A Study on Knowledge and Screening for Cervical Cancer among Women in Mangalore City

"Cancer Education on Wheels," a Novel Cost-Effective Method in Creating Awareness in the Community: a Pilot Study

Cancer education raises disease awareness, the value of early identification and importantly the need for prompt screening and treatment when diagnosed. In this study, an effort was made to understand how well a unique cancer education program, "Cancer Education on Wheels," transfers knowledge in general public in society. The community was shown prerecorded cancer awareness videos using a TV monitor, CD player, and speaker system mounted on an eight-seat Toyota Innova. Before and after seeing the video presentation, consenting volunteers filled out questionnaires asking about demographics and understanding of cancer. Frequency and percentage calculations were done on the demographic information and a Wilcoxon signed-rank test was run on the overall subject score. Data was stratified based on demographic information and compared by applying Kruskal-Wallis test and Mann-Whitney test. p values under 0.05 were regarded as significant. A total of 584 people completed the pre-test and post-test questionnaires. The Wilcoxon signed-rank test revealed a difference between the pre-test and post-test (3.29 ± 2.48 vs. 6.78 ± 3.52; P = 0.0001). The pre-test results showed that volunteers between the ages of 18 and 30; men; students; urban residents; single volunteers; graduates; people who had known a person/or family member with cancer; and people who were aware of the suffering cancer causes had a high baseline knowledge of cancer (p = 0.015 to 0.001). The post-test results show that participants who had less baseline scores like housewives and unemployed people performed better (p = 0.006 to 0.0001). The findings unambiguously demonstrated that "Cancer Education on Wheels" was successful in raising participants' awareness of cancer signs and screening. Additionally, the findings showed that volunteers who were aged, married, housewives, and unemployed had higher scores. Most importantly, this approach to cancer education is simple to organize and carry out in a local setting. It is also affordable and simple to execute using readily available technological equipment and manageable logistics. According to the authors' knowledge, this is the first study to use "Cancer Education on Wheels" to spread awareness of cancer throughout the neighborhood especially in budget constrained areas.

Cervical Cancer Screening Coverage at Tertiary Care Institutes Across India

OBJECTIVES

The 70% screening coverage target proposed in the global cervical cancer elimination strategy is not achieved even at tertiary centres in India. A situational analysis was done to assess the currently existing facilities and barriers in tertiary care institutes.

METHODS

This cross sectional multicentric study was conducted from August to September 2021 in six tertiary care institutes across India. Women aged 30-49 years attending outpatient services (OPD) were invited for cervical screening. Women and health care professionals (HCPs) were administered structured questionnaires to assess knowledge, attitude and practices regarding cervical cancer screening services.

RESULTS

Out of 6709 eligible women who attended OPD, 1666 (24.8%; range:19-57%) received screening. Availability of screening kits was limited to 10-25 Pap/HPV tests per day. Visual inspection with acetic acid (VIA) and HPV testing were offered only at certain centres. Colposcopy and treatment facilities were optimal at all centres. Knowledge, attitude and practices were analysed for 1800 women: 45.7% had heard of cervical cancer, 78.0% did not know that it is preventable, 75.8% never heard about screening. Common symptoms correctly identified included postmenopausal bleeding (4.8%), postcoital bleeding (5.7%), intermenstrual bleeding (5.8%) and vaginal discharge (12.4%). Risk factors were identified by minority: poor menstrual hygiene (6.6%), oral contraceptive pill use (6.4%), multiparity (4.4%), and HPV infection (3.0%). Out of 21, mean total knowledge score (MTKS) was 2.07± 2.67. Out of 317 HCPs, 96.5% knew that cervical cancer is caused by HPV infection, is preceded by premalignant stage, and that it is preventable by screening and treatment (80.1%). Knowledge about screening modalities was present in 87.4% for cytology, 75.1% for VIA, 68.8% for HPV test. MTKS of HCPs was 20.88±6.61 out of 32.

CONCLUSION

Even at tertiary centres, limited availability of HPV tests, reluctance to implement VIA and lack of awareness among women remain the major barriers.

Knowledge on cervical cancer among Indian women in the state of Gujarat

Women all around the world are affected by Cervical Cancer (CC). Nearly 5, 00,000 women were diagnosed with cervical cancer and more than 270,000 women die every year. Cervical Cancer is the second most typical form of Cancer in females worldwide. The aim of this study is to evaluate the effectiveness of an awareness programme on knowledge and attitude regarding CC among women. Quasi experimental research design was selected to evaluate the effectiveness of an awareness programme. Non-probability convenient sampling method was used to select 60 women from setting. Self-prepared multiple choice questionnaire was used to assess the knowledge level of women and 5 point likert scale (uni-dimensional scale for collecting opinion) was used to assess the attitude level of women. The Results were discussed by using mean, SD, paired "t" test and chi-square test. Data were collected & gathered. Knowledge levels were 2.87±1.50 and attitude level was 6.37±13.35 reported in the control group. But the knowledge and attitude levels in the experimental group were respectively 9.73±2.60 and 12.87±14.72. It concluded that the CC awareness program was successful in changing women's attitudes through knowledge.

Using Delphi method to develop Chinese women's cervical cancer screening intention scale based on planned behavior theory

BACKGROUND

Cervical cancer is the most common malignant tumor in women with a high mortality rate. However, the awareness and participation of women in cervical cancer screening were not high, and rare attention was paid to cervical cancer screening. The extensive promotion and execution of cervical cancer screening in China are still facing difficulties. In order to fully comprehend and evaluate the barriers and promote factors of cervical cancer screening in women, the objective of this study was to develop a scientifically sound and clinically useful Chinese cervical cancer screening intention scale. This study would allow for the development of targeted interventions which may contribute to the increase of individual participation in cervical cancer screening going forward.

METHODS

This study used the Delphi method to construct a Chinese cervical cancer screening intention scale based on the theory of planned behavior (TPB) and evaluate its validity. The study was based on the overview of the TPB questionnaire proposed by Ajzen, and was conducted through the literature search and two rounds of the Delphi expert consultation. According to the literature search published from 2012 to 2022, the scale item pool was established and a questionnaire was designed. A survey of 16 experts from 6 different provinces, cities and regions in China was conducted, and the Delphi technique was used to collect and analyze expert opinions data.

RESULTS

The final scale consisted of 4 dimensions and 23 items. The response rates in two rounds of expert consultation were 80% and 93.75%, respectively, with authority coefficients of 0.928 and 0.930. Variation coefficients varied from 0.07 to 0.21. Dimensions included "attitude towards behavior", "subjective norm", "perceived behavioral control" and "behavioral intention".

CONCLUSIONS

Women's cervical cancer screening intentions could be assessed with the scale, since it had high validity and reliability, as well as high authority and coordination, meanwhile affording explanations and improving the efficiency of interventions.

Cervical cancer screening-related knowledge among community health workers in Eswatini: a cross-sectional survey

Eswatini has the highest age-standardized incidence and second highest mortality rate related to cervical cancer globally. In Eswatini, community health workers educate communities about cervical cancer screening. They need to have accurate knowledge about cervical cancer and screening to do this effectively. Therefore, the current study aimed to assess knowledge regarding cervical cancer screening among community health workers in Eswatini. A telephone survey of 172 community health workers from eight selected constituencies was conducted. Descriptive analyses were performed to assess participants' socio-demographic and service-related characteristics. Linear regression was applied to investigate factors associated with cervical cancer screening-related knowledge. One hundred and seven (62%) participants answered at least 80% of the questions correctly. However, knowledge regarding cervical cancer risk factors, the meaning of screening results and Eswatini cervical cancer screening guidelines was suboptimal. Community health workers aged 46-55 were more likely (β = 1.27, 95% confidence interval [CI]: 0.39-2.15, p < 0.01) to have a higher cervical cancer screening knowledge score than those aged 30-45 years. Community health workers from Lubombo were marginally less likely (β = -0.83, 95% CI: -1.80 to -0.04, p = 0.05) to have a higher knowledge score than those from Hhohho. This study suggests knowledge deficits amongst community health workers in Eswatini. Knowledge deficits may result in inaccurate information being communicated to clients. While increasing knowledge of these vital health workers may not be sufficient to increase cervical cancer screening rates in Eswatini, it is an essential first step that should be the focus of future educational efforts.

Asking physicians how best to implement cervical cancer prevention services in India: A qualitative study from Mysore

Cervical cancer is the second most common cancer among Indian women. Screening is an effective prevention strategy, but achieving high screening rates depend upon identifying barriers at multiple levels of healthcare delivery. There is limited research on understanding the perspectives of providers who deliver cancer prevention services. The objective of this study was to explore physician perspectives on cervical cancer prevention, barriers to effective implementation, and strategies to overcome these barriers in India. Guided by the "Multilevel influences on the Cancer Care Continuum" theoretical framework, we conducted semi-structured interviews with physicians in Mysore, India. From November 2015- January 2016, we interviewed 15 (50.0%) primary care physicians, seven (23.3%) obstetrician/gynecologists, six (20.0%) oncologists, and two (6.7%) pathologists. We analyzed interview transcripts in Dedoose using a grounded theory approach. Approximately two-thirds (n = 19, 63.3%) of the participants worked in the public sector. Only seven (23.3%) physicians provided cervical cancer screening, none of them primary care physicians. Physicians discussed the need for community-level, culturally-tailored education to improve health literacy and reduce stigma surrounding cancer and gynecologic health. They described limited organizational capacity in the public sector to provide cancer prevention services, and emphasized the need for further training before they could perform cervical cancer screening. Physicians recommend an integrated strategy for cervical cancer prevention at multiple levels of uptake and delivery with specific efforts focused on culturally-tailored stigma-reducing education, community-level approaches utilizing India's community health workers, and providing physician training and continuing education in cancer prevention.

Awareness, knowledge and screening for cervical cancer among women of a faith-based organization in Nigeria

Introduction

cervical cancer is the second most frequent cancer among women in Nigeria. With proper screening, the disease can be detected early enough and properly managed. However, there seems to be limited knowledge of cervical cancer among women and several barriers might prevent them from accessing the screening services. We determined the awareness, knowledge and screening for cervical cancer among women of a faith-based organization in Nigeria.

Methods

we employed descriptive survey research design and purposively sampled a Catholic Parish in Nsukka Local Government Area of Enugu State, Nigeria. All consenting women in the Parish were used for the study. We utilized researchers' structured instrument titled ‘Awareness and knowledge about Cervical Cancer and Screening’ to collect data. Frequencies, percentages and logistic regression were employed for data analysis.

Results

awareness of cervical cancer (70.8%) and its screening (68.1%) are high but there is generally poor level of knowledge (65.3%) of different aspects of cervical cancer among the women. Age (aOR: 7.183, 95% CI 1.769-29.168; p=.006), number of children (aOR: .074, 95% CI .009- .631; p=.017), and occupation (aOR: .032, 95% CI .004-.260; p= .001 and aOR: .050, 95% CI .007-.347; p=.002) were significantly associated with knowledge of cervical cancer. Majority of the women studied had never been screened for cervical cancer (91.7%) and the reasons for not screening ranged from lack of knowledge of; where to go for screening (69.7%) and the importance of being screened (40.9%) to not feeling susceptible to cervical cancer (18.2%).

Conclusion

there was generally poor knowledge of cervical cancer and its screening; and very poor screening practice. There is, therefore, an urgent need to improve women´s knowledge of cervical cancer and address the identified barriers in order to improve screening practices of the women.

Knowledge and intentions regarding the Pap smear test among Saudi Arabian women

Background

The knowledge of Pap smear and uptake of preventive behaviors to prevent cervical cancer are the most important contributors to the advanced stage of the disease. Knowledge is one of the most leading factors to predict the health behaviors and a helpful factor in performing screening procedures. This study aimed to investigate Saudi Arabian women knowledge of Pap testing in relation to their intention to undergo the test.

Methods

An online survey including demographic characteristics (3 questions), knowledge (13 questions), and intentions (3 questions) towards Pap smear was completed by 467 Saudi Arabian women. Data were analyzed through SPSS version 22, using descriptive statistics and correlation to measure the relationship between knowledge, demographic factors, and intention.

Results

The study found that average level of knowledge was 1.3 which is between high and moderate knowledge, and the average score for the intention was 2.88, to indicate that the intentions to uptake Pap smear among the participants were above the average. The study revealed a significant correlation between demographic factors and intention (p<0.01).

Conclusion

Findings from the current study can inform health care providers about Saudi Arabian women knowledge of Pap smear and the intention to uptake the test. Strategies to motivate women to undergo Pap screening should be introduced.

Knowledge, Attitude, and Practice on Cervical Cancer and Screening Among Women in India: A Review

Background:

Cervical Cancer is the second most common cancer among women in the world leading to 90% deaths in low and middle income countries. About 96,922 new Cervical Cancer cases are diagnosed annually in India.

Objective:

To study the knowledge, attitude and practice on Cervical Cancer and screening among women in India.

Materials and Methods:

Health sciences electronic databases PubMed and Google Scholar were searched for studies published between 2012 to March 2020. Keywords used for the search were (“Cervical Cancer screening”), (“knowledge”),(“attitude”), (“practice”) AND (“India”). 19 articles were included in the review based on the eligibility criteria. Statistical software SPSS-V.23 was used for the statistical application.

Results:

7688 women were included in the study. Age of study participants ranged from 12-65 years. Overall knowledge on Cervical Cancer among women was 40.22%. Knowledge of risk factors and signs and symptoms was fairly adequate among the women. 32.68% of women knew that early age of marriage was a risk factor for Cervical Cancer followed by 23.01% women who mentioned that early age of initiation of sexual activity was a common risk factor for Cervical Cancer. Inter menstrual bleeding and foul smelling discharge was the most common sign and symptom reported in 30.75% and 28.86% women respectively. Knowledge, attitude and practice regarding Cervical Cancer screening was seen in 20.31%, 43.64% and 13.22% of women respectively.

Conclusion:

Effective information, education and communication strategies are required to improve the level of awareness of women on Cervical Cancer.

Knowledge, Attitude and Practices Towards Cervical Cancer and its Screening Among Women from Tribal Population: a Community-Based Study from Southern India

Background

Cervical cancer continues to be a leading cancer among women in India. Despite availability of various screening techniques, majority of Indian women remain unscreened for cancer cervix. The increasing incidence could be attributed to the lack of awareness regarding cervical cancer screening and paucity of organized screening facilities in the country. This study assessed the knowledge, attitude and practices (KAP) towards cervical cancer screening among tribal women of coastal Karnataka, southern India.

Methods

A community-based cross-sectional study was conducted among 1140 women aged 20–65 years from three tribes. Information on their KAP towards cervical cancer screening was collected using a semi-structured questionnaire.

Results

Mean age of the participants was 39.8 ± 10.1 years. Although 82.9% of the participants reported to have heard of cervical cancer, 51% were aware that the disease could be prevented, and only 2.3% knew that it can be detected at an early stage. Over 75% of the participants did not have adequate knowledge regarding cervical cancer. However, majority of them (99.9%) had a favourable attitude towards cervical cancer screening. None of them had undergone cervical cancer screening prior to the study. The knowledge scores were significantly associated with age group, marital status, education level, socioeconomic status and tribal community of the participants (p < 0.05).

Conclusion

Overall knowledge regarding cervical cancer among the surveyed women was poor, though they exhibited a positive attitude. This calls for a sustained health education and screening program to create awareness and improve the uptake of cervical cancer screening among these women.

Cervical Cancer Screening Acceptance among Women in Dabat District, Northwest Ethiopia, 2017: An Institution-Based Cross-Sectional Study

Background

Cervical cancer is a global health problem. It is the second most common cancer in women worldwide, and it is the most frequent form and the leading cause of cancer mortality among Ethiopian women. Cervical cancer screening can reduce at least 50% of cervical cancer deaths. In Ethiopia, practice of cervical cancer screening is below 1%. Hence, this study aimed at assessing cervical cancer screening acceptance and determinant factors among women in Dabat district of Northwest Ethiopia.

Methods

A community-based cross-sectional study design was conducted in Dabat district in Northwest Ethiopia, 2016. The multistage sampling method was used to recruit 790 women from the selected rural and urban kebeles. Data were collected using a structured questionnaire. Multivariate logistic regression analysis method was employed to determine factors significantly associated with the acceptance of cervical cancer screening with a 95% CI at p value <0.05.

Results

The overall awareness of cervical cancer screening was 12.1% (95% CI: 9.6, 14.5), and 17.1% (95% CI 14.4, 19.8) of them accepted the screening. In multivariate logistic regression analysis, having knowledge about cervical cancer (AOR = 2.6, 95% CI: 1.7, 3.8), parity women who had more children (AOR = 3.1, 95% CI: 1.7, 5.5) and those who perceived the severity of the disease (AOR = 1.9, 95% CI (1.3–3.1)) were statistically significant factors for acceptance of cervical cancer screening.

Conclusions

Most of the women had poor awareness and acceptance of cervical cancer screening. The findings also revealed that women of multiparous, knowledge about cervical cancer, and perceived the disease as severe were shown to be significant factors of acceptance for cervical cancer screening. Hence, continuous health education and appropriate counseling to women should be performed.

Challenges of health promotion and education strategies to prevent cervical cancer in India: A systematic review

BACKGROUND

Although there is a reduction in cervical cancer incidence over the years, it keeps the second position of the most common cancers among females in India. The aim of this review is to understand the challenges of health promotion and education strategies to prevent cervical cancer in India.

MATERIALS AND METHODS

This review is based on 78 studies published during 1993-2017 on the topics of awareness, attitude, and acceptance toward cervical cancer, screening, and human papilloma virus vaccination among Indians. The extracted information was summarized according to different populations such as people from different social and community groups, women and men attended clinics, students (nursing/medical/nonmedical), health-care providers (doctors, nurses, and other health workers), migrated Indians, and cervical cancer patients.

RESULTS

The awareness about cervical cancer and its prevention was very poor among women from different communities and the majority had a negative attitude toward screening and vaccination in general. The health professionals and medical students were more aware of cervical cancer and its prevention compared to the general population. Majority of students irrespective of medical or nonmedical background had a positive attitude toward vaccination. Only a small proportion of women in the general population were ever screened.

CONCLUSIONS

Observations from this review indicate immediate attention of the public health authority to take appropriate actions to educate and motivate general population toward cervical cancer prevention and to improve the facilities to incorporate the much needed preventive and early detection interventions in India.

Peer Educators as Change Leaders - Effectiveness of Peer Education Process in Creating Awareness on Reproductive Health among Women Workers in Textile Industry

Context:

India is one of the leading manufacturers of garments with roughly 80% of the workforce dominated by female migrant workers. Lack of education and access to resources in these women contribute to unsafe sexual behaviors, sometimes leading to unwanted pregnancies or sexually transmitted infections (STIs). Awareness raising, and peer education in particular, is extremely effective in addressing reproductive health issues.

Aims:

This study aims to study the effectiveness of peer health education in improving the awareness on reproductive health among women workers in textile industries.

Settings and Design:

A health educational interventional study for women in garment and spinning mills using peer education process carried out over a period of 18 months.

Subjects and Methods:

The process includes orientation to factory management, health needs’ assessment, identifying health topics, peer educators’ selection, peer educator trainings followed by outreach sessions, and impact measurement. The impact of peer education on reproductive health has been assessed among 597 participants from 9 factories.

Statistical Analysis Used:

Data were entered in SPSS version 24 and analyzed. Results were expressed as percentages. Chi square test was used where appropriate to find association between categorical variables.

Results:

The mean age of the workers in both the groups is 25.4 (±9.6) years and 25.1 (±8.3) years. In both the groups, most of the workers were single and more than half of them reside within the factory premises. Significant change in menstrual hygiene practices, knowledge in family planning methods, STIs, and cervical cancer has been observed following peer health education.

Conclusions:

A well-designed health educational interventional program using peer educators could be a successful approach to create awareness on sensitive topics.

Risk Factors of Cervical Cancer: A Case-Control Study

Objective:

Cervical cancer is one of the most common malignancies among women. The present study aims to assess the risk factors for cervical cancer in women aged 25-80 years.

Methods:

The current study was a case-control study. In total, 75 age matched cases and 75 controls were enrolled. In case group sampling technique was total enumeration. Sampling for control group is done by purposive sampling. Women who satisfied the inclusion criteria were included in the study. A questionnaire was developed to assess the risk factors of cervical cancer among the participants. Face to Face interview were conducted with the participants.

Results:

There was a significant association (P < 0.05) of cervical cancer with education, place of residence, using an old cloth sanitary napkins, young age at marriage, number of husband's partners, washing the genitalia after sexual intercourse, and availability of health services. Bathing daily and during menstruations was found to be preventive factors for cervical cancer. In logistic regression, the utilization of health services and the presence of sexually transmitted infections showed a significant association with the development of cervical cancer.

Conclusions:

The present study aimed to assess the risk factors of cervical cancer. With prior knowledge of risk factors, cervical cancer can be identified. Identification of high-risk populations and starting early screening is found to be effective in early recognition of cervical cancer.

Knowledge and Attitude of Adolescent Girls and Their Mothers Regarding Cervical Cancer: A Community-Based Cross-Sectional Study

Background:

Cervical cancer is the second most commonly diagnosed cancer in India. The mother's awareness about the symptoms and risk factors has a large impact on the daughter's knowledge and attitude. Mother and adolescent daughter duos were selected as the sample as they are the target population at risk for suffering from carcinoma cervix. Mothers are the prime information providers and in an excellent position to aware their adolescent daughters about cervical cancer.

Objectives:

The aim of this study is to determine knowledge and attitude of adolescent girls and their mothers regarding cervical cancer and to find the association between the education of the mothers and their knowledge about risk factors.

Materials and Methods:

A community-based cross-sectional study was conducted among 100 duos of adolescent daughters along with their mothers residing in Balmiki Basti (Delhi), using a predesigned, pretested, semi-structured interview schedule. The collected data were analyzed using SPSS-22 version.

Results:

Only 61% of mothers and 52% of daughters have heard about cervical cancer. Inter-menstrual bleeding was the most common symptom recognized by the mother (50%) and daughter (44%) duos followed by postmenopausal bleeding (47% of mothers and 33% of daughters). Most common risk factors recognized by mothers and their daughters were promiscuity and tobacco and smoking. About 81% of mothers and 68% of daughters have a positive attitude toward internal examination by a gynecologist at least once in 3 years. Human papillomavirus infection was recognized as a risk factor by 13 among which 8 were educated till graduation (P < 0.05).

Conclusions:

Study revealed a low-level knowledge about cervical cancer among adolescent daughters and their mothers. Therefore, there is an urgent need to empower the women by educating them on this issue. Furthermore, there is a need to encourage the mothers to communicate the right information to their adolescent daughters.