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Impact of Cervical Cancer Self-Sampling Education on Cervical Cancer Screening Knowledge among Women in Nigeria

Abstract

Cervical cancer remains an important public health concern among women in Nigeria and is largely preventable through human papillomavirus (HPV) vaccination, appropriate cervical cancer screening, early identification of precancerous lesions, and timely treatment. Despite the availability of screening approaches, many women have limited knowledge of cervical cancer risk factors, HPV infection, recommended screening procedures, screening intervals, and the importance of early detection. Conventional screening methods may also be associated with barriers such as fear, embarrassment, concerns about discomfort, limited privacy, financial costs, geographical distance, and inadequate access to trained healthcare personnel. Cervical cancer self-sampling provides an alternative approach that allows women to collect their own samples for HPV testing and may make screening more acceptable and accessible. Education on cervical cancer self-sampling can improve women's understanding of the procedure, its purpose, appropriate sample collection, HPV testing, interpretation of results, and the importance of follow-up. Against this background, this study investigates the impact of cervical cancer self-sampling education on cervical cancer screening knowledge among women 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 women's perceptions of cervical cancer susceptibility, perceived severity, perceived benefits of self-sampling, perceived barriers, and cues to action may influence their understanding and acceptance of screening. The Theory of Planned Behavior explains how attitudes toward self-sampling, subjective norms, perceived behavioural control, and behavioural intentions may influence women's engagement with cervical cancer screening information. Social Cognitive Theory emphasizes knowledge, self-efficacy, observational learning, social support, and environmental influences in developing preventive health behaviours. Collectively, these theoretical perspectives provide a suitable framework for explaining how self-sampling education may influence women's knowledge of cervical cancer screening. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise women of reproductive age or eligible adult women residing in selected communities or attending selected healthcare facilities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, 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, information about HPV infection, cervical cancer risk factors, benefits of screening, eligibility for screening, self-sampling procedures, sample collection instructions, HPV testing, interpretation of results, recommended follow-up, referral information, educational materials, healthcare-provider counselling, and opportunities for questions and clarification. Cervical cancer screening knowledge will be assessed using indicators such as knowledge of HPV as a major cause of cervical cancer, awareness of cervical cancer risk factors, knowledge of screening benefits, understanding of screening procedures, awareness of HPV self-sampling, knowledge of appropriate screening intervals, understanding of positive and negative screening results, knowledge of the need for follow-up after a positive result, and awareness of available screening services. Data will be collected using structured questionnaires and validated cervical cancer knowledge assessment instruments where appropriate, together with relevant cervical cancer screening programme records and educational materials. Descriptive statistics will be used to summarize participants' demographic characteristics, exposure to self-sampling education, and levels of cervical cancer screening knowledge. 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 impact of cervical cancer self-sampling education on screening knowledge. Where a quasi-experimental design is adopted, knowledge scores before and after exposure to structured self-sampling education may be compared, while relevant demographic, socioeconomic, educational, 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 cervical cancer self-sampling education has a significant positive impact on cervical cancer screening knowledge among women in Nigeria. Women who receive structured and culturally appropriate education are expected to demonstrate greater knowledge of HPV infection, cervical cancer prevention, screening benefits, self-sampling procedures, result interpretation, and the importance of appropriate follow-up than women with limited exposure to such education. Clear information and practical demonstrations may improve women's confidence in understanding and using self-sampling approaches while reducing misconceptions and fears surrounding cervical cancer screening. Education delivered through healthcare facilities, community health programmes, women's groups, and other appropriate platforms may also improve awareness among women who have limited contact with conventional screening services. However, low health literacy, language barriers, misconceptions, limited access to trained educators, inadequate educational materials, and limited availability of HPV testing services may reduce the effectiveness of self-sampling education. The study therefore expects accessible, repeated, culturally sensitive, and evidence-based cervical cancer self-sampling education to contribute significantly to improved cervical cancer screening knowledge among women in Nigeria. The study is expected to contribute to the literature on cervical cancer self-sampling education, cervical cancer screening knowledge, HPV testing, cervical cancer prevention, women's health, reproductive health, health education, cancer prevention, 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, healthcare professionals, women's health organizations, development partners, and policymakers regarding strategies for improving cervical cancer screening knowledge. The study will also provide evidence-based recommendations for integrating HPV self-sampling education into cervical cancer prevention programmes, strengthening community-based screening education, developing culturally and linguistically appropriate educational materials, training healthcare workers and community health educators, improving access to HPV testing services, and linking screening education with accessible referral and follow-up systems across Nigeria.

Keywords: Cervical cancer self-sampling education, cervical cancer screening knowledge, HPV self-sampling, human papillomavirus, cervical cancer prevention, women, health education, cancer screening, women's health, Nigeria, public health.