Awareness of cervical cancer screening among nursing staff in a tertiary institution of rural India

Objective

To determine the baseline information about the knowledge of cervical cancer and explore attitude and practice of Pap smear screening among staff nurses.

Methods

A pretested structured self administered questionnaire based survey was done on 205 staff nurses working in Rural Institute of Medical Sciences & Research, Saifai, Etawah, containing mostly recognition and some recall type questions about demographics, knowledge about cervical cancer, its risk factors, screening techniques, attitudes towards cervical cancer screening and its practices.

Results

In this study, 74% knew that Pap smear is used for detection of cervical cancer, but only 59% knew that it can detect both cancerous as well as precancerous lesions of the cervix. Only 18% of the respondents knew about human papillomavirus vaccine. A 47% of respondents had never taken a Pap smear; 63% never referred patients for the screening. Most nurses (79%) thought that a speculum examination and Pap smear are procedures to be performed by the doctors. Among all the respondents, only 11% had ever undergone a Pap smear on themselves.

Conclusion

Despite knowledge of the gravity of cervical cancer and prevention by screening, attitudes and practices towards screening were negative.     

Limited Understanding of Pap Smear Testing among Women,a Barrier to Cervical Cancer Screening in the United Arab Emirates

Global data indicate that cervical cancer is the fourth most common cancer among women worldwide. Important factors that affect interventions for early diagnosis of cervical cancer include social beliefs and values and poor knowledge. These may contribute to women’s participation in screening for cervical cancer and have a significant impact on decisions to take preventive action. The present study was conducted with 599 women in the UAE between September 2016 and March 2017. A cross-sectional survey was conducted to determine knowledge about cervical cancer and screening, demographic characteristics and perceived barriers. Knowledge about the Pap smear test was limited, and awareness that they should undergo the Pap smear test every three years even with an initial negative/normal Pap smear result was abysmal. In spite of the positive attitude of the women towards the Pap smear test, almost 80% of the women surveyed had no knowledge of precancerous lesions. Having higher income (21/29, 72%, p=0.027) and more miscarriages were associated with better practice of Pap smears (19/26, 73%, p=0.010). Knowledge levels were significantly higher (66.3±22.2,) that values for attitude (60.5±20.9, p= 0.03, 95% CI {0.22-11.3}, Chi-square 4.38) and practice (53.7 24.1, p= 0.001, 95% CI {6.9-18.1}, Chi-square 19.7). A well-designed health education programme on cervical cancer and benefits of screening should increase the awareness among women in UAE. One point to stress is that better communication with health professionals and improvement of access to health care services should increase the rate of cervical cancer screening.     

Health Literacy,Knowledge on Cervical Cancer and Pap Smear and Its Influence on Pre-Marital Malay Muslim Women Attitude towards Pap Smear

Background: Cervical cancer is preventable. In Malaysia, women are found to have good awareness of the disease and yet, the Pap smear uptake is still poor. Measuring health literacy level could explain this discrepancy. This study aims to determine the relationship between health literacy, level of knowledge of cervical cancer and Pap smear with attitude towards Pap smear among women attending pre-marital course. Methods: A cross sectional study was performed in three randomly selected centres that organised pre-marital courses. All Malay Muslim women participants aged 18 to 40 years old were recruited while non-Malaysian, illiterate, and had hysterectomy were excluded. Validated self-administered questionnaires used were European Health Literacy Questionnaire (HLS-EU-Q16 Malay) and Knowledge and attitude towards Cervical Cancer and Pap Smear Questionnaire. The mean percentage score (mean± SD) was calculated, with higher scores showed better outcomes. Multiple linear regression was used to measure the relationship of independent variables with attitude towards Pap smear. Results: A total of 417 participants were recruited with a mean age of 24.9 ± 3.56 years old. Prevalence of awareness of cervical cancer was 91.6% (n=382, 95% CI: 89.0%, 94.2%) and mean percentage score was 74.7%±7.6. Prevalence of awareness of Pap smear was 59.0% (n=246, 95% CI: 54.2%, 63.8%) and mean percentage score was 80.2% ± 6.5. The health literacy mean score was 13.3±3.6, with minimum score 0 and maximum score 16. The mean percentage score of attitudes towards Pap smear was 64.8%±9.3. Multiple linear regression analysis demonstrated significant relationship between health literacy (p=0.047) and knowledge of Pap smear (p<0.001) with attitude towards Pap smear. Conclusion: A higher health literacy with high knowledge of Pap smear improves the attitude towards Pap smear. Pre-marital course is an opportunistic platform to disseminate information to improve health literacy and knowledge of cervical cancer and Pap smear screening.     

Knowledge,Attitude and Practice of the Pap Smear as aScreening Procedure Among Nurses in a Tertiary Hospital inNorth Eastern India

Background: Cancer of the uterine cervix is one of the most common cancers among women worldwide.Industrialized countries have dramatically reduced the incidence of mortality from cervical carcinoma in the last50 years through aggressive screening programs utilizing pelvic examinations and Papanicolaou (Pap) smearsbut it still remains a major problem in the developing world. Objectives: This study was performed to determineknowledge, attitude and practice of Pap smear as a screening procedure among nurses in a tertiary hospitalin north eastern India. Material and Methods: This cross sectional study was carried out with a questionnairesurvey covering the socio demographic factors, knowledge, attitude and practices about Pap smear screeningamong 224 nurses in Regional Institute of Medical Sciences, Imphal, Manipur, India during December 2011.Results: Two hundred and twenty one participants (98.6%) had heard about cervical carcinoma but 18.3%lacked adequate knowledge regarding risk factors. Knowledge about the Pap smear was adequate in 88.8% ofthe respondents. Out of these, only 11.6% had Pap smear at least once previously. The most common reasons fornon-participation in screening were lack of any symptoms (58.4%), lack of counselling (42.8%), physician doesnot request (29.9%) and fear of vaginal examination (20.5%). Conclusion: Although knowledge of Pap smear asa screening procedure for cervical cancer is high, practice is still low. The nurses who should be responsible foropportunistic screening of women they care for are not keen on getting screened themselves. If we can improvethe practice of Pap smear screening in such experts, they should be able to readily provide appropriate andaccurate information and motivate the general population to join screening programs.     

Knowledge and Attitudes towards Cervical Cancer Screening amongst University of Botswana Female Students

Background: Cervical cancer is the leading cause of cancer deaths in Botswana. More than two-thirds of cases occur in HIV-infected women, in a nation with a high HIV prevalence of 17%. Even though cancer screening is free in health facilities, cervical cancer screening is low. The objective of this study was to assess the knowledge and attitudes of University of Botswana female students on cervical cancer screening. Methods: A cross-sectional study was conducted among University of Botswana female students to elicit information about their knowledge and attitudes on cervical cancer screening. Results: A total of 335 students completed the questionnaire and all reported that they were aware of cervical cancer. The awareness was mostly through brochures, posters and other printed material. Regarding cervical cancer risk 315 (94%) attributed cervical cancer to smoking and 301 (89.9%) to early sexual debut. The majority of students 329 (98.2 %) were aware of cervical cancer screening. Papanicolaou (Pap) smear was the most popular screening test reported by 160 (47.8%) of the respondents as compared to Human Papilloma Virus testing (HPV) reported by 106 (31.6 %) of the respondents. The overall Pap smear screening rate was 92 of 335 students (27.5%). Those who perceived themselves to be at risk of contracting cervical cancer 203 (60.6%) where 1.8 times more likely to go for Pap smear than those who perceived to be safe, (Adjusted Odds Ratio [AOR] 1.834; 95% Confidence Interval [CI]; 1.094-3.067), (P = 0.02). Conclusions: Pap smear screening uptake is low amongst University of Botswana female students. The likely reason for this could be because students do not perceive themselves to be susceptible to cancer so the lesser the likelihood of engaging in preventive behaviours. There is urgent need for university based cancer education campaign on cervical cancer screening benefits and incorporating these campaigns into the existing university medical services to increase uptake of screening programs offered.     

Knowledge and Barriers Towards Cervical Cancer Screening Among Young Women in Malaysia

Objectives: This study examined the level of knowledge and barriers towards cervical cancer screening of female university students. Methodology: A cross-sectional design was used for 287 female students at a tertiary institution located in Selangor, Malaysia. A name list of all students in the all faculties were obtained from each faculty’s registrar and the ethics committee of the Faculty of Health and Life Sciences, approved the study. Respondents completed a consent form before they were given the questionnaire consisting of four sections: socio-demographic characteristics (six questions); risk factor of cervical cancer (six); knowledge about cervical cancer and the Pap smear test (ten); and finally barriers to Pap screening (eleven). Data were analyzed using SPSS version 13. Results: The prevalence of ever having had a Pap test was 6%. Majority of the participants had adequate knowledge about risk factors of cervical cancer. The highest knowledge about cervical cancer risk factor reported by the respondents was having more than one sex partner (77.5%), whereas the lowest was the relationship between HPV and cervical cancer (51.2%). Age, marital status, ethnicity, monthly family income and faculty were significantly associated with knowledge of cervical cancer screening (p=0.003; p=0.001; p=0.002; p=0.002; p=0.001 & p=0.002; respectively). The most common barriers of cervical cancer screening were the Pap smear test will make them worry (95.8%) whereas the least common barrier reported among participants was no encouragement from the partner (8.8%). Conclusion: Some misconceptions and barriers in uptaking Pap smear test are still serious problems among young women. Although knowledge about cervical cancer screening is adequate they have a very poor practice of Pap smear test. The introduction of reproductive health subjects is warranted for all university students.     

Association of Knowledge,Attitude and Demographic Variables with Cervical Pap Smear Practice in Nepal

Background: Coverage of cervical pap smear test in Nepal is below general global values. One of the reasonsmay be that cervical cancer prevention policy of Nepal has ‘Visual Inspection of Cervix with Acetic Acid’ as theonly screening tool. The focus of present study was to find out association of demographic factors, knowledgeand attitude regarding cervical Pap smear test with its practice by women in Nepal. Materials and Methods:This cross sectional analytical observational study was conducted between February 1, 2013 and April 30, 2013.Participants were interviewed with the help of a structured questionnaire. Chi square and multivariate logisticregression tests were used to detect associations of variables with pap smear practice. Results: Chi square testshowed that practice was significantly associated with knowledge about pap smear test and cervical cancer,having favourable attitude towards the test, urban residency and 36-50 years age-group. Pap smear utilizationwas not associated with age-at-marriage, parity and age-at-first-child-birth. Multivariate logistic regressionshowed favorable attitude towards pap smear test as the only variable which significantly influenced pap smearpractice (p= 0.006, OR: 2.4). Conclusions: Pap smear coverage has been found to be 15.7% which is lower thanglobal average and that for developing countries. Health education programs which are effective not only inincreasing knowledge about cervical cancer and pap smear test but also effective in positively changing attitudetowards the test should be organized to increase pap smear coverage.     

Knowledge,Attitudes and Practices about the Pap Smear among Medical Workers in Naresuan University Hospital

Background: Cervical cancer, very common in females of the developing world, has a long premalignantperiod. Primary and secondary prevention can reduce the incidence. The Pap smear is the main screening modalityin Thailand but the coverage is rather poor. Objective: This study was performed to evaluate the knowledge,attitudes and practices of medical workers in Naresuan university hospital who met the WHO guidelines forscreening. Methods: A questionnaire covering general characteristics, knowledge, attitudes and practices aboutcervical cancer screening was administered and the data obtained were analyzed with SPSS version 16. Results:The majority of the 78 included participants were nurses with an education mostly more than diploma level.Knowledge about the importance of the Pap smear, early detection and the treatment of early stage cervicalcancer was adequate (90.9 % and 81.6%, respectively) but awarness of cervical cancer risk factors was quitelow. The most frequent reasons for avoiding Pap smear screening were fear of vaginal examination (27.6%),embarrassment (26.3%), lack of any symptoms (22.4%) and being busy (17%). Conclusion: The Pap smear isappropriate for detection of premalignant lesions of cervical cancer in Thailand but the coverage is still low.Although this study was performed with medical workers, their compliance with screening recommendationswas still low. If we can improve the knowledge and attitudes about Pap smear cervical cancer screening insuch experts, they should be able to readily provide appropriate and accurate information to the population tomotivate the general population to join screening programs.     

Cervical Cancer‐Related Knowledge,Attitudes, and Practices of Health Professionals Working in Brazil's Network of Primary Care Units

Introduction.

Brazil’s national strategy for cervical cancer screening includes using the Papanicolaou (Pap) test every 3 years among women aged 25–64 years. Comprehensive primary care services are provided through a network of primary health units, but little is known about cervical cancer-related knowledge, attitudes, and practices among health professionals and coordinators working in these facilities.

Methods.

In 2011, we conducted a cross-sectional nationally representative phone survey of 1,600 primary health care units to interview one unit coordinator and one health care professional per unit (either nurse, physician, or community health worker). Responses were obtained from 1,251 coordinators, 182 physicians, 347 nurses, and 273 community health workers. Questionnaires were administered to assess health units’ characteristics and capacity for cervical cancer-related services as well as health professionals’ perceived effectiveness of the Pap test, preparedness to talk to women about cervical cancer, adherence with screening guidelines, and willingness to recommend human papillomavirus (HPV) vaccination to females.

Results.

Most units conducted screening (91.9%), used home visits to conduct recruitment and outreach (83.4%), and provided follow-up to women who did not return to discuss Pap test results (88.1%). Approximately 93% of health professionals stated that Pap testing was effective in decreasing death rates from cervical cancer and 65% stated that national guidelines for cervical cancer screening are very influential; 93% of nurses and physicians reported screening women annually and 75% reported beginning to screen women younger than 25 years old. Regarding HPV vaccination, almost 90% of nurses and physicians would recommend the HPV vaccine to their females patients if it were available. A larger proportion of physicians and nurses recommended the HPV vaccine to older girls (13–18 years) and women (19–26 years and even older than 26 years) than to younger girls (12 years or younger).

Conclusion.

Although Brazil’s network of primary care units has significantly increased access to cervical cancer screening, effective strategies are needed to ensure that women get screened at the appropriate ages and intervals. Additionally, this study’s baseline data on HPV vaccination may be useful as Brazil embarks on a national HPV vaccination program in 2014.     

Knowledge,Attitudes and Practices of Sudanese Women Regarding the Pap Smear Test and Cervical Cancer

Background: Despite the established role of the Pap smear test (PST) in prevention and early detection of cervical cancer, it is still rarely practiced in Sudan. Many challenges hinder the establishment of an effective cervical cancer screening program, including socio-cultural factors. Therefore, this study aimed to investigate the knowledge, attitudes and practices (KAP) of Sudanese women with regard to the Pap smear test and cervical cancer. Materials and Methods: A total of 500 married women aged 14 to 58 years were recruited from obstetric clinics, hospitals and universities in Khartoum in 2014. Data were collected using a standardized, pretested questionnaire that inquired socio-demographic characteristics and their KAP about cervical cancer and the PST. Results: More than 52% of participating women were above 30 years of age, and the majority (78.8%) were university degree holders. A total of 486 (97.2 %) of participants were resident in urban areas of Khartoum State. However about 48% of the respondents had never heard about PST, and only 15.8% of the participants had undergone a Pap smear test previously; 46.6% (233/500) knew that the human papilloma virus (HPV) was the causative agent, but only 39.2% (196/500) had heard about HPV vaccination, and only 11.4% (57/500) had received the vaccine. However 68% of the respondents agreed to do Pap smear if properly informed about the test and 75.4% of the respondents agreed to participate in a cervical cancer screening program. Conclusions: Despite a high educational level, less than half of our participants had accurate knowledge about cervical cancer, HPV, and cervical cancer screening. Health education about cervical cancer, HPV and sexually transmitted infections and the role of PST in cervical cancer prevention are crucial when designing interventions aimed at improving cervical cancer screening for Sudanese women.     

Awareness of Cervical Cancer Among Female Students of Premier Colleges in Kolkata,India

In the absence of any nationwide cervical screening program, cancer of cervix remains a major public health problem for India. We here assessed knowledge levels of female college students about cervical cancer, its risk factors, the human papillomavirus (HPV) etiologic agent and Pap (Papanicolaou) smear testing for screening. We conducted a questionnaire survey of the students (N=630), aged 17 to 24 years, in Kolkata, India. Only 20% correctly identified cervix cancer as the most prevalent female cancer in India, while 43% were aware of the ages of occurrence. Though 41% thought sexual activity to be associated with cervical cancer, its risk factors, like, ‘smoking’, ‘having multiple sex partners’, ‘cervical infections’, ‘early onset of sexual intercourse’, ‘multiple parity’ were recognized by 29%, 3%, 4%, 13% and 15%, respectively. The terms ‘Pap test’ and HPV had been heard by 11% and 15 % of the students, respectively, and 75% of the students desired to have protective vaccination. Bivariate analysis revealed that educational stream, standard of the college and family size were significantly associated with knowledge levels. Additionally, multivariate regression analysis indicated city students were more knowledgeable than those from outside the city. It is imperative that women gather adequate knowledge on cervical cancer for the success of any program to control the disease. Wide and effective spreading of awareness about the disease among women must form an integral part of public health policy of government.     

Effectiveness of a Health Education Program to Improve Knowledge and Attitude Towards Cervical Cancer and Pap Smear: A Controlled Community Trial in Malaysia

Objective: We examined the effectiveness of a health education program to improve; knowledge and attitude towards cervical cancer and Pap smear, and uptake of Pap smear test among female entrepreneurs in Kedah, a northern state of Malaysia. Methods: This controlled community trial involved 210 women from the districts of Alor Setar and Sungai Petani. Simple random sampling was applied to select 105 women from each district. Self-administered questionnaires were used to obtain information about the variables of interest. Health education intervention program included educational talk, demo video, experience sharing, pamphlet distribution, and text message reminders. Evaluation of outcomes was performed twice. The text message reminders acted as the cues to action that were sent between the two evaluation times at one-month interval. Women in the control group received educational talk alone. In the control group, evaluation of outcomes was done only once, which was one month after the educational talk. Results: Knowledge on cervical cancer and Pap smear, and attitude towards Pap smear among women in both intervention and control group improved significantly at Evaluation stage 1. However, no further improvements were observed in the intervention group at Evaluation stage 2. The uptake of Pap smear in the intervention group increased significantly from 48.0% at Baseline to 68.0% at Evaluation stage 1 (P<0.001), and from 68.0% to 79.0% at Evaluation stage 2 (P<0.001). A significant increase in Pap smear uptake was also seen in the control group from 63.0% at Baseline to 76.0% at Evaluation stage 1 (P=0.003). Conclusions: Educational talk alone was effective in improving knowledge on cervical cancer and Pap smear, attitude towards the test, and the actual uptake of the test. However, text reminders were more effective than having an educational talk alone in increasing uptake of Pap smear test among participants.     

Awareness of Cervical Cancer Risk Factors and Screening Behaviour among Nurses in a Rural Region of Turkey

The demographic characteristics of nurses and knowledge on risk factors of cervical cancer, as well asawareness of symptoms and attitudes in terms of screening programmers such as Pap smear, were assessed in across-sectional survey of nurses working in public Health Cabins and Family Health Centers in the rural area ofIzmir, located in the western region of Turkey. Of the nurses who participated in the research, 69.1% (67) saidthat they had talked about cancer and cancer prevention with their families or friends; 60.8% (59) believed thattheir occupation was important for cancer prevention; 11.3% of the nurses had a history of cancer in theirfamilies; and 63.9% (62) thought that their knowledge about cervical cancer was adequate. There were nosignificant differences between knowledge or attitudes about cervical cancer risk factors or symptoms andscreening methods regarding age, marital status, years of experience (p>0.05). However, there was a statisticallysignificant relationship between having received a pap test and having a history of cancer in their family (p<0.05).In conclusion, this study has shown that most nurses knew about the Pap smear test as a cervical cancer screeningmethods. However, there were no significant differences between knowledge or attitudes about cervical cancerrisk factors or symptoms and screening methods regarding age, marital status, years of experience.     

Knowledge,Attitudes, and Practices Regarding Cervical Cancer Screening among Omani Women Attending Primary Healthcare Centers in Oman: A Cross-Sectional

Background: This study aimed to assess knowledge, attitudes, and practices regarding cervical cancer, cervical cancer screening, and Papanicolaou (Pap) smear testing among Omani women attending primary healthcare centers in Oman, and to establish a correlation with various sociodemographic characteristics. Methods: A multi-center cross-sectional survey was carried out from August 2019 to January 2020 and included 805 women attending 18 primary healthcare centers. A pre-tested questionnaire was utilized to assess the participants’ sociodemographic characteristics, cervical cancer risk factors, knowledge, attitudes, and practices related to cervical cancer, cervical cancer screening, and Pap smear testing. Results: All 805 women participated in the study (response rate: 100%). Overall, 67.5% and 50.9% had heard of cervical cancer and Pap smear testing, respectively; however, only 13.4% and 10.9% demonstrated high levels of knowledge concerning these topics. Knowledge was significantly associated with educational level, type of educational qualification (i.e. if their degree was related to healthcare), monthly income, and employment status (p ≤ 0.05 each). Only 15.7% of the participants had previously undergone Pap smear testing, although 42.7% were willing to undertake such screening in future. No associations were noted between Pap smear practice or willingness and sociodemographic characteristics, family history of cervical cancer or personal history of cervical cancer or related risk factors. Conclusions: Knowledge regarding cervical cancer and Pap smear testing was suboptimal among a cohort of Omani women attending primary healthcare centers in Oman. This may be a factor behind the increased number of cervical cancer cases in Oman; as such, a well-structured awareness and educational program is needed to address this issue.     

Knowledge,Attitudes, and Practices Regarding Cervical Cancer Screening among Omani Women Attending Primary Healthcare Centers in Oman: A Cross-Sectional Survey

Background:This study aimed to assess knowledge, attitudes, and practices regarding cervical cancer, cervical cancer screening, and Papanicolaou (Pap) smear testing among Omani women attending primary healthcare centers in Oman, and to establish a correlation with various sociodemographic characteristics. Methods:A multi-center cross-sectional survey was carried out from August 2019 to January 2020 and included 805 women attending 18 primary healthcare centers. A pre-tested questionnaire was utilized to assess the participants’ sociodemographic characteristics, cervical cancer risk factors, knowledge, attitudes, and practices related to cervical cancer, cervical cancer screening, and Pap smear testing. Results:All 805 women participated in the study (response rate: 100%). Overall, 67.5% and 50.9% had heard of cervical cancer and Pap smear testing, respectively; however, only 13.4% and 10.9% demonstrated high levels of knowledge concerning these topics. Knowledge was significantly associated with educational level, type of educational qualification (i.e. if their degree was related to healthcare), monthly income, and employment status (p ≤ 0.05 each). Only 15.7% of the participants had previously undergone Pap smear testing, although 42.7% were willing to undertake such screening in future. No associations were noted between Pap smear practice or willingness and sociodemographic characteristics, family history of cervical cancer or personal history of cervical cancer or related risk factors. Conclusions:Knowledge regarding cervical cancer and Pap smear testing was suboptimal among a cohort of Omani women attending primary healthcare centers in Oman. This may be a factor behind the increased number of cervical cancer cases in Oman; as such, a well-structured awareness and educational program is needed to address this issue.Key Words: Cervical cancer, papanicolaou test, screening- knowledge, attitudes, practice, Oman