Senior High School Nurse-led Education (SHiNE) for improving cervical cancer primary prevention among students in Ghana: Pilot cluster non-randomized controlled trial.

OBJECTIVES: Strengthening adolescent HPV vaccination intentions and reduction of cervical cancer risk factors through school-based prevention strategies may improve future vaccine uptake and reduce cervical cancer incidence. This pilot study aimed to inform the design of a future definitive trial by evaluating the Senior High School Nurse-led Education (SHiNE) intervention in relation to: (i) feasibility (uptake, engagement and acceptability) among participants; and (ii) potential to improve HPV vaccination intentions and cervical cancer risk-related behaviors among senior high school students in Ghana. STUDY DESIGN: Pilot two-arm, cluster non-randomised controlled trial. METHODS: The study was conducted in four senior high schools (clusters) in the Ashanti Region of Ghana. Two schools were allocated to receive the SHiNE intervention and two were assigned to a control condition (no intervention). The four-week SHiNE intervention included a nurse-led face-to-face session, printed leaflet, website, and gamified mobile application. Primary outcomes were uptake, engagement and acceptability. Secondary outcomes included HPV vaccination intention, condom use and smoking status. RESULTS: There was strong uptake, and high acceptability of the nurse-led face-to-face session and printed leaflet. There was lower uptake of the website and no uptake of the gaming application. There was some indication of potential effectiveness: at one-month follow-up, students exposed to SHiNE had higher odds (adjusted OR = 4.75, 95% CI 1.85-12.18) of reporting strong intentions to receive HPV vaccination compared with students in the control group. CONCLUSIONS: A nurse-led, school-based education intervention is feasible and has the potential to improve HPV vaccination intentions among adolescents in Ghana. However, while a non-digital approach may be more feasible in low- and middle-income countries, the implementation of digital interventions in school settings remains constrained in the absence of policies permitting students access to technology devices. The findings indicated that further refinement to optimise uptake and engagement of digital intervention and a full-scale effectiveness trial.