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

Abstract

Background Cervical cancer is a leading cause of death among women in Africa, yet Human papillomavirus (HPV) vaccination and self-collection screening remain underutilized. HPV vaccination significantly reduces cervical cancer risk; additionally, HPV self-collection can improve screening access to prevent progression to invasive cervical cancer. Few studies use theory-driven approaches to examine contextual factors influencing cervical cancer prevention. Guided by the PEN-3 Cultural Model, this qualitative study examined social and cultural influences, facilitators, and preferences related to HPV vaccination and HPV self-collection among Nigerian girls and women. Methods Semi-structured, in-depth interviews with girls (9–26 years) and women (30–65 years) in Lagos, Nigeria, explored perceptions and preferences related to cervical cancer prevention. Using the PEN-3 cultural model, thematic analysis examined how Cultural Identity, Relationships and Expectations, and Cultural Empowerment domains influenced participants' preferences and behaviors. Multilevel factors such as knowledge gaps, misconceptions, high costs, and limited access were categorized, and positive and negative influences on HPV prevention behaviors were identified. Results A total of 56 purposively selected participants (girls aged 9–26 years and women aged 30–65 years) were included in the study. For HPV vaccination, girls reported that recommendations from the health ministry ( n = 24, 86%), health providers ( n = 24, 86%), and family and friends ( n = 18, 64%) strongly influenced their decisions. For HPV self-collection, adult women prioritized messages from health providers ( n = 27, 96%) and health ministry officials ( n = 25, 89%). Findings demonstrated that multilevel (i.e., individual, relational, sociocultural, and structural) factors influence HPV vaccination and HPV self-collection. Across both groups, limited knowledge, concerns about cost and access, and misconceptions about cervical cancer, some cultural beliefs, including stigma, were identified as barriers to prevention behaviors. For younger participants, family dynamics significantly influenced decision-making. Among older women, concerns related to privacy, trust in healthcare providers, spousal support, and preferences for female providers were described as key drivers for HPV self-collection. Participants expressed a strong preference for affordable, accessible vaccines and self-collection kits available at health facilities and pharmacies. Conclusion Culturally grounded cervical cancer prevention strategies that align with women's preferences and leverage existing community resources are essential for empowering informed decision-making and increasing HPV vaccination and self-collection.