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

Cervical cancer is a leading cause of cancer death among women in Zambia, and vaccination of girls aged 9-14 years against human papillomavirus (HPV) is the principal primary prevention strategy. Because the vaccine is given to minors, uptake depends on parental consent, which is shaped by how parents perceive the vaccine. In Kabompo, a rural, ethnically diverse district of North-Western Province, only 59% of eligible girls had been vaccinated by 2024, well below the global target, yet no qualitative evidence existed on how parents in such settings understand and decide about the vaccine. We conducted a descriptive phenomenological study at Kabompo Hospital Affiliated Health Centre between June and August 2025. Twenty parents and legal guardians of girls aged 9-14 years were purposively selected using maximum variation sampling and interviewed in depth in English or Luvale. Interviews were audio-recorded, transcribed verbatim and analysed using Colaizzi's seven-step method with QDA Miner Lite. Five themes were generated: knowledge and awareness of HPV and its vaccine; perceptions of safety and efficacy; sociocultural and religious influences; the role of health workers; and barriers to access. Most parents knew the vaccine prevents cervical cancer, but few could explain how HPV causes cancer or state the schedule, and several first learned about the vaccine at the point of service. Fear of infertility was the most prominent concern, alongside unease that the vaccine was too new. Religious framings of divine protection, preference for herbal remedies, and concern that vaccination condones early sexual activity shaped decisions. Health workers were the most trusted source of information and were often decisive. Distance, transport costs, fear of injections and incomplete dosing limited uptake. Stated acceptability was high but did not consistently translate into vaccination, indicating an intention-behaviour gap that information campaigns alone are unlikely to close.