Abstract

Introduction – Human papillomavirus (HPV) vaccine offers a remarkable opportunity in the primary prevention of cervical cancer which is one of the leading causes of women’s deaths in Nigeria and the greatest in Africa. Parents who play a major role in the vaccination of their girls lack the knowledge of HPV vaccine, yet there is a dearth of educational interventions that have addressed these topics in Nigeria. The aim of this study was to assess the effect of health education on parents’ knowledge, attitude and uptake of HPV vaccine and to determine barriers to its uptake for their adolescent girls in private schools in Lagos, Nigeria.
Materials and methods – A non-randomized, controlled intervention study was carried out in four private schools in Lagos, Nigeria. A two-stage sampling method was used to recruit 440 parents of adolescent girls aged 28 to 68 years (220 in the intervention group and 220 in the control group) into the study. The study was conducted for 6 months between the months of January and July 2017. Baseline data was collected using a pre-tested, semi-structured, interviewer-administered questionnaire and a Focus Group Guide. The intervention given was health education using a lecture on HPV and HPV vaccine based on the ‘Health Belief Model’, HPV vaccine fact sheet and pamphlets supported with the provision of hotlines for an interactive conversation with the researcher. Access barrier was removed by making the HPV vaccines available at the selected school clinics in both intervention and control groups. Post-intervention data collection took place six months later. Statistical Package for the Social Sciences (SPSS) version 22.0 and Nvivo 11 were employed in the data analysis.
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Results – From the focus group discussions, it was noted that there were misinformation and lack of knowledge about HPV vaccine among the parents. At baseline assessment, awareness of HPV vaccine was high among the respondents in the study and control groups (76.8% and 75.9%) respectively. Majority of the respondents in the intervention (67.3%) and the control group (69.1%) had poor level of knowledge of HPV vaccine at baseline. Majority of the respondents (86.8%) in the intervention group and (93.2%) in the control group had negative attitude towards HPV vaccine at baseline. The observed differences at the baseline were not statistically significant. (p > 0.05). At baseline, the most frequent factors perceived as extremely likely barriers to uptake of HPV vaccine were “the lack of information about HPV vaccine”, “hard to find facility where the vaccine is available” and “the lack of convenient clinic time”. The observed differences regarding perceived barriers were not statistically significant at baseline. (p > 0.05).
Six months post interventions; the mean knowledge score increased from 37.9 ± 32.9 at baseline to 87.8 ± 18.0 in the intervention group. (p < 0.001) and from 38.0 ± 28.9 to 44.0 ± 30.7 in the control group. (p < 0.037). In the general performance score, there was a statistically significant increase of 64.5% from baseline in the proportion of respondents with a good level of knowledge of HPV vaccine in the intervention group. (p < 0.001). Also, the proportion of respondents with positive attitude increased significantly by 24.5% from baseline post-intervention. (p < 0.001). After six months, there was a significant improvement in proportions of respondents who obtained HPV vaccine for their girls in the intervention group and the control group (25% and 7.3%) respectively, (p < 0.001), compared to zero uptake at the
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baseline. The predictors of HPV vaccine uptake identified in this study were religion and parents’ positive attitude towards HPV vaccine.
Conclusion: The health education program was effective at improving the knowledge, modifying the attitude and subsequent uptake of HPV vaccine among the respondents in the intervention group. Therefore, strengthening health education of parents represents a simple yet potentially effective strategy for increasing HPV vaccine uptake and garnering stronger support for school-based HPV vaccination programs.