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Impact of Cervical Cancer Self-Sampling Education on Willingness to Use HPV Self-Sampling among Women in Nigeria

Abstract

Cervical cancer remains an important public health concern among women in Nigeria, particularly because many women may not participate regularly in cervical cancer screening despite the availability of effective prevention and early-detection approaches. Persistent infection with high-risk human papillomavirus (HPV) is the primary cause of cervical cancer, while screening and appropriate follow-up can facilitate early identification of women at increased risk and reduce progression to invasive disease. HPV self-sampling may provide an alternative approach that can improve privacy, convenience, and accessibility for women who experience barriers to facility-based screening. However, limited knowledge of HPV self-sampling, concerns about the accuracy and safety of self-collected samples, embarrassment, fear of obtaining a positive result, uncertainty about the correct procedure, and limited awareness of where to obtain or submit self-samples may influence women's willingness to use HPV self-sampling. Cervical cancer self-sampling education provides an opportunity to improve women's understanding of HPV, cervical cancer prevention, self-sampling procedures, and the importance of follow-up after an abnormal result. Against this background, this study investigates the impact of cervical cancer self-sampling education on willingness to use HPV self-sampling among women in Nigeria. The study will be anchored on the Health Belief Model, Health Literacy Theory, and Social Ecological Model. The Health Belief Model explains how women's perceptions of cervical cancer susceptibility, perceived severity, perceived benefits of HPV self-sampling, perceived barriers, self-efficacy, and cues to action may influence their willingness to use self-sampling. Health Literacy Theory emphasizes women's ability to obtain, understand, evaluate, and use reliable health information to make informed decisions about cervical cancer screening. The Social Ecological Model highlights the influence of individual, interpersonal, community, healthcare-system, socioeconomic, and cultural factors on women's access to and acceptance of HPV self-sampling. Collectively, these theoretical perspectives provide a suitable framework for explaining how cervical cancer self-sampling education may influence willingness to use HPV self-sampling among women in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise women aged 18 years and above residing in selected urban, semi-urban, and rural communities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, households, healthcare facilities, and eligible women. Cervical cancer self-sampling education will be assessed using indicators such as exposure to educational sessions, frequency and duration of education, knowledge of cervical cancer and HPV infection, awareness of HPV as a major cause of cervical cancer, knowledge of HPV self-sampling, understanding of sample-collection procedures, appropriate timing and storage of samples where applicable, awareness of testing and laboratory procedures, interpretation of screening results, understanding of the need for follow-up after an abnormal result, awareness of screening locations and service providers, privacy and confidentiality, accuracy and safety of self-sampling, and misconceptions about self-collected HPV samples. Willingness to use HPV self-sampling will be assessed using indicators such as willingness to obtain a self-sampling kit, willingness to collect a sample independently, intention to use HPV self-sampling within a specified period, willingness to recommend self-sampling to other women, confidence in performing the procedure correctly, willingness to submit a collected sample for testing, acceptance of professional guidance when needed, and willingness to complete follow-up procedures after a positive or abnormal result. Data will be collected using structured questionnaires, cervical cancer and HPV knowledge assessment tools, willingness or behavioural-intention scales, educational demonstrations, scenario-based questions, and pre-test and post-test assessments where a quasi-experimental intervention is adopted. Descriptive statistics will be used to summarize participants' demographic and socioeconomic characteristics, reproductive-health history, previous cervical cancer screening experience, sources of health information, HPV knowledge, and attitudes toward self-sampling. Inferential statistical techniques, including chi-square tests, paired and independent t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of cervical cancer self-sampling education on willingness to use HPV self-sampling. Where a quasi-experimental design is adopted, willingness scores before and after the educational intervention may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that cervical cancer self-sampling education has a significant positive impact on willingness to use HPV self-sampling among women in Nigeria. Women exposed to structured, evidence-based, and practical self-sampling education are expected to demonstrate greater knowledge, confidence, and willingness to use HPV self-sampling than women without comparable exposure. Education may improve women's understanding of HPV infection, cervical cancer prevention, the purpose of HPV testing, self-sample collection procedures, and the importance of completing recommended follow-up after a positive result. Practical demonstrations and supervised explanations may reduce fears concerning privacy, discomfort, embarrassment, and the accuracy of self-collected samples. Education may also help women distinguish reliable information from misconceptions and increase confidence in self-sampling as a potential screening option where it is available through appropriate health services. However, limited availability of self-sampling kits, cost, inadequate laboratory capacity, concerns about result accuracy, fear of a positive diagnosis, limited access to follow-up care, cultural beliefs, misinformation, and lack of awareness of service locations may reduce the effectiveness of education alone. The study therefore expects accessible, culturally appropriate, evidence-based, practical, and sustained cervical cancer self-sampling education, supported by reliable HPV testing and follow-up services, to contribute significantly to improved willingness to use HPV self-sampling among women in Nigeria. The study is expected to contribute to the literature on cervical cancer prevention, HPV screening, HPV self-sampling, women's health, reproductive health, cancer screening, health education, health literacy, screening acceptance, 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, state ministries of health, hospitals, primary healthcare centres, cancer-control programmes, gynaecologists, nurses, community health workers, women's health organizations, development partners, and policymakers regarding strategies for improving cervical cancer screening participation. The study will also provide evidence-based recommendations for integrating HPV self-sampling education into cervical cancer prevention programmes, expanding community-based screening education, improving access to self-sampling services and testing kits, strengthening follow-up systems, addressing misconceptions and stigma, increasing women's confidence in self-sampling, and developing sustainable cervical cancer prevention programmes that promote HPV self-sampling uptake across Nigeria.

Keywords: Cervical cancer self-sampling education, HPV self-sampling, willingness to use HPV self-sampling, cervical cancer screening, human papillomavirus, women, reproductive health, cancer prevention, health education, health literacy, Nigeria, public health.