KNOWLEDGE, ATTITUDE AND UPTAKE OF HPV VACCINE AMONG GIRLS IN JUNIOR SECONDARY SCHOOL IN LAGOS, NIGERIA

TOPIC IS SUITABLE FOR: NURSING DEPARTMENT, PUBLIC HEALTH DEPARTMENT, COMMUNITY HEALTH DEPARTMENT & MEDICAL LABORATORY SCIENCE DEPARTMENT.

TOPIC: Knowledge, Attitude and Uptake of HPV vaccine among girls in junior secondary school in Lagos, Nigeria

TABLE OF CONTENTS
Abstract
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study
1.2 Statement of the Problem
1.3 Aim and Objectives of the Study
1.4 Research Questions/Hypothesis
1.5 Significance of the Study
1.6 Scope of the Study/Delimitation
1.6 Scope of the Study/Delimitation
CHAPTER TWO: REVIEW OF LITERATURE

2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review
2.4 Gap Identification.
CHAPTER THREE: METHODOLOGY
3.1 Research Design 
3.2 Study Area
3.3 Population of  the study
3.4 Sample(s) and Sampling Techniques
3.5 Nature/Sources of Data
3.6 Methods of Data Collection/Instrumentation  
3.7 Validity/Reliability of Instrument
3.8 Methods of Data Analysis
3.9 Ethical Approval
CHAPTER FOUR: RESULTS AND DISCUSSION
4.1 Results and Analysis
4.2 Discussion of Findings
CHAPTER FIVE: SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS
5.1 Summary of Findings
5.2 Limitations
5.3 Conclusion
5.4 Recommendations
5.5 Contributions to knowledge
References
Appendix

ABSTRACT

This study analyzed the Knowledge, Attitude and Uptake of HPV vaccine among girls in junior secondary school in Lagos, Nigeria. The specific objectives of the study were to evaluate level of knowledge, attitude towards, extent of vaccine uptake and associated factors affecting HPV vaccine uptake among female junior secondary school students. The study was delimited to three local governments which included; Ikeja, Surulere, and Alimosho. The descriptive cross-sectional survey design was employed because the study was aimed at examining the prevalence of the study variable among the female junior secondary school students in Ikeja, Lagos. A sample size of 394 respondents determined using the Cochran formula based on prevalence level of 3.6% as reported by Ojule and Anika, (2020), and a 10% attrition rate.  A multi-stage sampling method with stratification, purposive and proportionate random sampling methodology was used. Data were obtained by employing a structured self-administered questionnaire with socio-demographic characteristics, knowledge, attitudes, uptake, and associated factors sections. Data were analyzed in SPSS 25 employing descriptive data statistics (frequency counts, percentages, means, and standard deviations) and Chi-square to test the hypotheses at the significance level = 0.05. The findings revealed that knowledge was overall poor with a grand mean of 2.54, attitudes were largely negative with greater acceptance of fears of side effects (mean = 3.53), and uptake was low with proactive vaccination behaviors rejected (grand mean < 2.9). The Chi-square tests showed that the associations were not statistically significant, and in each case the null hypotheses were accepted: knowledge of HPV vaccine was low (X² = 95.53, df = 1, p = 0.102), attitude was negative (X² = 56.63, df = 1, p = 0.300), and uptake was low (X² = 95.00, df = 1, p = 0.060). Among the key related factors, there was lack of awareness, influence of parents and peers, poor access, cost, and cultural/religious beliefs (means greater than 3.0). The study recommends that government should incorporate HPV awareness in school curriculum, schools should carry out sensitization and vaccination programs, parents should support their daughters to be vaccinated, and health agencies should make HPV vaccines affordable and accessible.

CHAPTER ONE
INTRODUCTION (PREVIEW)

1.1 Background to the Study

Human health and behaviour are influenced by an interplay of biological, social and environmental factors; health is not just the result of one's individual choices but also dependent on a societal context that dictates the prevailing norms and beliefs and the availability of environmental and social resources (Okoka et al., 2023). As the level of health literacy has been identified as a determinant of preventive behavior (Bai et al. 2024), the public health impact often relies on the level to which the population comprehends and takes action based on correct health information. Adolescence is a developmental stage in which individuals are increasingly assuming responsibility for making decisions about health, and are heavily influenced by their peers, family and institutions (Hundesa et al., 2023). Mobilisation-based interventions for health, including vaccination programmes, therefore rely on individual and supportive social structures to be most effective and sustainable in the long term (Adebola et al., 2023). In order to develop interventions that translate knowledge into preventive behavior, it's important to recognize what motivates health-related behavior among this population.
"Vaccination continues to be among the most effective public health interventions in the prevention of infectious diseases, the reduction of morbidity, and the long-term cost on health systems." HPV is one of the most common DNA viruses and consists of different HPV strains with different clinical implications, thus so-called high-risk strains are related to cervical cancer while so-called low-risk are normally related to benign lesions - such as genital warts (Onasoga et al. 2025). Human papillomavirus (HPV) infection is a worldwide health issue and is particularly important among adolescents and young adults, because young age correlates with exposure to HPV. HPV vaccination is the foremost preventative measure for cervical neoplasia and its effective use hinges on availability as well as awareness (Ampofo et al. 2022). By focusing on an avoidable source of morbidity and mortality, HPV turns the flow of work between academics and public health practitioners into the hot spot in the interface between education, perception, and healthcare intervention (Bai et al. 2024).
Awareness and understanding of HPV and how to prevent it is at the core of promoting adolescent health. Regarding the effect of adolescent exposure to factual health information, we found evidence of a direct effect of factual health information exposure on adolescent acceptability of vaccination programmes (Hundesa et al., 2024). As the authors of Okoka et al. maintained, knowledge about HPV transmission, clinical implications and the protective effect of vaccination is positively correlated with the intention to get vaccinated and the uptake of vaccination. Moreover, the transmission of knowledge is influenced by social, familial, and educational environments, and adolescents are very sensitive to the cues they receive from other school children, teachers, and parents (Oboro & Ogaji, 2023). The effectiveness of school-based health education programmes in enhancing understanding and promoting accurate knowledge, in a context that can support informed decision-making, has been proven (Onasoga, Obike, Michael; Jumbo, Albert; Aku-Apem, Bright; Mawusi, Susan (2025). Hence, apart from acting as the intellectual structure for the comprehension of risks of morbidity, knowledge also acts as a springboard for developing positive perceptions and attitudes towards preventive interventions (Ampofo et al., 2022).
Attitudinal disposition turns out to be a mediator between knowledge and behavior as it is responsible for shaping the way adolescents act on, or translate, their awareness into behavior (Bai et al., 2024). Positive attitudes towards HPV vaccination which contribute to a greater intention to participate in preventive health behaviours, and misconceptions, fear or cultural opposition which hinder participation (Ampofo et al., 2022). For adolescents, not only factual information, but also social and emotional factors such as parental guidance and interaction with peer groups play a role in forming attitudes, as do cultural norms (Hundesa et al. 2024). In school settings, curriculum-based health education (comprising factual teaching and discussion/participation techniques) has been shown to be effective in influencing positive attitude to vaccination (Adebola et al. 2023). Schools can promote facilitative attitudinal conditions for reinforcing knowledge regarding preventive health behaviors by creating and maintaining positive values, perceptions that can facilitate behavioral concordance (Okoka et al., 2023).
Behavioral uptake - or receipt of vaccination itself - is the end-result of knowledge and attitude drivers. Even though awareness and perception are known to impact uptake, practical factors such as accessibility, affordability and parental authorization influence adolescent uptake of HPV (Onasoga et al. 2025). Therefore, where there are opportunities and catalyzing factors (such as knowledge and attitudinal disposition; 'Awareness'), but uptake remains low, structural barriers can be identified and it is important to explore psychosocial and logistical explanations for this (Oboro & Ogaji, 2023). These findings indicate that adolescents' knowledge of HPV and good attitude could be associated with completion of the HPV vaccination series, but it has been shown that there is an overlap across the concepts of knowledge, attitude and behavior (Bai et al., 2024). For this demographic, understanding uptake allows an evaluation of the impact of health education programs, which in turn can be used to fine-tune interventions to address the behavioral intention and behavior gap (Ampofo et al., 2022).
Schools are important venues for adolescent health promotion due to the unique opportunity they provide to impart information, to shape behavioral attitudes, and to implement preventive measures (like immunization) (Adebola et al. 2023). Schools, universities, and other educational settings create environments in which interactive peer education, professional educator instruction, and policy-based interventions can reinforce health promoting behaviors. In the context of school-based HPV immunization programs, some of these challenges related to access, parental consent, and logistics can be minimized and uptake can be increased by mainstreaming HPV immunization programs into school health programming (Onasoga et al., 2025). Second, the interventions are founded on social mechanisms: for example, young people are very receptive to peer norms and to the example of teachers, which, in turn, can have a positive effect on the perception and behavior of children (Hundesa 2024 et al.). They therefore, are a multifaceted dual practice which addresses simultaneously the knowledge, attitudes, and practical constraints that might optimize preventative health outcomes in school settings.
Within the Nigerian context, Lagos is particularly appropriate as a site for study of HPV vaccination in adolescents, because of its vast population and array of socio-cultural settings (Bai et al., 2024). Female junior secondary school students are a population at a pivotal stage for preventive intervention, as early vaccination may confer long-term protection against acquisition of HPV infection and related cervical pathologies (Hundesa et al. 2024). Whilst there is some overlap in the relationship between awareness, attitude, and uptake, it has been demonstrated that their mediation also depends on cultural factors like parents, societal and cultural beliefs, and institutional support (Adebola et al., 2023). Thus, knowledge, attitude, and vaccine uptake of HPV among this population will allow stakeholders to develop specific evidence-based interventions that target both education and system determinants (Onasoga et al., 2025). Ultimately, it is a contribution not only to public health at the local level but also to the overall strategy for reducing the burden of HPV-related disease in adolescents globally.
The behaviours around HPV vaccination among female adolescents in Lagos requires an integrated solution that incorporates education, social and structural factors. If there were certain gaps in one of these areas, it could negatively impact other preventative strategies as knowledge, attitude and behavioural uptake are not mutually exclusive (Bai et al. 2024). By situating this research within the context of schools, researchers and policymakers will find a more controllable environment in which interventions can be more readily implemented, outcomes observed, and peer and institutional support leveraged to promote health-promoting behaviors (Hundesa et al. 2024). The information thus gained is invaluable in the development of strategies to improve immunization coverage, decrease HPV prevalence and in general improve reproductive health outcomes in the adolescent female population in urban Nigeria.

1.2 Statement of the Problem
The importance of preventive practices has been stressed upon by public health research on many occasions and it is only through the efforts of research and practice that population health outcomes have improved and disease burden reduced. Preventive measures like vaccination prove to be extremely efficient at the appropriate age and under the conditions of socially favorable environment. According to Hundesa et al. (2024), the impacts of knowledge dissemination and the social willingness of a group of people to embrace them can determine the level of adoption on the preventive health innovations. Following the same line of thought, Adebola et al. (2023) decide to state that adolescents will seek health, or rather their health-seeking behavior will depend on their educational exposure and environment. Within this perspective, the Human Papillomavirus (HPV) vaccine serves as an exemplary case of how knowledge, attitude, and uptake must align for a preventive program to achieve its intended goals.
Although HPV vaccine is available and proven to be efficacious, many parts of the region are still utilizing it less in adolescent girls than what is ideal. According to HPV as an underutilized vaccine (Meshach et al., 2024), Meshach et al. (2024) emphasize that HPV is the most prevalent sexually transmitted infection in the world, and some of its strains increase the risk of cervical cancer and other cancers, which, nevertheless, have a vaccine. According to Nasoga et al. (2025), the HPV vaccination is mostly targeted to adolescents, especially school-aged girls, but the process of scientific evidence, in turn, its widespread acceptance, and use has been inconsistent. In an ideal world, the rate of vaccination must be high enough to achieve a population-level immunity defense thus preventing morbidity and mortality related to HPV. IME, however, this difference between the scientific potential and the coverage as witnessed is an issue that is worth further exploring in order to investigate the contributing factors to the uptake.
In Nigeria and more specifically in Lagos, the HPV vaccine is still yet to reach the perfect level of acceptance among the intended primary target group; females of adolescent age. Okaa et al. (2023) remark that HPV and its vaccine are unequally distributed and distributed knowledge contributes to perceptions and willingness to take the vaccine. As Ampofo et al. (2022) argue, the school environment can be a formidable determinant of the health behavior of adolescents, but the currently available health education models fail to produce any results in the form of measurable vaccine acceptance. Hence, despite the availability of the vaccine, there remains a disparity between awareness and positive attitude in relation to uptake. The optimal would be that a high percentage of vaccine uptake be supported by well-educated student base, however the given situation indicates that this has not yet been achieved in Lagos.
The lack of knowledge in this subject is that there is little empirical evidence on the understanding and reaction of junior secondary school students in Lagos on the HPV vaccine. As Oboor and Ogaji (2023) argue, one cannot assume or presume that any population accepts vaccines but rather needs to study them within the framework of a particular culture and level of education because attitudes can drastically differ. Bai et al. (2024) also point out that interventions in the sphere of public health must be based on the comprehensive investigation of the correlation between knowledge, attitude, and behavior. This research thus aims to help fill the gap by assessing the knowledge, attitude, and uptake of HPV vaccine among female junior secondary school students in Lagos, Nigeria.

1.3 Aim and Objectives of the Study
The general objective of the study is to assess the knowledge, attitude, and uptake of HPV vaccine among female junior secondary school students in Lagos, Nigeria, specifically the study intends to;
1. To assess the level of knowledge of female junior secondary school students in Lagos on the HPV vaccine and its role in cervical cancer prevention.
2. To examine the attitudes of female junior secondary school students in Lagos toward receiving the HPV vaccine.
3. To determine the extent of HPV vaccine uptake among female junior secondary school students in Lagos.
4. To determine associated factors affecting HPV vaccine uptake among female junior secondary school students in Lagos.

CHAPTER TWO 
REVIEW OF LITERATURE (PREVIEW)

This chapter critically examines relevant literature that would assist in explaining the research problem and furthermore recognizes the efforts of scholars who had previously contributed immensely to similar research. The chapter intends to deepen the understanding of the study and close the perceived gaps. This chapter therefore focuses on the concept of Human Papillomavirus (HPV), Human Papillomavirus (HPV), etc.

CHAPTER THREE
METHODOLOGY (PREVIEW)

Research Design: The study adopted cross sectional descriptive research design
Population of the Study: The study population consists of female junior secondary school students (JSS1–JSS3) in Lagos State, Nigeria
Sample Size Determination: The study adopted the Cochran formula to determine a sample size of 394 participants
Sampling Technique: A multistage sampling technique were adopted for this study.
Research Instrument: The study utilized a questionnaire as the instrument for data collection.
Methods of Data Analysis: The collected data were analyzed using frequencies, percentages, means, and standard deviations to summarize and present the demographic characteristics of the respondents and their responses. While inferential statistics, such as Chi-square was conducted in testing the hypothesis.

CHAPTER FOUR
 RESULTS AND FINDINGS (PREVIEW)

Note: The results are presented in tables and charts

Based on the results obtained from the analysis, the following findings are made:
1. The results of Table 4.3 indicated that the average score of all the 33 items were less than the cutoff mean score of 3.0, and the grand mean was 2.98. This shows that the respondents have low levels of knowledge concerning HPV, its health risks, and the preventive effectiveness of the vaccine. Hypothesis One was also tested with Chi-square, and the outcome (X² = 95.53, df = 1, p = 0.102) was insignificant, as the p-value is greater than 0.05. As such, the alternate hypothesis was rejected, while the null hypothesis  which posits that the level of knowledge that female junior secondary school students in Lagos have about HPV and the preventive functions of the vaccine is low.
2. The results in Table 4.4 indicated that Item 1, 2, and 3 had a mean score of less than 3.0, whereas item 4, 5, and 6 had a mean score greater than 3.0. That means that students expressed their negative attitudes regarding HPV vaccination, and there were issues of side effects, safety, and intentions to recommend the vaccine to others. Hypothesis Two was also tested using Chi-square, and the result (X² = 56.63, df = 1, p = 0.300) showed no significant difference, as the p-value is greater than 0.05. Thus, the alternate hypothesis was rejected, and the null hypothesis, which states that the attitudes of female junior secondary school students in Lagos toward HPV vaccination are negative, was accepted.
3. The results of Table 4.5 indicated that the score of items 2, 3, 4, and 5 were lower than 3.0, whereas that of items 1 and 6 was above 3.0. This shows that the frequency of HPV vaccination is low among respondents since almost all of the proactive behaviors were rejected. The related Hypothesis Three was tested by Chi-square, and the outcome (X² = 95.00, df = 1, p = 0.060) was not statistically significant, as the p-value is greater than 0.05. Therefore, the alternate hypothesis was rejected, and the null hypothesis   that uptake of HPV vaccine among female junior secondary school students in Lagos is low
4. The results of Table 4.6 showed that all the six items exceeded the cut off mean of 3.0 with the factors (lack of awareness, parental and peer influence, poor accessibility, cost, cultural and religious beliefs) being accepted as major influences. This indicates that there are many socio-cultural, economic and information barriers to vaccine uptake. Although no formal hypothesis was tested against this research question, the results revealed that there are various factors that play a strong role in the levels of knowledge, attitude, and uptake among students.