Cervical cancer screening - community based approach to knowledge, attitudes, practice and behavior of Nepali women in Nagarjuna municipality-4, Sitapaila, Kathmandu.

Thesis Report.

Abstract:

Background: Cervical cancer is one of the most common cancers among women in Nepal. It is preventable by effective screening with Pap smear, which is reliable and inexpensive. This study was carried out with the objective to describe the predisposing factors and barriers to cervical cancer and Pap smear screening in women in Sitapaila region and to determine the level of knowledge, attitude, and behavior of women towards cervical cancer and Pap smear screening. Screening can be possible if women are aware of the problem and if they have positive attitude.

Method: This was descriptive, cross sectional study in which participants were selected by simple random sampling, one participant was selected from every fifth household, women of reproductive age group were included. The data was collected in questionnaires both in Nepali and English consisting of 32 questions including personal data and questions about knowledge, attitudes, practice and behavior towards cervical cancer and its screening. The questionnaire was conducted through face to face interview with the participants, and filled in by the interviewer. Data were entered and analyzed using SPSS, Version 21.

Results: There were 380 respondents, mean age was 33.09 years, 88.2% were married,70.3% were housewives and 77.7% were literate (77.6%). 46.3% had fair knowledge while 44.7% had poor and 8.9% had good knowledge regarding cervical cancer and screening. 93.1% gave at least 1 cause of risk factor, most common answer was having many sexual partners (50.3%). Also a look at knowledge level versus education level using Chi square test gave a χ2 = 81.4 Df = 10; p= 0.000, which was very significant. When attitude was graded it was seen that majority had positive attitude 278(73.2%) while 102(26.8%) had negative attitude. While approximately more than two thirds of the participants (82.6%) have not had a Pap smear test only 17.4% had a Pap smear test at some time in their lives. Knowledge level versus utilization of Pap smear test using Chi square test gave a χ2 = 14.64 Df = 2; p= 0.001, which was very significant. Attitude versus utilization of Pap smear test using Chi square test gave a χ2 = 26.091 Df = 1; p= 0.000, which was very significant. It was seen that those who had good knowledge had positive attitude (94.1%) with χ2 = 23.18 Df = 2; p = 0.000. Most of the women (~89.7%) reported that they plan to have or continue with Pap smear screening in the future.

Conclusion: It is seen in this study that though the participants felt that Pap smear testing was beneficial and had positive attitude. They do not have adequate knowledge and practice regarding cervical cancer and cervical cancer screening. It is important to impart knowledge so that health education programs be effective in removing barriers.