3% (234/516) wanted more information first, 34.1% (176/516) refused, and 20.5% (106/516) agreed. Three out of four girls (75.6%, 390/516) were concerned or uncertain about whether the vaccine causes infertility. Only 3.5% (18/516) had heard of a Pap smear. Conclusion: The findings demonstrate a pronounced decoupling between nominal awareness and actionable prevention literacy among adolescent schoolgirls in Himachal Pradesh. The predominant driver of vaccine hesitation was an unmet informational requirement rather than active ideological refusal. School-based immunization campaigns must incorporate structured, age-appropriate educational curriculum addressing the need of vaccination and infertility misconceptions prior to injection sessions.