|Year : 2021 | Volume
| Issue : 3 | Page : 178-185
Knowledge and awareness of cervical cancer and attitude toward HPV vaccination among female undergraduate physiotherapy students in Belgaum, Karnataka
Renu Pattanshetty, Nikita Pawar
Department of Oncology Physiotherapy, KAHER Institute of Physiotherapy, Nehru Nagar, Belagavi, Karnataka, India
|Date of Submission||15-May-2021|
|Date of Decision||15-Jun-2021|
|Date of Acceptance||01-Sep-2021|
|Date of Web Publication||17-Mar-2022|
Dr. Nikita Pawar
Department of Oncology Physiotherapy, KAHER Institute of Physiotherapy, Nehru Nagar, Belagavi - 590 010, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Cervical cancer is the fourth leading cause of cancer mortality representing 7.5% of all female cancer deaths. In India, it is the second most frequent cancer among women and it usually occurs between 15 and 44 years of age. The key to prevent this cancer is early detection. Hence, awareness regarding cervical cancer and screening measures for cervical cancer should be spread widely in the community. This study was taken up to evaluate the knowledge of the symptoms, risk factors, and preventive measures for cervical cancer among undergraduate female physiotherapy students.
Methods: This observational study was carried out over a period of 3 months among 154 female undergraduate physiotherapy students in Belagavi city, Karnataka, India. A pretested self-administered questionnaire was provided to evaluate their basic knowledge and awareness about cervical cancer. Statistical analysis was done using SPSS version. 23.
Results: Knowledge regarding having multiple sexual partners as one of the risk factors for cervical cancer was the commonest among the undergraduate students (76.6%) and least for early menarche (24%). HPV vaccination as a preventive measure was known by only 20% of students. Only 9.7% knew the appropriate age to get vaccinated.
Conclusion: The present study demonstrated that the undergraduate students had poor knowledge and awareness regarding risk factors for cervical cancer, human papillomavirus and its vaccination.
Keywords: Awareness, cervical cancer, HPV vaccine, physiotherapy female students
|How to cite this article:|
Pattanshetty R, Pawar N. Knowledge and awareness of cervical cancer and attitude toward HPV vaccination among female undergraduate physiotherapy students in Belgaum, Karnataka. J NTR Univ Health Sci 2021;10:178-85
|How to cite this URL:|
Pattanshetty R, Pawar N. Knowledge and awareness of cervical cancer and attitude toward HPV vaccination among female undergraduate physiotherapy students in Belgaum, Karnataka. J NTR Univ Health Sci [serial online] 2021 [cited 2022 Nov 30];10:178-85. Available from: https://www.jdrntruhs.org/text.asp?2021/10/3/178/339808
| Introduction|| |
Cancer is one of the primary causes which results in adult deaths worldwide. Fourteen million new cases of cancer are diagnosed every year with 8 million deaths occurring every year due to cancer. Globally, cervical cancer is the fourth most common cause of cancer mortality in women representing 7.5% of all female cancer deaths. Out of these cases, 85% has been shown to occur in developing countries. Every year, an estimated 1, 22, 844 women are diagnosed with cervical cancer in India with 67,477 deaths. In India, it is the second most frequent cancer among urban women and it usually occurs between 15 and 44 years of age. Cervical squamous cell carcinoma is the commonest histology, followed by adenocarcinomas which account for 5% to 10% of cervical cancers. [4,5]
The risk factors for cervical cancer include poor genital hygiene, increasing age, human papillomavirus (HPV) infection, cigarette smoking, HIV infection, use of oral contraceptive pills, first birth at an early age, high parity, early sexual intercourse, and females having multiple sexual partners. The commonest cause of cervical cancer in the Indian population is HPV infection. It is associated with increasing age with a peak at the fifth decade of life, manual work, lower literacy level, first sexual intercourse at an early age, and widowhood/separation. It is highly prevalent among commercial sex workers and females residing in the urban slums. HIV-positive women show a higher prevalence of cervical cancer in India. [6,7]
HPV belongs to the family of small, nonenveloped deoxyribonucleic acid (DNA) viruses known as Papillomaviridae which infects the basal epithelium. Among all the HPV types, 18 have been classified as high-risk types for cervical cancer. HPV prevalence among cervical cancer patients in India varies from 87.8% to 96.67%. Studies have shown that HPV-16 and 18 are two common highly oncogenic types in cervical cancer, out of which HPV-16 is found to be more common. [3,9]
Among all the preventive measures available for cervical cancer, HPV vaccination has shown to be most effective. In India, two vaccines are currently available: a quadrivalent vaccine Gardasil, which is a combination of L1 proteins of HPV serotypes 16, 18, 6 and 11 with aluminium-containing adjuvant, and a bivalent vaccine Cervarix, which is a combination of L1 proteins of HPV sterotypes 16 and 18 with AS04 as an adjuvant. The different types of screening tests available for cervical cancer are human papillomavirus (HPV) testing for high-risk HPV type, Papanicolaou (Pap) test, and visual inspection with acetic acid.
Cervical cancer can be completely prevented. The key to prevention of the disease is early detection for which one must have knowledge and awareness about the signs, symptoms, risk factors, preventive and screening measures for the same. Thus, knowing about this disease, its symptoms, risk factors, and preventive measures at a young age would be beneficial. Hence, the present study was taken up to study the knowledge and awareness of cervical cancer and attitude toward HPV vaccination among female undergraduate physiotherapy students in Belagavi city, Karnataka.
| Materials and Methods|| |
This study was carried out over a period of 3 months from January 2020 to March 2020 after approval of the Institutional Ethical Review Committee (IERC). The sample size was calculated using the formula, where, alpha value of 1.96, beta value of 1.2816, standard deviation of 5, and effect size of 1.5 was substituted in retrieving the sample size of n = 150 [Figure 1]. The data was collected from female students of a co-educational physiotherapy college in Belagavi city, Karnataka. To begin with, an official intimation letter was obtained from the Head of the Institute. The students were addressed in groups of 25–50 students, with the introduction and consent for the study. After the consent from each student, all were administered with a questionnaire. First part of the questionnaire included information on the age and level of education. The remaining part of the questionnaire contained questions about general knowledge, risk factors, preventive measures, and information sources regarding cervical cancer.
| Results|| |
Statistical analysis was done using the statistical package of social sciences (SPSS) version. 23. The data obtained was categorized using frequency and percentage forms to indicate knowledge on health issues. Hence, nonparametric Chi-square test was used to test the level of significance, which was set at P ≤ 0.05.
The study included a total of 154 undergraduate female students from a physiotherapy college of Belagavi city, Karnataka, who were administered a self-reported questionnaire regarding cervical cancer. Out of 154 undergraduate physiotherapy female students, 50% of the students belonged to the age group of 17–19 years and 50% were from 20–22 years of age. Majority of the student subjects were first-year undergraduates, accounting for 29.2% [Table 1].
|Table 1: Sociodemographic Profile of the Undergraduate Physiotherapy Students in the Study (N=154)|
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All the questions of the domain assessing general knowledge about cervical cancer demonstrated a statistical significance with P = 0.001 wherein 98.1% of the students had heard about cervical cancer and 78.6% were of the opinion that it is a terminal illness and 71.4% stating it to be associated with an infection. 70.8% of the students knew there was an effective method to reduce the risk of the disease and 41% of them thought it could affect them in the future, but most of the students (88.3%) stated that they never had direct contact with any individuals with cervical cancer [Table 2]. Common risk factors known to the students were multiple sexual partners (76.6%) followed by HIV infection (70.8%) and history of sexually transmitted diseases (65.6%), which was noted to be statistically significant (P = 0.001) [Table 3].
|Table 2: Description of General Knowledge About Cervical Cancer Among Undergraduate Physiotherapy Students in the Study|
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|Table 3: Description of Knowledge of Risk Factors of Cervical Cancer Among Undergraduate Physiotherapy Students (N=154)|
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A large proportion of students had good knowledge regarding the lifestyle preventive measures (55%–87%), had heard about the vaccine for cervical cancer (33.8%), and were of the opinion that smelly vaginal discharge (81.2%), itching in the genital area (66.2%), and irregular menstruation (66.2%) were distressing symptoms (P = 0.001). Knowledge regarding the appropriate duration to undergo a test for cervical cancer after sexual initiation among most of the students was found to be 49.4%. However, there was poor knowledge regarding the cytological examination [Table 4] and [Table 5]. Majority of the students (72.7%) stated that all the sources, that is, Internet, TV, newspaper, doctors, leaflets, college, and family were the basis of their information regarding cervical cancer [Table 6].
|Table 4: Description of Knowledge About Primary Prevention of Cervical Cancer Among Undergraduate Physiotherapy Students (N=154)|
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|Table 5: Description of Knowledge About Secondary Prevention Among Undergraduate Physiotherapy Students (N=154)|
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|Table 6: Description of the Sources of Information About Cervical Cancer Among Undergraduate Physiotherapy Students (N=154)|
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| Discussion|| |
Cervical cancer is one of the most prevalent cancers in India among women. This is mainly due to a dearth of awareness, knowledge, and access to resources. The key to prevent this deadly disease is early detection for which one must have knowledge and awareness about the signs, symptoms, risk factors, and preventive and screening measures for cervical cancer. Though the disease is being completely preventable, it typically affects younger women. Thus, being aware of the symptoms, risk factors, and preventive measures at a young age is beneficial.
The demographic findings of the current study correlated with the study done by Saha et al. In a study carried out to evaluate the level of knowledge and attitudes toward cervical cancer screening and HPV vaccination, it was found that majority of the participants were female students.
In the present study, a good level of knowledge was depicted by the undergraduate female students about cervical cancer with 98.1% of the student subjects having heard about cervical cancer and 78.6% were of the opinion that it is a terminal illness. This percentage was much higher when compared to a study done in Delhi, India, wherein, among 150 participants only 50% of the women had heard about cervical cancer whereas in a study done by Sharma et al., 83% of the female students had heard about cervical cancer. [15,16]
Among all the students who participated, 65.6%, 46.1%, 45.5%, and 33.1%, respectively recognized sexually transmitted diseases, early sexual initiation, multiparity, and cigarette smoking as risk factors for cervical cancer. Indian women in the age group of 17–24 years have shown to have minimal level of knowledge about these risk factors. It has been observed that 38.8% Nepalese, 27.7% Sri Lankans, and 26.1% Indians were aware that early sexual intercourse could cause cervical cancer. Smoking has shown to be a risk factor in 31.8% of Indians, 20.8% in Sri Lankans, and 0.2% in Nepalese women, demonstrating that cervical cancer awareness among Nepalese women was found to be the least.
Knowledge regarding multiple sexual partners and HPV infection causing cervical cancer was found to be 76.6% and 57.1% among the female physiotherapy students. However, among medical students of Himachal Pradesh, India, it was found to be only 39% regarding multiple sexual partners and as a cause of cervical cancer due to HPV infection being 56.75%. A Brazilian survey noticed as low as 6% of the women aged 15–24 years could identify HPV infection to be a causative factor for cervical cancer. Use of hormonal contraception as a risk factor for cervical cancer was reported by 50.6% of the students in the present study. However, in a study undertaken to evaluate the level of awareness about HPV vaccination and cervical cancer screening, it was conceded to be 49.8%.
A significant proportion of the female undergraduate physiotherapy students in the present study knew about the lifestyle preventive measures, with 57.1% stating a diet rich in antioxidants and using a condom during sexual intercourse as primary methods of prevention, whereas in other studies only 18% of the students were aware of the dietary measures and 62.5% of the students were of the opinion that use of condom prevents cervical cancer. [12,22] 33.8% of the female students had heard of the vaccine against cervical cancer and only 11% were vaccinated for HPV which coincided with a study wherein 44% of the female students between the age group of 16 and 26 years had heard about the vaccine and only 7.16% were vaccinated.
In the present study, the female students knew that smelly vaginal discharge (81.2%), bleeding between periods (57.1%) and after intercourse (46.8%) were found to be the distressing symptoms that related to cervical cancer and 35.7% of them had heard about the cytological examination and knew the ideal time frame to undergo a test for cervical cancer after sexual initiation. These results were better as compared to a previous study conducted in the Northern part of India.
| Conclusion|| |
To conclude, despite a largely positive attitude toward the preventive measures among the female undergraduate physiotherapy students, most of them had little knowledge regarding the risk factors, awareness regarding HPV and cytological examination, and a poor uptake of the HPV vaccine. Thus, there is a need for greater awareness among young women, which can be provided by conducting awareness campaigns emphasizing on informing the students regarding the modifiable risk factors and benefits of HPV vaccination and cervical cancer screening.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the participants have given their consent for their images and other clinical information to be reported in the journal. The participants understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]