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Impact of HPV Self-Sampling Services on Cervical Cancer Screening Participation among Eligible Women in Nigeria

Abstract

Cervical cancer remains a significant public health concern among women in Nigeria despite being largely preventable through human papillomavirus (HPV) vaccination, cervical cancer screening, early detection, and appropriate management of precancerous lesions. Persistent infection with high-risk HPV is the major cause of cervical cancer, yet many eligible women do not participate in recommended screening because of barriers such as limited access to healthcare facilities, transportation difficulties, cost, concerns about privacy, embarrassment, fear of pelvic examination, inadequate awareness, and inconvenient service arrangements. HPV self-sampling provides an alternative approach that allows eligible women to collect their own samples for HPV testing, potentially improving privacy, convenience, acceptability, and access to cervical cancer screening. Against this background, this study investigates the impact of HPV self-sampling services on cervical cancer screening participation among eligible women in Nigeria. The study will be anchored on the Health Belief Model, Theory of Planned Behavior, and Technology Acceptance Model. The Health Belief Model explains how women's perceptions of their susceptibility to HPV infection and cervical cancer, perceived severity, perceived benefits of self-sampling, perceived barriers, and cues to action may influence participation in cervical cancer screening. The Theory of Planned Behavior explains how attitudes toward self-sampling, perceived social expectations, perceived behavioural control, and intention may influence women's decision to participate in screening. The Technology Acceptance Model explains how perceived usefulness, ease of use, convenience, and acceptability of HPV self-sampling may influence women's adoption of the screening approach. Collectively, these theoretical perspectives provide a suitable framework for explaining how HPV self-sampling services may influence cervical cancer screening participation among eligible women in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise eligible women within the recommended age or risk group for cervical cancer screening in selected communities, healthcare facilities, workplaces, women's organizations, and other relevant settings across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, and eligible women. HPV self-sampling services will be assessed using indicators such as availability of self-sampling kits, accessibility, ease of sample collection, privacy, convenience, instructions provided, healthcare-provider support, availability of HPV testing, result communication, referral arrangements, and follow-up services. Cervical cancer screening participation will be assessed using indicators such as acceptance of HPV self-sampling, completion and return of self-collected samples, participation in HPV testing, receipt of screening results, attendance for follow-up after positive results, and completion of recommended diagnostic evaluation where required. Data will be collected using structured questionnaires, screening registers, HPV testing records, sample-return records, referral registers, and relevant programme documents. Descriptive statistics will be used to summarize participants' characteristics, accessibility and use of HPV self-sampling services, and screening participation patterns. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of HPV self-sampling services on cervical cancer screening participation. Where a quasi-experimental design is adopted, screening participation before and after introduction or implementation of HPV self-sampling services may be compared 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 HPV self-sampling services have a significant positive impact on cervical cancer screening participation among eligible women in Nigeria. Women offered accessible, confidential, convenient, and well-supported HPV self-sampling services are expected to demonstrate higher screening participation than women who have access only to conventional facility-based screening approaches. Self-sampling may reduce barriers associated with pelvic examinations, privacy concerns, embarrassment, transportation, waiting time, and inconvenient clinic schedules. The availability of clear instructions, healthcare-provider support, reliable laboratory testing, timely communication of results, and effective referral systems may further improve women's willingness to participate in screening and complete the screening pathway. However, concerns about sample collection, uncertainty about the accuracy of self-sampling, inadequate information, limited availability of testing facilities, cost, poor follow-up systems, and digital or geographical barriers may reduce participation. The study therefore expects accessible, acceptable, affordable, quality-assured, and appropriately supported HPV self-sampling services to contribute significantly to improved cervical cancer screening participation among eligible women in Nigeria. The study is expected to contribute to the literature on HPV self-sampling, cervical cancer screening, screening participation, HPV testing, women's health, cancer prevention, preventive healthcare, 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, healthcare providers, cancer-control programmes, women's health organizations, development partners, and policymakers regarding strategies for expanding cervical cancer screening. The study will also provide evidence-based recommendations for integrating HPV self-sampling into appropriate cervical cancer screening programmes, improving availability and affordability of self-sampling kits, strengthening community-based screening services, training healthcare providers, developing culturally appropriate educational materials, ensuring quality laboratory testing, strengthening result communication and referral systems, and improving follow-up after positive HPV results across Nigeria.

Keywords: HPV self-sampling, cervical cancer screening, screening participation, human papillomavirus, HPV testing, women, cancer prevention, women's health, preventive healthcare, self-collected HPV testing, Nigeria, public health.