A Designathon to Co-create HPV Screening and Vaccination Approaches for Mothers and Daughters in Nigeria: Findings from a Community-led Participatory Event

"Innovative strategies are needed to promote HPV screening for mothers and vaccination for girls in Nigeria."

Nigeria has low cervical cancer screening and human papillomavirus (HPV) vaccination rates. Many women and girls in Nigeria have limited awareness of cervical cancer and methods for prevention. Engaging the local community to identify and co-create strategies to increase HPV vaccination and cervical cancer screening can be an effective strategy to improve awareness. Researchers with the Actions for Collaborative Community-Engaged Strategies for HPV (ACCESS-HPV) organised a designathon to finalise a set of community-engaged HPV screening and vaccination interventions, identify local female leadership for implementation, and galvanise momentum for policy action.This paper describes the process, summarises the community-led strategies proposed, and discusses public health implications.

The researchers organised a three-phase designathon for women (30-65 years) and girls (11-26 years) in Nigeria. A designathon is a participatory process informed by design thinking that includes: (i) a preparation phase that includes soliciting innovative ideas from end-users, (ii) an intensive collaborative event to co-create intervention components, and (iii) follow-up activities. ACCESS-HPV decided to focus on mother/daughter dyads, given that the engagement of those directly receiving cervical cancer prevention interventions may increase the likelihood of the future uptake of participatory strategies. The approach capitalises on reciprocal learning between mothers and daughters and reinforces prevention attitudes and behaviours. Dyadic strategies align with cultural values in Nigeria, where family involvement in health decisions is a common expectation.

From February 1 2023 to March 12 2023, ACCESS-HPV launched a national crowdsourcing open call for ideas on community-driven strategies to support HPV screening among women and vaccination among girls. The open call was promoted widely on social media and at in-person gatherings. In total, 612 submissions to the open call were received from mother-daughter dyads. Participants submitted ideas via a website designated for the contest (n = 392), in-person (n = 99), email (n = 31), or via an instant messaging application (n = 92). Four hundred and seventy ideas were eligible for judging after initial screening.

Next, 16 teams representing all six geo-political zones of Nigeria were invited to join an in-person event held over three days in Lagos to refine their ideas and present them to a panel of expert judges. Themes from the top 16 proposals included leveraging local leaders, faith-based networks, other community networks, educational systems, and annual female-related celebrations to promote awareness of cervical cancer prevention services. The ideas from teams were reviewed and scored based on relevance, feasibility, innovation, potential impact, and mother-daughter team dynamics.

After this in-person collaborative event, 8 teams were selected to join a 4-week-long innovation training boot camp for capacity building to implement ideas. The participants had intensive training sessions from experts around project logistics and implementation science. The majority of the implementation strategies relied heavily on community networks. This includes faith-based approaches (5 strategies), local leaders and notable people (7 strategies), markets (3), and mobile, media and tele-health approaches (7 strategies). In addition, local media such radio and television stations, market campaigns. and social media jingles were proposed as potential channels to disseminate the HPV services (6 strategies). Also, faith-based institutions, market stalls, community pharmacies, and schools were identified as venues to distribute test kits for screening and vaccination programmes within the communities (8 strategies).

As reported in the paper, this series of participatory activities resulted in high-quality strategies, as determined by independent volunteer judges. This finding is consistent with earlier studies that reported crowdsourcing and designathons leveraging strengths of diverse groups in the community to co-create health interventions. Crowdsourcing is a bottom-to-top problem-solving approach that harnesses the collective intelligence and diverse skills of a large community, known as the "crowd". Bottom-up approaches are more likely to generate innovative and impactful solutions with greater uptake with greater potential for sustainability in the long term.

The researchers conclude that, while they were able to engage females in Nigeria to locally co-create HPV and cervical cancer screening services for implementation in their local communities, there is need for further research to further explore the impact of these strategies and their sustainability in the longer term.