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Influence of Cervical Cancer Education on Screening Uptake among Women of Reproductive Age in Nigeria

Abstract

Cervical cancer remains an important public health concern and is one of the major cancers affecting women, particularly in settings where access to preventive services and early detection is limited. Persistent infection with high-risk human papillomavirus (HPV) is the primary cause of cervical cancer, while timely screening and appropriate follow-up can facilitate the identification and management of precancerous lesions before they progress to invasive disease. Cervical cancer education provides women with information about cervical cancer, HPV infection, risk factors, signs and symptoms, prevention, available screening methods, the importance of early detection, and appropriate follow-up after abnormal screening results. Cervical cancer screening uptake refers to the utilization of recommended cervical cancer screening services among eligible women. In Nigeria, screening uptake remains affected by inadequate awareness, misconceptions about cervical cancer and HPV, fear of screening procedures or test results, stigma, cost, limited access to screening services, lack of healthcare information, and inadequate integration of screening into routine healthcare services. Effective cervical cancer education may improve women's knowledge, risk perception, confidence in screening, and willingness to utilize available screening services. Against this background, this study investigates the influence of cervical cancer education on screening uptake among women of reproductive age in Nigeria. The study is anchored on the Health Belief Model (HBM), Theory of Planned Behavior (TPB), and Knowledge-Attitude-Practice (KAP) framework. The Health Belief Model explains preventive health behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding women's decisions to participate in cervical cancer screening. The Theory of Planned Behavior proposes that attitudes, subjective norms, and perceived behavioural control influence intentions and subsequent health behaviours, including screening utilization. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from cervical cancer education may influence screening practices. Collectively, these theoretical perspectives provide a comprehensive framework for explaining how cervical cancer education may influence screening uptake among women of reproductive age in Nigeria. The study adopts a quantitative quasi-experimental research design. Primary data will be collected from women of reproductive age in selected communities and healthcare facilities in Nigeria using a structured interviewer-administered questionnaire. A multistage sampling technique will be employed to select states, local government areas, communities, healthcare facilities, and eligible participants. Where feasible, selected communities or healthcare facilities will be assigned to intervention and comparison groups. Women in the intervention group will receive structured cervical cancer education covering cervical cancer and HPV infection, risk factors, prevention, signs and symptoms, available screening approaches, the importance of early detection, eligibility for screening, possible barriers and misconceptions, and appropriate follow-up after abnormal screening results. Cervical cancer screening uptake will be assessed based on whether participants have previously utilized an appropriate cervical cancer screening service, the timing of their most recent screening, intention to utilize screening when recommended, and completion of appropriate follow-up where applicable. Where feasible and ethically appropriate, self-reported screening uptake may be supported by available screening records. Descriptive statistics will be used to summarize participants' sociodemographic and reproductive health characteristics, exposure to cervical cancer education, and screening uptake. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and multiple logistic regression analysis, will be employed to determine the influence of cervical cancer education on screening uptake. Appropriate diagnostic tests will also be conducted to assess the reliability of the research instrument, model assumptions, goodness of fit, and robustness of the findings. The study anticipates that cervical cancer education will have a significant positive influence on screening uptake among women of reproductive age in Nigeria. Women exposed to structured cervical cancer education are expected to demonstrate improved knowledge of HPV and cervical cancer, greater awareness of screening benefits, reduced misconceptions and fear, and increased utilization of available screening services. Education may improve perceived susceptibility and severity, encourage preventive health behaviour, and promote timely participation in screening and follow-up services. However, education alone may not guarantee screening uptake because women may continue to face barriers such as cost, geographical distance, limited availability of screening facilities, concerns about privacy and discomfort, fear of abnormal results, stigma, and inadequate access to trained healthcare professionals. Consequently, cervical cancer education is expected to be most effective when combined with affordable, accessible, confidential, high-quality screening services and effective referral and follow-up systems. This study is expected to contribute to the literature on cervical cancer prevention, cancer screening, women's reproductive health, health education, disease prevention, and public health in Nigeria by providing empirical evidence on the influence of cervical cancer education on screening uptake among women of reproductive age. The findings will provide useful information for the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency (NPHCDA), state ministries of health, hospitals, primary healthcare facilities, cancer-control programmes, reproductive health professionals, community health workers, development partners, and policymakers regarding strategies for improving cervical cancer prevention and early detection. The study will also provide evidence-based recommendations for strengthening cervical cancer education, integrating screening education into reproductive and primary healthcare services, expanding access to affordable screening, addressing misconceptions and stigma, strengthening referral and follow-up systems, and promoting regular cervical cancer screening among eligible women across Nigeria.

Keywords: Cervical cancer education, cervical cancer screening, screening uptake, women of reproductive age, human papillomavirus, cervical cancer prevention, early detection, women's health, reproductive health, health education, public health, Nigeria.