The scale of the problem provides urgent context for the research. Globally, cervical cancer is the fourth most common cancer among women, with an estimated 662,000 new cases and 349,000 deaths reported in 2024. In Nigeria, it is the second most common cancer in women, contributing approximately 15,000 new cases and nearly 10,000 deaths annually. Human papillomavirus, the primary etiologic agent of cervical cancer, is a common sexually transmitted infection with more than 100 genotypes, including 13 high-risk types linked to cervical carcinogenesis. HPV types 16 and 18 alone account for about 70 percent of cervical cancer cases worldwide. Persistent infection with high-risk HPV can progress to precancerous lesions, invasive cervical cancer, and ultimately death, making early detection and vaccination critical tools in interrupting this trajectory.

Despite the proven benefits of HPV vaccination and screening, uptake in Nigeria remains strikingly low. Only 8.7 percent of women aged 18 to 69 have ever been screened, mainly due to limited awareness, cultural beliefs, stigma, and inadequate access to affordable services. HPV self-collection, though promising as a convenient, private, and empowering alternative to clinic-based pelvic examinations, is still emerging and underutilized, constrained by low awareness, limited self-efficacy, minimal provider recommendations, and scarce kit availability. Evidence demonstrates that HPV self-collection is equally effective at detecting high-grade cervical precancer and can substantially increase screening uptake. HPV vaccination continues to be a key element in primary prevention for eligible adolescents, lowering the risk of HPV infection and cervical cancer by as much as 90 percent. Notably, Nigeria recently achieved 71 percent first-dose HPV vaccination coverage among girls aged 9 to 14, immunizing nearly 12 million girls, a remarkable public health achievement that contrasts sharply with the persistent barriers to screening.

The study employed semi-structured, in-depth interviews lasting 45 to 60 minutes, conducted privately and in a culturally appropriate manner in English or Yoruba. Participants were recruited through purposive sampling from community-based settings including schools, marketplaces, churches, mosques, and health facilities across Lagos State, which has an estimated population of about 21 million distributed across 20 Local Government Areas. The research team, trained in semi-structured qualitative interviewing techniques and culturally sensitive research practices, applied the Consolidated Criteria for Reporting Qualitative Research to ensure rigorous and transparent reporting. Thematic analysis was guided by the PEN-3 Cultural Model, which organizes health behavior influences into three domains: Cultural Identity, Relationships and Expectations, and Cultural Empowerment. Data collection continued until saturation was reached, assessed separately within each age group, and coding was performed by two independent researchers who met regularly to resolve discrepancies.

The results revealed significant variations in knowledge about HPV and cervical cancer across age groups. Many younger participants had never heard of HPV, with statements like, “I have never heard about it,” and “This is like the first time I am hearing about it.” Among older women, knowledge was similarly limited, with one participant stating, “I don’t know anything about cervical cancer,” and another explaining, “It is cancer that occurs in the women in their private parts.” A few participants who were health professionals demonstrated accurate understanding, while some older women expressed confidence and self-efficacy in managing their health needs independently, with one 39-year-old stating, “I can do it myself as long as I am taught.” Conversely, others expressed hesitation, admitting, “I don’t think I can do it; I’d rather go to the hospital.”

Family influence emerged as a central theme shaping health decisions in both age groups. For HPV vaccination, girls reported that recommendations from the health ministry (86 percent), health providers (86 percent), and family and friends (64 percent) strongly influenced their decisions. Younger participants indicated that decisions about vaccinations heavily depended on family approval, with one stating, “Yes, they will have to allow me, for me to take it.” Among older participants, male partners played a pivotal role as either facilitators or barriers, with one woman noting, “Men can encourage us, like reminding you and all that,” while another stated, “If my husband says no, then I can’t go.” Some participants reported that family opinions would not ultimately prevent them from seeking preventive services, with one 35-year-old explaining, “It is necessary so I’ll make him understand… I will lecture him on why it is important.” For HPV self-collection, adult women prioritized messages from health providers (96 percent) and health ministry officials (89 percent).

Misinformation, stigma, and spiritual beliefs created significant barriers to prevention behaviors across both groups. Some participants voiced concerns about vaccine safety and quality within the Nigerian health system, with one stating, “You know Nigeria and expired vaccine, I don’t really trust Nigeria.” Misinformation about the vaccines was shared, including the belief that “the vaccine may prevent me from having children.” Among older participants, misconceptions about cervical cancer origins were evident, with beliefs such as “maybe somebody put it on the chair… It’s a curse,” and fears that self-collection samples “may use it for ritual… people are afraid.” Stigma towards reproductive health was demonstrated through statements like, “Women don’t want to talk about things that affect the private part,” and “Some people think it’s an abomination.” One participant reflected reliance on spiritual protection, stating, “I am not praying to get that kind of sickness… the sickness will not know me.”

Financial constraints and accessibility emerged as prominent structural barriers. Younger participants expressed concerns about the cost of vaccines, noting a narrow affordability range of 3,500 to 5,000 naira per dose, with one stating, “Cost, if it’s too expensive, then I can’t.” Older participants indicated willingness to pay small amounts, with one explaining, “I want it to be free… but maybe 500,” and another adding, “If it’s free, I’ll take my daughter for the vaccine, but I can only pay maybe 200 naira per dose.” While low costs were preferred, some participants were willing to pay more, typically 500 to 1,000 naira, and in a few cases up to 10,000 naira, depending on perceived importance and financial capacity. Participants across both groups expressed a strong preference for affordable, accessible vaccines and self-collection kits available at health facilities and pharmacies, with proximity and trust in the service provider being recurring themes.

Trust in healthcare providers and formal institutions emerged as a central determinant of HPV vaccine acceptance and self-collection participation. Participants expressed strong preferences for receiving services in trusted settings such as hospitals, pharmacies, and schools. Younger participants articulated a desire for vaccinations at recognizable healthcare facilities, with one stating, “I would prefer to get it from my hospital. I would least prefer an outreach like this.” Older participants echoed this sentiment, emphasizing the importance of local health facilities for accessibility, with remarks like, “I would prefer it at the pharmacy because it is nearby,” and “They should make it closer to the market.” Some participants expressed preference for hospitals over pharmacies, with one noting, “I prefer to get it from the hospital. I don’t know about these pharmacy people; they can just give you anything.”

The study’s findings carry significant implications for designing culturally grounded cervical cancer prevention strategies in Nigeria and similar low-resource settings. The researchers emphasize that future HPV prevention efforts should be community-based and family-inclusive, engaging parents, spouses, religious leaders, and community gatekeepers to ensure cohesive, informed, and sustained uptake of vaccination and self-collection services. Endorsements from health ministries, religious leaders, and high-profile public figures could enhance the perceived legitimacy of HPV vaccination. Equipping clinicians and pharmacists to actively recommend HPV vaccination and self-collection may enhance confidence in these preventive interventions. The authors suggest promoting positive cultural values, such as emphasizing cancer control rather than HPV as a sexually transmitted infection, and highlighting the maternal role in health decision-making. Addressing misinformation and stigma through targeted, socio-culturally appropriate educational initiatives within schools, faith-based institutions, and media platforms can help dispel misconceptions, normalize cervical cancer prevention, and support informed decision-making. The study acknowledges limitations including self-reported data subject to social desirability bias, a sample limited to Lagos State, and underrepresentation of younger adolescents due to consent and logistical issues. Nevertheless, the findings underscore that addressing structural, social, and cultural factors is crucial for increasing HPV vaccine coverage and promoting equitable cervical cancer prevention in Nigeria.

Subject of Research: Cultural and social facilitators and barriers influencing HPV vaccination and HPV self-collection preferences among Nigerian girls and women

Article Title: Her health, her choice: a PEN-3 exploration on facilitators, and preferences for HPV vaccinations and HPV self-collection among Nigerian girls and women

Article References: Olusanya, O. A., Kabutey, P., Koledowo, A., Wapmuk, A., Kokelu, E., Gbaja-biamila, T., Ojo, T., Akinsolu, F., Nwaozuru, U., Obi-Jeff, C., Anikamadu, O., Musa, A. Z., Kalulu, P., Veluri, R., Ong, J. J., Zhang, L., Smith, J. S., Xian, H., Azuogu, B., … Iwelunmor, J. (2026). Her health, her choice: a PEN-3 exploration on facilitators, and preferences for HPV vaccinations and HPV self-collection among Nigerian girls and women. Frontiers in Cancer Control and Society, 4, Article 1790326. https://doi.org/10.3389/fcacs.2026.1790326

Image Credits: AI Generated

DOI: 10.3389/fcacs.2026.1790326

Keywords: HPV vaccination, cervical cancer, HPV self-collection, Nigeria, PEN-3 Cultural Model, qualitative research, cervical cancer screening, health behavior, Lagos, cultural beliefs, women's health, misinformation