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Effect of HPV Vaccine Reminder Systems on HPV Vaccination Completion among Adolescent Girls in Nigeria

Abstract

Human papillomavirus (HPV) infection is a major cause of cervical cancer, making HPV vaccination an important component of cervical cancer prevention among adolescent girls. Although HPV vaccination programmes provide an opportunity to protect girls against HPV infection before potential exposure, completion of recommended vaccination schedules may be affected by inadequate awareness, missed vaccination opportunities, poor follow-up, parental concerns, communication gaps, and limited access to vaccination services. HPV vaccine reminder systems provide a mechanism for notifying parents, caregivers, adolescents, and healthcare providers about upcoming or missed vaccination appointments through approaches such as text messages, phone calls, mobile applications, school-based reminders, or other appropriate communication channels. Timely reminders may reduce missed appointments and improve completion of HPV vaccination among adolescent girls. Against this background, this study investigates the effect of HPV vaccine reminder systems on HPV vaccination completion among adolescent girls in Nigeria. The study will be anchored on the Health Belief Model, Theory of Planned Behavior, and Social Cognitive Theory. The Health Belief Model explains how perceptions of HPV infection susceptibility, cervical cancer severity, perceived benefits of vaccination, perceived barriers, and cues to action may influence vaccination completion. The Theory of Planned Behavior explains how attitudes toward HPV vaccination, subjective norms, perceived behavioural control, and behavioural intentions may influence completion of recommended vaccination. Social Cognitive Theory emphasizes self-efficacy, observational learning, social support, communication, and environmental factors in developing and maintaining preventive health behaviours. Collectively, these theoretical perspectives provide a suitable framework for explaining how HPV vaccine reminder systems may influence vaccination completion among adolescent girls in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise adolescent girls eligible for HPV vaccination in selected communities, schools, and healthcare facilities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, schools, healthcare facilities, and eligible adolescent girls. HPV vaccine reminder systems will be assessed using indicators such as availability of reminder programmes, type of reminder used, frequency and timing of reminders, text-message or telephone reminders, school-based reminders, parental or caregiver notifications, healthcare-provider reminders, reminders for missed appointments, communication content, accessibility of reminder platforms, and follow-up procedures. HPV vaccination completion will be assessed using indicators such as receipt of the recommended HPV vaccine dose or doses according to the applicable national schedule, timely receipt of subsequent doses where multiple-dose schedules apply, adherence to vaccination appointments, completion within the recommended period, and documented vaccination status. Data will be collected using structured questionnaires, school immunization records, vaccination registers, immunization cards, electronic immunization records where available, healthcare facility records, and relevant HPV vaccination programme documents. Descriptive statistics will be used to summarize participants' characteristics, exposure to reminder systems, vaccination attendance, and completion patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of HPV vaccine reminder systems on vaccination completion. Where a quasi-experimental design is adopted, vaccination completion among girls exposed to structured reminder systems may be compared with completion among girls receiving standard vaccination services, while relevant demographic, socioeconomic, parental, school, and healthcare-access factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that HPV vaccine reminder systems have a significant positive effect on HPV vaccination completion among adolescent girls in Nigeria. Adolescent girls and their parents or caregivers who receive timely and appropriately designed reminders are expected to have higher rates of vaccination appointment attendance and completion than those without structured reminder support. Reminders may reduce forgetfulness, improve awareness of vaccination schedules, encourage timely return for subsequent doses where applicable, and strengthen communication between families, schools, and healthcare providers. School-based and digital reminder approaches may be particularly useful for reaching large numbers of eligible adolescent girls and their caregivers. However, limited access to mobile phones, incorrect contact information, poor network connectivity, parental concerns about HPV vaccination, vaccine availability, transportation difficulties, and inadequate follow-up systems may reduce the effectiveness of reminder interventions. The study therefore expects accessible, timely, reliable, and well-coordinated HPV vaccine reminder systems to contribute significantly to improved vaccination completion among adolescent girls in Nigeria. The study is expected to contribute to the literature on HPV vaccine reminder systems, HPV vaccination completion, adolescent immunization, cervical cancer prevention, vaccination adherence, school health services, digital health interventions, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, National Primary Healthcare Development Agency, state ministries of health and education, primary healthcare centres, schools, healthcare providers, immunization programmes, development partners, and policymakers regarding strategies for improving HPV vaccination completion. The study will also provide evidence-based recommendations for integrating reminder systems into routine HPV vaccination programmes, strengthening school-based vaccination follow-up, improving communication with parents and caregivers, maintaining accurate vaccination records and contact information, expanding appropriate digital reminder platforms, ensuring vaccine availability, and strengthening follow-up mechanisms for adolescents who miss scheduled vaccination opportunities across Nigeria.

Keywords: HPV vaccine reminder systems, HPV vaccination completion, adolescent girls, human papillomavirus, cervical cancer prevention, adolescent immunization, vaccination adherence, school health services, digital health, Nigeria, public health.