Health Workers' Perspectives on Caregiver Barriers to Human Papillomavirus (HPV) Vaccine Uptake in Selected Health Facilities in Edo State, Nigeria: A Qualitative Study

Abstract

Background: Human papillomavirus (HPV) vaccination is highly effective in preventing HPV-related disease, yet uptake remains uneven in many low- and middle-income settings. This study explored caregiver-related barriers to HPV vaccine uptake as reported by immunisation-clinic health workers in selected health facilities in Edo State, Nigeria. Methods: A qualitative cross-sectional study was conducted in 2024 among 11 health workers purposively recruited from immunisation clinics in three hospitals in Benin City. Individual in-depth interviews were conducted with a structured interview guide by a trained moderator. Interviews were audio-recorded, transcribed verbatim, independently checked for accuracy, and analysed using Braun and Clarke's thematic approach with MAXQDA 2022. Thematic saturation was reached by the eleventh interview. Results: Participants described low and inconsistent HPV vaccine utilisation at their facilities. Reported barriers included limited awareness, misconceptions and culturally mediated concerns, historical out-of-pocket costs, and intermittent vaccine availability. Participants also described facility-level or transitional gaps in routine integration during Nigeria's 2024 phased HPV vaccine rollout. Suggested strategies included community mobilisation, sustained health education, health-worker training, reliable vaccine availability, and removal of financial barriers. Conclusion: The findings indicate that HPV vaccine uptake in the study setting was shaped by interacting informational, sociocultural, financial, and service-delivery barriers. Because the interviews occurred during a period of national programme transition, reports of payment and non-inclusion should be interpreted as local or historical experiences rather than as current national policy. Strengthening communication, community engagement, workforce capacity, and reliable routine vaccine delivery may support sustained uptake.