{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T07:11:34Z","timestamp":1787987494467,"version":"build-2784847793"},"reference-count":47,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018712","name":"\u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy","doi-asserted-by":"publisher","award":["32153\/18\/16.12.2024"],"award-info":[{"award-number":["32153\/18\/16.12.2024"]}],"id":[{"id":"10.13039\/501100018712","id-type":"DOI","asserted-by":"publisher"}]},{"award":["32153\/18\/16.12.2024"],"award-info":[{"award-number":["32153\/18\/16.12.2024"]}],"id":[{"id":"https:\/\/ror.org\/051h0cw83","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Med. Sci.","Medical Sciences"],"abstract":"<jats:p>Background: Although cervical cancer is a highly preventable malignancy, Romania continues to report critical mortality rates. This paradox is largely attributable to the suboptimal implementation of clinical guidelines and a passive, \u201copt-in\u201d administrative framework. This cross-sectional study investigates the cognitive and behavioural determinants\u2014specifically, human papillomavirus (HPV) knowledge, institutional trust in healthcare systems, and digital misinformation exposure\u2014that modulate female attitudes toward HPV immunisation. Methods: An observational cross-sectional study was conducted between December 2025 and March 2026 across four obstetrics and gynaecology clinics. Data were collected via digital questionnaires administered to adult female patients aged 18 to 65 years. The assessment tool evaluated four primary domains: HPV knowledge, perceived vaccine safety, immunisation intention, and the degree of exposure to social media misinformation. Results: The cohort demonstrated a substantially low vaccination rate (28.6%). Statistical analysis elucidated significant positive correlations between HPV knowledge, trust in health authorities, and vaccination intention. Furthermore, reliance on official information sources strongly correlated with perceived vaccine safety. Conversely, exposure to negative online content exhibited a weak negative association with knowledge levels, yet it did not directly influence vaccination intention. Conclusions: Health literacy and institutional trust emerge as fundamental pillars for HPV vaccine acceptance. To overcome patient vaccine hesitancy, the national healthcare system must initiate a strategic paradigm shift, prioritising the neutralization of digital misinformation and transitioning from a passive model to a proactive, \u201copt-out\u201d infrastructure.<\/jats:p>","DOI":"10.3390\/medsci14040431","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T08:15:56Z","timestamp":1785140156000},"page":"431","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Cervical Cancer Paradox in Eastern Europe: How Knowledge and Institutional Trust Shape HPV Vaccination Attitudes in Romania"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0187-3682","authenticated-orcid":false,"given":"Ionel-Daniel","family":"Nati","sequence":"first","affiliation":[{"name":"2nd Department of Obstetric and Ginecology, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400610 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9419-4824","authenticated-orcid":false,"given":"Carmen Mihaela","family":"Mihu","sequence":"additional","affiliation":[{"name":"Department of Morphofunctional Sciences, Iuliu Ha\u021bieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Mihu","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetric and Ginecology, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400610 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Razvan","family":"Ciortea","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetric and Ginecology, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400610 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doru","family":"Diculescu","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetric and Ginecology, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400610 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela","family":"Oancea","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetric and Ginecology, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400610 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Bucuri","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetric and Ginecology, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400610 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Patricia","family":"Roman","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetric and Ginecology, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400610 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Mihaela","family":"Ormindean","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetric and Ginecology, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400610 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1909-7367","authenticated-orcid":false,"given":"Viorela","family":"Suciu","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetric and Ginecology, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400610 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dumitru Rares","family":"Ciocoi-Pop","sequence":"additional","affiliation":[{"name":"Physical Therapy and Theoretical Subjects Department, Babe\u0219-Bolyai University of Cluj Napoca, 400347 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei Mihai","family":"Malutan","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetric and Ginecology, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400610 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Zhou, L., Li, Y., Wang, H., Qin, R., Han, Z., and Li, R. 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