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.     

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 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.     

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.     

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.     

Knowledge About Cervical Cancer, Pap Test and Barriers Towards Cervical Screening of Women in Turkey

We aimed to identify knowledge about cervical cancer (CC) and Pap test (PT) and the barriers why women do not have Pap test done. The study was conducted with a sample of 1,036 women. Overall, 64.4 % had heard of CC, 43.1 % had heard about PT and 24.7 % had had a test at least once. It was determined that women had moderate knowledge of cervical cancer but poor knowledge of Pap test. Knowledge of CC and PT was significantly better among employed and single women, who had higher education, no prior delivery, a higher income level and regular gynaecological examination. Common barriers to PT were lack of awareness, being uncomfortable with the procedure and not knowing where to go for a PT. Utilization of the PT will not increase unless knowledge is improved and barriers are eliminated. Healthcare professionals are the key persons to provide both knowledge and facilities towards the goal of CC prevention.     

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.     

Evaluation of Managerial Needs for Palliative Care Centers: Perspectives of Medical Directors

Background: Palliative therapies have an important role in increasing the quality of healthcare and in dealingwith physical and psychosocial problems due to cancer. We here aimed to evaluate the managerial perspectivesand opinions of the hospital managers and clinical directors about specialized palliative care centers. Materialsand Methods: This study was conducted in two large-scale hospitals in which oncology care is given with medicaldirectors (n:70). A questionnaire developed by the researchers asking about demographic characteristics andprofessional experience, opinions and suggestions of medical directors about providing and integrating palliativecare into healthcare was used and responses were analyzed. Results: Potential barriers in providing palliativecare (PC) and integrating PC into health systems were perceived as institutional by most of the doctors (97%)and nurses (96%). Social barriers were reported by 54% of doctors and 82% of nurses. Barriers due to interestand knowledge of health professionals about PC were reported by 76% of doctors and 75% of nurses. Amongencouragement ideas to provide PC were dealing with staff educational needs (72%), improved working conditions(77%) and establishing a special PC unit (49)%. An independent PC unit was suggested by 27.7% of participantsand there was no difference between the hospitals. To overcome the barriers for integration of PC into healthsystems, providing education for health professionals and patient relatives, raising awareness in society, financialarrangements and providing infrastructure were suggested. The necessity for planning and programming wereemphasized. Conclusions: In our study, the opinions and perspectives of hospital managers and clinical directorswere similar to current approaches. Managerial needs for treating cancer in efficient cancer centers, increasingthe capacity of health professionals to provide care in every stage of cancer, effective education planning andpatient care management were emphasized.     

La prise en charge du cancer du sein au Niger : connaissances, attitudes et pratiques des professionnels de santé non médecins de Niamey, Niger, 2010

Background

There has been an increase in the number of cases of cancer in the developing countries. The objective of this study was to assess the level of knowledge, attitude, and practice (KAP) regarding breast cancer among non-medical doctor (MD) health professionals in health facilities in Niamey, Niger.

Methods

This cross-sectional study was carried out in 10 health facilities. The information on KAP (10 items) about breast cancer was collected from midwives, nurses, and social workers. For each professional, a score ranging from 0 to 10 was computed indicating KAP level. Factors associated with KAP scores > 5 were assessed using multiple logistic regression analysis.

Results

The health professionals participating in the KAP study (N = 112) were rather poorly informed on breast cancer and its diagnosis. Further analyses showed that professionals aged 38 years and older (adjusted odds ratio [OR] = 0.11; 95% confidence interval [95% CI] = 0.03?C0.43), working in intermediate (OR = 0.05; 95% CI = 0.01?C0.26) or primary health care facility (OR = 0.02; 95% CI = 0.01?C0.13), nurses (OR = 0.05; 95% CI = 0.01?C0.22), and social workers (OR = 0.01; 95% CI = 0.01?C0.08) were less likely to have a KAP score > 5 than those in the age group (22?C30), working in a central health care facility, and midwives.

Conclusion

Results suggest the need for continuous training of health professionals. Further, involving midwives in breast cancer care could improve early detection of the cases.     

Perception and Opinion of Medical Students about Pap SmearTest: A Qualitative Study

Objective: the objective of this study is to explore the perceptions of medical students regarding the Papsmear test. Methodology: Focus group discussion was held with twenty three medical students. The students weredivided into three focus groups; two groups of female participants consisting of 9 and 8 students; respectively.The third group consistedof 6 male students. Questions regarding Pap smear testing included barriers thatprevented women from taking the test, gender preference for the physician to conduct the cervical screeningtest, willingness to suggest Pap smear test to the family or friends. The data obtained were classified into variouscategories and analyzed manually. Results: Most of the study participants mentioned that the main barriersfor women to not perform Pap smear test is lack of awareness 16 (70%), followed by shyness 12 (52%) and thecost of the test 12 (52%). Most agreed that the gender of the physician will affect the women decision to do Papsmear test. All mentioned that the advantage of a regular Pap smear test is to detect the abnormality at the earlystage of cervical cancer. Some of the participants 9 (39%) mentioned that the disadvantages are expense, possibleinjury in the vagina due to the test procedures 8 (35%), associated infection 7(30.4%) and pain 7(30.4%) . Themajority, 20 (87%) mentioned that the most effective prevention methods for cervical cancer are having sex onlyafter getting married with the spouse only, HPV vaccination 15 (65%) and Pap smear14 (61%). Conclusion:The main barriers for women to not perform Pap smear test is lack of awareness, shyness and the cost of thetest. Gender of the physician will affect the women decision to do Pap smear test.     

Socio-demographic and behavioural risk factors for cervical cancer and knowledge, attitude and practice in rural and urban areas of North Bengal, India

Background: Cervical cancer is common among women worldwide. A multitude of risk factors aggravatethe disease. This study was conducted to: (1) determine the prevalence and (2) make a comparative analysis ofthe socio-demographic and behavioural risk factors of cervical cancer and knowledge, attitude and practicebetween rural and urban women of North Bengal, India. Study Design: Community-based cross-sectional study.Methods: A survey (first in North Bengal) was conducted among 133 women in a rural area (Kawakhali) and88 women in an urban slum (Shaktigarh) using predesigned semi-structured questionnaires. The respondentswere informed of the causes (including HPV), signs and symptoms, prevention of cervical cancer and treatment,and the procedure of the PAP test and HPV vaccination. Results: The prevalence of risk factors like multiparity,early age of marriage, use of cloth during menstruation, use of condom and OCP, early age of first intercoursewas 37.2%, 82%, 83.3%, 5.4%, 15.8% and 65.6% respectively. Awareness about the cause, signs and symptoms,prevention of cervical cancer, PAP test and HPV vaccination was 3.6%, 6.3%, 3.6%, 9.5% and 14.5% respectively.Chi-square testing revealed that in the study population, significant differential at 5% exists between rural andurban residents with respect to number of children, use of cloth/sanitary napkins, family history of cancer andawareness regarding causes of cervical cancer. Regarding KAP, again using chi-square tests, surprisingly, levelof education is found to be significant for each element of KAP in urban areas in contrast to complete absence ofassociation between education and elements of KAP in rural areas. Conclusions: A large number of risk factorswere present in both areas, the prevalence being higher in the rural areas. The level of awareness and role ofeducation appears to be insignificant determinants in rural compared to urban areas. This pilot study needs tobe followed up by large scale programmes to re-orient awareness campaigns, especially in rural areas.     

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.     

Perceptions and practices of a pakistani population regarding cervical cancer screening.

Cervical cancer is among the three leading causes of cancers among females worldwide. It is also among the three most common causes of cancer deaths among females, about 80% of which occur in less developed countries. The present cross-sectional knowledge, attitude and practice survey was carried out to determine the perceptions and practices of a Pakistani female population regarding cervical cancer screening. Through convenient sampling, 192 subjects were recruited and administered a pre-tested and structured questionnaire. About 5% of subjects knew that screening was available for cervical cancer. Only 2.6% of the sample had ever received a Pap test. The most common reason cited for not having received a Pap test was the lack of information. In conclusion, the Pakistani population studied here demonstrated a very low coverage of the Pap test and a poor knowledge regarding its utility.