Impact of health education intervention on knowledge and attitude towards HPV vaccination in Africa: A systematic review.
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BACKGROUND: Human Papillomavirus (HPV) is a leading cause of cervical cancer, with sub-Saharan Africa experiencing the highest prevalence and mortality. Although an effective vaccine exists, uptake across Africa remains low due to poor knowledge, misinformation, logistical barriers, and vaccine hesitancy. This review aimed to synthesize evidence on the impact of health education interventions on HPV vaccination knowledge and attitudes in Africa. METHODS: This systematic review was conducted following Aromataris & Pearson's guidelines and PRISMA reporting standards. A comprehensive search was conducted in PubMed Central, Scopus, JSTOR, ERIC, and CINAHL for English-language studies published from 2000 onwards. A convergent synthesis approach was applied where quantitative findings were qualitised and integrated with qualitative findings through thematic analysis. This was done because statistical pooling was not feasible due to substantial clinical and methodological heterogeneity across included studies. RESULTS: Findings suggest that interventions improved knowledge, with individual study gains ranging from 42.7% to 79.5% (average 69.3%). Delivery modes included online methods (e.g., videos, lectures) and in-person strategies (e.g., lectures, pamphlets). While knowledge gains were evident, improvements in attitudes and willingness to vaccinate varied across studies, ranging from 8.4% to 71.5%, indicating that information alone does not fully address underlying barriers such as social norms and perceived risk. CONCLUSION: Health education interventions suggested effective improvement in knowledge but were less consistent in shifting attitudes. Policymakers should embed culturally sensitive HPV education into national strategies, while practitioners adopt sustained, holistic approaches. Future research should explore socio-cultural barriers, long-term sustainability, actual uptake, and optimal delivery strategies.