Impact of cervical cancer education on knowledge, attitudes and preventive practices among adolescent girls in secondary schools: a scoping review

Abstract

Cervical cancer remains one of the most preventable yet deadliest cancers affecting women in Africa. Despite global advances in prevention through human papillomavirus (HPV) vaccination, screening, and early treatment, Sub-Saharan Africa continues to experience disproportionately high incidence and mortality rates because of limited health infrastructure, inadequate awareness, and delayed diagnosis. Given that adolescence represents a critical window for establishing lifelong health behaviors, school-based cervical cancer education may provide an effective platform for improving knowledge and promoting preventive practices in line with the World Health Organization’s (WHO) cervical cancer elimination strategy. This review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported following the PRISMA-ScR guidelines. A comprehensive search of PubMed, Scopus, Web of Science, CINAHL, African Journals Online (AJOL), the Cochrane Library, and Google Scholar was undertaken for studies published up to 2026. A total of 1,700 records were identified and screened, resulting in the inclusion of 20 eligible studies. Data were extracted, charted, and synthesized using a narrative approach. Evidence suggests that baseline knowledge of cervical cancer and HPV among adolescent girls in African secondary schools remains generally low to moderate. A consistent knowledge-attitude gap was identified, whereby positive attitudes toward prevention frequently coexisted with limited factual understanding of cervical cancer risk factors, screening, and HPV vaccination. Educational interventions, including peer-led programmes, classroom-based teaching, health campaigns, and multimodal educational strategies, consistently produced significant improvements in knowledge and awareness. However, improvements were less pronounced for more complex concepts, including disease curability, recommended screening intervals, and vaccine mechanisms. Furthermore, an intention-behavior gap was observed, as high levels of vaccine acceptance rarely translated into actual uptake because of parental, sociocultural, and health system barriers. Geographical analysis revealed a substantial concentration of studies in a limited number of Anglophone countries, particularly Nigeria, Ghana, Ethiopia, Kenya, and Uganda, highlighting important gaps in evidence across many African settings. School-based cervical cancer education represents a feasible and scalable strategy for improving cervical cancer literacy among African adolescents. However, achieving the WHO’s cervical cancer elimination targets will require a shift from isolated educational sessions toward sustainable, curriculum-integrated, multilevel interventions involving schools, families, healthcare providers, and policymakers. Future research should prioritize the evaluation of long-term behavioral outcomes, particularly HPV vaccine uptake and participation in cervical cancer screening programmes.