Digital Interventions to Increase HPV Vaccination Intentions Among Nigerian Caregivers

A Randomized Trial of Digital Interventions to Increase HPV Vaccination Intentions Among Nigerian Caregivers

This study evaluates whether different types of digital health communication can increase parents' intention to vaccinate their daughters against human papillomavirus (HPV) in Nigeria. HPV vaccination is recommended for girls aged 9-14 years and helps prevent cervical cancer, yet vaccination rates remain low.

Parents of eligible, unvaccinated girls will be randomly assigned to receive one of several types of digital content delivered online. These include: (1) a short chatbot conversation based on motivational interviewing principles, (2) an interactive game designed to help parents recognize and resist common forms of vaccine misinformation, (3) a set of short edutainment videos about HPV vaccination, (4) standard informational infographics about HPV vaccination from a national public health agency, or (5) unrelated health content about menstruation.

The main outcome is parents' self-reported intention to vaccinate their daughter against HPV, measured immediately and one week after exposure to the assigned content. Additional outcomes include HPV-related knowledge, perceptions of vaccine safety, willingness to recommend the vaccine to others, and self-reported vaccine uptake at 1-week and 6 month follow-up. The results will help inform scalable communication strategies to improve HPV vaccination uptake in low- and middle-income settings.

Study Overview

• Status: Not yet recruiting
• Conditions: HPV Vaccine; HPV
• Intervention / Treatment: Behavioral: Chatbot counseling; Behavioral: Misinformation-resistance pre-bunking inoculation; Behavioral: Short edutainment; Behavioral: Standard infographic control

Detailed Description

Cervical cancer remains a leading cause of cancer-related mortality among women in Nigeria. Persistent infection with high-risk types of human papillomavirus (HPV) is the primary cause of cervical cancer, and safe, effective vaccines are available and recommended for girls aged 9-14 years. Despite national and global efforts to expand access, HPV vaccination coverage in Nigeria remains low. Parental hesitancy, misinformation, limited knowledge, and lack of engagement with existing health communication materials are key barriers.

This randomized controlled trial examines whether different forms of digital communication can increase HPV vaccination intention among parents of unvaccinated, vaccine-eligible girls in Nigeria. The study focuses on scalable, low-cost interventions that could be deployed through mobile phones and other digital platforms.

Eligible participants are parents or primary caregivers of at least one unvaccinated girl aged 9-14 years. Participants will be individually randomized in equal proportions to one of five conditions:

A motivational interviewing-style chatbot that provides brief, interactive counseling adapted from World Health Organization vaccination guidance.

A short interactive "pre-bunking" game designed to build resistance to common forms of HPV vaccine misinformation.

A series of short edutainment videos providing information about HPV, cervical cancer prevention, and HPV vaccination in the Nigerian context.

A standard informational control consisting of existing HPV vaccination infographics produced by Nigeria's National Primary Health Care Development Agency.

An unrelated-content attention control consisting of infographics on menstruation awareness produced by a Nigerian health advocacy organization.

All content will be delivered digitally. Participants will complete baseline measures prior to randomization and follow-up surveys after exposure to the assigned content. The primary outcome is self-reported intention to vaccinate the selected daughter against HPV, measured immediately and one week post-intervention on a numeric scale. Secondary outcomes include HPV and vaccine-related knowledge, perceived vaccine safety, willingness to recommend the HPV vaccine to other parents, and self-reported HPV vaccine uptake. Additional intention measures will be collected 1-week after the intervention and at six months post-intervention, with vaccine uptake assessed at the six-month follow-up.

Primary analyses will be conducted under an intention-to-treat framework, comparing outcomes across randomized groups regardless of engagement with the assigned content. Secondary and exploratory analyses will examine engagement patterns and heterogeneity of effects by baseline attitudes, knowledge, and demographic characteristics.

The findings will provide evidence on the comparative effectiveness of different digital communication strategies for increasing HPV vaccination intention and uptake among parents in Nigeria and similar settings.

• Study Type: Interventional
• Enrollment (Estimated): 3340
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Parent or primary caregiver of at least one girl aged 9-14 years
• Parent states "no" or "unsure" to question asking if eligible daughter has received any doses of the HPV vaccine
• Provides informed consent to participate

Exclusion Criteria:

• Parent or caregiver of a girl who has already received one or more doses of the HPV vaccine
• Does not meet age eligibility criteria for an eligible daughter
• Fails Attention Checks

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

5

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Chatbot counseling arm; A brief motivational-interviewing-style chatbot dialogue adapted from WHO vaccination counseling guidance	Behavioral: Chatbot counseling; A brief motivational-interviewing-style chatbot dialogue adapted from WHO vaccination counseling guidance
Experimental: Misinformation-resistance pre-bunking inoculation arm; A short interactive game (approximately 3-5 minutes) designed to build resistance to HPV vaccine misinformation	Behavioral: Misinformation-resistance pre-bunking inoculation; A short interactive game (approximately 3-5 minutes) designed to build resistance to HPV vaccine misinformation
Experimental: Short edutainment arm; 5-6 brief edutainment videos (total viewing time approximately 10-15 minutes) providing HPV vaccine information tailored to the Nigerian context	Behavioral: Short edutainment; 5-6 brief edutainment videos (total viewing time approximately 10-15 minutes) providing HPV vaccine information tailored to the Nigerian context
Active Comparator: Standard infographic control arm; Existing infographics on HPV vaccination from Nigeria's National Primary Health Care Development Agency (NPHCDA)	Behavioral: Standard infographic control; Existing infographics on HPV vaccination from Nigeria's National Primary Health Care Development Agency (NPHCDA)
No Intervention: Unrelated content control arm; Series of infographics on menstruation from Nigeria's Menstrual Health Advocacy Consortium

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
HPV Vaccination Intention (1-Week Post-Intervention)	Parent's self-reported intention to vaccinate their selected daughter (aged 9-14 years) against HPV, measured on a 10-point numeric scale, where higher values indicate greater intention to vaccinate. If a participant has more than one eligible daughter, one daughter is randomly selected for all outcome questions.	1 week after exposure to the assigned intervention content
HPV Vaccination Intention (Immediately Post-Intervention)	Parent's self-reported intention to vaccinate their selected daughter against HPV, measured on a 10-point numeric scale.	Immediately Post-Intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
HPV Vaccination Intention (6 months post-intervention)	Parent's self-reported intention to vaccinate their selected daughter against HPV, measured on a 10-point numeric scale, assessed immediately after completion of the assigned intervention content.	6 months post-intervention
Self-Reported HPV Vaccine Uptake	Parent's self-report of whether their selected daughter has received at least one dose of the HPV vaccine since participation in the study (yes/no).	6 months post-intervention
Perceived Safety of the HPV Vaccine	Parent's perceived safety of the HPV vaccine, measured using Likert-scale items assessing agreement with statements about HPV vaccine safety.	1 week post-intervention, 6 months post-intervention
Likelihood of Recommending the HPV Vaccine to Other Parents	Parent's self-reported likelihood of recommending the HPV vaccine to other parents of eligible girls, measured on a Likert-type scale.	1 week post-intervention, 6 months post-intervention
Self-Reported Knowledge of the HPV Vaccine	Parent's self-assessed knowledge about the HPV vaccine, measured using Likert-scale items assessing perceived understanding.	1 week post-intervention, 6 months post-intervention
Knowledge of the Protective Effects of the HPV Vaccine	Parent's knowledge that the HPV vaccine helps prevent cervical cancer, measured using objective knowledge questions.	1 week post-intervention, 6-months post-intervention
Knowledge of Cervical Cancer Detection Methods	Parent's knowledge of cervical cancer detection methods, including awareness of Pap smear or cervical cancer screening tests, measured using objective knowledge questions.	1 week post-intervention, 6 months post-intervention
Knowledge of HPV Vaccine Eligibility	Parent's knowledge of eligibility criteria for free HPV vaccination in Nigeria, measured using objective knowledge questions.	1 week post-intervention, 6 months post-intervention
Perceived Support of HPV Vaccine	Primary caregiver's perceived level of support for HPV and routine vaccination among other parents and community, measured using Likert-type scale.	1 week post-intervention, 6 months post-intervention
Attitudes towards HPV Vaccine	Primary caregiver's perceived importance of HPV vaccination, likelihood of vaccination if recommended by a healthcare worker, and desire for more information, measured using Likert-type scale.	1 week post-intervention, 6 months post-intervention
Self-reported Information-seeking behaviors	Primary caregiver's self-reported information-seeking behaviors related to the HPV vaccine, including online research, conversations with healthcare workers, school officials, or community members, outreach to a hotline, or appointment-setting, measured as an index of yes/no responses.	6 months post-intervention
Objective information-seeking behavior	Primary caregiver's engagement with UNICEF Nigeria's HPV informational site for parents, measured via link-tracking.	6 months post-intervention

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Engagement With Assigned Intervention Content	Behavioral engagement metrics including completion status and time spent interacting with the assigned intervention content.	During intervention exposure

Collaborators and Investigators

• Sponsor: University of Pennsylvania
• Collaborators: World Bank Group

Study record dates

Study Major Dates

• Study Start (Estimated): May 18, 2026
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): December 31, 2026

Study Registration Dates

• First Submitted: March 23, 2026
• First Submitted That Met QC Criteria: March 23, 2026
• First Posted (Actual): March 27, 2026

Study Record Updates

• Last Update Posted (Actual): May 20, 2026
• Last Update Submitted That Met QC Criteria: May 18, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: HPV; Misinformation; HPV Vaccine; Chatbots; Pre-Bunking
• Additional Relevant MeSH Terms: Behavior; Communication
• Other Study ID Numbers: nigeria_hpv_857299

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data underlying the primary and secondary outcome analyses will be shared. This includes randomized treatment assignment, baseline covariates, outcome measures related to HPV vaccination intention, knowledge, attitudes, and self-reported vaccine uptake, as well as basic demographic variables. Data will be de-identified prior to sharing and will not include direct identifiers or information that could reasonably be used to re-identify participants.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No