Effect of a comic book-based educational intervention on human papillomavirus vaccine knowledge and safety perception among girls aged 9-14 in Nigeria.
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BACKGROUND: Cervical cancer is a leading cause of death for women and is preventable with the human papillomavirus (HPV) vaccine and regular screening. However, awareness of vaccines and screenings is poor in many low- and middle-income countries. In 2023, Nigeria sought to deliver 15 million doses of the HPV vaccine to girls aged 9-14. Within this vaccination campaign, we studied the effect of a comic book educational intervention on knowledge and perception of HPV, cervical cancer, and vaccine safety in girls eligible for the vaccine. METHODS: This single-arm study evaluated the effect of a bundled educational intervention on HPV knowledge and safety perception. The three-part intervention was a schoolwide assembly and lecture for children using a culturally tailored comic book as a guide, distribution of the comic book to all the children at the school and then separate focus groups with adult community leaders. The primary outcome was the change in the HPV knowledge score in girls aged 9-14 six weeks post-intervention. Exploratory outcomes were the differential effect of low versus high baseline knowledge, vaccine safety perception, and change in vaccine receipt status at the class level. RESULTS: We found significant gains in knowledge across all four states (n = 396; p < 0.01). Classes with lower baseline knowledge gained more from the intervention (p < 0.01). Perception of vaccine safety increased from 62% to 81% (p < 0.01). We did not find a relationship between increased learning and vaccination receipt (p = 0.16). CONCLUSION: Awareness and positive perception of the safety of the HPV vaccine increased following an educational comic book intervention in girls aged 9-14 across Nigeria. Comics may be a low-cost, scalable, and culturally adaptable tool for health education.