Co-Designing HPV Vaccine Programs with Girls and Caregivers: Insights from a Human-Centered Design Approach

Cervical cancer is a significant global health issue, ranking as the fourth highest cause of cancer-related deaths among women globally. HPV vaccination for girls aged 9-14 offers a powerful tool for cervical cancer prevention, yet global coverage remains low, particularly in low- and middle-income countries. While research has documented parental and stakeholder perspectives, few studies center on girls own experiences and how gender norms shape their access and decision-making. This study applied a human-centered design (HCD) approach in Nigeria and Indonesia to explore barriers to HPV vaccination and co-develop context-specific solutions with girls, caregivers, and immunization stakeholders. Eight co-creation workshops were conducted with adolescent girls (ages 10-17) and caregivers in Nigeria (n=64) and Indonesia (n=66). Using HCD techniques--including persona development, journey mapping, and prototyping--participants identified barriers, enablers, and potential solutions. Stakeholder workshops in both countries validated and refined these community-generated ideas. Data were analyzed thematically using UNICEFs Journey to Health and Immunization framework. Across both countries, girls and caregivers reported limited awareness and inconsistent information about HPV vaccination. Misinformation, unclear communication, and insufficient preparation were common. Gender norms strongly shaped decision-making: while mothers typically led discussions, fathers or male community leaders often held final authority, particularly in Nigeria. Access challenges included transportation costs, distance to facilities, missed opportunities during school-based delivery, stockouts, and limited guidance on managing adverse events, with out-of-school girls experiencing the greatest barriers. Co-designed solutions emphasized improving communication through trusted messengers, strengthening coordination between schools and health facilities, increasing engagement with fathers and community leaders, and expanding flexible, community-based delivery models to reach out-of-school girls. Findings underscore the importance of centering girls in HPV program design and demonstrate the value of HCD in generating actionable, locally relevant strategies. Strengthening communication, addressing gender norms, and improving equitable service delivery are critical to increasing HPV vaccination uptake and advancing cervical cancer prevention.