Knowledge and Attitude Toward Human Papillomavirus Infection and Vaccination among Thai Women: A Nationwide Social Media Survey

Knowledge and health literacy related to human papillomavirus infection, cervical cancer, and cervical cancer screening among nursing students in rural and urban areas of Thailand

BACKGROUND

Cervical cancer is the second leading cause of death among women in Thailand. Understanding health literacy and knowledge of HPV, cervical cancer, and their screening is vital for nursing students as they prepare for professional practice.

OBJECTIVES

To identify factors influencing health literacy and knowledge of HPV infection, cervical cancer, and screening among Thai nursing students at rural and urban universities.

DESIGN

A cross-sectional descriptive comparative study.

PARTICIPANTS/SETTINGS

Current undergraduate nursing students from rural and urban universities in Thailand.

METHODS

A self-administered survey assessed health literacy and knowledge related to HPV infection, cervical cancer, and their screening. Descriptive and logistic regression analyses were used to identify factors associated with these variables.

RESULTS

Among 641 nursing students (255 rural students and 386 urban students), rural students had significantly higher mean scores in cervical cancer screening knowledge (t = -4.86, p < 0.001) and health literacy compared to urban students (t = -2.57, p = 0.01). Rural students using the internet more than three days per week were 1.92 times more likely to have better knowledge of HPV and cervical cancer (95 % CI: 1.10-7.73). Awareness of HPV (ORa = 2.51, 95 % CI: 1.31-4.80) and frequent internet use (ORa = 2.31, 95 % CI: 1.04-5.12) were associated with higher knowledge about cervical cancer screening and health literacy among rural nursing students.

CONCLUSIONS

Rural students exhibit higher health literacy and knowledge about cervical cancer screening than urban students. These findings highlight the need for diverse teaching strategies to enhance students' understanding and competency.

Attitude toward human papillomavirus self-sampling and associated factors among Thai women undergoing colposcopy

OBJECTIVE

To compare attitudes toward self-sampling for human papillomavirus (HPV) testing before and after specimen collection in women undergoing colposcopy. The factors associated with the pre-sampling attitude were also studied.

METHODS

This prospective study enrolled women with abnormal cervical cytology and/or positive high-risk HPV who attended colposcopy clinics at 10 cancer centers in Thailand between October 2021 and May 2022. Prior to colposcopy, the attitudes of the women toward self-sampling were surveyed through a questionnaire. Written and verbal instructions for self-sampling were provided before the process and subsequent colposcopy. The attitudes toward self-sampling were reassessed after the actual self-sampling. Factors associated with the attitudes were analyzed.

RESULTS

A total of 499 women were included in this study. The mean age was 39.28±11.36 years. A total of 85.3% were premenopause, and 98.8% had sexual experience. With the full score of 45, the attitude score after self-sampling was significantly higher than the attitude score before self-sampling (39.69±5.16 vs. 37.76±5.71; P<0.001). On univariate analysis, the factors associated with attitude before HPV self-sampling were age, menopausal status, sexual activity, education level, income, knowledge regarding HPV, and prior high-grade squamous intraepithelial lesion histology. The remaining significant factor on multivariate analysis was sexual activity within the past year (B=0.105, 95% confidence interval, 0.014-2.870; P=0.048).

CONCLUSION

Attitudes toward self-sampling improved after the actual self-sampling process, as evidenced by higher attitude scores. Sexual activity was the only independent factor related to the attitude before self-sampling.

Social media use in HPV-, cervical cancer-, and cervical screening-related research: A scoping review

OBJECTIVE

In response to the World Health Organization's global call to eliminate cervical cancer, many countries have targets to implement human papillomavirus (HPV) primary screening. Social media may offer opportunities to promote uptake of HPV screening. We aimed to describe the extent of the scientific literature regarding social media research on HPV, cervical cancer and cervical screening.

METHODS

Seven databases were searched for peer-reviewed English-language studies related to social media research and HPV, cervical cancer and cervical screening published up to November 2023. One reviewer completed the title/abstract screening and two reviewers independently reviewed full-text articles. Data extraction was carried out by one reviewer and verified by a second reviewer. Information such as the research topic, social media platform of interest, participant characteristics, methods, analysis type, outcome measures, and key findings were collected.

RESULTS

In the 58 articles included, researchers used social media in the following ways: evaluate content, recruit participants or disseminate a survey/questionnaire, disseminate health communication content, examine the relationship between social media use and outcomes, and to conduct experiments testing the effects of social media content on outcomes. Twitter and Facebook were the most common platforms mentioned. Four articles explicitly mentioned theory.

CONCLUSIONS

Opportunities for research are identified such as further exploration of how newer social media platforms such as Instagram and TikTok can be used to share HPV content, examination of appropriate images for effective communication, and determining key features of social media content to promote information sharing and improve cervical screening knowledge, attitudes and behaviours.

Survival after Diagnosis of Cervical Cancer Patients at a Tertiary Referral Hospital in Northeast Thailand

BACKGROUND

Cervical cancer (CC) is the third most common cancer in women globally, including Thailand, where the incidence rate was 16.2 cases per 100,000 individuals in 2018. Survival rates for patients with this condition have not improved over recent years. This study evaluated the survival rate and median survival time after diagnosis among CC patients, and investigated factors associated with survival in Northeast Thailand.

METHODS

This study included CC patients admitted to the gynecological ward at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand from 2010 to 2019. Survival rates and median survival time since the date of diagnosis and 95% confidence intervals (CIs) were calculated. Multiple cox regression was performed to investigate factors associated with survival which were quantified by adjusted hazard ratios (AHR) and their 95% CIs.

RESULTS

Of 2,027 CC patients, the overall mortality incidence rate was 12.44 per 100 person-years (95% CI: 11.7 - 13.22), median survival time was 4.82 years (95% CI: 3.92 - 5.72), and 10-year survival rate was 43.16% (95% CI: 40.71 - 45.59). The highest 10-year survival rate was 87.85% (95% CI: 82.23 - 91.78) found among those with stage I CC, followed by those who received surgical treatment, which was 81.22% (95% CI: 74.47 - 86.35). Factors that were associated with decreased survival included age ≥60 years (AHR = 1.25; 95% CI: 1.07 - 1.46), health insurance with the Universal Health Coverage Scheme (UCS) (AHR = 6.26; 95% CI: 5.13 - 7.64), malignant neoplasms histopathology (AHR = 1.36; 95% CI: 1.07 - 1.74), and treatment with supportive care (AHR = 7.48; 95% CI: 5.22 - 10.71).

CONCLUSION

Among patients diagnosed with CC, those with stage I had the highest 10-year survival rate. CC patients with older age, UCS, malignant neoplasms histopathology, and received supportive care showed the highest survival association.

A Scoping Review of Knowledge, Awareness, Perceptions, Attitudes, and Risky Behaviors of Sexually Transmitted Infections in Southeast Asia

This scoping review synthesizes literature to examine the extent of research focusing on knowledge, awareness, perceptions, attitudes, and risky behaviors related to sexually transmitted infections (STIs) in Southeast Asia (SEA). The PRISMA-Scoping approach was adopted targeting articles published from 2018 to 2022, sought from CINALH, PubMed, Web of Science and Scopus. A process of screening and elimination resulted in a total of 70 articles reviewed. Most of the studies were conducted in Indonesia, Thailand, Vietnam, and Malaysia, with the majority focusing on HIV/AIDS. In general, studies examining knowledge, awareness, and risky behaviors related to STIs in SEA reported low levels across various cohorts. However, evidence suggests that these issues are more prominent among individuals with low levels of education or low socioeconomic status, those living in rural areas or those working in the sex/industrial sectors. Engaging in unsafe sex and having multiple partners are the key examples for risky sexual behavior, while fear of being rejected/discriminated/stigmatized and lacking STI awareness were identified as social risky behaviors in SEA. Overall, cultural, societal, economic and gender inequality (male dominance) greatly impact people's knowledge, awareness, perceptions, attitudes, and risky behaviors in SEA. Education is an important factor influencing healthy behavior; therefore, this scoping review calls for increased investment in educating vulnerable populations to prevent STIs, particularly in less-developed countries/regions of SEA.

Evaluation of mobile health applications for cervical cancer in the digital marketplace

Objective

To assess the quality of mobile health (mHealth) applications (apps) for cervical cancer using the mobile app rating scale (MARS), APPLICATIONS scoring system, and app rating using specific statements.

Methods

We searched for cervical cancer apps on two major mobile operating systems (Google Play Store and Apple iTunes Store) in March 2021. Eligible apps were downloaded and assessed for quality by two independent reviewers using multimodal assessment tools.

Results

The overall quality of the MARS score was 2.61±0.795. The highest scoring app was “The American Society for Colposcopy and Cervical Pathology (ASCCP) Management Guidelines” (3.98). Overall, apps scored highest in the functionality domain, followed by information, engagement, and aesthetics domains. The mean±standard deviation of the APPLICATIONS scoring system was 8.50±1.712. The highest-rated apps were “ASCCP Management Guidelines,” “The British Society for Colposcopy and Cervical Pathology (BSCCP),” and “Cervical Cancer Guide.” Apps scored the highest in the paid subscription and price domains. By contrast, apps scored poorly in the text search, literature, and subjective presentation domains. Concerning app content, many apps infrequently provided misconceptions regarding cervical cancer. The apps’ rating using specific statements was 7.81±4.562.

Conclusion

Overall, the apps analyzed using the MARS and APPLICATIONS scoring systems demonstrated above-average quality. However, there is a need to improve the essential information conveyed by these applications. Moreover, the assessment tools have influenced different app quality rating results, confirming the lack of standardized quality assessment tools for mHealth apps.