Awareness, knowledge, perception, and barriers to R21 malaria vaccine introduction in Northern Nigeria: A mixed-methods assessment among nurses in tertiary hospitals.

Background Nurses constitute the largest proportion of the health workforce in Nigeria, and their knowledge and perceptions of the newly introduced R21 malaria vaccine are crucial to its implementation, particularly in Northern Nigeria, where the malaria burden is highest. This study explored nurses’ awareness, knowledge, perceptions, and perceived barriers to the introduction of the R21 malaria vaccine in selected tertiary hospitals in Northern Nigeria. Methods A convergent parallel mixed-methods design was used. Quantitative data were collected from 368 nurses using a structured questionnaire and analyzed using descriptive (frequencies, percentages, and means) and inferential statistics (Statistical significance at p < 0.05). Qualitative data obtained through in-depth interviews with nine purposively selected nurses were analyzed thematically using ATLAS.ti version 8. Findings Awareness and knowledge of the R21 malaria vaccine among nurses were generally poor, with social media identified as the primary source of information. No statistically significant differences in knowledge were observed across health facilities (p > 0.05). Overall perception toward the vaccine was positive, although some uncertainty regarding vaccine safety persisted. Key perceived barriers to uptake included inadequate funding, cold chain and logistical challenges, as well as religious and cultural resistance driven by misconceptions. Conclusion Nurses demonstrated low awareness and limited knowledge of the R21 malaria vaccine, although perceptions toward its introduction were generally favorable, with some uncertainty regarding vaccine safety. The prominence of social media as an information source indicates a shift in information dissemination pathways and highlights the need to leverage digital platforms to improve knowledge and counter misinformation.