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

Effect of Nurse-facilitated Educational Intervention on Parents’ Knowledge and Perception on 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 on Safety of Human Papillomavirus Vaccine in Ogun State, Nigeria Serifat Omobolanle AMINU, Ngozi Anthonia OKAFOR, Omowunmi Modupe AWONUGA, and 2 more This is a preprint; it has not been peer reviewed by a journal.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-9296181/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background 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. Methods The study used 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%. Results 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. Conclusions 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 & Nwadike, 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, with the Information, Motivation, and Behavioural Skills Model (IMB) being the most effective. 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. Also, 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. Despite concerns about side effects and vaccine protection, nearly two-thirds of participants supported HPV vaccination. 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. Atitt-Allah et al ( 2019 ) evaluated the impact of an educational intervention on HPV-related knowledge and attitudes among 200 first-year female nursing students at Benha University. Using questionnaires and a modified Likert scale, researchers observed significant post-intervention improvements in knowledge and attitudes. Although a weak correlation was noted pre-intervention, a strong positive correlation emerged post-intervention between knowledge and attitudes. The study concludes that targeted education effectively enhances awareness and promotes positive perceptions of HPV infection and vaccination. 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: Ho1 There is no significant difference in the knowledge of safety, and perception of safety of Human Papillomavirus (HPV) between parents in the experimental and control groups before intervention. Ho2 There is no significant difference in the knowledge of safety, and perception of safety of Human Papillomavirus (HPV) between parents in the experimental and control groups after intervention. Methods Research Design This study employed a quasi-experimental design - 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. Population 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 and Exclusion Criteria 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. Sample Size and Sampling Technique 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. Instrumentation 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. Validation of the Instruments 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. Intervention 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 researcher and the 6 trained research assistants had the first session with the selected parents at initial designated venues from where the main venues and time for subsequent meetings were discussed, agreed and arranged. Subsequent sessions among the experimental group lasted for a duration of 1 hour per session, twice a week while there was no intervention for the control group. 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 researcher implemented the intervention starting from the first week of the experiment by teaching the contents stated which focused on delivering the objectives of the set curricular contents which revolved around instilling the right knowledge in the minds of the parents of 9–14 year old girls on HPV vaccine, and utilizing the care, compassion and professionalism characteristic of the nurse to positively alter perception on HPV vaccine safety, in order to give a relatively permanent boost to HPV vaccine acceptability. Discussions, role playing and think pair share methods were explored Week 1 : Parents were taught the following topics: Meaning of HPV, Epidemiology, types, means of contraction, and Risk factors for HPV. Also, how to recognize HPV related diseases, causes and signs and symptoms. Parents were taught the basic concepts involved in the effect of HPV on the body, particularly its role in causing cervical cancer. How HPV is contracted and risk factors using PowerPoint slides, parents learnt how to recognize HPV-related diseases, such as cervical cancer, and understand the symptoms, causes, epidemiology and types. The activities involved the use of PowerPoint presentations to discuss what happens when someone contracts HPV, the common diseases associated with HPV, were also explained Week 2: At the second week, Strategies and Preventive measures against cervical cancers were taught to the parents, Topics taught were safer sex practices, Strengthening the Immunity, Health Education, Cervical Cancer screening and HPV Vaccination. The objective was to provide detailed information on preventive measures against Cervical Cancers.. Parents were exposed to the concept of vaccines, with a particular focus on HPV vaccination. Parents also learnt measures such as safe sex practices, regular screenings and vaccinations. The activities involved the use of PowerPoint presentations. Formative and summative assessment questions and multimedia was employed to emphasise the points. Week 3: Objective of training was on side effect of HPV vaccination including Common concerns, myths and misconceptions about vaccine safety Using PowerPoint presentations. The session defined common terminologies on HPV vaccination, and the benefits of the HPV vaccine in preventing these diseases. The session also addressed common concerns and misconceptions about vaccine safety, aimed to provide a comprehensive understanding of the importance and efficacy of the HPV vaccine for teenagers. Pre-constructed questions were used formatively as well as summatively to unravel how the HPV vaccine works, stating the importance of vaccination in preventing HPV-related diseases. This was to make achievable, the main objectives of scaffolding parent to clarify concerns and common misconceptions surrounding HPV vaccines, its impact on health-seeking behaviour and differences between myths and realities about HPV vaccines. Week 4: At week 4, flip cards and PowerPoint slides were used to teach the topic, ‘Understanding Vaccine Hesitancy’, common reasons for hesitancy and general safety measures for HPV vaccines. more focus was given on action points and tips for parents. Formative and summative evaluation procedures were incorporated during and at the end of the lesson respectively. Data Analysis 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. Results Table 1 Description of the Socio-demographic Characteristics of the Respondents Variables Intervention Group (131) Control Group (129) 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 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. 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 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. 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, and perception of safety 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, and perception of safety 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 This study demonstrates that a structured, nurse-led educational intervention can significantly enhance both knowledge and perception of the HPV vaccine among parents. Prior to the intervention, knowledge levels in both groups were markedly low, mirroring existing evidence in Nigeria and other low-resource settings (Adebayo et al., 2017 ; Iliyasu et al., 2018 ). The post-intervention shift in the intervention group highlights the pivotal role of education in addressing knowledge gaps and correcting misinformation. Importantly, knowledge gains were sustained over time, suggesting that the intervention had a durable impact, an outcome echoed by Nwagha et al. ( 2021 ) in their study on health communication. A notable transformation was also observed in parental perception of the HPV vaccine’s safety, which had been overwhelmingly negative at baseline. This aligns with previous findings that parental hesitancy often stems from fear of side effects and distrust in vaccine safety (Marlow et al., 2017 ; Brewer et al., 2017 ). Following the intervention, the majority of parents in the intervention group shifted to a more favourable perception, indicating that interactive education can effectively mitigate concerns rooted in misinformation, an outcome that aligns with studies by Grandahl et al. ( 2019 ) and Donadiki et al. ( 2018 ). The sustained improvement in perception at the eighth-week post-intervention further affirms the long-term effectiveness of such interventions. Zimet et al. ( 2018 ) emphasised that positive vaccine attitudes can be maintained when educational efforts are continuous and strategically designed. The current study reflects this by demonstrating that short-term improvements were not transient but persisted over time, in contrast to the control group, which showed no measurable change. Socioeconomic and contextual factors also likely influenced knowledge and perception improvements, as suggested by Abiodun et al. ( 2020 ), who identified these variables as important determinants in rural vaccine uptake. While this study did not measure those factors directly, the effectiveness of the intervention across a demographically similar population suggests that such educational strategies can transcend socioeconomic barriers when properly implemented. Community engagement may also enhance intervention outcomes, the findings resonate with Ezeanolue et al. ( 2022 ), who advocated for leveraging community and religious leaders to increase vaccine acceptance. Their insight supports the idea that community-based interventions such as the one used in this study may yield broader and more sustainable public health impact. The consistent pattern across knowledge and perception domains reinforces the conclusion that targeted educational interventions are not only effective but necessary. The control group’s static scores underscore that in the absence of intervention, misconceptions and low awareness persist, thereby limiting vaccine uptake. This observation is supported by findings from Osazuwa-Peters et al. (2020) and Balogun et al. ( 2017 ), both of whom highlighted the importance of information access and the dangers of misinformation in shaping parental attitudes. Overall, this study contributes to the growing body of evidence that interactive, nurse-led educational interventions can have a meaningful and sustained impact on public health outcomes. It supports calls for integrated education strategies within immunisation programmes, especially in contexts where vaccine hesitancy remains high. Further research is warranted to explore how such interventions can be scaled up and embedded into existing healthcare or community-based healthcare delivery systems for wider societal benefit. Limitations A key limitation of this study is the exclusion of parental acceptance or intention to vaccinate their children against HPV, which would have provided a more comprehensive understanding of how improved knowledge and perception translate into actual behaviour. While the intervention successfully enhanced knowledge and perception of HPV vaccine safety, it did not measure whether these changes influenced parents’ willingness to allow vaccination. This omission was deliberate, as the assessment of HPV vaccine acceptance is the focus of a separate follow-up study that builds on the findings presented here and is intended for publication subsequently. 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. Furthermore, 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. Finally, 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. 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. Abbreviations HPV Human Papillomavirus NFIEI Nurse-Facilitated Interactive Educational Intervention (NFIEI) LGA Local Government Area SPSS Statistical Package for Social Sciences CVR Content Validity Ratio IMB Information, Motivation, and Behavioural TDF Theoretical Domains Framework CDA Community Development Associations 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 Clinical Trial Number Not Applicable 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, O. A., Olu-Abiodun, O. O., Sotunsa, J. O., & Oluwole, F. A. (2019). 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, 14 (8), 23-30. Abiodun, A. J., Akinwumi, A. F., Oluwatosin, A. O., & Olatunji, B. S. (2020). Human papillomavirus vaccine awareness, knowledge, and acceptability among female adolescents in rural communities in Nigeria. Journal of Pediatric and Adolescent Gynecology, 33 (6), 611-616. Adebayo, T., Iliyasu, Z., Abubakar, I. S., &Saidu, Y. (2017). Knowledge and perceptions of human papillomavirus vaccines among university students in northern Nigeria. International Journal of Adolescent Medicine and Health, 29 (6), 1-8. Adeyanju, G. C., Essoh, T.-A., Sidibe, A. R., Kyesi, F., &Aina, M. (2024). Human papillomavirus vaccination acceleration and introduction in Sub-Saharan Africa: A multi-country cohort analysis. Vaccines, 12 , 489. https://doi.org/10.3390/vaccines12050489 Agha, S., Bernard, D., Francis, S., Fareed, A., &Nsofor, I. (2024). Determinants of human papillomavirus vaccine acceptance among caregivers in Nigeria: A Fogg Behavior Model-based approach. Vaccines, 12 , 84. https://doi.org/10.3390/vaccines12010084 Akinleye, H. W., Kanma-Okafor, O. J., Okafor, I. P., &Odeyemi, K. A. (2020). Parental willingness to vaccinate adolescent daughters against human papilloma virus for cervical cancer prevention in Western Nigeria. Pan African Medical Journal, 36 , 112. Al Alawi, S., Al Zaabi, O., Heffernan, M. E., Arulappan, J., Al Hasani, N., Al Baluchi, M., ... & Al Saadi, A. (2023). Knowledge, attitudes and acceptance toward Human papillomavirus (HPV) vaccination: Perspectives of Muslim women and men. Vaccine , 41 (13), 2224- 2233. Ambali, R. T., John-Akinola, Y. O., &Oluwasanu, M. M. (2022). Indepth interviews on acceptability and concerns for human papilloma virus vaccine uptake among mothers of adolescent girls in community settings in Ibadan, Nigeria. Journal of Cancer Education, 37 , 748–754. Atitt-Allah, N. A. A., Abd-Elhady, R. M., & Araby, O. A.-W. A. (2019). Effect of educational intervention on knowledge and attitudes regarding human papillomavirus infection and its vaccination among nursing students. American Journal of Nursing Research, 7 (4), 453–464. https://pubs.sciepub.com/ajnr/7/4/7 Azuogu, B. N., Umeokonkwo, C. D., Azuogu, V. C., Onwe, O. E., Okedo-Alex, I. N., &Egbuji, C. C. (2019). Appraisal of willingness to vaccinate daughters with human papilloma virus vaccine and cervical cancer screening uptake among mothers of adolescent students in Abakaliki, Nigeria. Nigerian Journal of Clinical Practice, 22 , 1286–1291. Balogun, M. R., Odukoya, O. O., Odetola, T. D., Oyediran, M. A., &Ujomu, P. I. (2017). Cervical cancer awareness and preventive practices: A challenge for female urban slum dwellers in Lagos, Nigeria. African Journal of Reproductive Health, 21 (2), 74-82. Brewer, N. T., Hall, M. E., Malo, T. L., Gilkey, M. B., Quinn, B., &Lathren, C. (2017). Announcements versus conversations to improve HPV vaccination coverage: A randomized trial. Pediatrics, 139 (1), e20161764. https://doi.org/10.1542/peds.2016-1764 Chen, L., Zhang, Y., Young, R., Wu, X., & Zhu, G. (2021). Effects of vaccine-related conspiracy theories on Chinese young adults’ perceptions of the HPV vaccine: An experimental study. Health Communication , 36 (11), 1343-1353. Donadiki, E. M., Jiménez-García, R., Hernández-Barrera, V., Sourtzi, P., Carrasco-Garrido, P., López de Andrés, A., &Velonakis, E. G. (2018). Health beliefs and HPV vaccine acceptance among US parents of adolescent girls. Preventive Medicine, 113 , 14-20. Egbon, M., Ojo, T., Aliyu, A., &Bagudu, Z. S. (2022). Challenges and lessons from a school-based human papillomavirus (HPV) vaccination program for adolescent girls in a rural Nigerian community. BMC Public Health, 22 , 1611. Ezeanolue, E. E., Nwagbo, D., Agunwa, C., &Ezeanolue, C. O. (2022). Perceptions of human papillomavirus vaccines among community leaders and religious stakeholders in Nigeria. Journal of Religion and Health, 61 (1), 307-317. Grandahl, M., Larsson, M., Dalianis, T., Stenhammar, C., &Tydén, T. (2019). Catch-up HPV vaccination status of adolescents in relation to socioeconomic factors, individual beliefs and sexual behaviour. PloS One, 14 (8), e0221415. https://doi.org/10.1371/journal.pone.0221415 Iliyasu, Z., Galadanci, H. S., Abubakar, I. S., &Saidu, Y. (2018). Knowledge, perception, and acceptance of human papillomavirus vaccine among health professionals in northern Nigeria. Journal of Obstetrics and Gynaecology, 38 (8), 1136-1142. https://doi.org/10.1080/01443615.2018.1438787 Isara, A. R., & Osayi, N. (2021). Knowledge of human papillomavirus and uptake of its vaccine among female undergraduate students of Ambrose Alli University, Ekpoma, Nigeria. Journal of Community Medicine & Primary Health Care, 33 (1), 85-92. https://doi.org/10.4314/jcmphc.v33i1.8 Marlow, L. A. V., Forster, A. S., Wardle, J., & Waller, J. (2017). Mothers’ and adolescents’ beliefs about risk compensation following HPV vaccination. Journal of Adolescent Health, 60 (3), 276-281. Nwagha, U. I., Eze, G. A., Enebe, J. T., &Nwagha, T. U. (2021). Awareness and knowledge of human papillomavirus vaccines among pregnant women in southeastern Nigeria. International Journal of Gynecology & Obstetrics, 153 (3), 413-419 Ogbolu, M. O., & Kozlovszky, M. (2024). Assessment of HPV knowledge and awareness among students and staff at IBB University, Niger State, Nigeria: Implications for health education and prevention. Healthcare, 12 (665). https://doi.org/10.3390/healthcare12060665 Ohaeri, B., Adefolaju, A.O., & Onyenecho, C.A.(2020). Knowledge, attitudes and perceptions of Nigerian parents towards human papilloma virus (HPV) vaccines. European journal of midwifery 4(1), 2-12 Okolie, E. A., & Nwadike, B. I. (2023). Spotlight on human papillomavirus vaccination coverage: Is Nigeria making any progress? JCO Global Oncology, 9 , e2300088. Olusanya, O. A., Tomar, A., Thomas, J., Alonge, K., & Wigfall, L. T. (2023). 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 , 41 (23), 3564-3576. Oluwole, E. O., Idowu, O. M., Adejimi, A. A., Balogun, M. R., & Osanyin, G. E. (2019). Knowledge, attitude and uptake of human papillomavirus vaccination among female undergraduates in Lagos State, Nigeria. Journal of Family Medicine and Primary Care, 8 (3627–3633). Osazuwa-Peters, N., & Hong, Y. (2020). Exploring the sociodemographic and geographic determinants of human papillomavirus (HPV) vaccine refusal among Nigerian adolescents. Journal of Cancer Education, 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. Journal of medical Internet research , 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. Xiao, X., Lee, D. K. L., Wong, R. M., & Borah, P. (2021). The impact of theory in HPV vaccination promotion research: A systematic review and meta-analysis. American Journal of Health Promotion , 35 (7), 1002-1014. Zimet, G. D., Rosberger, Z., Fisher, W. A., Perez, S., &Stupiansky, N. W. (2018). Beliefs, barriers, and facilitators of adolescent vaccination against sexually transmitted infections: A longitudinal analysis. International Journal of STD & AIDS, 29 (9), 878-884. Additional Declarations No competing interests reported. Supplementary Files AminuetalQUESTIONNAIRE.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 22 May, 2026 Reviewers agreed at journal 12 May, 2026 Reviews received at journal 08 May, 2026 Reviewers agreed at journal 07 May, 2026 Reviewers invited by journal 07 May, 2026 Editor assigned by journal 04 May, 2026 Editor invited by journal 10 Apr, 2026 Submission checks completed at journal 09 Apr, 2026 First submitted to journal 09 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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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-9296181","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":641544619,"identity":"1a6faa74-5e15-4ff5-98e8-55fcca2b04e7","order_by":0,"name":"Serifat Omobolanle AMINU","email":"data:image/png;base64,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","orcid":"","institution":"Babcock University","correspondingAuthor":true,"prefix":"","firstName":"Serifat","middleName":"Omobolanle","lastName":"AMINU","suffix":""},{"id":641544625,"identity":"3962d89b-9b50-4287-b1f9-6aba5a99c39a","order_by":1,"name":"Ngozi Anthonia OKAFOR","email":"","orcid":"","institution":"Babcock University","correspondingAuthor":false,"prefix":"","firstName":"Ngozi","middleName":"Anthonia","lastName":"OKAFOR","suffix":""},{"id":641544629,"identity":"462d667f-bfa6-41da-8f90-5fc0f48f2c97","order_by":2,"name":"Omowunmi Modupe AWONUGA","email":"","orcid":"","institution":"Babcock University","correspondingAuthor":false,"prefix":"","firstName":"Omowunmi","middleName":"Modupe","lastName":"AWONUGA","suffix":""},{"id":641544633,"identity":"efa14dce-a48b-4d93-ab60-ce23934500a7","order_by":3,"name":"Tijani ADELANI","email":"","orcid":"","institution":"Federal University Oye Ekiti","correspondingAuthor":false,"prefix":"","firstName":"Tijani","middleName":"","lastName":"ADELANI","suffix":""},{"id":641544637,"identity":"9d3cc008-b963-46cb-a185-a6f9c9233403","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":"2026-04-01 22:08:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9296181/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9296181/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109759721,"identity":"352b119a-83fc-4416-98a8-25d8a8b9fa61","added_by":"auto","created_at":"2026-05-22 07:27:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":337074,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9296181/v1/c0c20735-7d31-48db-b8ae-facaf1c93280.pdf"},{"id":109457358,"identity":"eea89973-5cb9-464c-b624-8e85d4982985","added_by":"auto","created_at":"2026-05-18 10:14:39","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":18391,"visible":true,"origin":"","legend":"","description":"","filename":"AminuetalQUESTIONNAIRE.docx","url":"https://assets-eu.researchsquare.com/files/rs-9296181/v1/db0bec9fece3c65f013abe55.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEffect of Nurse-facilitated Educational Intervention on Parents’ Knowledge and Perception on 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 citationid=\"CR1\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Oluwole et al., \u003cspan citationid=\"CR26\" 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 citationid=\"CR19\" 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 citationid=\"CR6\" 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 citationid=\"CR10\" 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 \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 citationid=\"CR8\" 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 citationid=\"CR15\" 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 citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \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 citationid=\"CR22\" 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 citationid=\"CR8\" 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 citationid=\"CR4\" 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 \u0026amp; Nwadike, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \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 citationid=\"CR5\" 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 \u003cp\u003eOlusanya, et al (\u003cspan citationid=\"CR25\" 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 citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) analysed multiple studies on HPV vaccine promotional strategies, finding that knowledge significantly increased under these strategies, with the Information, Motivation, and Behavioural Skills Model (IMB) being the most effective.\u003c/p\u003e \u003cp\u003eIn Nigeria, Adebayo et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) identified significant knowledge gaps among parents, with prevalent misconceptions about vaccine safety. Iliyasu et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) found similar gaps among healthcare workers in Northern Nigeria, underscoring the need for training programs. Also, 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. Despite concerns about side effects and vaccine protection, nearly two-thirds of participants supported HPV vaccination.\u003c/p\u003e \u003cp\u003eChen, et al (\u003cspan citationid=\"CR13\" 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 citationid=\"CR20\" 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 citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) surveyed US parents and found that safety concerns predicted vaccine hesitancy. Trim et al. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) found similar concerns in Australia, with parental understanding of HPV influencing their perceptions. Tomaszewski et al. (\u003cspan citationid=\"CR28\" 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 \u003cp\u003eAtitt-Allah et al (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) evaluated the impact of an educational intervention on HPV-related knowledge and attitudes among 200 first-year female nursing students at Benha University. Using questionnaires and a modified Likert scale, researchers observed significant post-intervention improvements in knowledge and attitudes. Although a weak correlation was noted pre-intervention, a strong positive correlation emerged post-intervention between knowledge and attitudes. The study concludes that targeted education effectively enhances awareness and promotes positive perceptions of HPV infection and vaccination.\u003c/p\u003e \u003cp\u003e 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.\u003c/p\u003e \u003cp\u003eTwo research hypotheses were formulated for the study which are:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHo1\u003c/strong\u003e \u003cp\u003eThere is no significant 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 \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHo2\u003c/strong\u003e \u003cp\u003eThere is no significant 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 \u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eResearch Design\u003c/h2\u003e \u003cp\u003eThis study employed a quasi-experimental design - 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.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePopulation\u003c/h3\u003e\n\u003cp\u003eThe 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.\u003c/p\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eInclusion 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\n\u003ch3\u003eSample Size and Sampling Technique\u003c/h3\u003e\n\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\n\u003ch3\u003eInstrumentation\u003c/h3\u003e\n\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 \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eValidation of the Instruments\u003c/h2\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 \u003c/div\u003e\n\u003ch3\u003eIntervention\u003c/h3\u003e\n\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 researcher and the 6 trained research assistants had the first session with the selected parents at initial designated venues from where the main venues and time for subsequent meetings were discussed, agreed and arranged. Subsequent sessions among the experimental group lasted for a duration of 1 hour per session, twice a week while there was no intervention for the control group. 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 researcher implemented the intervention starting from the \u003cb\u003efirst\u003c/b\u003e week of the experiment by teaching the contents stated which focused on delivering the objectives of the set curricular contents which revolved around instilling the right knowledge in the minds of the parents of 9\u0026ndash;14 year old girls on HPV vaccine, and utilizing the care, compassion and professionalism characteristic of the nurse to positively alter perception on HPV vaccine safety, in order to give a relatively permanent boost to HPV vaccine acceptability. Discussions, role playing and think pair share methods were explored\u003c/p\u003e \u003cp\u003e \u003cb\u003eWeek 1\u003c/b\u003e: Parents were taught the following topics: Meaning of HPV, Epidemiology, types, means of contraction, and Risk factors for HPV. Also, how to recognize HPV related diseases, causes and signs and symptoms. Parents were taught the basic concepts involved in the effect of HPV on the body, particularly its role in causing cervical cancer. How HPV is contracted and risk factors using PowerPoint slides, parents learnt how to recognize HPV-related diseases, such as cervical cancer, and understand the symptoms, causes, epidemiology and types. The activities involved the use of PowerPoint presentations to discuss what happens when someone contracts HPV, the common diseases associated with HPV, were also explained\u003c/p\u003e \u003cp\u003eWeek 2: At the second week, Strategies and Preventive measures against cervical cancers were taught to the parents, Topics taught were safer sex practices, Strengthening the Immunity, Health Education, Cervical Cancer screening and HPV Vaccination. The objective was to provide detailed information on preventive measures against Cervical Cancers.. Parents were exposed to the concept of vaccines, with a particular focus on HPV vaccination. Parents also learnt measures such as safe sex practices, regular screenings and vaccinations. The activities involved the use of PowerPoint presentations. Formative and summative assessment questions and multimedia was employed to emphasise the points.\u003c/p\u003e \u003cp\u003eWeek 3: Objective of training was on side effect of HPV vaccination including Common concerns, myths and misconceptions about vaccine safety Using PowerPoint presentations. The session defined common terminologies on HPV vaccination, and the benefits of the HPV vaccine in preventing these diseases. The session also addressed common concerns and misconceptions about vaccine safety, aimed to provide a comprehensive understanding of the importance and efficacy of the HPV vaccine for teenagers. Pre-constructed questions were used formatively as well as summatively to unravel how the HPV vaccine works, stating the importance of vaccination in preventing HPV-related diseases. This was to make achievable, the main objectives of scaffolding parent to clarify concerns and common misconceptions surrounding HPV vaccines, its impact on health-seeking behaviour and differences between myths and realities about HPV vaccines.\u003c/p\u003e \u003cp\u003eWeek 4: At week 4, flip cards and PowerPoint slides were used to teach the topic, \u0026lsquo;Understanding Vaccine Hesitancy\u0026rsquo;, common reasons for hesitancy and general safety measures for HPV vaccines. more focus was given on action points and tips for parents. Formative and summative evaluation procedures were incorporated during and at the end of the lesson respectively.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\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.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab1\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of the Socio-demographic Characteristics of the Respondents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003eIntervention Group (131)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003eControl Group (129)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eFreq.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eFreq.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLess than 25 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e11.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e25–34 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e37.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e35–44 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e49.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e42.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e45 years and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e19.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eTribe\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eYoruba\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e67.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e65.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHausa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e11.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eIgbo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e13.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003eEducational Qualification\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNo Formal Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e13.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e19.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e19.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e24.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePost-Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e27.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e24.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eFirst Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e16.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePost Graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e131\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e100.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e129\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003e100.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \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 35–44 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.\u003c/p\u003e \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 \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab2\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \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 \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" rowspan=\"2\"\u003e \u003cp\u003eKnowledge of HPV Vaccine\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003ePRE INTERVENTION\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003eIMMEDIATE POST INTERVENTION\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003e8\u003csup\u003eTH\u003c/sup\u003e WEEK POST INTERVENTION\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePoor Knowledge (0–9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e126 (96.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e123 (95.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2 (1.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e123 (95.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e1 (0.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e124 (96.12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAverage Knowledge (10–13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e5 (3.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e6 (4.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e19 (14.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e6 (4.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e21 (16.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e5 (3.88)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGood Knowledge (14–20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e110 (83.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e109 (83.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMean ± SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e5.27 ± 1.81\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e5.28 ± 1.79\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e15.63 ± 2.22\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e5.51 ± 1.78\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e15.42 ± 2.09\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e5.44 ± 1.81\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eIntervention: Nurse-Facilitated Interactive Educational Intervention\u003c/h2\u003e \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 (0–9). 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.\u003c/p\u003e \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 ± 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.\u003c/p\u003e \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 ± 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.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab3\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \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 \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" rowspan=\"2\"\u003e \u003cp\u003ePerception of Safety of HPV Vaccine\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003ePRE INTERVENTION\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003eIMMEDIATE POST INTERVENTION\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003e8\u003csup\u003eTH\u003c/sup\u003e WEEK POST INTERVENTION\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePoor Perception (12–29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e131 (100.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e129 (100.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3 (2.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e129 (100.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2 (1.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e129 (100.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAverage Perception (30–37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e60 (45.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e63 (48.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGood Perception (38–48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e68 (51.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e66 (50.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMean ± SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e16.18 ± 1.81\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e15.98 ± 2.27\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e36.89 ± 2.93\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e16.07 ± 2.22\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e36.85 ± 2.73\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e\u003cb\u003e15.98 ± 2.28\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eIntervention: Nurse-Facilitated Interactive Educational Intervention\u003c/h2\u003e \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 − 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 \u0026lt; 30 as poor perception.\u003c/p\u003e \u003cp\u003eThe data presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e 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.\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 ± 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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eTest of Hypotheses\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eHo1\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThere is no significant 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 \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab4\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \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 \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003et\u003csub\u003ecal\u003c/sub\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eP (Sig)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eEffect Size (Cohen’s D)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eKnowledge of Safety of HPV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eExperimental Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e5.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" rowspan=\"2\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" rowspan=\"2\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" rowspan=\"2\"\u003e \u003cp\u003e0.958\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" rowspan=\"2\"\u003e \u003cp\u003e-0.098\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e5.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e1.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePerception of Safety of HPV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eExperimental Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e16.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" rowspan=\"2\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" rowspan=\"2\"\u003e \u003cp\u003e0.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" rowspan=\"2\"\u003e \u003cp\u003e0.419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" rowspan=\"2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e15.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eP \u0026gt; 0.05\u003c/h2\u003e \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 = 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.\u003c/p\u003e \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 ± 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.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHo2\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThere is no significant 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 \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab5\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \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 \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003et\u003csub\u003ecal\u003c/sub\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eP (Sig)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eEffect Size (Cohen’s D)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eKnowledge of Safety of HPV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eExperimental Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e15.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" rowspan=\"2\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" rowspan=\"2\"\u003e \u003cp\u003e40.515*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" rowspan=\"2\"\u003e \u003cp\u003e9.47 (8.35–10.59)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e5.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e1.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePerception of Safety of HPV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eExperimental Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e36.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" rowspan=\"2\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" rowspan=\"2\"\u003e \u003cp\u003e64.591*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" rowspan=\"2\"\u003e \u003cp\u003e10.93 (9.61–11.82)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e16.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e*P \u0026lt; 0.05\u003c/h2\u003e \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 = 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 \u0026lt; 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.\u003c/p\u003e \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 = 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 \u0026lt; 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\u003c/p\u003e \u003c/div\u003e "},{"header":"Discussion of Findings","content":"\u003cp\u003eThis study demonstrates that a structured, nurse-led educational intervention can significantly enhance both knowledge and perception of the HPV vaccine among parents. Prior to the intervention, knowledge levels in both groups were markedly low, mirroring existing evidence in Nigeria and other low-resource settings (Adebayo et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e; Iliyasu et al., \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e). The post-intervention shift in the intervention group highlights the pivotal role of education in addressing knowledge gaps and correcting misinformation. Importantly, knowledge gains were sustained over time, suggesting that the intervention had a durable impact, an outcome echoed by Nwagha et al. (\u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e) in their study on health communication. A notable transformation was also observed in parental perception of the HPV vaccine’s safety, which had been overwhelmingly negative at baseline. This aligns with previous findings that parental hesitancy often stems from fear of side effects and distrust in vaccine safety (Marlow et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e; Brewer et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). Following the intervention, the majority of parents in the intervention group shifted to a more favourable perception, indicating that interactive education can effectively mitigate concerns rooted in misinformation, an outcome that aligns with studies by Grandahl et al. (\u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e) and Donadiki et al. (\u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe sustained improvement in perception at the eighth-week post-intervention further affirms the long-term effectiveness of such interventions. Zimet et al. (\u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e) emphasised that positive vaccine attitudes can be maintained when educational efforts are continuous and strategically designed. The current study reflects this by demonstrating that short-term improvements were not transient but persisted over time, in contrast to the control group, which showed no measurable change. Socioeconomic and contextual factors also likely influenced knowledge and perception improvements, as suggested by Abiodun et al. (\u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e), who identified these variables as important determinants in rural vaccine uptake. While this study did not measure those factors directly, the effectiveness of the intervention across a demographically similar population suggests that such educational strategies can transcend socioeconomic barriers when properly implemented.\u003c/p\u003e\u003cp\u003eCommunity engagement may also enhance intervention outcomes, the findings resonate with Ezeanolue et al. (\u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e), who advocated for leveraging community and religious leaders to increase vaccine acceptance. Their insight supports the idea that community-based interventions such as the one used in this study may yield broader and more sustainable public health impact. The consistent pattern across knowledge and perception domains reinforces the conclusion that targeted educational interventions are not only effective but necessary. The control group’s static scores underscore that in the absence of intervention, misconceptions and low awareness persist, thereby limiting vaccine uptake. This observation is supported by findings from Osazuwa-Peters et al. (2020) and Balogun et al. (\u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e), both of whom highlighted the importance of information access and the dangers of misinformation in shaping parental attitudes.\u003c/p\u003e\u003cp\u003eOverall, this study contributes to the growing body of evidence that interactive, nurse-led educational interventions can have a meaningful and sustained impact on public health outcomes. It supports calls for integrated education strategies within immunisation programmes, especially in contexts where vaccine hesitancy remains high. Further research is warranted to explore how such interventions can be scaled up and embedded into existing healthcare or community-based healthcare delivery systems for wider societal benefit.\u003c/p\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eA key limitation of this study is the exclusion of parental acceptance or intention to vaccinate their children against HPV, which would have provided a more comprehensive understanding of how improved knowledge and perception translate into actual behaviour. While the intervention successfully enhanced knowledge and perception of HPV vaccine safety, it did not measure whether these changes influenced parents’ willingness to allow vaccination. This omission was deliberate, as the assessment of HPV vaccine acceptance is the focus of a separate follow-up study that builds on the findings presented here and is intended for publication subsequently.\u003c/p\u003e\u003ch2\u003eRecommendations\u003c/h2\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. 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. Furthermore, 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. Finally, 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.\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"},{"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 \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLGA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLocal Government Area\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCVR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eContent Validity Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIMB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInformation, Motivation, and Behavioural\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTDF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTheoretical Domains Framework\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCDA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity Development Associations\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\u003cbr\u003e\u0026nbsp;All 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’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\u003eClinical Trial Number\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNot Applicable\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003cbr\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\u003cbr\u003e\u0026nbsp;All 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\u003cbr\u003e\u0026nbsp;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.\u0026nbsp;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\u003cbr\u003e\u0026nbsp;No external fund was received for the research by the authors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors' contributions\u003c/em\u003e\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;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\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\n \u003cli\u003eAbiodun, O. A., Olu-Abiodun, O. O., Sotunsa, J. O., \u0026amp; Oluwole, F. A. (2019). Impact of health education intervention on knowledge and perception of cervical cancer and cervical screening uptake among adult women in rural communities in Nigeria. \u003cem\u003eBMC Public Health, 14\u003c/em\u003e(8), 23-30.\u003c/li\u003e\n \u003cli\u003eAbiodun, A. J., Akinwumi, A. F., Oluwatosin, A. O., \u0026amp; Olatunji, B. S. (2020). 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(2022). Challenges and lessons from a school-based human papillomavirus (HPV) vaccination program for adolescent girls in a rural Nigerian community. \u003cem\u003eBMC Public Health, 22\u003c/em\u003e, 1611.\u003c/li\u003e\n \u003cli\u003eEzeanolue, E. E., Nwagbo, D., Agunwa, C., \u0026amp;Ezeanolue, C. O. (2022). Perceptions of human papillomavirus vaccines among community leaders and religious stakeholders in Nigeria. \u003cem\u003eJournal of Religion and Health, 61\u003c/em\u003e(1), 307-317.\u003c/li\u003e\n \u003cli\u003eGrandahl, M., Larsson, M., Dalianis, T., Stenhammar, C., \u0026amp;Tyd\u0026eacute;n, T. (2019). Catch-up HPV vaccination status of adolescents in relation to socioeconomic factors, individual beliefs and sexual behaviour. \u003cem\u003ePloS One, 14\u003c/em\u003e(8), e0221415. https://doi.org/10.1371/journal.pone.0221415\u003c/li\u003e\n \u003cli\u003eIliyasu, Z., Galadanci, H. S., Abubakar, I. S., \u0026amp;Saidu, Y. (2018). Knowledge, perception, and acceptance of human papillomavirus vaccine among health professionals in northern Nigeria. \u003cem\u003eJournal of Obstetrics and Gynaecology, 38\u003c/em\u003e(8), 1136-1142. https://doi.org/10.1080/01443615.2018.1438787\u003c/li\u003e\n \u003cli\u003eIsara, A. R., \u0026amp; Osayi, N. (2021). Knowledge of human papillomavirus and uptake of its vaccine among female undergraduate students of Ambrose Alli University, Ekpoma, Nigeria. \u003cem\u003eJournal of Community Medicine \u0026amp; Primary Health Care, 33\u003c/em\u003e(1), 85-92. https://doi.org/10.4314/jcmphc.v33i1.8\u003c/li\u003e\n \u003cli\u003eMarlow, L. A. V., Forster, A. S., Wardle, J., \u0026amp; Waller, J. (2017). Mothers\u0026rsquo; and adolescents\u0026rsquo; beliefs about risk compensation following HPV vaccination. \u003cem\u003eJournal of Adolescent Health, 60\u003c/em\u003e(3), 276-281.\u003c/li\u003e\n \u003cli\u003eNwagha, U. I., Eze, G. A., Enebe, J. T., \u0026amp;Nwagha, T. U. (2021). Awareness and knowledge of human papillomavirus vaccines among pregnant women in southeastern Nigeria. \u003cem\u003eInternational Journal of Gynecology \u0026amp; Obstetrics, 153\u003c/em\u003e(3), 413-419\u003c/li\u003e\n \u003cli\u003eOgbolu, M. O., \u0026amp; Kozlovszky, M. (2024). Assessment of HPV knowledge and awareness among students and staff at IBB University, Niger State, Nigeria: Implications for health education and prevention. \u003cem\u003eHealthcare, 12\u003c/em\u003e(665). https://doi.org/10.3390/healthcare12060665\u003c/li\u003e\n \u003cli\u003eOhaeri, B., Adefolaju, A.O., \u0026amp; Onyenecho, C.A.(2020). Knowledge, attitudes and perceptions of Nigerian parents towards human papilloma virus (HPV) vaccines. \u003cem\u003eEuropean journal of midwifery\u003c/em\u003e 4(1), 2-12\u003c/li\u003e\n \u003cli\u003eOkolie, E. A., \u0026amp; Nwadike, B. I. (2023). Spotlight on human papillomavirus vaccination coverage: Is Nigeria making any progress? \u003cem\u003eJCO Global Oncology, 9\u003c/em\u003e, e2300088.\u003c/li\u003e\n \u003cli\u003eOlusanya, O. A., Tomar, A., Thomas, J., Alonge, K., \u0026amp; Wigfall, L. T. (2023). 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. \u003cem\u003eVaccine\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(23), 3564-3576.\u003c/li\u003e\n \u003cli\u003eOluwole, E. O., Idowu, O. M., Adejimi, A. A., Balogun, M. R., \u0026amp; Osanyin, G. E. (2019). Knowledge, attitude and uptake of human papillomavirus vaccination among female undergraduates in Lagos State, Nigeria. \u003cem\u003eJournal of Family Medicine and Primary Care, 8\u003c/em\u003e(3627\u0026ndash;3633).\u003c/li\u003e\n \u003cli\u003eOsazuwa-Peters, N., \u0026amp; Hong, Y. (2020). Exploring the sociodemographic and geographic determinants of human papillomavirus (HPV) vaccine refusal among Nigerian adolescents. \u003cem\u003eJournal of Cancer Education, 35\u003c/em\u003e(1), 39-45.\u003c/li\u003e\n \u003cli\u003eTomaszewski, T., Morales, A., Lourentzou, I., Caskey, R., Liu, B., Schwartz, A., \u0026amp; Chin, J. (2021). Identifying false human papillomavirus (HPV) vaccine information and corresponding risk perceptions from Twitter: advanced predictive models. \u003cem\u003eJournal of medical Internet research\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(9), e30451.\u003c/li\u003e\n \u003cli\u003eTrim, K., Nagji, N., Elit, L., \u0026amp; Roy, K. (2019). Parental knowledge, attitudes, and behaviours towards human papillomavirus vaccination for their children: A systematic review from 2001 to 2011. \u003cem\u003eObstetrics and Gynecology International, 2012\u003c/em\u003e, 921236.\u003c/li\u003e\n \u003cli\u003eXiao, X., Lee, D. K. L., Wong, R. M., \u0026amp; Borah, P. (2021). The impact of theory in HPV vaccination promotion research: A systematic review and meta-analysis. \u003cem\u003eAmerican Journal of Health Promotion\u003c/em\u003e, \u003cem\u003e35\u003c/em\u003e(7), 1002-1014.\u003c/li\u003e\n \u003cli\u003eZimet, G. D., Rosberger, Z., Fisher, W. A., Perez, S., \u0026amp;Stupiansky, N. W. (2018). Beliefs, barriers, and facilitators of adolescent vaccination against sexually transmitted infections: A longitudinal analysis. \u003cem\u003eInternational Journal of STD \u0026amp; AIDS, 29\u003c/em\u003e(9), 878-884.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Educational Intervention, HPV Vaccine, Knowledge, Perception, Safety","lastPublishedDoi":"10.21203/rs.3.rs-9296181/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9296181/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study used 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%.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBefore 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.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe 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 on Safety of Human Papillomavirus Vaccine in Ogun State, Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-18 10:14:35","doi":"10.21203/rs.3.rs-9296181/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-22T06:48:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211687359224654981922139279150801124042","date":"2026-05-12T11:14:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-09T02:33:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336792410911400744210457314010648078638","date":"2026-05-07T23:59:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-07T14:06:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-04T12:33:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-10T10:41:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-09T18:44:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-04-09T18:21:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"59049ce4-59ea-44fb-bd2a-540505be90db","owner":[],"postedDate":"May 18th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-22T06:48:42+00:00","index":64,"fulltext":""},{"type":"reviewerAgreed","content":"211687359224654981922139279150801124042","date":"2026-05-12T11:14:25+00:00","index":45,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-09T02:33:53+00:00","index":44,"fulltext":""},{"type":"reviewerAgreed","content":"336792410911400744210457314010648078638","date":"2026-05-07T23:59:50+00:00","index":43,"fulltext":""},{"type":"reviewersInvited","content":"30","date":"2026-05-07T14:06:10+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T10:14:36+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-18 10:14:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9296181","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9296181","identity":"rs-9296181","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}