Knowledge,Attitude and Practice Concerning Human Papilloma Virus Infection and its Health Effects among Rural Women,Karnataka, South India

Background: Cervical cancer is one of the commonest cancers among women all over the world. Theassociation of cervical cancer with human papilloma virus (HPV) is well established. Knowledge about the causalrelationship between HPV and cervical cancer is important to make appropriate, evidence-based health carechoices. In this context we conducted a community based study among women about the knowledge, attitude andpractice about HPV infections and their health effects. Materials and Methods: A cross sectional interview basedhouse to house survey was conducted with a validated data collection tool covering sociodemographic factors,knowledge, attitude and practice about HPV and its health effects, among 1020 women from a rural village,Perdoor, in Udupi district, Karnataka, India in 2013-14. Results: The mean age of participants was 38.9 years(SD=12.6). Study participants showed a high literacy rate (85.7%). Only 2.4% of sexually exposed women hadundergone Pap smear testing. Partners of 4.4%women had undergone circumcision and they belonged to theMuslim community. Male condom usage was reported by 26 women (2.6%). However, none of the participantshad heard of HPV and its health effects. Conclusions: This community based study found complete ignoranceabout HPV among rural South Indian women in spite of a high literacy level.     

A Qualitative Study of Parental Knowledge and Perceptions of Human Papillomavirus and Cervical Cancer Prevention in Rural Central Java,Indonesia: Understanding Community Readiness for Prevention Interventions

Background: Cervical cancer (CC) is a leading cause of cancer deaths among Indonesian women. Pilot preventionprograms, including human papillomavirus (HPV) vaccination for young adolescent girls, and cervical screening forwomen, have been implemented. However, many communities are yet to receive these interventions, nor targetededucation regarding CC prevention. This study explored community readiness and acceptance of HPV vaccinationand CC screening, as well as knowledge and perceptions of HPV and CC, to determine facilitators and barriers toupscaling CC prevention in rural Central Java. Methods: Qualitative data collection in October 2015 consisted of fourfocus group discussions with married women and men, and 22 semi-structured interviews with married women. All57 participants, 39 women and 15 men, lived in Purworejo Regency in rural Central Java. Results: Most participantshad no knowledge of HPV or the causal link between HPV and CC. However, most participants were supportive ofvaccinating their children against HPV. Most participants had heard of cervical cancer, although understandings ofsymptoms and causes were very poor. Less than half of the women interviewed had undergone CC screening. Multiplebarriers to screening were reported, including: a dislike of pelvic exams; embarrassment at being screened by a male;anxiety over the cost; fearing a positive result; and being asymptomatic and thus not perceiving the need for screening.Conclusions: Extensive community education about HPV and CC, targeting women and men, adolescents, healthworkers and teachers, is crucial to support the introduction of the HPV Demonstration Program and the upscaling ofCC screening. Low incomes among rural families underline the need for the HPV vaccine to be provided free withinthe National Immunization Program, and for CC screening to be free at primary health clinics.     

Human papillomavirus and vaccination: knowledge, attitudes, and behavioural intention in adolescents and young women in Italy

This study assesses knowledge, attitudes, and behavioural intention towards human papillomavirus (HPV) infection and vaccination in a random sample of 1348 adolescents and young women aged 14-24 years in Italy. A self-administered anonymous questionnaire covered demographics; knowledge about HPV infection, cervical cancer, and HPV vaccine; the perceived risk for contracting HPV infection and/or for developing cervical cancer, the perceived benefits of a vaccination to prevent cervical cancer, and willingness to receive an HPV vaccine. Only 23.3% have heard that HPV is an infection of the genital mucosa and about cervical cancer. Those older, with at least one parent who is a health care professional, with personal, familiar, or friendly history of cervical cancer, and having underwent a health checkup in the last year with information about HPV vaccination were significantly more knowledgeable. Risk perception scores (range: 1-10) of contracting HPV infection and of developing cervical cancer were 5.8 and 6.5. Older age, not having a parent who is a health care professional, having had a personal, familiar, or friendly history of cervical cancer, and need of additional information were predictors of the perceived susceptibility of developing cervical cancer. The vast majority professed intent to receive an HPV vaccine and the significant predictors were having at least one parent who is a health care professional, a high perceived risk of contracting HPV infection and of developing cervical cancer, and a high belief towards the utility of a vaccination for preventing cervical cancer. Knowledge about HPV infection and cervical cancer should be improved with more attention to the benefit of HPV vaccination.     

Epidemiology, prevention and treatment of cervical cancer in the Philippines

Cervical cancer remains to be one of the leading malignancies among Filipino women. High-risk human papillomavirus (HPV) types, such as 16 and 18, are consistently identified in Filipino women with cervical cancer. Factors identified to increase the likelihood of HPV infection and subsequent development of cervical cancer include young age at first intercourse, low socioeconomic status, high parity, smoking, use of oral contraception and risky sexual behaviors. Cancer screening programs presently available in the Philippines include Pap smears, single visit approach utilizing visual inspection with acetic acid followed by cryotherapy, as well as colposcopy. However, the uptake of screening remains low and is further compounded by the lack of basic knowledge women have regarding screening as an opportunity for prevention of cervical cancer. Prophylactic HPV vaccination of both quadrivalent and bivalent vaccines has already been approved in the Philippines and is gaining popularity among the Filipinos. However, there has been no national or government vaccination policy implemented as of yet. The standard of treatment of cervical cancer is radiotherapy concurrent with chemotherapy. Current researches are directed towards improving availability of both preventive and curative measures of cervical cancer management.     

The Impact of Perceived Barriers on Self-Efficacy for HPV Preventive Behavior

Background: Cervical cancer is one of the most common cancers found among women. Many studies have focusedon factors associated with human papilloma virus (HPV) preventive behavior and early detection using models such asthe health belief model (HBM). Despite a growing body of knowledge regarding HPV preventive behavior, few studieshave examined how self-efficacy affects this behavior in foreign women living in South Korea. This study identifiedfactors affecting the self-efficacy of foreign women living in South Korea and the impact on HPV preventive behavior.Methods: A total of 171 participants consisting of international school parents who voluntarily participated in HPVpreventive behavior were selected. A multivariate regression analysis included key variables such as demographics,cervical cancer knowledge, perceived susceptibility, and perceived barriers. Results: Self-efficacy for HPV preventivebehavior was significantly associated with perceived barriers. That is, women with lower perceived barriers were likelyto have higher self-efficacy scores. However, demographics, cervical cancer knowledge, and perceived susceptibilitydid not show any association with self-efficacy. The final model was significant and accounted for 14.4% of thevariance in self-efficacy. Conclusion: This study showed the importance of considering perceived barriers of HPVpreventive behavior related to self-efficacy. However, different from HBM, modifying factors, such as knowledge,perceived susceptibility, and individual demographics were not related to self-efficacy. Based on these findings, futureresearch should investigate self-efficacy and HPV preventive behavior among individuals who do not participate inHPV preventive behavior.     

What do women in the U.S. know about human papillomavirus and cervical cancer?

BACKGROUND: Women need to understand the link between human papillomavirus (HPV) and cervical cancer in order to make appropriate, evidence-based choices among existing prevention strategies (Pap test, HPV DNA test, and HPV vaccine). Assessment of the public's knowledge in nationally representative samples is a high priority for cervical cancer control. OBJECTIVES: To assess factors associated with U.S. women's awareness of HPV and knowledge about its link to cervical cancer. METHODS: Analyzed cross-sectional data from women ages 18 to 75 years old responding to the 2005 Health Information National Trends Survey (n = 3,076). RESULTS: Among the 40% of women who had ever heard about HPV, <50% knew it caused cervical cancer; knowledge that HPV was sexually transmitted and caused abnormal Pap tests was higher (64% and 79%, respectively). Factors associated with having heard about HPV included: younger age, being non-Hispanic White, higher educational attainment, exposure to multiple health information sources, trusting health information, regular Pap tests, awareness of changes in cervical cancer screening guidelines, and having tested positive for HPV. Accurate knowledge of the HPV-cervical cancer link was associated with abnormal Pap and positive HPV test results. CONCLUSIONS: Awareness about HPV among U.S. women is low. Having heard about HPV did not ensure accurate knowledge. Strategies for communicating accurate information about HPV transmission, prevention, and detection as well as risk and treatment of cervical cancer are needed.     

Acceptability and Concordance of Self- Versus Clinician- Sampling for HPV Testing among Rural South Indian Women

Background: Despite being largely preventable, HPV-related cervical cancers continues to be the second highest cause of cancer deaths among Indian women. HPV testing using self-sampled samples may offer an opportunity to expand cervical cancer screening in India where there is currently a shortage of providers and facilities for cervical cancer screening. The study examines acceptability and concordance of self vs. clinician collected samples for HPV-relted cervical cancer screening among rural South Indian women. Methods: Between May and August 2017, eight mobile screening clinics were conducted among 120 eligible women in rural villages in Mysore District, India. Women over the age of 30 underwent informed consent process and then self-sampled a sample for cervicovaginal HPV DNA testing. Next, the women underwent clinical exam where the clinician collected a cervicovaginal HPV DNA sample. Following the clinical exam, all participants answered an interviewer-administered questionnaire to assess their history of cervical cancer screening and acceptability of self- and clinician-sampling methods. To assess diagnostic accuracy, concordance of self- and clinician-sampled HPV DNA specimens was calculated in addition to five measures of acceptability (feeling of caring, privacy, embarrassment, genital discomfort, and genital pain). Results: Study participants had a median age 39 years, about four-in-ten (41.7%) had a secondary education or above, the vast majority (87.5%) were married and only 3.4% reported having screened for cervical cancer. For all measures of participant acceptability, self-sampling was rated significantly higher than clinician-sampling. Cohen’s kappa was 0.73 (95% CI: 0.34, 1.00), indicating substantial agreement between self- and clinician-sampling. Conclusion: This study demonstrates that HPV self-sampling for cervical cancer screening is feasible and acceptable in a community setting among South Indian rural women. Concordance between self-sampling and clinician-sampling was adequate for screening in community settings.     

Women’s Knowledge,Attitude and Practice on Cervical Cancer and Its Screening in Dhaka,Bangladesh

Background:Cervical cancer is the fourth most common cancer among women in the world. Visual Inspection with Acetic Acid (VIA) is a common screening test for cervical cancer in Bangladesh. This study will assess the knowledge, attitude and practice towards cervical cancer and screening among women residing in Dhaka district. Methods:A cross-sectional survey was conducted among 956 women aged 30 years and above in Dhaka. The women’s score on knowledge, attitude and practice were categorized as sufficient or insufficient. We calculated frequencies and used binary logistic regression to describe and assess the association between scores and socio-demographic characteristics of respondents. Results:Most (87%) respondent knew about cervical cancer and 13% knew that HPV is a risk factor for cervical cancer. Women who had sufficient knowledge were more likely to test VIA than those who had insufficient knowledge (39%, OR: 2.5; CI: 1.6, 2.8). Most (92%) would advise other women to have a VIA test. However, only 26% had a VIA test and 2% were vaccinated in private health care facilities for Human Papilloma Virus (HPV). Women who had sufficient attitude were equally likely to test VIA than those who had insufficient attitude. The VIA was underutilized because of low privacy during examination, unaware that VIA screened for cervical cancer, belief that they must pay for the test, and nurses performed examination. Conclusion:Women were knowledgeable about cervical cancer and likely to have a VIA test. However, the VIA test in underutilized and HPV vaccine coverage was low. Key Words: Cervical cancer, screening, VIA test, HPV- women, Bangladesh     

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.     

Community-Based Prevalence of Genital Human Papilloma Virus (HPV) Infection: a Systematic Review and Meta-Analysis

Introduction: Cervical cancer probably represents the best-studied human cancer caused by a viral infection and the causal association of this preventable cancer with human papilloma virus (HPV) is well established. Worldwide there is a scarcity of data regarding HPV prevalence with vast differences existing among populations. Objective: The aim of this meta-analysis was to determine the community-based HPV prevalence estimates among asymptomatic women from urban and rural set ups and in participants of cancer screening clinics. Study design: Systematic review and meta-analysis. Methods: PubMed-Medline, CINAHL, Scopus, and Google scholar were systematically searched for studies providing prevalence data for HPV infection among asymptomatic women between 1986 and 2016. Results: The final analysis included 32 studies comprising a population of 224,320 asymptomatic women. The overall pooled HPV prevalence was 11% (95% confidence interval (CI), 9%-12%). The pooled HPV prevalence of 11% (95% CI, 9%-11%) was observed among women attending cervical cancer screening clinics. The pooled HPV prevalences were 10% (95% CI 8%-12%) and 11% (95% CI 4%-18%) from urban and rural areas respectively, indicating higher infection rates among the rural women with the least access to cancer screening and cancer care. Conclusion: The prevalence rates in this systematic quantitative review provide a reliable estimate of the burden of HPV infection among asymptomatic women from developed as well as developing nations. Rural women and women attending cervical cancer screening programmes feature higher genital HPV prevalences compared to their urban counterparts.     

Knowledge and Awareness of Human Papillomavirus Vaccination and Cervical Cancer among Men and Women in Japan: A Questionnaire Survey

Background: In many advanced countries other than Japan, the incidence and mortality rates of cervical cancer, which is mainly caused by the human papillomavirus (HPV) infection, are decreasing probably due to the high rate of HPV vaccination and cervical cancer screening. In Japan, these rates are on the rise owing to the stagnation of vaccination and low screening rate. To improve these situations, active promotion of HPV vaccination and screening is required. As a preliminary stage, we investigated perceptions regarding cervical cancer and HPV vaccines among Japanese men and women and examined the difference in perceptions by sex. Methods: This was a prospective cross-sectional questionnaire survey targeting Sojo University students and working adults. University students were targeted before learning about cervical cancer. Working adults were recruited on the basis of information from the Health Promotion of Health and Welfare Department of Kumamoto Prefectural Government in Japan and from companies via student organizations promoting cancer prevention. We surveyed respondents’ knowledge and awareness about HPV vaccination and cervical cancer and performed logistic regression analysis to compare the results between men and women. Result: A total of 557 completed questionnaires (205 men and 352 women) were analyzed. Women had high levels of knowledge and awareness about HPV vaccination and cervical cancer compared with men. However, 70% of women surveyed had never been screened for cervical cancer. Conclusion: A total of 557 completed questionnaires (205 men and 352 women) were analyzed. Women had high levels of knowledge and awareness about HPV vaccination and cervical cancer compared with men. However, among surveyed women, the degree of knowledge and awareness was lower than that among women in other countries with established HPV vaccination programs. Furthermore, 70% of women surveyed had never been screened for cervical cancer.     

Knowledge of Cervical Cancer and Human Papillomavirus Vaccines among Child-Bearing Aged Women in Hanoi,Vietnam

Objectives: The study sought to examine knowledge of cervical cancer and human papillomavirus (HPV) vaccines among child-bearing aged women in Hanoi, Vietnam. Methods: In 2016, 807 women aged 18 to 49 years were recruited from one urban area and one rural area in 2016 and were examined through face-to-face paper-based interviews. Pearson’s chi-square test and an independent t-test were utilized to compare awareness of cervical cancer and HPV vaccination among women according residential status. Results: Overall, 83.8% and 71.3% women had heard about cervical cancer and HPV vaccination, respectively. Mean knowledge scores for cervical cancer and HPV vaccination were 4.60±1.43 out of 7 and 1.53±1.35 out of 5, respectively. Women living in an urban area were more likely to be aware of cervical cancer and to be more knowledgeable of HPV vaccination than women in a rural area. Conclusions: Despite strong awareness, we found knowledge on cervical cancer and HPV vaccination to be alarmingly insufficient among Vietnamese women.     

Cervical cancer screening research in the PROSPR I consortium: Rationale,methods and baseline findings from a US cohort

Little is known about the effect of evolving risk-based cervical cancer screening and management guidelines on United States (US) clinical practice and patient outcomes. We describe the National Cancer Institute's Population-based Research Optimizing Screening through Personalized Regimens (PROSPR I) consortium, methods and baseline findings from its cervical sites: Kaiser Permanente Washington, Kaiser Permanente Northern California, Kaiser Permanente Southern California, Parkland Health & Hospital System/University of Texas Southwestern (Parkland-UTSW) and New Mexico HPV Pap Registry housed by University of New Mexico (UNM-NMHPVPR). Across these diverse healthcare settings, we collected data on human papillomavirus (HPV) vaccinations, screening tests/results, diagnostic and treatment procedures/results and cancer diagnoses on nearly 4.7 million women aged 18–89 years from 2010 to 2014. We calculated baseline (2012 for UNM-NMHPVPR; 2010 for other sites) frequencies for sociodemographics, cervical cancer risk factors and key screening process measures for each site's cohort. Healthcare delivery settings, cervical cancer screening strategy, race/ethnicity and insurance status varied among sites. The proportion of women receiving a Pap test during the baseline year was similar across sites (26.1–36.1%). Most high-risk HPV tests were performed either reflexively or as cotests, and utilization pattern varied by site. Prevalence of colposcopy or biopsy was higher at Parkland-UTSW (3.6%) than other sites (1.3–1.4%). Incident cervical cancer was rare. HPV vaccination among age-eligible women not already immunized was modest across sites (0.1–7.2%). Cervical PROSPR I makes available high-quality, multilevel, longitudinal screening process data from a large and diverse cohort of women to evaluate and improve the effectiveness of US cervical cancer screening delivery.     

Perceived Susceptibility,and Cervical Cancer Screening Benefits and Barriers in Malaysian Women Visiting Outpatient Clinics

Aims: A main reason for increasing incidence of cervical cancer worldwide is the lack of regular cervicalcancer screening. Coverage and uptake remain major challenges and it is crucial to determine the perceivedsusceptibility to cervical cancer, as well as the benefits of, and barriers to, cervical cancer screening among women.Materials and Methods: A cross-sectional survey was conducted among 369 women attending an outpatient centrein Malaysia and data were collected by administering a self-report questionnaire. Results: The majority of theparticipants (265, 71.8%) showed good level of perception of their susceptibility to cervical cancer. Almost allresponded positively to four statements about the perceived benefits of cervical cancer screening (agree, 23.1% orstrongly agree, 52.5%), whereas negative responses were received from most of the participants (agree, 29.9%orstrongly agree, 14.6 %) about the eleven statements on perceived barriers. Significant associations were observedbetween age and perceived susceptibility(x2=9.030, p=0.029); between employment status (p<0.001) as well asethnicity and perceived benefits (p<0.05 [P=0.003]); and between education and perceived barriers to cervicalcancer screening (p<0.001). Conclusions: Perceived susceptibility, including knowledge levels and personal riskassessment, should be emphasized through education and awareness campaigns to improve uptake of cervicalcancer screening in Malaysia.     

Knowledge,Attitude and Practice of Commercial Sex Workers Regarding Cervical Cancer and Its Screening,Daulatdia Brothel,Rajbari District,Bangladesh, 2020-2021

Background: Cervical cancer is the second most common cancer in females in Bangladesh. This is caused by Human Papilloma Virus (HPV). Multiple sex partners, HIV infection, smoking, using birth control pills, and having more than three children are risk factors of cervical cancer. Hence, female sex workers have a high prevalence of infection with high risk HPV genotypes which eventually may causes cervical cancer. Unfortunately, the status of knowledge, attitude and practice among female sex workers regarding cervical cancer is mostly unknown. The aim of the study was to assess the knowledge, attitude and practice of women living in Daulatdia brothel regarding cervical cancer and its screening.  Methods: A cross-sectional knowledge-practice survey was conducted among 400 female sex workers in Daulatdia Brothel, Rajbari District, Bangladesh. The women’s total score on knowledge, and practice were categorized as sufficient or insufficient. We calculated frequencies and used binary logistic regression to describe and assess the association between scores and socio-demographic characteristics of respondents. Results: Most sex workers (61%) were between 29 to 35 years, married at 13 to 15 years of age, and divorced (91%). Middle aged sex workers were more likely have a VIA test  than women in the 29 to 35 years group (18%, OR:5.2; CI: 2.0, 13.5). Less than half of the studied women (40%) had sufficient knowledge regarding cervical cancer and 12% knew that infection by HPV is a risk factor. Respondents with primary and secondary education were more likely to have sufficient knowledge than the illiterate (42%, OR: 1.32; CI: 0.82, 2.12). Practices to prevent cervical cancer were very poor. Nearly all women (99%) would recommend other women to have a VIA test. There were only 7% who had a VIA test and 2% were vaccinated against HPV. Unmarried sex workers were more likely to take action to prevent cervical cancer. Sex workers educated up to the primary level were more likely to have a VIA or other tests than the illiterate sex workers (10%, OR: 1.3; CI: 0.6, 3.2). Conclusion: Sex workers in Daulatdia brothel were less knowledgeable about cervical cancer and less likely to have a VIA test and poor practices towards preventing cervical cancer. The sex workers underutilized the VIA test and HPV vaccine.     

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.