Perceived knowledge, attitudes, and practices toward genital warts and HPV vaccination among college students in Shandong Province, China

ObjectiveThis study aimed to investigate the perceived knowledge, attitudes, and practices regarding genital warts and HPV vaccination among college students in Shandong Province, China.MethodsA cross-sectional study was conducted on Chinese college students from March 13 to April 2, 2026, in four universities in Shandong Province, China. Data were collected using a self-administered questionnaire in Chinese that was newly developed for this study and covered demographic characteristics and the three dimensions of the knowledge–attitude–practice (KAP) framework: perceived knowledge (14 items, score range 0–28), attitude (9 items, score range 9–45), and practice (10 items, score range 10–50). Bloom's cut-off criteria were applied to the attainable range of each scale, calculated as (observed score – minimum possible score) / (maximum possible score – minimum possible score) × 100%, and scores were classified as poor (< 60%), moderate (60%−79%), or good (≥80%). Structural equation modeling (SEM) was used to examine the associations among perceived knowledge, attitude, and practice.ResultsA total of 959 participants were included, with 58.39% of participants being male. The mean perceived knowledge, attitude, and practice scores were 15.34 ± 7.64, 35.92 ± 7.42, and 36.84 ± 11.71, corresponding to 54.79%, 74.78%, and 67.10% of the attainable range of each scale, and therefore to poor perceived knowledge and moderate attitude and practice. In the SEM, perceived knowledge was directly associated with attitude (β = 0.119, P = 0.012) and with practice (β = 0.461, P = 0.014), and attitude was directly associated with practice (β = 0.118, P = 0.007). An indirect association between perceived knowledge and practice through attitude was also observed (β = 0.014, P = 0.003). Perceived knowledge, attitude, and practice scores were positively correlated with each other (all P < 0.001).ConclusionCollege students in Shandong Province, China had poor perceived knowledge and moderate attitudes and practices regarding genital warts and HPV vaccination. Perceived knowledge showed the strongest association with the practice construct in the specified SEM, with attitude acting as a modest indirect association through attitude. Because the design was cross-sectional; these findings represent associations rather than causal effects. Campus-based sexual health education should prioritize accurate HPV-related knowledge, male vaccination awareness, and accessible referral pathways for STI examination and HPV vaccination.