WED-036 - Understanding HPV Vaccine Uptake in Nigeria: A Qualitative Study Guided by the Health Belief Model

Brief Abstract Summary: Cervical cancer is the second leading cause of female cancer morbidity and mortality in Nigeria. HPV vaccination rate in Lagos is far below the national average. To address this gap, the study explored facilitators and barriers to HPV vaccination uptake in Lagos. Using a phenomenological design, semi-structured individual and focus groups were conducted with 20 parents and 19 adolescents. Guided by the Health Belief Model, major themes were identified. Perceived severity: HPV can cause cancer, and HPV can cause death. Perceived benefits: protecting children, preventing HPV infection, and viewing the vaccine as safe and effective. Perceived barriers: affordability, availability, no confidence in the HPV vaccine, lack of trust in healthcare workers, and perceived judgment or stigma associated with vaccination. Cues to action: government incentives and creating more awareness about the vaccine. Findings highlighted the need for collaborative strategies to enhance HPV vaccination.

Detailed abstract description: Background
Cervical cancer is the second leading cause of female cancer morbidity and mortality in Nigeria, with over 12,000 new cases and 8,000 deaths reported in 2020. To prevent cervical cancer, Nigeria recently introduced the human papillomavirus (HPV) vaccination for girls aged 9-14 into the national immunization program and achieved 71% coverage nationally. However, rates varied by state with Lagos reporting the lowest HPV vaccination coverage (31%). This study aimed to assess the facilitators and barriers to HPV vaccination among parents and adolescents in Lagos, Nigeria.
Methods
This study employed a phenomenological research design with an inductive thematic analysis approach. Semi-structured interviews were conducted with parents and adolescents recruited through convenience sampling. Participants included 20 parents (aged 29–49 years) and 19 adolescents (aged 13–16 years). Data were collected through four in-depth individual interviews and two focus group discussions for each group. Guided by the Health Belief Model (HBM), data were analyzed thematically across the constructs of perceived severity, perceived benefits, perceived barriers, and cues to action using NVivo 15 software.
Results
Major themes identified as perceived severity include (1) HPV can cause cancer and (2) HPV can cause death. Perceived benefits themes included (1) protecting children, (2) preventing HPV infection, and (3) viewing the vaccine as safe and effective. Perceived barriers themes included (1) affordability, (2) availability, (3) lack of confidence in the HPV vaccine, (4) lack of trust in healthcare workers, and (5) perceived judgment or stigma associated with vaccination. Cues to action themes included (1) government incentives and (2) creating more awareness about the vaccine.
Conclusions
Guided by the HBM, this study revealed a complex interplay of knowledge, perceived benefits, structural barriers, and social barriers that influence HPV vaccination uptake in Nigeria. Findings showed that government incentives, expanding awareness efforts, and improving trust in healthcare providers are essential to enhance HPV vaccine uptake. Collaborative efforts involving parents, schools, healthcare workers, and policymakers are critical to improving vaccination coverage and mitigating the burden of cervical cancer in Nigeria.