Effect of Nurse-facilitated Educational Intervention on Parents’ Knowledge and Perception of Safety of Human Papillomavirus Vaccine in Ogun State, Nigeria

Effect of Nurse-facilitated Educational Intervention on Parents’ Knowledge and Perception of Safety of Human Papillomavirus Vaccine in Ogun State, Nigeria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Nurse-facilitated Educational Intervention on Parents’ Knowledge and Perception of Safety of Human Papillomavirus Vaccine in Ogun State, Nigeria Serifat AMINU, Ngozi Anthonia OKAFOR, Omowunmi Modupe AWONUGA, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6444469/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract HPV vaccine hesitancy remains a public health concern due to poor knowledge and safety perceptions among parents. This study assessed the impact of a Nurse-Facilitated Educational Intervention (NFEI) on parental knowledge and perception in Ogun State, Nigeria, using a quasi-experimental pre-test-post-test design. A total of 276 parents were selected through multistage sampling. Data were collected using standardized instruments with reliability (α = 0.78–0.89). The intervention was delivered twice weekly for four weeks. Hypotheses were tested using repeated measures analysis of covariance (ANCOVA) with level of significance of 5%. Before the intervention, poor knowledge of HPV vaccines was high (96.18% in the intervention group, 95.35% in the control group). Post-intervention, good knowledge rose to 83.97% in the intervention group, but remained 0% in the control. At eight weeks, good knowledge remained high (83.21% in the intervention group, 0% in the control). Both groups initially had poor perceptions of HPV vaccine safety (Mean ± SD: 16.18 ± 1.81 for the intervention, 15.98 ± 2.27 for the control). After the intervention, the intervention group’s perception improved (36.89 ± 2.93), maintaining at eight weeks (36.85 ± 2.73), while the control group remained unchanged (15.98 ± 2.28). Significant differences were found between the groups post-intervention in both knowledge (t = 40.515, p < 0.05) and perception (t = 64.591, p < 0.05), indicating a large intervention effect. The study concludes that parent’s knowledge, and perception of safety of HPV Vaccines was improved by NFIE. It is recommended that government continue the campaign on HPV vaccination utilizing the Nurse Facilitated Educational intervention. Educational Intervention HPV Vaccine Knowledge Perception Safety Introduction Cervical cancer remains a significant public health challenge, particularly in low- and middle-income countries, where over 85% of cases occur (Abiodun et al., 2019 ; Oluwole et al., 2019 ). Despite being preventable through early screening and HPV vaccination, many women remain reluctant to access these services due to issues related to knowledge, perception, and vaccine acceptability (Isara & Osayi, 2021 ). In Nigeria, cervical cancer continues to be the second most diagnosed female cancer, with high mortality rates due to limited awareness and misconceptions about the HPV vaccine (Akinleye et al., 2020 ). The prevalence of HPV infections remains high, with 52% of Nigerian women under 30 years testing positive, compared to 23% of older women (Azuogu et al., 2019 ). These statistics highlight the urgent need for effective educational interventions to enhance knowledge and change perceptions regarding HPV vaccination. Knowledge gaps and misconceptions significantly impact HPV vaccine uptake in Nigeria. Unlike developed countries such as the UK, where high vaccination rates are supported by widespread awareness, Nigeria struggles with misinformation and low levels of health literacy (Ambali et al., 2022 ). Many parents and adolescents are unaware of the vaccine’s role in preventing cervical cancer, contributing to low acceptance rates. Studies have shown that 42.9% of women in Northern Nigeria and 26.3% of the general population in the South have HPV antibodies, suggesting high exposure to the virus (Egbon et al., 2022 ). However, public health campaigns have not been sufficient in translating knowledge into action, as evidenced by Nigeria’s suboptimal HPV vaccination coverage, despite national efforts to roll out large-scale immunisation campaigns (Adeyanju et al., 2024 ). Perception of HPV vaccine safety also plays a crucial role in its uptake. Parental hesitancy, fuelled by distrust in the vaccine’s efficacy and concerns about side effects, remains a major barrier to widespread adoption (Ogbolu & Kozlovszky, 2024 ). Cultural and religious beliefs further reinforce these hesitations, as many parents associate HPV vaccination with promoting early sexual activity (Ambali et al., 2022 ). In Ogun State, only 56% of the targeted 500,000 girls received the HPV vaccine, leaving a significant proportion unprotected due to these misconceptions (Adeyanju et al., 2024 ). Additionally, Nigeria has yet to integrate HPV vaccination into its national routine immunisation programme, further limiting access and acceptability (Okolie et al., 2023). To bridge the knowledge and perception gap, targeted educational interventions are essential. Nurse-led initiatives have shown promise in addressing vaccine hesitancy by providing reliable information and engaging with communities to dispel myths. Studies have demonstrated that interactive sessions with parents significantly improve acceptance rates, as seen in the Rochester HPV Immunization Project and similar programmes in Australia and Kenya (Agha et al., 2024 ). By leveraging trusted healthcare providers such as nurses, Nigeria can enhance public understanding of HPV vaccination and increase coverage rates. Addressing misinformation, improving access to vaccines, and integrating HPV vaccination into national immunisation schedules are crucial steps towards reducing cervical cancer incidence and mortality in Nigeria. Olusanya, et al ( 2023 ) found that HPV infection is the most common sexually transmitted infection among young adults aged 15–25 years in the US, yet vaccine completion rates remain low. Using the Theoretical Domains Framework (TDF), they identified key factors influencing HPV vaccination among college males, including knowledge (82%), environmental context (53%), beliefs about consequences (53%), and social influences (50%). Barriers included lack of knowledge, absence of healthcare recommendations, and misinformation, while enablers included perceived benefits of the vaccine. Xiao, et al ( 2021 ) analysed multiple studies on HPV vaccine promotional strategies, finding that knowledge significantly increased under these strategies (r + = .25, p < .001), with the Information, Motivation, and Behavioural Skills Model (IMB) being the most effective (r + = .75, p < .001). In Nigeria, Adebayo et al. ( 2017 ) identified significant knowledge gaps among parents, with prevalent misconceptions about vaccine safety. Iliyasu et al. ( 2018 ) found similar gaps among healthcare workers in Northern Nigeria, underscoring the need for training programs. Al Alawi et al. ( 2023 ) examined knowledge, attitudes, and acceptance of HPV vaccination in Oman, revealing that less than a quarter of participants had heard of HPV infection. Women, healthcare providers, and those with higher education were more likely to be aware (p < .001). Despite concerns about side effects (71.5%) and vaccine protection (84.6%), nearly two-thirds of participants supported HPV vaccination. In Nigeria, Okafor et al. ( 2019 ) found low awareness and misconceptions about HPV vaccines among female secondary school students, emphasizing the need for comprehensive sexual education. Similarly, Abiodun et al. ( 2020 ) reported limited awareness among adolescent girls in rural Nigeria, with socioeconomic factors influencing vaccine acceptance. Nwagha et al. ( 2021 ) studied pregnant women in Southeastern Nigeria and found low awareness levels, highlighting the role of healthcare providers in disseminating accurate information. Ezeanolue et al. ( 2022 ) explored community and religious stakeholders’ perceptions, revealing varying knowledge levels and the influence of religious beliefs on vaccine acceptance. Engaging religious institutions emerged as a strategy to promote vaccine uptake. Chen, et al ( 2021 ) used the Theory of Planned Behaviour to examine the impact of conspiracy theories on Chinese young adults' perceptions of HPV vaccines. Exposure to anti-vaccine misinformation led to lower vaccination intentions, but prior vaccine knowledge moderated these effects, suggesting that awareness campaigns could counter misinformation. Regarding safety perceptions, Marlow et al. ( 2017 ) synthesized 26 studies, finding that concerns about side effects were a major barrier to vaccine acceptance. Brewer et al. ( 2017 ) surveyed US parents and found that safety concerns predicted vaccine hesitancy. Trim et al. ( 2019 ) found similar concerns in Australia, with parental understanding of HPV influencing their perceptions. Tomaszewski et al. ( 2021 ) highlighted the role of social media misinformation in vaccine hesitancy. Morales et al. (2021) developed machine learning models to identify and counter false HPV vaccine information on social media, emphasizing the need for proactive misinformation management Inview of the above, this study aimed to evaluate the impact of nurse-facilitated educational interventions on parents' knowledge and perception of the safety of Human Papillomavirus (HPV) vaccines in selected communities in Ogun State, Nigeria. Specifically, it assessed the pre-, immediate post-, and 8th-week post-intervention mean scores of both knowledge and perception of HPV vaccine safety among parents in the experimental and control groups. Two research hypotheses were formulated for the study which are: H 0 1: There is no significant difference among the pre, immediate post- intervention and 8th week follow-up mean of knowledge of Human Papillomavirus (HPV) vaccines in the experimental and control groups. H 0 2: There is no significant difference among the pre, immediate post- intervention and 8th week follow-up mean of perception of safety of Human Papillomavirus (HPV) vaccines in the experimental and control groups. Methods This study employed a quantitative research approach using a quasi-experimental design with two groups: an experimental and a control group. A pretest-posttest structure was implemented, where the experimental group received an educational intervention over four weeks, while the control group did not. Data collection occurred at baseline, immediately after the intervention, and at an eight-week follow-up. The study targeted parents of 9–14-year-old girls in Ogun State, Nigeria, as their knowledge and perceptions of the Human Papillomavirus (HPV) vaccine are crucial for vaccine acceptance. The total population size was estimated at 213,713 based on the 2022 projected population of Ogun State and demographic fertility rates. Inclusion criteria encompassed parents of adolescent girls eligible for the HPV vaccine, permanent residents of Ogun State, and those who provided informed consent. Healthcare professionals, non-permanent residents, and unwilling participants were excluded to minimise bias and ensure data integrity. The study employed Cohen’s formula to determine the appropriate sample size for a quasi-experimental study involving a large population, resulting in a required minimum of 251 participants. To account for potential dropouts, the sample size was increased by 10%, yielding a final total of 276 participants. A multi-stage sampling technique was adopted, beginning with the stratification of Ogun State into three senatorial districts, from which one local government area (LGA) was randomly selected per district. Within each selected LGA, two wards were chosen through simple random sampling, followed by the random selection of two communities from each ward, totalling 12 communities. Proportionate sampling was then used to select parents of 9-14-year-old girls from each community, ensuring representativeness. Finally, systematic sampling was employed to select participants at every nth house, and the 12 communities were allocated to experimental and control groups using block random sampling via balloting. The study employed a self-developed questionnaire to collect data on HPV vaccine knowledge and perception (uploaded as a supplementary file). The test question paper assessed cognitive knowledge and was divided into two sections: Section A gathered socio-demographic details, while Section B contained 20 objective questions on HPV vaccine knowledge, scored from 0 to 20 based on correct responses. The questionnaire evaluated respondents' perceptions of HPV vaccine safety and acceptance of uptake. It included 12 perception-related items measured on a 4-point Likert scale (Strongly Agree to Strongly Disagree), with positive items scored from 4 to 1 and negative items scored in reverse. The maximum obtainable score for vaccine safety perception was 48, while the minimum was 12 for fully completed responses. Adequate motivation was provided to ensure full participation. The reliability and validity of the research instruments were ensured through rigorous statistical and expert validation processes. Internal consistency was assessed using Cronbach's Alpha, yielding reliability coefficients of 0.709 for knowledge of the HPV vaccine and 0.804 for perception of its safety, based on data collected from 10% of the sampled population outside the study area and analysed using SPSS Version 28. Validity was established through expert reviews for topic relevance, clarity, and adequacy. Face validity was confirmed by feedback from the research supervisor, test and measurement experts, and the Nursing department seminar panel, leading to refinements in the instrument. Content validity was verified by five experts using the Content Validity Ratio (CVR), which resulted in a CVR of 0.60 for the test questions on HPV vaccine knowledge and 1.0 for the questionnaire on perception of vaccine safety, ensuring the accuracy and credibility of the study. A quantitative data collection method was employed for the study, with ethical approvals obtained from Babcock University and the Ogun State Ministry of Health to gain access to the communities. Collaboration with Community Development Associations (CDAs) through ward leaders facilitated the identification of parents for participation. The researcher and six trained research assistants conducted house-to-house mobilization, gathering parents at town halls or community meeting points. The intervention lasted four weeks, with biweekly one-hour sessions for the experimental group, while the control group participated in shorter sessions at specific intervals. Data collection spanned 12 weeks, including pre-intervention, intervention, and post-intervention phases. During the pre-intervention phase, introduction letters and ethical approvals were presented to local government officials, and several visits were made to familiarise with the communities and recruit participants. Ward Development Committee chairmen assisted in identifying eligible parents, and informed consent was obtained following detailed explanations of the study. A two-day training was conducted for six research assistants on the study's objectives and data collection tools. In the first week, parents were assembled at designated venues, rapport was built, and pre-intervention data, including demographic profiles and research instruments, were administered to both the control and intervention groups. The pre- and post-intervention instruments were serially numbered for control and recall, checked for completeness, and manually coded using a coding guide before analysis with IBM SPSS version 28. Descriptive statistics, including mean and standard deviation, were used, while t-test tested differences in mean scores across experimental and control groups at pretest, immediate posttest, and 8th-week posttest at a 0.05 significance level. Ethical approval was obtained from Ogun State Health Research Ethics Committee (OGHREC/456/2024/497/APP). Participants provided informed consent after receiving comprehensive study details, and confidentiality was ensured through numerical coding and secure data storage. Access to research data was restricted to authorized personnel, and participation was entirely voluntary. Results Table 1 Description of the Socio-demographic Characteristics of the Respondents Intervention Group (131) Control Group (129) Variables Freq. Percent (%) Freq. Percent (%) Age Less than 25 years 7 5.3 15 11.6 25–34 years 34 26.0 48 37.2 35–44 years 65 49.6 55 42.6 45 years and above 25 19.1 11 8.5 Tribe Yoruba 88 67.2 84 65.1 Hausa 19 14.5 15 11.6 Igbo 10 7.6 13 10.1 Others 14 10.7 17 13.2 Educational Qualification No Formal Education 17 13.0 18 14.0 Primary 26 19.8 14 10.9 Secondary 26 19.8 32 24.8 Post-Secondary 36 27.5 32 24.8 First Degree 22 16.8 24 18.6 Post Graduate 4 3.1 9 7.6 Total 131 100.0 129 100.0 The socio-demographic characteristics of the respondents, as presented in Table 4.1, reveal variations in age distribution between the intervention and control groups. Among the intervention group, the majority (49.6%) were aged 35–44 years, while 26.0% were between 25–34 years, and only 5.3% were below 25 years. Conversely, the control group had a slightly lower proportion (42.6%) in the 35–44 age bracket, while a larger percentage (37.2%) were in the 25–34 age group. Notably, the control group had a higher proportion (11.6%) of respondents below 25 years compared to the intervention group (5.3%). This suggests that the intervention group consists of relatively older participants, while the control group has a slightly younger composition. Regarding tribal affiliation, Yoruba respondents dominated both groups (67.2% in the intervention and 65.1% in the control), followed by Hausa (14.5% vs. 11.6%) and Igbo (7.6% vs. 10.1%). The distribution of other ethnic groups was slightly higher in the control group (13.2%) than in the intervention group (10.7%). These figures indicate that the sample primarily consists of Yoruba participants, reflecting the predominant ethnic composition of the study area. In terms of educational qualifications, the distribution varies between the two groups. Among the intervention group, 27.5% had post-secondary education, while 16.8% had a first degree and only 3.1% possessed a postgraduate qualification. Comparatively, the control group had a slightly higher proportion of respondents with postgraduate education (7.6%), while the percentage with a first degree (18.6%) was marginally higher than that of the intervention group. Interestingly, a larger percentage of the control group (24.8%) had secondary education compared to the intervention group (19.8%). However, the intervention group had a higher proportion of respondents with only primary education (19.8%) compared to the control group (10.9%). The percentage of respondents without formal education was similar in both groups (13.0% vs. 14.0%) Table 2 Summary of pre, immediate post and 8th week post intervention level of knowledge Human Papillomavirus (HPV) vaccines among parents in the intervention and control Knowledge of HPV Vaccine PRE INTERVENTION IMMEDIATE POST INTERVENTION 8 TH WEEK POST INTERVENTION Intervention Freq. (%) Control Freq. (%) Intervention Freq. (%) Control Freq. (%) Intervention Freq. (%) Control Freq. (%) Poor Knowledge (0–9) 126 (96.18) 123 (95.35) 2 (1.53) 123 (95.35) 1 (0.76) 124 (96.12) Average Knowledge (10–13) 5 (3.82) 6 (4.65) 19 (14.50) 6 (4.65) 21 (16.03) 5 (3.88) Good Knowledge (14–20) 0 (0.00) 0 (0.00) 110 (83.97) 0 (0.00) 109 (83.21) 0 (0.00) Mean ± SD 5.27 ± 1.81 5.28 ± 1.79 15.63 ± 2.22 5.51 ± 1.78 15.42 ± 2.09 5.44 ± 1.81 Intervention: Nurse-Facilitated Interactive Educational Intervention (dup: abstract ?) The findings in Table 2 indicate a improvement in the level of knowledge about the Human Papillomavirus (HPV) vaccine among parents in the intervention group following the educational intervention, while the control group remained largely unchanged. At the pre-intervention stage, the majority of parents in both groups had poor knowledge, with 96.18% in the intervention group and 95.35% in the control group scoring within the poor knowledge range (0–9). Only a small percentage had Average knowledge (3.82% in the intervention and 4.65% in the control), and none demonstrated good knowledge (14–20). The mean knowledge scores were nearly identical at this stage (5.27 ± 1.81 for the intervention group and 5.28 ± 1.79 for the control group), indicating an equally low baseline understanding in both groups. Following the intervention, there was a dramatic increase in knowledge levels among parents in the intervention group, with 83.97% achieving good knowledge scores and 14.50% reaching Average knowledge. This improvement is reflected in the sharp rise in the mean knowledge score for the intervention group (15.63 ± 2.22), while the control group showed no change (mean = 5.51 ± 1.78). Despite the intervention, the control group remained largely in the poor knowledge category (95.35%), suggesting that without targeted educational efforts, parents’ awareness of the HPV vaccine does not naturally improve over time. The stark contrast between the intervention and control groups at this stage highlights the effectiveness of the intervention in increasing HPV vaccine knowledge. At the 8th week post-intervention, knowledge retention in the intervention group remained high, with 83.21% still maintaining good knowledge and 16.03% in the Average category. Although there was a slight decline from the immediate post-intervention phase, the overall mean knowledge score remained higher than the pre-intervention level (15.42 ± 2.09). Conversely, the control group exhibited minimal change, with the majority (96.12%) still classified as having poor knowledge and a negligible shift in mean score (5.44 ± 1.81). This suggests that without continuous reinforcement or exposure to educational materials, knowledge gain may slightly decline over time but remains substantially higher than baseline levels. The findings underscore the importance of structured educational interventions in enhancing and sustaining knowledge about the HPV vaccine among parents. Research Question 2 What is the pre, immediate post and 8th week post intervention level of perception of safety of Human Papillomavirus (HPV) vaccines among parents in selected communities in Ogun state? Items on perception of safety of Human Papillomavirus (HPV) vaccines was a 12-item likert scale where Strongly Agree was assigned 4 points, Agree − 3, Disagree − 2 and Strongly Disagree − 1 for positive statements while Strongly Agree was assigned 1 point, Agree − 2, Disagree − 3 and Strongly Disagree − 4 for negative statements making up a 48-point perception scale. Scores of 38 and above were regarded as good perception, scores between 30 to 37 were regarded as Average perception and < 30 as poor perception. Table 3 Summary of pre, immediate post and 8th week post intervention level of perception of safety of Human Papillomavirus (HPV) vaccines among parents in the intervention and control Perception of Safety of HPV Vaccine PRE INTERVENTION IMMEDIATE POST INTERVENTION 8 TH WEEK POST INTERVENTION Intervention Freq. (%) Control Freq. (%) Intervention Freq. (%) Control Freq. (%) Intervention Freq. (%) Control Freq. (%) Poor Perception (12–29) 131 (100.00) 129 (100.00) 3 (2.29) 129 (100.00) 2 (1.53) 129 (100.00) Average Perception (30–37) 0 (0.00) 0 (0.00) 60 (45.80) 0 (0.00) 63 (48.09) 0 (0.00) Good Perception (38–48) 0 (0.00) 0 (0.00) 68 (51.91) 0 (0.00) 66 (50.38) 0 (0.00) Mean ± SD 16.18 ± 1.81 15.98 ± 2.27 36.89 ± 2.93 16.07 ± 2.22 36.85 ± 2.73 15.98 ± 2.28 Intervention: Nurse-Facilitated Interactive Educational Intervention The data presented in Table 3 illustrate the changes in parents' perception of the safety of the Human Papillomavirus (HPV) vaccine across three different time points: pre-intervention, immediate post-intervention, and the 8th week post-intervention. Prior to the intervention, all parents (100%) in both the intervention and control groups exhibited a poor perception of the vaccine’s safety, as reflected in their low mean scores (16.18 ± 1.81 for the intervention group and 15.98 ± 2.27 for the control group). This suggests that there was a general lack of awareness or prevalent misconceptions about the HPV vaccine before any educational intervention was introduced. The absence of participants in the Average or good perception categories further confirms the uniformly low perception levels among all parents. Following the nurse-facilitated interactive educational intervention, there was an improvement in the intervention group’s perception of HPV vaccine safety. The percentage of parents with a poor perception dropped dramatically from 100% to just 2.29%, while 45.80% of parents developed an Average perception, and 51.91% reported a good perception of the vaccine’s safety. This shift was accompanied by an increase in the mean perception score from 16.18 ± 1.81 to 36.89 ± 2.93. Meanwhile, in the control group, perception levels remained unchanged, with all parents (100%) still exhibiting a poor perception and a nearly identical mean score (16.07 ± 2.22). These results indicate that the intervention had an immediate and substantial impact on parents' understanding and confidence in the HPV vaccine’s safety. At the 8th week post-intervention, the intervention group sustained their improved perception, with 50.38% of parents maintaining a good perception and 48.09% retaining an Average perception. The mean score (36.85 ± 2.73) remained stable compared to the immediate post-intervention assessment, suggesting that the educational intervention had a lasting effect. Conversely, the control group exhibited no change, with all parents still classified under poor perception and a mean score of 15.98 ± 2.28. This persistent disparity between the two groups underscores the effectiveness of the nurse-facilitated interactive educational intervention in positively shifting parents’ perceptions of HPV vaccine safety over time. Test of Hypotheses Ho1: There is no significant difference in the knowledge of safety, perception of safety, and acceptance of uptake of Human Papillomavirus (HPV) between parents in the experimental and control groups before intervention Table 4 t-test analysis for difference in the knowledge of safety and perception of safety of Human Papillomavirus (HPV) between parents in the experimental and control groups before intervention Variable Groups N Mean SD df t cal P (Sig) Effect Size (Cohen’s D) Knowledge of Safety of HPV Experimental Group 131 5.27 1.81 258 0.053 0.958 -0.098 Control Group 129 5.28 1.79 Perception of Safety of HPV Experimental Group 131 16.18 1.81 258 0.810 0.419 0.002 Control Group 129 15.98 2.28 P > 0.05 The results of the independent t-test analysis in Table 4 indicate that there was no significant difference in the knowledge of HPV vaccine safety between parents in the experimental and control groups before the intervention. The mean knowledge scores for the experimental and control groups were 5.27 (SD = 1.81) and 5.28 (SD = 1.79), respectively, with a negligible mean difference. The calculated t-value (0.053) and the p-value (0.958) suggest that any observed difference between the groups was not statistically significant, as the p-value exceeds the conventional 0.05 threshold. Additionally, the effect size (Cohen’s D = -0.098) is very small, indicating an almost negligible practical difference in knowledge levels between the two groups at baseline. The independent t-test analysis presented also in Table 4 shows that there was no significant difference in the perception of the safety of the Human Papillomavirus (HPV) vaccine between parents in the experimental and control groups before the intervention. This is evident from the calculated t-value (0.810) and the p-value (0.419), which is greater than the 0.05 significance threshold, indicating that any observed difference in perception was not statistically significant. The mean perception scores for both groups were relatively similar, with the experimental group scoring 16.18 ± 1.81 and the control group scoring 15.98 ± 2.28. Additionally, the effect size (Cohen’s D = 0.002) suggests an extremely small difference between the groups, reinforcing that the perception of vaccine safety was nearly identical across both groups before the interventio. Ho2: There is no significant difference in the knowledge of safety, perception of safety, and acceptance of uptake of Human Papillomavirus (HPV) between parents in the experimental and control groups after intervention Table 5 t-test analysis for difference in the knowledge of safety, and perception of safety of Human Papillomavirus (HPV) between parents in the experimental and control groups after intervention Variable Groups N Mean SD df t cal P (Sig) Effect Size (Cohen’s D) Knowledge of Safety of HPV Experimental Group 131 15.63 2.22 258 40.515* 0.000 9.47 (8.35–10.59) Control Group 129 5.51 1.78 Perception of Safety of HPV Experimental Group 131 36.89 2.93 258 64.591* 0.000 10.93 (9.61–11.82) Control Group 129 16.07 2.22 *P < 0.05 The results from the independent t-test analysis reveal a significant difference in knowledge of HPV safety between parents in the experimental and control groups immediately after the intervention. The experimental group recorded a mean knowledge score of 15.63 (SD = 2.22), compared to 5.51 (SD = 1.78) in the control group. The t-value was 40.515 (df = 258), which was statistically significant at p < 0.05, indicating that the intervention substantially improved participants' knowledge. The effect size, measured by Cohen’s d, was 9.47 (95% CI: 8.35–10.59), reflecting a very large and practically meaningful impact of the nurse-facilitated educational intervention. Additionally, Table 5 shows a significant difference in perception of HPV vaccine safety between the two groups. The experimental group reported a higher mean perception score of 36.89 (SD = 2.93), while the control group had a mean score of 16.07 (SD = 2.22). The calculated t-value was 64.591, with a p-value of 0.000 (p < 0.05), confirming statistical significance. Cohen’s d was 10.93 (95% CI: 9.61–11.82), indicating an extremely large effect size. These results suggest that the nurse-led interactive education greatly enhanced both knowledge and perception of HPV vaccine safety among parents in the experimental group Discussion of Findings The findings demonstrated the effectiveness of an educational intervention in significantly improving parents’ knowledge about the HPV vaccine. Initially, both the intervention and control groups exhibited poor knowledge, with over 95% of parents in each group scoring within the lowest knowledge category. However, following the intervention, a dramatic increase in knowledge was observed among the intervention group, with 83.97% attaining good knowledge scores, whereas the control group remained largely unchanged. The retention of knowledge at the eighth-week post-intervention further underscores the long-term benefits of structured educational efforts. These findings align with previous studies highlighting the widespread knowledge gap regarding HPV vaccines in Nigeria. Adebayo et al. ( 2017 ) conducted a cross-sectional study among Nigerian parents and found significant gaps in knowledge, particularly concerning vaccine safety. This supports the baseline findings, where parents exhibited a poor understanding of the HPV vaccine before the intervention. The study by Adebayo et al. also emphasised the prevalence of misinformation, which aligns with the need for targeted educational efforts observed in this study. Similarly, Iliyasu et al. ( 2018 ) explored knowledge gaps among healthcare workers in Northern Nigeria and found inadequate knowledge about HPV vaccines among providers. The lack of awareness among healthcare workers suggests that parental knowledge may also be limited, reinforcing the necessity of structured educational programs. The intervention’s effectiveness in this study mirrors Iliyasu et al.’s conclusion that training and education play a vital role in improving HPV vaccine awareness and acceptance. The study by Okafor et al. ( 2019 ) among female secondary school students in Southwestern Nigeria also corroborates the findings, as it revealed low awareness and prevalent misconceptions about vaccine safety. The study underscored the importance of school-based sexual education programs, which parallels the significant improvement in knowledge levels observed in the intervention group after targeted education. This further suggests that structured information dissemination is crucial in addressing HPV vaccine-related misconceptions. Furthermore, the findings resonate with Abiodun et al. ( 2020 ), who examined HPV vaccine knowledge among adolescent girls in rural communities in Nigeria. Their study identified socioeconomic factors and healthcare accessibility as determinants of vaccine knowledge and acceptance. This supports the notion that educational interventions should be tailored to address barriers such as misinformation and limited access to credible health information, as demonstrated in this study. The long-term impact of the educational intervention, as evidenced by sustained knowledge retention at the eighth-week post-intervention, aligns with Nwagha et al. ( 2021 ), who found that healthcare providers play a critical role in disseminating accurate vaccine information. The need for continuous reinforcement of knowledge is evident in this study’s slight decline in post-intervention knowledge scores, suggesting that ongoing engagement with parents and healthcare providers is necessary to maintain awareness levels. Lastly, the influence of community leaders and religious stakeholders, as discussed by Ezeanolue et al. ( 2022 ), underscores the broader sociocultural factors affecting HPV vaccine acceptance. Their study highlighted varying levels of knowledge and the role of religious beliefs in shaping attitudes towards vaccination. While this study did not specifically assess religious influences, the findings reinforce the importance of community-based educational efforts in increasing HPV vaccine knowledge and acceptance. In conclusion, the findings of this study provide strong empirical support for the effectiveness of structured educational interventions in enhancing and sustaining knowledge about the HPV vaccine among parents. The results align with existing literature that highlights significant knowledge gaps in various populations and emphasises the importance of targeted education, engagement with healthcare providers, and community-based interventions in improving vaccine awareness and acceptance. The findings illustrated a significant transformation in parents' perception of the safety of the Human Papillomavirus (HPV) vaccine following a nurse-facilitated interactive educational intervention. Prior to the intervention, all parents (100%) in both the intervention and control groups exhibited poor perceptions of the vaccine’s safety, with low mean scores (16.18 ± 1.81 for the intervention group and 15.98 ± 2.27 for the control group). This indicates a general lack of awareness or prevalent misconceptions about the HPV vaccine. The absence of participants in the Average or good perception categories reinforces the notion that vaccine hesitancy and safety concerns were widespread among the parents before the intervention. These initial findings align with the conclusions of Marlow et al. ( 2017 ), who identified safety concerns as a predominant barrier to HPV vaccine acceptance among parents and adolescents. Similarly, Brewer et al. ( 2017 ) found that fears of potential long-term side effects significantly influenced parental hesitancy towards the vaccine. The present study’s findings support this, as parents in the pre-intervention phase demonstrated a complete lack of confidence in the vaccine’s safety. Additionally, Trim et al. ( 2019 ) noted that while some parents acknowledged the vaccine’s benefits, lingering doubts about its safety persisted, particularly among those with limited knowledge of HPV and its related diseases. The poor perception seen in the current study further corroborates Trim et al.’s ( 2019 ) assertion that vaccine acceptance is hindered by inadequate awareness. However, following the educational intervention, there was a dramatic improvement in the intervention group’s perception of HPV vaccine safety. The proportion of parents with poor perceptions dropped to just 2.29%, while 45.80% developed an Average perception and 51.91% reported a good perception. This was accompanied by a significant increase in the mean perception score from 16.18 ± 1.81 to 36.89 ± 2.93. In contrast, the control group showed no improvement, with all parents (100%) maintaining a poor perception and a nearly identical mean score (16.07 ± 2.22). These findings indicate that structured, interactive educational interventions can be highly effective in addressing misconceptions and improving vaccine perception. This shift in perception is supported by the findings of Grandahl et al. ( 2019 ), who demonstrated that misinformation and lack of trust in healthcare authorities contribute to vaccine hesitancy, but targeted educational interventions can effectively counteract these concerns. Similarly, Donadiki et al. ( 2018 ) found that safety concerns were a major barrier to HPV vaccination in Greece, and addressing these concerns through education significantly improved vaccine acceptance. Zimet et al. ( 2018 ) further reinforced this by showing that vaccine safety concerns decreased over time when targeted educational efforts were implemented. The current study aligns with these findings by demonstrating the efficacy of an interactive nurse-led intervention in changing parental attitudes towards vaccine safety. At the 8th week post-intervention, the intervention group sustained their improved perception, with 50.38% of parents maintaining a good perception and 48.09% retaining an Average perception. The mean score (36.85 ± 2.73) remained stable compared to the immediate post-intervention assessment, indicating that the educational intervention had a lasting effect. Conversely, the control group showed no change, with all parents still classified under poor perception and a mean score of 15.98 ± 2.28. This sustained improvement aligns with the findings of Zimet et al. ( 2018 ), who noted that continued exposure to educational messages and increased awareness helped maintain positive vaccine attitudes over time. Further supporting these findings, Osazuwa-Peters et al. (2020) found that in Nigeria, safety concerns significantly hindered HPV vaccine uptake among college students, highlighting the need for targeted awareness campaigns. Similarly, Balogun et al. ( 2017 ) reported that low levels of awareness and misconceptions about HPV vaccines contributed to hesitancy among mothers in southwestern Nigeria. The current study's findings confirm that addressing these concerns through well-structured education can lead to a sustained positive change in perception. In conclusion, the findings highlight the transformative impact of an interactive educational intervention in improving parents’ perception of HPV vaccine safety. The study supports existing literature that identifies safety concerns as a primary barrier to vaccine uptake and demonstrates that targeted educational efforts can effectively address these concerns. Moving forward, broader implementation of such interventions, along with further research on the long-term impact of educational strategies, is essential for enhancing HPV vaccine acceptance globally. Conclusion The findings of this study demonstrate the significant impact of the Nurse-Facilitated Interactive Educational Intervention (NFIEI) on parents' knowledge and perception of the safety of the Human Papillomavirus (HPV) vaccine in Ogun State. The demographic analysis revealed a balanced distribution across age, gender, and educational levels, suggesting that the sample is representative. The intervention group showed a substantial increase in knowledge and perception of HPV vaccine safety, as indicated by the sharp rise in mean scores from the pretest to the immediate posttest and sustained improvement at the 8th-week post-intervention assessment. In contrast, the control group exhibited minimal changes across all time points. The statistical analyses further confirmed that these differences were significant, leading to the rejection of the null hypotheses. Recommendations Healthcare facilities should incorporate Nurse-Facilitated Interactive Educational Interventions into routine immunisation services to enhance parental awareness and acceptance of HPV vaccines, thereby improving vaccination uptake. Government and non-governmental organisations should implement community-based awareness campaigns leveraging local languages and culturally appropriate materials to further educate parents on the benefits and safety of HPV vaccination. Continuous professional development and training should be provided to healthcare workers on effective communication strategies and educational interventions to improve parental engagement and trust in HPV vaccination programs. Education ministries should introduce HPV vaccine awareness programs in secondary schools, ensuring that both students and parents receive accurate information on the importance of vaccination in preventing HPV-related diseases. Abbreviations HPV Human Papillomavirus NFIEI Nurse-Facilitated Interactive Educational Intervention (NFIEI) Declarations Ethics approval and consent to participate All experiments were performed in accordance with relevant guidelines and regulations. The principle of ethical research study was upheld throughout the study. The study was reviewed by the Ethical review committees of Babcock University. Letter of introduction/permission obtained from the Dean of School of Nursing Sciences, Babcock University was presented to Health Research Committee of the State Ministry of Health alongside the research protocol for ethical approval which was used to access the Local Government areas of interest to use the settings and set the tones for the research study.The Ethical approval notification letter number from Babcock University is BUHREC 712/24 while that from the Ogun State Health research Ethics committee is OGHREC/456/2024/497/APP Informed Consent: Participants were provided with comprehensive information about the study purpose, procedures, potential risks, benefits and their voluntary participation sought. Confidentiality and Anonymity: Participant’s identities and personal information were treated with utmost confidentiality throughout the study. Any identifying information was replaced with numerical codes to ensure anonymity. Data collected were securely stored and accessible only to the research team, and also restricted from unauthorized access, use, and disclosure. Data security: Access to research data was restricted to authorized personnel, ensuring that sensitive information remained protected from unauthorized access, use or disclosure. Voluntary Participation: Participation was entirely voluntary Consent for publication The authors hereby give consent for the publication of our work Availability of data and materials All data used for this study are available upon request through the correspondence author Competing Interests The authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article. Authors declare no competing interest. The authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Funding No external fund was received for the research by the authors. Authors' contributions All the five authors designed the study, literature review and manuscript writing. All authors also participated in data collection while Olofin-Samuel performed data analysis. All the authors reviewed the draft while the final draft was also approved by all the authors Acknowledgements The authors acknowledge the support of the community leaders of the selected communities in Ogun state, and parents used as participants for their support and understanding during this research References Abiodun OA, Olu-Abiodun OO, Sotunsa JO, Oluwole FA. Impact of health education intervention on knowledge and perception of cervical cancer and cervical screening uptake among adult women in rural communities in Nigeria. BMC Public Health. 2019;14(8):23–30. Abiodun AJ, Akinwumi AF, Oluwatosin AO, Olatunji BS. Human papillomavirus vaccine awareness, knowledge, and acceptability among female adolescents in rural communities in Nigeria. J Pediatr Adolesc Gynecol. 2020;33(6):611–6. Adebayo T, Iliyasu Z, Abubakar IS, Saidu Y. Knowledge and perceptions of human papillomavirus vaccines among university students in northern Nigeria. Int J Adolesc Med Health. 2017;29(6):1–8. Adeyanju GC, Essoh T-A, Sidibe AR, Kyesi F, Aina M. Human papillomavirus vaccination acceleration and introduction in Sub-Saharan Africa: A multi-country cohort analysis. Vaccines. 2024;12:489. https://doi.org/10.3390/vaccines12050489 . Agha S, Bernard D, Francis S, Fareed A, Nsofor I. Determinants of human papillomavirus vaccine acceptance among caregivers in Nigeria: A Fogg Behavior Model-based approach. Vaccines. 2024;12:84. https://doi.org/10.3390/vaccines12010084 . Akinleye HW, Kanma-Okafor OJ, Okafor IP, Odeyemi KA. Parental willingness to vaccinate adolescent daughters against human papilloma virus for cervical cancer prevention in Western Nigeria. Pan Afr Med J. 2020;36:112. Al Alawi S, Al Zaabi O, Heffernan ME, Arulappan J, Al Hasani N, Baluchi A, Saadi M…A, A. Knowledge, attitudes and acceptance toward Human papillomavirus (HPV) vaccination: Perspectives of Muslim women and men. Vaccine. 2023;41(13):2224–33. Ambali RT, John-Akinola YO, &Oluwasanu MM. Indepth interviews on acceptability and concerns for human papilloma virus vaccine uptake among mothers of adolescent girls in community settings in Ibadan, Nigeria. J Cancer Educ. 2022;37:748–54. Azuogu BN, Umeokonkwo CD, Azuogu VC, Onwe OE, Okedo-Alex IN, Egbuji CC. Appraisal of willingness to vaccinate daughters with human papilloma virus vaccine and cervical cancer screening uptake among mothers of adolescent students in Abakaliki, Nigeria. Niger J Clin Pract. 2019;22:1286–91. Balogun F, Omotade O. She must have been sleeping around… Contextual interpretations of cervical cancer and views regarding HPV vaccination for adolescents in selected communities in Ibadan, Nigeria. PLoS ONE. 2018;13:e0203950. Balogun MR, Odukoya OO, Odetola TD, Oyediran MA, Ujomu PI. Cervical cancer awareness and preventive practices: A challenge for female urban slum dwellers in Lagos, Nigeria. Afr J Reprod Health. 2017;21(2):74–82. Brewer NT, Hall ME, Malo TL, Gilkey MB, Quinn B, Lathren C. Announcements versus conversations to improve HPV vaccination coverage: A randomized trial. Pediatrics. 2017;139(1):e20161764. https://doi.org/10.1542/peds.2016-1764 . Chen L, Zhang Y, Young R, Wu X, Zhu G. Effects of vaccine-related conspiracy theories on Chinese young adults’ perceptions of the HPV vaccine: An experimental study. Health Commun. 2021;36(11):1343–53. Donadiki EM, Jiménez-García R, Hernández-Barrera V, Sourtzi P, Carrasco-Garrido P, de López A, Velonakis EG. Health beliefs and HPV vaccine acceptance among US parents of adolescent girls. Prev Med. 2018;113:14–20. Egbon M, Ojo T, Aliyu A, Bagudu ZS. Challenges and lessons from a school-based human papillomavirus (HPV) vaccination program for adolescent girls in a rural Nigerian community. BMC Public Health. 2022;22:1611. Ezeanochie M, &Olasimbo P. Awareness and uptake of human papilloma virus vaccines among female secondary school students in Benin City, Nigeria. Afri Health Sci. 2020;20(1):45–50. https://dx.doi.org/10.4314/ahs.v20i1.8 . Ezeanolue EE, Nwagbo D, Agunwa C, Ezeanolue CO. Perceptions of human papillomavirus vaccines among community leaders and religious stakeholders in Nigeria. J Relig Health. 2022;61(1):307–17. Grandahl M, Larsson M, Dalianis T, Stenhammar C, Tydén T. Catch-up HPV vaccination status of adolescents in relation to socioeconomic factors, individual beliefs and sexual behaviour. PLoS ONE. 2019;14(8):e0221415. https://doi.org/10.1371/journal.pone.0221415 . Iliyasu Z, Galadanci HS, Abubakar IS, Saidu Y. Knowledge, perception, and acceptance of human papillomavirus vaccine among health professionals in northern Nigeria. J Obstet Gynaecol. 2018;38(8):1136–42. https://doi.org/10.1080/01443615.2018.1438787 . Isara AR, Osayi N. Knowledge of human papillomavirus and uptake of its vaccine among female undergraduate students of Ambrose Alli University, Ekpoma, Nigeria. J Community Med Prim Health Care. 2021;33(1):85–92. https://doi.org/10.4314/jcmphc.v33i1.8 . Marlow LAV, Forster AS, Wardle J, Waller J. Mothers’ and adolescents’ beliefs about risk compensation following HPV vaccination. J Adolesc Health. 2017;60(3):276–81. Nwagha UI, Eze GA, Enebe JT, Nwagha TU. Awareness and knowledge of human papillomavirus vaccines among pregnant women in southeastern Nigeria. Int J Gynecol Obstet. 2021;153(3):413–9. Ogbolu MO, Kozlovszky M. Assessment of HPV knowledge and awareness among students and staff at IBB University, Niger State, Nigeria: Implications for health education and prevention. Healthcare. 2024;12(665). https://doi.org/10.3390/healthcare12060665 . Ohaeri B, Adefolaju AO, Onyenecho CA. Knowledge, attitudes and perceptions of Nigerian parents towards human papilloma virus (HPV) vaccines. Eur J midwifery. 2020;4(1):2–12. Okafor IP, Onuchukwu C, Nwamoh UN, Ezeanolue EE. Human papillomavirus vaccine: Knowledge and acceptability among female secondary school students in South Eastern Nigeria. Afr J Reprod Health. 2019;23(1):93–102. Okolie EA, Nwadike BI. Spotlight on human papillomavirus vaccination coverage: Is Nigeria making any progress? JCO Global Oncol. 2023;9:e2300088. Olusanya OA, Tomar A, Thomas J, Alonge K, Wigfall LT. Application of the theoretical domains framework to identify factors influencing catch-up HPV vaccinations among male college students in the United States: A review of evidence and recommendations. Vaccine. 2023;41(23):3564–76. Oluwole EO, Idowu OM, Adejimi AA, Balogun MR, Osanyin GE. Knowledge, attitude and uptake of human papillomavirus vaccination among female undergraduates in Lagos State, Nigeria. J Family Med Prim Care. 2019;8:3627–33. Osazuwa-Peters N, Hong Y. Exploring the sociodemographic and geographic determinants of human papillomavirus (HPV) vaccine refusal among Nigerian adolescents. J Cancer Educ. 2020;35(1):39–45. Tomaszewski T, Morales A, Lourentzou I, Caskey R, Liu B, Schwartz A, Chin J. (2021). Identifying false human papillomavirus (HPV) vaccine information and corresponding risk perceptions from Twitter: advanced predictive models. J Med Internet Res, 23(9), e30451. Trim K, Nagji N, Elit L, Roy K. (2019). Parental knowledge, attitudes, and behaviours towards human papillomavirus vaccination for their children: A systematic review from 2001 to 2011. Obstetrics and Gynecology International, 2012 , 921236. Wang W. The role of personal health beliefs and altruistic beliefs in young Chinese adult men’s acceptance of the human papillomavirus vaccine. Sci Rep. 2024;14(1):20341. Xiao X, Lee DKL, Wong RM, Borah P. The impact of theory in HPV vaccination promotion research: A systematic review and meta-analysis. Am J Health Promotion. 2021;35(7):1002–14. Zimet GD, Rosberger Z, Fisher WA, Perez S, Stupiansky NW. Beliefs, barriers, and facilitators of adolescent vaccination against sexually transmitted infections: A longitudinal analysis. Int J STD AIDS. 2018;29(9):878–84. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6444469","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":454795159,"identity":"e11952c2-9563-4fdd-8c88-44dff3962d27","order_by":0,"name":"Serifat AMINU","email":"data:image/png;base64,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","orcid":"","institution":"Babcock University","correspondingAuthor":true,"prefix":"","firstName":"Serifat","middleName":"","lastName":"AMINU","suffix":""},{"id":454795162,"identity":"99cb9c76-8799-4d88-9a82-55101ff9a3a1","order_by":1,"name":"Ngozi Anthonia OKAFOR","email":"","orcid":"","institution":"Babcock University","correspondingAuthor":false,"prefix":"","firstName":"Ngozi","middleName":"Anthonia","lastName":"OKAFOR","suffix":""},{"id":454795164,"identity":"964f44e6-4eba-4756-a979-df35aa1523a2","order_by":2,"name":"Omowunmi Modupe AWONUGA","email":"","orcid":"","institution":"Babcock University","correspondingAuthor":false,"prefix":"","firstName":"Omowunmi","middleName":"Modupe","lastName":"AWONUGA","suffix":""},{"id":454795165,"identity":"349b21e5-07ec-49d3-89f4-29521d545eec","order_by":3,"name":"Tijani ADELANI","email":"","orcid":"","institution":"Federal University Oye Ekiti","correspondingAuthor":false,"prefix":"","firstName":"Tijani","middleName":"","lastName":"ADELANI","suffix":""},{"id":454795166,"identity":"d42fb4ac-8aaf-41a4-b335-4bc14eb5567a","order_by":4,"name":"Mary Ayodeji OLOFIN-SAMUEL","email":"","orcid":"","institution":"Ekiti State University","correspondingAuthor":false,"prefix":"","firstName":"Mary","middleName":"Ayodeji","lastName":"OLOFIN-SAMUEL","suffix":""}],"badges":[],"createdAt":"2025-04-14 09:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6444469/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6444469/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89243844,"identity":"eee1caf1-cfaf-401c-b4da-8362ad2f2184","added_by":"auto","created_at":"2025-08-17 23:16:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1038536,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6444469/v1/745c323f-96df-4a34-b516-c37a93538fa3.pdf"},{"id":82516875,"identity":"19480820-f0fd-4197-90d3-4f6b8dd252e3","added_by":"auto","created_at":"2025-05-12 11:54:08","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":12878,"visible":true,"origin":"","legend":"","description":"","filename":"AminuInformedConsentForm.docx","url":"https://assets-eu.researchsquare.com/files/rs-6444469/v1/f80d220c2f7c68e8ad52f197.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEffect of Nurse-facilitated Educational Intervention on Parents’ Knowledge and Perception of Safety of Human Papillomavirus Vaccine in Ogun State, Nigeria\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCervical cancer remains a significant public health challenge, particularly in low- and middle-income countries, where over 85% of cases occur (Abiodun et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e; Oluwole et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e). Despite being preventable through early screening and HPV vaccination, many women remain reluctant to access these services due to issues related to knowledge, perception, and vaccine acceptability (Isara \u0026amp; Osayi, \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). In Nigeria, cervical cancer continues to be the second most diagnosed female cancer, with high mortality rates due to limited awareness and misconceptions about the HPV vaccine (Akinleye et al., \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e). The prevalence of HPV infections remains high, with 52% of Nigerian women under 30 years testing positive, compared to 23% of older women (Azuogu et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e). These statistics highlight the urgent need for effective educational interventions to enhance knowledge and change perceptions regarding HPV vaccination.\u003c/p\u003e\n\u003cp\u003eKnowledge gaps and misconceptions significantly impact HPV vaccine uptake in Nigeria. Unlike developed countries such as the UK, where high vaccination rates are supported by widespread awareness, Nigeria struggles with misinformation and low levels of health literacy (Ambali et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). Many parents and adolescents are unaware of the vaccine\u0026rsquo;s role in preventing cervical cancer, contributing to low acceptance rates. Studies have shown that 42.9% of women in Northern Nigeria and 26.3% of the general population in the South have HPV antibodies, suggesting high exposure to the virus (Egbon et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). However, public health campaigns have not been sufficient in translating knowledge into action, as evidenced by Nigeria\u0026rsquo;s suboptimal HPV vaccination coverage, despite national efforts to roll out large-scale immunisation campaigns (Adeyanju et al., \u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003ePerception of HPV vaccine safety also plays a crucial role in its uptake. Parental hesitancy, fuelled by distrust in the vaccine\u0026rsquo;s efficacy and concerns about side effects, remains a major barrier to widespread adoption (Ogbolu \u0026amp; Kozlovszky, \u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e). Cultural and religious beliefs further reinforce these hesitations, as many parents associate HPV vaccination with promoting early sexual activity (Ambali et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). In Ogun State, only 56% of the targeted 500,000 girls received the HPV vaccine, leaving a significant proportion unprotected due to these misconceptions (Adeyanju et al., \u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e). Additionally, Nigeria has yet to integrate HPV vaccination into its national routine immunisation programme, further limiting access and acceptability (Okolie et al., 2023).\u003c/p\u003e\n\u003cp\u003eTo bridge the knowledge and perception gap, targeted educational interventions are essential. Nurse-led initiatives have shown promise in addressing vaccine hesitancy by providing reliable information and engaging with communities to dispel myths. Studies have demonstrated that interactive sessions with parents significantly improve acceptance rates, as seen in the Rochester HPV Immunization Project and similar programmes in Australia and Kenya (Agha et al., \u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e). By leveraging trusted healthcare providers such as nurses, Nigeria can enhance public understanding of HPV vaccination and increase coverage rates. Addressing misinformation, improving access to vaccines, and integrating HPV vaccination into national immunisation schedules are crucial steps towards reducing cervical cancer incidence and mortality in Nigeria.\u003c/p\u003e\n\u003cp\u003eOlusanya, et al (\u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e) found that HPV infection is the most common sexually transmitted infection among young adults aged 15\u0026ndash;25 years in the US, yet vaccine completion rates remain low. Using the Theoretical Domains Framework (TDF), they identified key factors influencing HPV vaccination among college males, including knowledge (82%), environmental context (53%), beliefs about consequences (53%), and social influences (50%). Barriers included lack of knowledge, absence of healthcare recommendations, and misinformation, while enablers included perceived benefits of the vaccine. Xiao, et al (\u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e) analysed multiple studies on HPV vaccine promotional strategies, finding that knowledge significantly increased under these strategies (r\u0026thinsp;+\u0026thinsp;=\u0026thinsp;.25, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), with the Information, Motivation, and Behavioural Skills Model (IMB) being the most effective (r\u0026thinsp;+\u0026thinsp;=\u0026thinsp;.75, p\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e\n\u003cp\u003eIn Nigeria, Adebayo et al. (\u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e) identified significant knowledge gaps among parents, with prevalent misconceptions about vaccine safety. Iliyasu et al. (\u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e) found similar gaps among healthcare workers in Northern Nigeria, underscoring the need for training programs. Al Alawi et al. (\u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e) examined knowledge, attitudes, and acceptance of HPV vaccination in Oman, revealing that less than a quarter of participants had heard of HPV infection. Women, healthcare providers, and those with higher education were more likely to be aware (p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Despite concerns about side effects (71.5%) and vaccine protection (84.6%), nearly two-thirds of participants supported HPV vaccination.\u003c/p\u003e\n\u003cp\u003eIn Nigeria, Okafor et al. (\u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e) found low awareness and misconceptions about HPV vaccines among female secondary school students, emphasizing the need for comprehensive sexual education. Similarly, Abiodun et al. (\u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e) reported limited awareness among adolescent girls in rural Nigeria, with socioeconomic factors influencing vaccine acceptance. Nwagha et al. (\u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e) studied pregnant women in Southeastern Nigeria and found low awareness levels, highlighting the role of healthcare providers in disseminating accurate information. Ezeanolue et al. (\u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e) explored community and religious stakeholders\u0026rsquo; perceptions, revealing varying knowledge levels and the influence of religious beliefs on vaccine acceptance. Engaging religious institutions emerged as a strategy to promote vaccine uptake.\u003c/p\u003e\n\u003cp\u003eChen, et al (\u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e) used the Theory of Planned Behaviour to examine the impact of conspiracy theories on Chinese young adults' perceptions of HPV vaccines. Exposure to anti-vaccine misinformation led to lower vaccination intentions, but prior vaccine knowledge moderated these effects, suggesting that awareness campaigns could counter misinformation. Regarding safety perceptions, Marlow et al. (\u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e) synthesized 26 studies, finding that concerns about side effects were a major barrier to vaccine acceptance. Brewer et al. (\u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e) surveyed US parents and found that safety concerns predicted vaccine hesitancy. Trim et al. (\u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e) found similar concerns in Australia, with parental understanding of HPV influencing their perceptions. Tomaszewski et al. (\u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e) highlighted the role of social media misinformation in vaccine hesitancy. Morales et al. (2021) developed machine learning models to identify and counter false HPV vaccine information on social media, emphasizing the need for proactive misinformation management\u003c/p\u003e\n\u003cp\u003eInview of the above, this study aimed to evaluate the impact of nurse-facilitated educational interventions on parents' knowledge and perception of the safety of Human Papillomavirus (HPV) vaccines in selected communities in Ogun State, Nigeria. Specifically, it assessed the pre-, immediate post-, and 8th-week post-intervention mean scores of both knowledge and perception of HPV vaccine safety among parents in the experimental and control groups.\u003c/p\u003e\n\u003cp\u003eTwo research hypotheses were formulated for the study which are:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH\u003csub\u003e0\u003c/sub\u003e1:\u0026nbsp;\u003c/strong\u003eThere is no significant difference among the pre, immediate post- intervention and 8th week follow-up mean of knowledge of Human Papillomavirus (HPV) vaccines in the experimental and control groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH\u003csub\u003e0\u003c/sub\u003e2:\u0026nbsp;\u003c/strong\u003eThere is no significant difference among the pre, immediate post- intervention and 8th week follow-up mean of perception of safety of Human Papillomavirus (HPV) vaccines in the experimental and control groups.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study employed a quantitative research approach using a quasi-experimental design with two groups: an experimental and a control group. A pretest-posttest structure was implemented, where the experimental group received an educational intervention over four weeks, while the control group did not. Data collection occurred at baseline, immediately after the intervention, and at an eight-week follow-up. The study targeted parents of 9\u0026ndash;14-year-old girls in Ogun State, Nigeria, as their knowledge and perceptions of the Human Papillomavirus (HPV) vaccine are crucial for vaccine acceptance. The total population size was estimated at 213,713 based on the 2022 projected population of Ogun State and demographic fertility rates. Inclusion criteria encompassed parents of adolescent girls eligible for the HPV vaccine, permanent residents of Ogun State, and those who provided informed consent. Healthcare professionals, non-permanent residents, and unwilling participants were excluded to minimise bias and ensure data integrity.\u003c/p\u003e \u003cp\u003eThe study employed Cohen\u0026rsquo;s formula to determine the appropriate sample size for a quasi-experimental study involving a large population, resulting in a required minimum of 251 participants. To account for potential dropouts, the sample size was increased by 10%, yielding a final total of 276 participants. A multi-stage sampling technique was adopted, beginning with the stratification of Ogun State into three senatorial districts, from which one local government area (LGA) was randomly selected per district. Within each selected LGA, two wards were chosen through simple random sampling, followed by the random selection of two communities from each ward, totalling 12 communities. Proportionate sampling was then used to select parents of 9-14-year-old girls from each community, ensuring representativeness. Finally, systematic sampling was employed to select participants at every nth house, and the 12 communities were allocated to experimental and control groups using block random sampling via balloting.\u003c/p\u003e \u003cp\u003eThe study employed a self-developed questionnaire to collect data on HPV vaccine knowledge and perception (uploaded as a supplementary file). The test question paper assessed cognitive knowledge and was divided into two sections: Section A gathered socio-demographic details, while Section B contained 20 objective questions on HPV vaccine knowledge, scored from 0 to 20 based on correct responses. The questionnaire evaluated respondents' perceptions of HPV vaccine safety and acceptance of uptake. It included 12 perception-related items measured on a 4-point Likert scale (Strongly Agree to Strongly Disagree), with positive items scored from 4 to 1 and negative items scored in reverse. The maximum obtainable score for vaccine safety perception was 48, while the minimum was 12 for fully completed responses. Adequate motivation was provided to ensure full participation.\u003c/p\u003e \u003cp\u003eThe reliability and validity of the research instruments were ensured through rigorous statistical and expert validation processes. Internal consistency was assessed using Cronbach's Alpha, yielding reliability coefficients of 0.709 for knowledge of the HPV vaccine and 0.804 for perception of its safety, based on data collected from 10% of the sampled population outside the study area and analysed using SPSS Version 28. Validity was established through expert reviews for topic relevance, clarity, and adequacy. Face validity was confirmed by feedback from the research supervisor, test and measurement experts, and the Nursing department seminar panel, leading to refinements in the instrument. Content validity was verified by five experts using the Content Validity Ratio (CVR), which resulted in a CVR of 0.60 for the test questions on HPV vaccine knowledge and 1.0 for the questionnaire on perception of vaccine safety, ensuring the accuracy and credibility of the study.\u003c/p\u003e \u003cp\u003eA quantitative data collection method was employed for the study, with ethical approvals obtained from Babcock University and the Ogun State Ministry of Health to gain access to the communities. Collaboration with Community Development Associations (CDAs) through ward leaders facilitated the identification of parents for participation. The researcher and six trained research assistants conducted house-to-house mobilization, gathering parents at town halls or community meeting points. The intervention lasted four weeks, with biweekly one-hour sessions for the experimental group, while the control group participated in shorter sessions at specific intervals. Data collection spanned 12 weeks, including pre-intervention, intervention, and post-intervention phases. During the pre-intervention phase, introduction letters and ethical approvals were presented to local government officials, and several visits were made to familiarise with the communities and recruit participants. Ward Development Committee chairmen assisted in identifying eligible parents, and informed consent was obtained following detailed explanations of the study. A two-day training was conducted for six research assistants on the study's objectives and data collection tools. In the first week, parents were assembled at designated venues, rapport was built, and pre-intervention data, including demographic profiles and research instruments, were administered to both the control and intervention groups.\u003c/p\u003e \u003cp\u003eThe pre- and post-intervention instruments were serially numbered for control and recall, checked for completeness, and manually coded using a coding guide before analysis with IBM SPSS version 28. Descriptive statistics, including mean and standard deviation, were used, while t-test tested differences in mean scores across experimental and control groups at pretest, immediate posttest, and 8th-week posttest at a 0.05 significance level. Ethical approval was obtained from Ogun State Health Research Ethics Committee (OGHREC/456/2024/497/APP). Participants provided informed consent after receiving comprehensive study details, and confidentiality was ensured through numerical coding and secure data storage. Access to research data was restricted to authorized personnel, and participation was entirely voluntary.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDescription of the Socio-demographic Characteristics of the Respondents\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eIntervention Group (131)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eControl Group (129)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFreq.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFreq.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLess than 25 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u0026ndash;34 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u0026ndash;44 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45 years and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTribe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYoruba\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHausa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIgbo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Qualification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo Formal Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost-Secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost Graduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e131\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e129\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe socio-demographic characteristics of the respondents, as presented in Table\u0026nbsp;4.1, reveal variations in age distribution between the intervention and control groups. Among the intervention group, the majority (49.6%) were aged 35\u0026ndash;44 years, while 26.0% were between 25\u0026ndash;34 years, and only 5.3% were below 25 years. Conversely, the control group had a slightly lower proportion (42.6%) in the 35\u0026ndash;44 age bracket, while a larger percentage (37.2%) were in the 25\u0026ndash;34 age group. Notably, the control group had a higher proportion (11.6%) of respondents below 25 years compared to the intervention group (5.3%). This suggests that the intervention group consists of relatively older participants, while the control group has a slightly younger composition. Regarding tribal affiliation, Yoruba respondents dominated both groups (67.2% in the intervention and 65.1% in the control), followed by Hausa (14.5% vs. 11.6%) and Igbo (7.6% vs. 10.1%). The distribution of other ethnic groups was slightly higher in the control group (13.2%) than in the intervention group (10.7%). These figures indicate that the sample primarily consists of Yoruba participants, reflecting the predominant ethnic composition of the study area.\u003c/p\u003e\n\u003cp\u003eIn terms of educational qualifications, the distribution varies between the two groups. Among the intervention group, 27.5% had post-secondary education, while 16.8% had a first degree and only 3.1% possessed a postgraduate qualification. Comparatively, the control group had a slightly higher proportion of respondents with postgraduate education (7.6%), while the percentage with a first degree (18.6%) was marginally higher than that of the intervention group. Interestingly, a larger percentage of the control group (24.8%) had secondary education compared to the intervention group (19.8%). However, the intervention group had a higher proportion of respondents with only primary education (19.8%) compared to the control group (10.9%). The percentage of respondents without formal education was similar in both groups (13.0% vs. 14.0%)\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary of pre, immediate post and 8th week post intervention level of knowledge Human Papillomavirus (HPV) vaccines among parents in the intervention and control\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eKnowledge of HPV Vaccine\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ePRE INTERVENTION\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eIMMEDIATE POST INTERVENTION\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e8\u003csup\u003eTH\u003c/sup\u003e WEEK POST INTERVENTION\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor Knowledge (0\u0026ndash;9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e126 (96.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e123 (95.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e123 (95.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1 (0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e124 (96.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAverage Knowledge (10\u0026ndash;13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5 (3.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (4.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19 (14.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (4.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21 (16.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5 (3.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood Knowledge (14\u0026ndash;20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e110 (83.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e109 (83.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e15.63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.78\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e15.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.09\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch3\u003eIntervention: Nurse-Facilitated Interactive Educational Intervention (dup: abstract ?)\u003c/h3\u003e\n\u003cp\u003eThe findings in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e indicate a improvement in the level of knowledge about the Human Papillomavirus (HPV) vaccine among parents in the intervention group following the educational intervention, while the control group remained largely unchanged. At the pre-intervention stage, the majority of parents in both groups had poor knowledge, with 96.18% in the intervention group and 95.35% in the control group scoring within the poor knowledge range (0\u0026ndash;9). Only a small percentage had Average knowledge (3.82% in the intervention and 4.65% in the control), and none demonstrated good knowledge (14\u0026ndash;20). The mean knowledge scores were nearly identical at this stage (5.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81 for the intervention group and 5.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79 for the control group), indicating an equally low baseline understanding in both groups.\u003c/p\u003e\n\u003cp\u003eFollowing the intervention, there was a dramatic increase in knowledge levels among parents in the intervention group, with 83.97% achieving good knowledge scores and 14.50% reaching Average knowledge. This improvement is reflected in the sharp rise in the mean knowledge score for the intervention group (15.63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22), while the control group showed no change (mean\u0026thinsp;=\u0026thinsp;5.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.78). Despite the intervention, the control group remained largely in the poor knowledge category (95.35%), suggesting that without targeted educational efforts, parents\u0026rsquo; awareness of the HPV vaccine does not naturally improve over time. The stark contrast between the intervention and control groups at this stage highlights the effectiveness of the intervention in increasing HPV vaccine knowledge.\u003c/p\u003e\n\u003cp\u003eAt the 8th week post-intervention, knowledge retention in the intervention group remained high, with 83.21% still maintaining good knowledge and 16.03% in the Average category. Although there was a slight decline from the immediate post-intervention phase, the overall mean knowledge score remained higher than the pre-intervention level (15.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.09). Conversely, the control group exhibited minimal change, with the majority (96.12%) still classified as having poor knowledge and a negligible shift in mean score (5.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81). This suggests that without continuous reinforcement or exposure to educational materials, knowledge gain may slightly decline over time but remains substantially higher than baseline levels. The findings underscore the importance of structured educational interventions in enhancing and sustaining knowledge about the HPV vaccine among parents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Question 2\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhat is the pre, immediate post and 8th week post intervention level of perception of safety of Human Papillomavirus (HPV) vaccines among parents in selected communities in Ogun state?\u003c/p\u003e\n\u003cp\u003eItems on perception of safety of Human Papillomavirus (HPV) vaccines was a 12-item likert scale where Strongly Agree was assigned 4 points, Agree \u0026minus;\u0026thinsp;3, Disagree \u0026minus;\u0026thinsp;2 and Strongly Disagree \u0026minus;\u0026thinsp;1 for positive statements while Strongly Agree was assigned 1 point, Agree \u0026minus;\u0026thinsp;2, Disagree \u0026minus;\u0026thinsp;3 and Strongly Disagree \u0026minus;\u0026thinsp;4 for negative statements making up a 48-point perception scale. Scores of 38 and above were regarded as good perception, scores between 30 to 37 were regarded as Average perception and \u0026lt;\u0026thinsp;30 as poor perception.\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary of pre, immediate post and 8th week post intervention level of perception of safety of Human Papillomavirus (HPV) vaccines among parents in the intervention and control\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ePerception of Safety of HPV Vaccine\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ePRE INTERVENTION\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eIMMEDIATE POST INTERVENTION\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e8\u003csup\u003eTH\u003c/sup\u003e WEEK POST INTERVENTION\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor Perception (12\u0026ndash;29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e131 (100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e129 (100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (2.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e129 (100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e129 (100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAverage Perception (30\u0026ndash;37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60 (45.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63 (48.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood Perception (38\u0026ndash;48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68 (51.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66 (50.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e16.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e15.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e36.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e16.07\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e36.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e15.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch3\u003eIntervention: Nurse-Facilitated Interactive Educational Intervention\u003c/h3\u003e\n\u003cp\u003eThe data presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e illustrate the changes in parents\u0026apos; perception of the safety of the Human Papillomavirus (HPV) vaccine across three different time points: pre-intervention, immediate post-intervention, and the 8th week post-intervention. Prior to the intervention, all parents (100%) in both the intervention and control groups exhibited a poor perception of the vaccine\u0026rsquo;s safety, as reflected in their low mean scores (16.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81 for the intervention group and 15.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27 for the control group). This suggests that there was a general lack of awareness or prevalent misconceptions about the HPV vaccine before any educational intervention was introduced. The absence of participants in the Average or good perception categories further confirms the uniformly low perception levels among all parents. Following the nurse-facilitated interactive educational intervention, there was an improvement in the intervention group\u0026rsquo;s perception of HPV vaccine safety. The percentage of parents with a poor perception dropped dramatically from 100% to just 2.29%, while 45.80% of parents developed an Average perception, and 51.91% reported a good perception of the vaccine\u0026rsquo;s safety. This shift was accompanied by an increase in the mean perception score from 16.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81 to 36.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93. Meanwhile, in the control group, perception levels remained unchanged, with all parents (100%) still exhibiting a poor perception and a nearly identical mean score (16.07\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22). These results indicate that the intervention had an immediate and substantial impact on parents\u0026apos; understanding and confidence in the HPV vaccine\u0026rsquo;s safety.\u003c/p\u003e\n\u003cp\u003eAt the 8th week post-intervention, the intervention group sustained their improved perception, with 50.38% of parents maintaining a good perception and 48.09% retaining an Average perception. The mean score (36.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73) remained stable compared to the immediate post-intervention assessment, suggesting that the educational intervention had a lasting effect. Conversely, the control group exhibited no change, with all parents still classified under poor perception and a mean score of 15.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28. This persistent disparity between the two groups underscores the effectiveness of the nurse-facilitated interactive educational intervention in positively shifting parents\u0026rsquo; perceptions of HPV vaccine safety over time.\u003c/p\u003e\n\u003ch3\u003eTest of Hypotheses\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eHo1:\u0026nbsp;\u003c/strong\u003eThere is no significant difference in the knowledge of safety, perception of safety, and acceptance of uptake of Human Papillomavirus (HPV) between parents in the experimental and control groups before intervention\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003et-test analysis for difference in the knowledge of safety and perception of safety of Human Papillomavirus (HPV) between parents in the experimental and control groups before intervention\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et\u003csub\u003ecal\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP (Sig)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEffect Size (Cohen\u0026rsquo;s D)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge of Safety of HPV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"char\"\u003e\n \u003cp\u003e258\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"char\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"char\"\u003e\n \u003cp\u003e0.958\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"char\"\u003e\n \u003cp\u003e-0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerception of Safety of HPV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"char\"\u003e\n \u003cp\u003e258\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"char\"\u003e\n \u003cp\u003e0.810\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"char\"\u003e\n \u003cp\u003e0.419\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"char\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eP\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\n\u003cp\u003eThe results of the independent t-test analysis in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e indicate that there was no significant difference in the knowledge of HPV vaccine safety between parents in the experimental and control groups before the intervention. The mean knowledge scores for the experimental and control groups were 5.27 (SD\u0026thinsp;=\u0026thinsp;1.81) and 5.28 (SD\u0026thinsp;=\u0026thinsp;1.79), respectively, with a negligible mean difference. The calculated t-value (0.053) and the p-value (0.958) suggest that any observed difference between the groups was not statistically significant, as the p-value exceeds the conventional 0.05 threshold. Additionally, the effect size (Cohen\u0026rsquo;s D = -0.098) is very small, indicating an almost negligible practical difference in knowledge levels between the two groups at baseline.\u003c/p\u003e\n\u003cp\u003eThe independent t-test analysis presented also in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e shows that there was no significant difference in the perception of the safety of the Human Papillomavirus (HPV) vaccine between parents in the experimental and control groups before the intervention. This is evident from the calculated t-value (0.810) and the p-value (0.419), which is greater than the 0.05 significance threshold, indicating that any observed difference in perception was not statistically significant. The mean perception scores for both groups were relatively similar, with the experimental group scoring 16.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81 and the control group scoring 15.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28. Additionally, the effect size (Cohen\u0026rsquo;s D\u0026thinsp;=\u0026thinsp;0.002) suggests an extremely small difference between the groups, reinforcing that the perception of vaccine safety was nearly identical across both groups before the interventio.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHo2:\u0026nbsp;\u003c/strong\u003eThere is no significant difference in the knowledge of safety, perception of safety, and acceptance of uptake of Human Papillomavirus (HPV) between parents in the experimental and control groups after intervention\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003et-test analysis for difference in the knowledge of safety, and perception of safety of Human Papillomavirus (HPV) between parents in the experimental and control groups after intervention\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et\u003csub\u003ecal\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP (Sig)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEffect Size (Cohen\u0026rsquo;s D)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge of Safety of HPV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"char\"\u003e\n \u003cp\u003e258\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"char\"\u003e\n \u003cp\u003e40.515*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"char\"\u003e\n \u003cp\u003e9.47 (8.35\u0026ndash;10.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerception of Safety of HPV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"char\"\u003e\n \u003cp\u003e258\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"char\"\u003e\n \u003cp\u003e64.591*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"char\"\u003e\n \u003cp\u003e10.93 (9.61\u0026ndash;11.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003cp\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n \u003cp\u003eThe results from the independent t-test analysis reveal a significant difference in knowledge of HPV safety between parents in the experimental and control groups immediately after the intervention. The experimental group recorded a mean knowledge score of 15.63 (SD\u0026thinsp;=\u0026thinsp;2.22), compared to 5.51 (SD\u0026thinsp;=\u0026thinsp;1.78) in the control group. The t-value was 40.515 (df\u0026thinsp;=\u0026thinsp;258), which was statistically significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, indicating that the intervention substantially improved participants\u0026apos; knowledge. The effect size, measured by Cohen\u0026rsquo;s d, was 9.47 (95% CI: 8.35\u0026ndash;10.59), reflecting a very large and practically meaningful impact of the nurse-facilitated educational intervention.\u003c/p\u003e\n \u003cp\u003eAdditionally, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e shows a significant difference in perception of HPV vaccine safety between the two groups. The experimental group reported a higher mean perception score of 36.89 (SD\u0026thinsp;=\u0026thinsp;2.93), while the control group had a mean score of 16.07 (SD\u0026thinsp;=\u0026thinsp;2.22). The calculated t-value was 64.591, with a p-value of 0.000 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), confirming statistical significance. Cohen\u0026rsquo;s d was 10.93 (95% CI: 9.61\u0026ndash;11.82), indicating an extremely large effect size. These results suggest that the nurse-led interactive education greatly enhanced both knowledge and perception of HPV vaccine safety among parents in the experimental group\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion of Findings","content":"\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eThe findings demonstrated the effectiveness of an educational intervention in significantly improving parents\u0026rsquo; knowledge about the HPV vaccine. Initially, both the intervention and control groups exhibited poor knowledge, with over 95% of parents in each group scoring within the lowest knowledge category. However, following the intervention, a dramatic increase in knowledge was observed among the intervention group, with 83.97% attaining good knowledge scores, whereas the control group remained largely unchanged. The retention of knowledge at the eighth-week post-intervention further underscores the long-term benefits of structured educational efforts.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThese findings align with previous studies highlighting the widespread knowledge gap regarding HPV vaccines in Nigeria. Adebayo et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) conducted a cross-sectional study among Nigerian parents and found significant gaps in knowledge, particularly concerning vaccine safety. This supports the baseline findings, where parents exhibited a poor understanding of the HPV vaccine before the intervention. The study by Adebayo et al. also emphasised the prevalence of misinformation, which aligns with the need for targeted educational efforts observed in this study.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSimilarly, Iliyasu et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) explored knowledge gaps among healthcare workers in Northern Nigeria and found inadequate knowledge about HPV vaccines among providers. The lack of awareness among healthcare workers suggests that parental knowledge may also be limited, reinforcing the necessity of structured educational programs. The intervention\u0026rsquo;s effectiveness in this study mirrors Iliyasu et al.\u0026rsquo;s conclusion that training and education play a vital role in improving HPV vaccine awareness and acceptance.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe study by Okafor et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) among female secondary school students in Southwestern Nigeria also corroborates the findings, as it revealed low awareness and prevalent misconceptions about vaccine safety. The study underscored the importance of school-based sexual education programs, which parallels the significant improvement in knowledge levels observed in the intervention group after targeted education. This further suggests that structured information dissemination is crucial in addressing HPV vaccine-related misconceptions.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFurthermore, the findings resonate with Abiodun et al. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), who examined HPV vaccine knowledge among adolescent girls in rural communities in Nigeria. Their study identified socioeconomic factors and healthcare accessibility as determinants of vaccine knowledge and acceptance. This supports the notion that educational interventions should be tailored to address barriers such as misinformation and limited access to credible health information, as demonstrated in this study.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe long-term impact of the educational intervention, as evidenced by sustained knowledge retention at the eighth-week post-intervention, aligns with Nwagha et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), who found that healthcare providers play a critical role in disseminating accurate vaccine information. The need for continuous reinforcement of knowledge is evident in this study\u0026rsquo;s slight decline in post-intervention knowledge scores, suggesting that ongoing engagement with parents and healthcare providers is necessary to maintain awareness levels.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eLastly, the influence of community leaders and religious stakeholders, as discussed by Ezeanolue et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), underscores the broader sociocultural factors affecting HPV vaccine acceptance. Their study highlighted varying levels of knowledge and the role of religious beliefs in shaping attitudes towards vaccination. While this study did not specifically assess religious influences, the findings reinforce the importance of community-based educational efforts in increasing HPV vaccine knowledge and acceptance.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIn conclusion, the findings of this study provide strong empirical support for the effectiveness of structured educational interventions in enhancing and sustaining knowledge about the HPV vaccine among parents. The results align with existing literature that highlights significant knowledge gaps in various populations and emphasises the importance of targeted education, engagement with healthcare providers, and community-based interventions in improving vaccine awareness and acceptance.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003cp\u003eThe findings illustrated a significant transformation in parents' perception of the safety of the Human Papillomavirus (HPV) vaccine following a nurse-facilitated interactive educational intervention. Prior to the intervention, all parents (100%) in both the intervention and control groups exhibited poor perceptions of the vaccine\u0026rsquo;s safety, with low mean scores (16.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81 for the intervention group and 15.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27 for the control group). This indicates a general lack of awareness or prevalent misconceptions about the HPV vaccine. The absence of participants in the Average or good perception categories reinforces the notion that vaccine hesitancy and safety concerns were widespread among the parents before the intervention.\u003c/p\u003e \u003cp\u003eThese initial findings align with the conclusions of Marlow et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), who identified safety concerns as a predominant barrier to HPV vaccine acceptance among parents and adolescents. Similarly, Brewer et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) found that fears of potential long-term side effects significantly influenced parental hesitancy towards the vaccine. The present study\u0026rsquo;s findings support this, as parents in the pre-intervention phase demonstrated a complete lack of confidence in the vaccine\u0026rsquo;s safety. Additionally, Trim et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) noted that while some parents acknowledged the vaccine\u0026rsquo;s benefits, lingering doubts about its safety persisted, particularly among those with limited knowledge of HPV and its related diseases. The poor perception seen in the current study further corroborates Trim et al.\u0026rsquo;s (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) assertion that vaccine acceptance is hindered by inadequate awareness.\u003c/p\u003e \u003cp\u003eHowever, following the educational intervention, there was a dramatic improvement in the intervention group\u0026rsquo;s perception of HPV vaccine safety. The proportion of parents with poor perceptions dropped to just 2.29%, while 45.80% developed an Average perception and 51.91% reported a good perception. This was accompanied by a significant increase in the mean perception score from 16.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81 to 36.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93. In contrast, the control group showed no improvement, with all parents (100%) maintaining a poor perception and a nearly identical mean score (16.07\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22). These findings indicate that structured, interactive educational interventions can be highly effective in addressing misconceptions and improving vaccine perception.\u003c/p\u003e \u003cp\u003eThis shift in perception is supported by the findings of Grandahl et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), who demonstrated that misinformation and lack of trust in healthcare authorities contribute to vaccine hesitancy, but targeted educational interventions can effectively counteract these concerns. Similarly, Donadiki et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) found that safety concerns were a major barrier to HPV vaccination in Greece, and addressing these concerns through education significantly improved vaccine acceptance. Zimet et al. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) further reinforced this by showing that vaccine safety concerns decreased over time when targeted educational efforts were implemented. The current study aligns with these findings by demonstrating the efficacy of an interactive nurse-led intervention in changing parental attitudes towards vaccine safety.\u003c/p\u003e \u003cp\u003eAt the 8th week post-intervention, the intervention group sustained their improved perception, with 50.38% of parents maintaining a good perception and 48.09% retaining an Average perception. The mean score (36.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73) remained stable compared to the immediate post-intervention assessment, indicating that the educational intervention had a lasting effect. Conversely, the control group showed no change, with all parents still classified under poor perception and a mean score of 15.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28. This sustained improvement aligns with the findings of Zimet et al. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), who noted that continued exposure to educational messages and increased awareness helped maintain positive vaccine attitudes over time.\u003c/p\u003e \u003cp\u003eFurther supporting these findings, Osazuwa-Peters et al. (2020) found that in Nigeria, safety concerns significantly hindered HPV vaccine uptake among college students, highlighting the need for targeted awareness campaigns. Similarly, Balogun et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) reported that low levels of awareness and misconceptions about HPV vaccines contributed to hesitancy among mothers in southwestern Nigeria. The current study's findings confirm that addressing these concerns through well-structured education can lead to a sustained positive change in perception.\u003c/p\u003e \u003cp\u003eIn conclusion, the findings highlight the transformative impact of an interactive educational intervention in improving parents\u0026rsquo; perception of HPV vaccine safety. The study supports existing literature that identifies safety concerns as a primary barrier to vaccine uptake and demonstrates that targeted educational efforts can effectively address these concerns. Moving forward, broader implementation of such interventions, along with further research on the long-term impact of educational strategies, is essential for enhancing HPV vaccine acceptance globally.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study demonstrate the significant impact of the Nurse-Facilitated Interactive Educational Intervention (NFIEI) on parents' knowledge and perception of the safety of the Human Papillomavirus (HPV) vaccine in Ogun State. The demographic analysis revealed a balanced distribution across age, gender, and educational levels, suggesting that the sample is representative. The intervention group showed a substantial increase in knowledge and perception of HPV vaccine safety, as indicated by the sharp rise in mean scores from the pretest to the immediate posttest and sustained improvement at the 8th-week post-intervention assessment. In contrast, the control group exhibited minimal changes across all time points. The statistical analyses further confirmed that these differences were significant, leading to the rejection of the null hypotheses.\u003c/p\u003e \u003cp\u003e \u003cb\u003eRecommendations\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHealthcare facilities should incorporate Nurse-Facilitated Interactive Educational Interventions into routine immunisation services to enhance parental awareness and acceptance of HPV vaccines, thereby improving vaccination uptake.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eGovernment and non-governmental organisations should implement community-based awareness campaigns leveraging local languages and culturally appropriate materials to further educate parents on the benefits and safety of HPV vaccination.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eContinuous professional development and training should be provided to healthcare workers on effective communication strategies and educational interventions to improve parental engagement and trust in HPV vaccination programs.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eEducation ministries should introduce HPV vaccine awareness programs in secondary schools, ensuring that both students and parents receive accurate information on the importance of vaccination in preventing HPV-related diseases.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHPV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Papillomavirus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNFIEI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNurse-Facilitated Interactive Educational Intervention (NFIEI)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll experiments were performed in accordance with relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003eThe principle of ethical research study was upheld throughout the study. The study was reviewed by the Ethical review committees of Babcock University. Letter of introduction/permission obtained from the Dean of School of Nursing Sciences, Babcock University was presented to Health Research Committee of the State Ministry of Health alongside the research protocol for ethical approval which was used to access the Local Government areas of interest to use the settings and set the tones for the research study.The Ethical approval notification letter number from Babcock University is BUHREC 712/24 while that from the Ogun State Health research Ethics committee is OGHREC/456/2024/497/APP\u003c/p\u003e\n\u003cp\u003eInformed Consent: Participants were provided with comprehensive information about the study purpose, procedures, potential risks, benefits and their voluntary participation sought.\u003c/p\u003e\n\u003cp\u003eConfidentiality and Anonymity: Participant\u0026rsquo;s identities and personal information were treated with utmost confidentiality throughout the study. Any identifying information was replaced with numerical codes to ensure anonymity. Data collected were securely stored and accessible only to the research team, and also restricted from unauthorized access, use, and disclosure. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData security: Access to research data was restricted to authorized personnel, ensuring that sensitive information remained protected from unauthorized access, use or disclosure.\u003c/p\u003e\n\u003cp\u003eVoluntary Participation: Participation was entirely voluntary\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors hereby give consent for the publication of our work\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data used for this study are available upon request through the correspondence author\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting Interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article. Authors declare no competing interest. The authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo external fund was received for the research by the authors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the five authors designed the study, literature review and manuscript writing. All authors also participated in data collection while Olofin-Samuel performed data analysis. All the authors reviewed the draft while the final draft was also approved by all the authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge the support of the community leaders of the selected communities in Ogun state, and parents used as participants for their support and understanding during this research\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbiodun OA, Olu-Abiodun OO, Sotunsa JO, Oluwole FA. Impact of health education intervention on knowledge and perception of cervical cancer and cervical screening uptake among adult women in rural communities in Nigeria. BMC Public Health. 2019;14(8):23\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbiodun AJ, Akinwumi AF, Oluwatosin AO, Olatunji BS. 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Sci Rep. 2024;14(1):20341.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiao X, Lee DKL, Wong RM, Borah P. The impact of theory in HPV vaccination promotion research: A systematic review and meta-analysis. Am J Health Promotion. 2021;35(7):1002\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZimet GD, Rosberger Z, Fisher WA, Perez S, Stupiansky NW. Beliefs, barriers, and facilitators of adolescent vaccination against sexually transmitted infections: A longitudinal analysis. Int J STD AIDS. 2018;29(9):878\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Educational Intervention, HPV Vaccine, Knowledge, Perception, Safety","lastPublishedDoi":"10.21203/rs.3.rs-6444469/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6444469/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eHPV vaccine hesitancy remains a public health concern due to poor knowledge and safety perceptions among parents. This study assessed the impact of a Nurse-Facilitated Educational Intervention (NFEI) on parental knowledge and perception in Ogun State, Nigeria, using a quasi-experimental pre-test-post-test design. A total of 276 parents were selected through multistage sampling. Data were collected using standardized instruments with reliability (α\u0026thinsp;=\u0026thinsp;0.78\u0026ndash;0.89). The intervention was delivered twice weekly for four weeks. Hypotheses were tested using repeated measures analysis of covariance (ANCOVA) with level of significance of 5%. Before the intervention, poor knowledge of HPV vaccines was high (96.18% in the intervention group, 95.35% in the control group). Post-intervention, good knowledge rose to 83.97% in the intervention group, but remained 0% in the control. At eight weeks, good knowledge remained high (83.21% in the intervention group, 0% in the control). Both groups initially had poor perceptions of HPV vaccine safety (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD: 16.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81 for the intervention, 15.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27 for the control). After the intervention, the intervention group\u0026rsquo;s perception improved (36.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93), maintaining at eight weeks (36.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73), while the control group remained unchanged (15.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28). Significant differences were found between the groups post-intervention in both knowledge (t\u0026thinsp;=\u0026thinsp;40.515, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and perception (t\u0026thinsp;=\u0026thinsp;64.591, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating a large intervention effect. The study concludes that parent\u0026rsquo;s knowledge, and perception of safety of HPV Vaccines was improved by NFIE. It is recommended that government continue the campaign on HPV vaccination utilizing the Nurse Facilitated Educational intervention.\u003c/p\u003e","manuscriptTitle":"Effect of Nurse-facilitated Educational Intervention on Parents’ Knowledge and Perception of Safety of Human Papillomavirus Vaccine in Ogun State, Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-12 11:54:03","doi":"10.21203/rs.3.rs-6444469/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"59049ce4-59ea-44fb-bd2a-540505be90db","owner":[],"postedDate":"May 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-17T23:08:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-12 11:54:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6444469","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6444469","identity":"rs-6444469","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}