Rethinking Evidence – Beyond Knowledge Scores in HPV Vaccine Uptake

Global immunization programs often rely on standardized indicators like coverage rates, knowledge scores, and attitude indices as proxies for behavior change. While valuable, these metrics can obscure local realities and reinforce top-down notions of what "counts" as evidence. Girl Effect's HPV baseline evaluation in Nigeria illustrates the limits of relying solely on such indicators to explain vaccine uptake.

A mixed-methods design assessed predictors of uptake among 9-year-old girls and parents while capturing community narratives around decision-making. Quantitative surveys (n=1,000 girls; n=2,900 parents) and FGDs with adolescents, parents, teachers, and religious leaders were conducted across five states: Delta, Kaduna, Ekiti, Oyo, and Ondo.

Results showed HPV vaccine uptake of 67% among girls, consistent with national data but with notable state-level variation and lower uptake among out-of-school girls. Parents' awareness of cervical cancer and positive attitudes predicted uptake, while comprehensive knowledge was inversely correlated with vaccination, suggesting that fragmented information may have heightened fears rather than encouraged uptake. For girls, awareness increased the likelihood of vaccination, but higher comprehensive knowledge was negatively associated with uptake. Trusted figures shaped decisions: girls relied most on mothers, schools, and, among out-of-school girls, religious leaders; parents cited spouses, schools, and religious leaders as key influences.

These findings underscore the need to rethink evidence in SBCC. Beyond global benchmarks, relational and community-defined metrics must inform equitable, context-driven strategies that reflect the lived realities of individuals.