Assessing knowledge, attitudes and belief toward HPV vaccination of parents with children aged 9-14 years in rural communities of Northwest Cameroon: a qualitative study.

BACKGROUND: Human papilloma virus (HPV) vaccination is essential for the WHO cervical cancer elimination initiative. In Cameroon, HPV vaccine uptake is currently 5%. To assess the knowledge, beliefs and attitudes of parents of young girls aged 9-14 years about HPV vaccines within rural communities in the Northwest Region of Cameroon. METHODS: During January-May 2022, we conducted 45 one-on-one interviews using a semistructured interview guide in the localities of Mbingo, Njinikom and Fundong. Participants were parents of girls aged 9-14 years who speak English or Pidgin English. Healthcare workers were excluded. The interviews were recorded, transcribed and analysed using ATLAS.ti V.9. Member checking was conducted presenting our findings and getting feedback from a focus group of parents. RESULTS: Thirty-five mothers and 10 fathers were interviewed with a mean age of 42 years. Ninety-one per cent of parents had ever been vaccinated. Seventy-seven per cent had no or only primary school education. Thirty-two parents (71.12%) had daughters who had not been vaccinated against HPV. The themes identified include: perceived effectiveness of the HPV vaccine, affective behaviour (how they feel about the vaccine), accessibility (ability to get the vaccine), intervention coherence, ethicality (including parental informed consent), opportunity cost (future potential financial implications of cancer prevention), decision-making in the home (predominantly paternalistic), self-efficacy (extent to which education initiatives were effective) and quality initiatives (use of village infrastructure including fons/qwifons, village crier, healthcare worker presenting at the njangi house, schools and churches). Member checking with 30 women from two other communities confirmed our findings. CONCLUSIONS: Lack of awareness concerning the availability and purpose of the HPV vaccination was prevalent. Use of mainstream media and top-down health education activities are not effective. Novel approaches should engage local community health workers and use established community social and leadership structures. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT05325138).

Study protocol for assessing knowledge, attitudes and belief towards HPV vaccination of parents with children aged 9-14 years in rural communities of North West Cameroon: a qualitative study.

INTRODUCTION: Despite human papilloma virus (HPV) vaccine being incorporated in the National Immunisation Programme in Cameroon in 2019, HPV vaccine uptake among eligible girls has been poor (5%). The barriers to HPV vaccination in this high-burden setting have not been previously studied, especially in rural areas. We propose to evaluate the knowledge, attitudes and beliefs of parents of girls aged 9-14 years regarding HPV vaccine. METHODS AND ANALYSIS: Study design: a qualitative descriptive study will be conducted using one-on-one semi-structured interviews with parents of girls aged 9-14 years from 3 health districts in Cameroon (Mbingo, Njinikom and Fundong) who can converse in English or Pidgin English. Enrolment will occur until thematic saturation-approximately 40 participants. Analysis: quantitative methods will be used to describe the interviewees. All interviews will be audio recorded, transcribed and loaded into a tool to facilitate analysis (ATLAS.ti). Transcripts will be coded and thematic analysis will be conducted. Analysis will occur concurrent with interviews. ETHICS AND DISSEMINATION: Ethics: institutional review board approval will be obtained from the Cameroon Baptist Convention Health Board (CBCHB), Cameroon and McMaster University, Hamilton, Canada. Dissemination: study findings will be presented via a report and webinar to the Ministry of Health, the funders, the CBCHB and in person to healthcare providers and interested members of the general population in the study region. Plans are to share findings internationally through peer-reviewed publication(s) and presentation(s). TRIAL REGISTRATION NUMBER: NCT05325138.