HPV knowledge and willingness to vaccinate among unvaccinated female college students: A cross-sectional comparison between a comprehensive university and a health vocational college in Fujian, China

Cervical cancer remains a significant burden in China, and HPV vaccination is key to prevention. Female college students are a crucial target, yet knowledge and willingness may vary across institution types. To compare HPV knowledge and vaccination willingness between female students from a comprehensive university and a health vocational college, and identify associated factors. A cross-sectional study was conducted from May to June 2026 among 2,761 female undergraduate students (first- and second-year) recruited from one comprehensive university and one health vocational college in Fujian, China. An electronic questionnaire collected data on demographic characteristics, HPV knowledge, vaccination willingness, vaccine preferences, and reasons for unwillingness. The overall HPV vaccination willingness rate was 78.7% (2,173/2,761). The mean HPV knowledge score was 6.17 ± 2.66 (out of 10), with only 37.0%(1,021/2,761) achieving high knowledge. Non-healthcare majors scored higher than healthcare majors (6.28 vs. 5.97, p = .003). Six independent factors were identified: healthcare major (OR = 0.65), higher income (OR = 0.58), maternal vaccination (OR = 2.28), friend vaccination (OR = 1.89), sexual history (OR = 1.74), and higher knowledge (middle level OR = 1.80; high level OR = 2.02). Among willing participants, 66.3% (1,441/2,173) preferred the nonavalent vaccine, and 56.1% (1,218/2,173) were unsure about domestic vs. imported vaccines. Main reasons for unwillingness were adverse reaction concerns, cost, and a wait-and-see attitude. HPV vaccination willingness was relatively high among unvaccinated female college students in Fujian, China, but knowledge gaps persisted, particularly regarding the recommended vaccination age. Willingness was significantly associated with academic major, household income, social influences, and knowledge level. Targeted educational interventions, financial support, and peer-based strategies are needed.