When Information Backfires: Digital Misinformation, Vaccine Hesitancy, and the Erosion of Health Worker Trust in HPV Vaccination Among Parents in Rural and Urban North Central Nigeria

Abstract

Daniel Ikechukwu Oseji, Moses Luke, Osayanmo Idemudia Osagie, Chibueze Linus Osuagwu, Olumide Stephen Adeyeye and Nneka Angela Oseji

Background: In Kogi State, Nigeria, higher parental HPV knowledge correlates with lower vaccination rates, driven by side-effect misinformation and an 83% deficit in reliable data. This mixed-methods study examines how information pathways, misinformation, unstable attitudes, and limited health worker outreach suppress vaccine uptake to inform the national communication strategy.

Methods: In 2025, 336 parents of girls aged 9–14 years across three Kogi State LGAs (Lokoja, Igalamela, Ibaji) were enrolled. Quantitative tools included an HPV knowledge composite (α=0.70), an attitude scale (α=0.44), a barrier inventory among non-vaccinators (n=275), and multivariable logistic regression. Qualitatively, inductive thematic analysis evaluated a focus group discussion in Ibaji LGA, comparing findings across regions.

Results: Unvaccinated parents scored higher on HPV knowledge than vaccinated parents (M=11.16 vs. 8.70, p<0.001), with higher knowledge predicting lower vaccination odds (aOR=0.244, 95% CI: 0.164–0.364, p<0.001). This paradoxical relationship reflects high misinformation prevalence. Among non-vaccinators, 28.3% believed the vaccine promotes early sexual activity, while 71.7% lacked formal information. Overall, 83.0% reported insufficient data, and 55.1% were unaware of vaccine availability. Parental attitudes were highly unstable (α=0.44) and statistically non-significant in the regression (aOR=0.649, p=0.197), indicating malleable beliefs vulnerable to rumours. Although 86.0% of parents prioritize a healthcare professional's recommendation, health workers reached only 39.5% of the population, leaving 35.6% completely unexposed to official channels.

Conclusions: Proliferating misinformation drives HPV vaccine hesitancy in Kogi State. Standard mass awareness campaigns risk aggravating the issue. Nigeria's HPV program must shift from broad broadcasting to targeted, localized interventions utilizing trusted healthcare workers, directly reaching underserved communities currently isolated from formal health information channels.

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