Knowledge, attitude, and practices of cervical cancer screening in health care providers in a teaching hospital

Anvitha Desaraju; Prabha Devi Kodey

doi:10.4103/JDRNTRUHS.JDRNTRUHS_126_20

ORIGINAL ARTICLE

Year : 2021 | Volume : 10 | Issue : 1 | Page : 33-38

Knowledge, attitude, and practices of cervical cancer screening in health care providers in a teaching hospital

Anvitha Desaraju, Prabha Devi Kodey
Department of Obstetrics and Gynecology, NRI Medical College, Guntur, Andhra Pradesh, India

Date of Submission	27-Aug-2020
Date of Decision	09-Sep-2020
Date of Acceptance	24-Nov-2020
Date of Web Publication	19-May-2021

Correspondence Address:
Anvitha Desaraju
D/O Dr. D. RadhaKrishnan, 49-36-40, Akkayyapalem Visakhapatnam - 530 016, Andhra Pradesh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/JDRNTRUHS.JDRNTRUHS_126_20

Abstract

Introduction: Cervical cancer is the most common cause of mortality and morbidity among women of reproductive age group in the world and is one of the few cancers amenable for prevention. Healthcare providers in hospitals (medical and nursing staff) constitute the most visible, front-line personnel play an integral role in educating women in the prevention of diseases, they can influence regarding cervical cancer screening adherence and health promotion among women.
Aim and Objectives: The purpose of this study is to assess knowledge, attitude, and level of awareness regarding cervical cancer among female health care providers with respect to risk factors, screening methods, vaccination, and the barriers in the acceptance of cervical cancer vaccine.
Materials and Methods: A descriptive cross-sectional study with self-administered, predesigned, questionnaire for knowledge of symptoms, screening, risk factors for cervical cancer and HPV vaccine in health care providers (n = 100) comprising doctors, nurses over duration of 2 months from May to June 2018 in teaching hospital setting on women aged between 21 and 65 years. Data was analyzed with SPSS17. Chi-square test used for statistical significance.
Results: Mean age of respondents was 32.9 years (range 21–54 years). Most participants were aware that cervical cancer is the most common female genital cancer (94%), majority were able to identify the HPV as most important etiological factor (88%) and believed that screening may prevent cervical cancer (92%), awareness about HPV vaccine and screening was known fully in doctors but only 72% of nurses. Knowledge about cancer etiology and screening was low among nurses than doctors. Self-practice and vaccination was low in total study population.
Conclusions: Knowledge and awareness on risk factors, cervical cancer screening, and HPV vaccination is more among doctors than on nursing staff, but self-practice and vaccination was low in total study subjects. Knowledge and awareness of cervical cancer among health care providers can help in promoting screening and early diagnosis, reducing cervical cancer morbidity and mortality.

Keywords: Attitude and perception, cervical cancer, HPV vaccination, knowledge, screening

How to cite this article:
Desaraju A, Kodey PD. Knowledge, attitude, and practices of cervical cancer screening in health care providers in a teaching hospital. J NTR Univ Health Sci 2021;10:33-8

How to cite this URL:
Desaraju A, Kodey PD. Knowledge, attitude, and practices of cervical cancer screening in health care providers in a teaching hospital. J NTR Univ Health Sci [serial online] 2021 [cited 2023 Mar 27];10:33-8. Available from: https://www.jdrntruhs.org/text.asp?2021/10/1/33/316312

Introduction

Cancer cervix is one of the most common and deadliest cancers affecting women, with high mortality, although preventable, commonly presents in late stages. The World has a population of 2,784 million women aged 15 years and older who are at risk of developing cervical cancer. Current estimates indicate that every year 527,624 women are diagnosed with cervical cancer and 311,365 die from the disease.^[1] Cervical cancer is the fourth most frequent cancer among women in the World, second most common cause of mortality and morbidity among women of reproductive age group in India.^[2] Annually, 1, 22, 844 cervical cancer cases occur in India causing 67,477 deaths.^[3] As per the WHO guidelines for Cervical Cancer Prevention 2013, the recommended screening methods are any of the following three tests: HPV (cut-off level ≥1.0 pg/ml), cytology (cut-off level ASC-US+) and visual inspection with acetic acid (VIA)^[4] Cytological screening is the common practicing modality here. ICMR recommendations are focused on implementation of screening for early detection of the precancerous conditions using cost effective methods and HPV vaccine administration among adolescent girls. Human Papilloma Virus (HPV) has recognizable pre-cancerous lesions and HPV vaccination has a preventive role^[5] Population-based screening programmes and increased utilization of Pap smear ^{More Details} test decreased cervical cancer death by more than 50% in the developed countries.^[6] Vaccine awareness and utilization has increased in recent past. More than 80 countries have introduced national HPV vaccination programme in last 12 years majority of these countries are high or upper-middle income countries and are needed in low income and lower-middle income countries with highest load.^[7]There are on- going plans for introduction of HPV vaccination in National immunization Programme in India to reduce this disease.^[8]

Early identification and treatment of precancerous/cancerous lesion of uterine cervix lead to better prognosis and survival. It is essential that our health care professionals are aware of these advances and especially of those interventions which can be utilized in low-resource settings. Healthcare providers in hospitals (medical, paramedical staff) constitute the most visible, front-line personnel providing health education to patients and the general population. Since they play an integral role in educating women in the prevention of diseases, they can also influence cervical cancer screening adherence and health promotion among women. Few studies have been done in India to assess the knowledge, attitude, and practice of Pap test and HPV vaccination among the health care providers.^{[9],[10],[11],[12],[13],[14]} In other formative research studies done worldwide also documented gaps in knowledge about screening and HPV vaccination.^{[15],[16],[17],[18],[19],[20],[21],[22]} Knowledge attitude and practice (KAP) studies are important to plan, implement, and evaluate screening programs and awareness about the disease with respect to risk factors, screening methods, and vaccination is necessary for early detection and prevention of this disease. The financial cost of treating late-stage cervical cancer is substantially higher than that of diagnosed early-stage cancer,^[23] increasing physical, financial, and stressful health aspects.

Materials and Methods

A descriptive cross-sectional study with self-administered predesigned, questionnaire for knowledge of symptoms, screening, risk factors for cervical cancer and HPV vaccine among health care providers, comprising female doctors and nurses (n = 100) over duration of 2 months from May–June 2018 in our teaching hospital setting. Ethical clearance was obtained from College Ethical Committee.

Ethical committee certificate number-389/2018.

Study Selection

Inclusion criteria

All women health care providers who fall in the age group of 21– 65 years
Written informed consent from women participating in the study.

Exclusion criteria

Women below the age of 21 years.
Women above the age of 65 years
Women who do not consent to be a part of the study.

Study sample size:

The sample size (n) was computed by single population proportion formula

[n = [(zα/2) 2 × P (1-P)]/d2] by assuming 95% confidence level of zα/2 = 1.96, margin of error 10% and P = 50% proportion. It comes to 346. However, because of constrains of time the sample restricted as a convenient sample of 100 women comprising 50 doctors and 50 nurses.

Study Tool

A self-administered, Predesigned, pretested, validated questionnaire used. Study variables questions included in four sections. All questions were close ended, easy, short, and understandable and were answered after taking consent with age, socio demographic details.

Section 1: To assess the knowledge and attitude towards screening with questions like symptoms of cervical cancer, prevention & methods used for prevention [Table 1].

Table 1: Knowledge About Cervical Cancer

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Section 2: To assess the risk factors cervical cancer [Table 2].

Table 2: Risk Factors Knowledge

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Section 3: To assess Awareness of cervical cancer [Table 3].

Table 3: Awareness About HPV Vaccine, Screening

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Section 4: To know the Practices. It contained questions to know the methods of cervical screening and HPV vaccine [Table 4].

Table 4: Practices On Cervical Cancer Screening and HPV Vaccination

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Data Analysis

Data entered in MS Excel presented as Tables and Figures, analyzed with Statistical Package for Social Sciences (SPSS version 18.0). Chi-square test used for testing association between categorical variables at 5% level of significance (P value).

Results

A total of n = 100 subjects with 50 female doctors and 50 female staff nurses contributed to the study. Their mean age was 32.9 years (range 21–54 years) but majority (45%) were between 21 and 30 years of age. Subjects above 54 years were also approached, but were not included as consent was not given. All selected participants were sexually active.

Majority of the participants (94%) had knowledge that cervical cancer is the commonest female genital cancer (100% in doctors, 88% in nurses). Cervical cancer can be detected at early stage, even when symptomless was agreed fully by doctors but 74% in nurses. This has an impact on early screening. Knowledge on age for screening up to 65 years, periodic screening at intervals and pelvic examination was not fully agreed by both doctors and nurses [Table 1]. Risk factors knowledge was more in doctors than nurses, on various factors varied from 42-84% like, having many sexual partners, sexual transmission, but smoking, OC pills as risk was known in less than 50% in both. Doctors were more aware than nurses P value = 0.06 significant. [Table 2]. Awareness about HPV vaccine and screening was known fully in doctors but only 72% of nurses [Table 3].

Awareness questions about self-practices for prevention with screening and HPV vaccination is low with only 2% having received HPV vaccination. In this study only few participants had ever got screened for cervical cancer and most common reason for not getting screened was, majority thought they were healthy, not feeling at risk, being shy to have pap smear and lack of symptoms and for not receiving vaccination most of the doctors opined not at risk and not necessary but financial cost expressed by nurses [Table 4].

The source of information through hospital CMEs and lectures was more than that through media or colleagues. The P value = 0.04 significant between lectures and seminars and other means of knowledge.

Discussion

Cervical cancer although preventable is a deadly disease. Healthcare providers in hospitals are front-line personnel in the prevention, screening, adherence, and early detection of pre-invasive cervical cancer lesions.

In developed countries, cervical cancer prevention has been successful because of simple and inexpensive screening tests which help in identification of pre-invasive cervical changes that develop and progress slowly over years, that precedes the development of invasive cancer of the cervix and treatment of these precursor lesions has greatly reduced the incidence of cervical cancer worldwide.^[24] Other methods like colposcopy and cervical biopsy require expertise and cost.

The subjects in this study included doctors and nurses (n = 100) with mean age of 32.9 years (21-54 years) majority 45% were between 21 and 30 years. This age distribution pattern was similar to other studies.^[25] Knowledge about cervical cancer analysis in our study showed that almost all doctors and 88% of nursing staff completely agreed that it is the commonest female genital carcinoma. Majority (88%) agreed that cervical cancer can be detected at early stage and is preventable. The opinion that cervical cancer can be present without symptoms at early stage was favoured by most doctors (88%) but only 68% of nurses. Age of screening as per ICMR, ACOG guidelines is 21–65 years was not universally known to all, especially nurses. Cyclical repetition of Pap test must be done once in every 3 years; even cervical screening is normal was not agreed by all, more so in nurses and necessity of periodic pelvic examination was agreed in less than 50% of study subjects. This was similar to other studies.^[26] In assessing risk factors knowledge in this study, doctors were more aware than nurses and was statistically significant (P value = 0.06), included knowledge that cervical cancer may be associated with having many sexual partners, sexually transmitted disease, having sex at early age, having early child bearing. But, risk with contraception like oral contraceptive pills, protection with condom, role of smoking, were not known completely in doctors also along with nurses.

In assessing awareness about HPV screening all doctors completely agreed that principal cause of cervical cancer is HPV similar to other studies^[27] and heard of a vaccine to prevent cervical cancer in contrast to only 72% of nurses, heard of screening methods of cervical cancer, advised regular screening tests for cervical cancer in married women, recommend screening and vaccination in their family.

When sources of knowledge on HPV vaccination were analyzed, lectures and seminars (60%) in our hospital, were informative then other means media, colleagues (P value = 0.04 significant) in contrast to other study^[28] have shown that hospitals played a little role as a source of information. Practices of cervical cancer screening and HPV vaccination in health care providers were not up to expectations, similar to conclusions in other studies.^[29],[30] Reason for not getting pap smear done in majority of subjects was not feeling necessity (58%), not feeling at risk, lack of symptoms and being shy to have pap smear. HPV Vaccine has been received in only 2%, others feeling not necessary and concerned about safety in 76% doctors, financially costly in 48% nurses.

However, practices were also improved in our centre with HPV vaccination and screening promotion as awareness campaigns were taken up with re-orientation programme, CMEs for doctors, nurses, paramedical staff and class IV employees too, regarding cervical cancer, to motivate their family members, friends, patients and general community to accept and adopt cervical screening.

Conclusions

Knowledge, Attitude and Practice (KAP) studies are essential to plan, implement and evaluate programs, and can help to identify knowledge gaps and correction, facilitate the success of a program. In our study Knowledge and awareness on risk factors, cervical cancer screening and HPV vaccination is more among doctors than on nursing staff, but self- practice and vaccination was low in total study subjects. Creating awareness among staff with health education and assessing their knowledge and practices on early screening of precursor lesions, can greatly reduce morbidity, mortality and make cervical cancer free world with healthy women.

Limitations of the study

Institution based and small sized study sample.

Ethical considerations

An informed consent was taken from the subjects. Institutional ethical committee approval was obtained before commencing the study. Ethical committee certificate number-389/2018

Acknowledgements

I thank the female health care providers, doctors and nurses of our institution for participating in this study, my colleagues for helping in data collection and our College authorities for permitting this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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