Parents’ perceptions and acceptability of the human papillomavirus vaccine in rural North-Western Zambia: a descriptive phenomenological study at Kabompo Hospital Affiliated Health Centre

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Abstract Background Human papillomavirus (HPV) vaccination is the principal primary prevention strategy against cervical cancer, but coverage in Zambia remains uneven and, in Kabompo District, stood at 59% of eligible girls in 2024 against a national and global target of 90%. Because the vaccine is administered to minors, uptake depends on parental consent, which is in turn shaped by parents’ perceptions and acceptability. Existing Zambian evidence is predominantly quantitative and urban. This study explored parents’ perceptions and acceptability of the HPV vaccine in a rural North-Western Zambian setting. Methods A descriptive phenomenological qualitative study was conducted at Kabompo Hospital Affiliated Health Centre between June and August 2025. We recruited 20 parents and legal guardians of girls aged 9–14 years through maximum-variation purposive sampling. We conducted face-to-face, 20–30-minute in-depth interviews in English or Luvale, guided by a single open-ended core question with theory-informed probes; interviews were audio-recorded and transcribed verbatim. Data were analyzed using Colaizzi’s seven-step method with QDA Miner Lite, and interpreted through Sekhon et al.’s Theoretical Framework of Acceptability. Trustworthiness was addressed through triangulation of transcripts and field notes, member checking, peer debriefing, an audit trail and a reflexive journal. Results Five themes were generated: knowledge and awareness of the HPV vaccine; perceptions of safety and efficacy; sociocultural and religious influences; the role of health workers; and barriers to access. Awareness that the vaccine prevents cervical cancer was widespread, but knowledge of dosing, mechanism and eligibility was shallow, and several parents first encountered substantive information only at the point of service. Positive appraisals of the vaccine coexisted with persistent fertility-related fears and concerns that the vaccine was “too new”. Preference for herbal remedies, religious framings of divine protection and anxiety that vaccination might licence early sexual activity shaped decisions. Health workers were consistently identified as the most trusted source of information and the decisive influence on consent. Distance, transport costs, fear of injections and non-completion of the schedule limited uptake despite stated willingness. Conclusions Parental acceptability of the HPV vaccine in this rural setting was high in principle but was attenuated by an intention–behaviour gap driven by misinformation, sociocultural framing and structural burden. Improving coverage will require moving beyond information dissemination to dialogic, nurse-led engagement with parents’ specific concerns, co-designed with traditional and religious leaders, and supported by outreach and dose-tracking systems that reduce the burden of completion.

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