School-Based Educational Intervention on Knowledge and Attitudes of Human Papillomavirus Screening and Vaccination among Female Junior Secondary School Students in Port Harcourt Metropolis, Nigeria

Abstract

Background: Persistent infection with high-risk human papillomavirus (HPV) is the necessary cause of nearly all cervical cancers and contributes substantially to other anogenital and oropharyngeal cancers. Despite the availability of highly effective HPV vaccines, awareness, preventive attitudes, and vaccine confidence among adolescents in many Nigerian settings remain suboptimal. This study aimed to assess the effect of a school-based educational intervention on HPV knowledge and on attitudes toward HPV screening and vaccination among female junior secondary school students in Port Harcourt Metropolis, Nigeria. Methods: A quasi-experimental one-group pretest–posttest study was conducted among 206 female junior secondary school students selected through multistage random sampling. The same cohort completed a baseline questionnaire, received a structured school-based educational package on HPV, cervical cancer, screening, and vaccination over four months, and was reassessed with the same instrument. Descriptive statistics summarized responses, and Pearson’s chi-square tests compared pre-intervention and post-intervention distributions at a 5% significance level. Results: The cohort was predominantly aged 12-14 years. Good knowledge increased from 79.1% to 85.4% (p = .093). Positive attitudes toward HPV vaccination improved significantly from 30.1% to 41.7% (p = .014). Item-level knowledge improved significantly for recognition that some HPV types can cause anal cancer (67.0% vs. 76.2%; χ² = 4.309, p = .038), that HPV can cause abnormal Pap test results (59.2% vs. 73.8%; χ² = 9.806, p = .002), and in rejection of the misconception that condoms fully protect against HPV transmission (70.9% vs. 51.0% endorsing the misconception; χ² = 17.138, p < .001). However, correct recognition that HPV may spread through routes other than sexual intercourse declined significantly (81.1% vs. 58.3%; χ² = 25.369, p < .001). Embarrassment about screening decreased significantly (χ² = 12.073, p = .017), whereas willingness to complete HPV vaccination did not improve significantly (χ² = 4.660, p = .324). Conclusion: The intervention improved several important areas of HPV prevention literacy and reduced some screening-related stigma, but substantial misconceptions and mixed vaccine intentions remained. Repeated, age-appropriate school health education reinforced by parent, teacher, and health-worker engagement may be needed to translate knowledge gains into consistently favorable prevention attitudes and future HPV vaccine uptake.