Health Workers' Perspectives on Caregiver Barriers to Human Papillomavirus (HPV) Vaccine Uptake in Selected Health Facilities in Edo State, Nigeria: A Qualitative Study
Ejovi Akpojaro
Department of General Studies, Edo State College of Nursing Sciences, Benin City, Edo State, Nigeria.
Azuogu Victoria Chioma
Department of Nursing Sciences, Faculty of Health Sciences and Technology, Ebonyi State University Abakaliki, Ebonyi State, Nigeria.
Olawale Yetunde Abosede
Achievers College of Nursing Sciences, Akure, Ondo State, Nigeria.
Udo Mary Anietie
Akwa Ibom State College of Nursing Sciences, Anua Campus Uyo, Nigeria.
Mazi Njideka Calista
Department of Family Medicine, National Obstetric Fistula Centre, Abakaliki (NOFIC), Ebonyi State, Nigeria.
O. Onyemereze Christian
Department of Pharmacology and Therapeutics, Faculty of Basic Clinical Sciences, Abia State University, Uturu, Nigeria.
Ekechukwu Nnaemeka Uzoma
Department of Family Medicine, National Obstetric Fistula Centre, Abakaliki (NOFIC), Ebonyi State, Nigeria.
Nweke Chibueze Ogbodo
Department of Family Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria.
Azuogu Benedicta Chiamaka
Department of Nursing Sciences, Faculty of Health Sciences and Technology, Ebonyi State University Abakaliki, Ebonyi State, Nigeria.
Ohanme Eugene Ohams *
Department of Pharmacology and Therapeutics Faculty of Clinical Medicine, Alex Ekwueme Federal University Ndufu-Alike Ikwo, Ebonyi State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Human papillomavirus (HPV) vaccination is highly effective in preventing HPV-related disease, yet uptake remains uneven in many low- and middle-income settings. This study explored caregiver-related barriers to HPV vaccine uptake as reported by immunisation-clinic health workers in selected health facilities in Edo State, Nigeria.
Methods: A qualitative cross-sectional study was conducted in 2024 among 11 health workers purposively recruited from immunisation clinics in three hospitals in Benin City. Individual in-depth interviews were conducted with a structured interview guide by a trained moderator. Interviews were audio-recorded, transcribed verbatim, independently checked for accuracy, and analysed using Braun and Clarke's thematic approach with MAXQDA 2022. Thematic saturation was reached by the eleventh interview.
Results: Participants described low and inconsistent HPV vaccine utilisation at their facilities. Reported barriers included limited awareness, misconceptions and culturally mediated concerns, historical out-of-pocket costs, and intermittent vaccine availability. Participants also described facility-level or transitional gaps in routine integration during Nigeria's 2024 phased HPV vaccine rollout. Suggested strategies included community mobilisation, sustained health education, health-worker training, reliable vaccine availability, and removal of financial barriers.
Conclusion: The findings indicate that HPV vaccine uptake in the study setting was shaped by interacting informational, sociocultural, financial, and service-delivery barriers. Because the interviews occurred during a period of national programme transition, reports of payment and non-inclusion should be interpreted as local or historical experiences rather than as current national policy. Strengthening communication, community engagement, workforce capacity, and reliable routine vaccine delivery may support sustained uptake.
Keywords: Human papillomavirus, HPV vaccination, caregivers, health workers, vaccine uptake, vaccine hesitancy, cervical cancer prevention, immunisation, Nigeria