Effect of Parental Health Literacy Program on their Adolescents’ Human Papillomavirus Vaccination Knowledge and Uptake in Ibadan, Nigeria

Background: Cervical cancer has been known to be one of the major causes of cancer morbidity and mortality among women (WHO/ICO, 2010). The major cause which is infection with the human Papilloma virus is now well known. Vaccines prevent 70% of cervical cancers, as well as HPV-16 and HPV-18, the 2 HPV strains that account for most cervical cancer cases worldwide (Wang & Wu, 2013). Ensuring universal access to HPV vaccination, screening and treatment services will be key to reducing the burden of cervical cancer worldwide (PATH, 2010). WHO (2013) recommends routine vaccination of girls 9-13 years of age because they are not as likely to have begun sexual activity. Yet, awareness about cervical cancer and the Human Papilloma virus has remained low. Study carried out recently in Ibadan by Ndikom and Obo (2016) revealed that only 11.8% of the adolescents had heard about HPV and majority of these few got information from internet. Mothers and teachers were the least sources of information. According to Perlman, Wamai, Bain, Welty, Welty, et al. (2014) “There is an urgent need for more education to inform the public about HPV, HPV vaccine, and cervical cancer.

Parental health literacy is very important in targeting uptake of HPV vaccination as their role in the health care of their adolescents cannot be under estimated. According to Selden, Zorn, Ratzan and Parker (2000) Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”. It was described as a constellation of skills that includes not only the ability to function in a health care environment but to also act on the informa¬tion being provided (Berkman, DeWalt and Pignone, 2004).

Children in the age range recommended for HPV vaccination are considered as minors who cannot make decision by themselves. In most country’s legal systems, the legal age of consent tends to coincide with the age of majority. A child or adolescent in the age group 6 to 17 years cannot provide consent to vaccination and so consent is normally required from their parent or legal guardian (WHO, 2014). Therefore, it paramount that parents and their children are targeted in issues relating to sexually transmitted infections like HPV and HIV with Health Literacy programmes.

Objectives

• To assess the level of awareness of cervical cancer and HPV vaccination among parents and their adolescents at baseline.
• To evaluate the level of acceptance of HPV Vaccination for adolescent girls among the parents at baseline.
• To determine the effect of health Literacy programme on the awareness in the experimental and control group.
• To determine the effect of the intervention on the acceptance and uptake of Vaccination for adolescents in Ibadan

Method: This study will utilize quasi experimental pre and post test design. There will be experimental and control groups.

Setting will be selected secondary schools in Ibadan. Two local government areas will be randomly selected one will be experimental and the other will be the control group. One from the Northern Ibadan and the other from the Southern to avoid contamination.

Study population: Junior secondary school students aged less than 18 years will be selected for the study. Parents of Adolescents from the selected schools will be invited to participate through their children.

Sample size: Estimated at 217 per group. Total sample will be 434.

Sampling technique: Multistage sampling will be used to select the schools for both experimental and control groups.

Instrument: Interviewer administered Questionnaire will be used for the study. It will consist of closed and open ended questions focusing on the objectives of the study.

Educational module covering various information on HPV and HPV vaccination for teaching will also be utilized for the intervention. Validity and Reliability of the instrument will be ensured.

Data collection: this study will last for one year. The study will commence with preliminary visits. Baseline data will be collected before the teaching from both Parents and the adolescents. Teaching will then be implemented. After teaching immediate post test will be carried out among the mothers. The students and their parents will be followed up for 3months to give room for their uptake of vaccination. We will ensure provide information on where to access vaccination and pay for vaccination (through grant resources )for those who are willing where possible. Post test data will be collected after followup.

Plan for data Analysis: Data will be analyzed use statistical package of the social sciences. Hypotheses will be tested using students’ test and Chi-square test statistics at P=0.05.

Ethical consideration: Proposal will be submitted to the research ethics committees and also permission will be sought from the ministry of health for the study.

References

Berkman N, DeWalt D, Pignone M, et al. (2004) Agency for Healthcare Research and Quality. Literacy and Health Outcomes. Summary: Evidence Report/Technology Assessment no.87. Rockville Md;.Available at: http://www.ahrq.gov/clinic/epcsums.  

PATH (2010). Progress in preventing cervical cancer: Updated evidence on vaccination and screening. Outlook. 27(2)1-12

World Health Organization (2013) HPV Vaccination  Comprehensive Cervical Cancer Control: A guide to essential practice http://www.who.int/immunization/hpv/plan/hpv_vaccine_intro_guide

Perlman, S., Wamai, R. G., Bain, P. A., Welty, T., & Welty, E. (2014) Knowledge and Awareness of HPV Vaccine and Acceptability to Vaccinate in Sub-Saharan Africa: A Systematic Review. PLoS ONE 9(3): e90912. doi:10.1371

Selden C, Zorn M, Ratzan S, Parker R. National Institute of Medicine National Library of Medicine, National Institutes of Health, DHHS. Current Bibli­ographies in Medicine: Health Literacy. Available at: http://www.nlm.nih.gov/pubs/cbm/hliteracy.html.

Wang, H., and Wu, S. (2013)  HPV Vaccine Knowledge and Perceived Risk of Cervical Cancer among Female College Students in Taiwan. Asian Pacific Journal of Cancer Prevention 14( 12) 7371-7374 DOI: 10.7314/APJCP.2013.14.12.7371

WHO/ICO Information Centre on HPV and Cervical Cancer (2010). Human Papillomavirus and Related Cancers in Nigeria. Summary Report 2010. Available at www.who. int/hpvcentre

WHO (2014) Considerations regarding consent in vaccinating children and adolescents between 6 and 17years old http://www.who.int/immunization/programmes_systems/policies_strategies