Document Type : Original Article
Authors
Department of Medical Surgical Nursing, Silver Oaks College of Nursing, Mohali, Punjab, India
Abstract
BACKGROUND: Cervical cancer is the leading cause of death worldwide, especially in developing
countries. More than one‑fifth of newly diagnosed cervical cancer cases are occurring in India. Cervical
cancer is a highly preventable and curable cancer compared with other types of cancer, if detected
at an early stage. The present study has been carried out to assess whether a community‑based,
multicomponent, nurse‑led intervention program improves cervical cancer screening behavior of
women.
MATERIALS AND METHODS: An experimental randomized controlled trial was carried out by
recruiting 419 women in the age group of 30–60 years (246 in the experimental group and 173 in the
control group) residing in a selected rural community (selected tribal settlements) of Idukki district of
Kerala, India, using multistage cluster sampling. The intervention comprising small group education
followed by reinforcement session, telephonic reminders, navigation and guidance for Pap smear,
and follow‑up visit by the investigator was administered to the experimental group, and the control
group did not receive any intervention. Knowledge, attitude, and screening behavior of women related
to prevention of cervical cancer were assessed before and twice after the intervention.
RESULTS: The experimental and control groups were homogenous in all baseline sociodemographic
variables. The community‑based intervention program was effective in improving knowledge(P< 0.001),
attitude (P < 0.001), and screening behavior (P < 0.001) of women regarding the prevention of cervical
cancer. A significant moderate positive correlation was found between knowledge and screening
behavior (r = 0.408). Significant association was found between knowledge, attitude, and practice
regarding prevention of cervical cancer with education, age at the time of marriage, and number of
pregnancies.
CONCLUSION: The community‑based, multicomponent, nurse‑led intervention program was
effective in improving cervical cancer screening behavior among women. Repeated motivation and
reinforcement are needed to bring behavioral change and to increase uptake of screening services
among rural women.
Keywords
Gómez D, et al. ICO Information Centre on HPV and Cancer(HPV
Information Centre). Human Papillomavirus and Related
Diseases in the World. Summary Report 7 October 2016.
2. Bruni L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J,
et al. ICO/IARC Information Centre on HPV and Cancer (HPV
Information Centre). Human Papillomavirus and Related
Diseases in the World. Summary Report 17 June 2019.
3. Denny L, Prendiville W. Cancer of the cervix: Early detection and
cost‐effective solutions. Int J Gynaecol Obstet 2015;131:S28‑32.
4. Demarteau N, Morhason‑Bello IO, Akinwunmi B, Adewole IF.
Modeling optimal cervical cancer prevention strategies in Nigeria.
BMC Cancer 2014;14:1‑6.
5. Sahasrabuddhe VV, Parham GP, Mwanahamuntu MH,
Vermund SH. Cervical cancer prevention in low‑and
middle‑income countries: feasible, affordable, essential. Cancer
Prev Res 2012;5:11‑7.
6. Singh S, Badaya S. Factors influencing uptake of cervical cancer
screening among women in India: A hospital‑based pilot study.
J Community Med Health Educ 2012;2:2161‑0711.
7. Roncancio AM, Ward KK, Fernandez ME. Understanding cervical
cancer screening intentions among Latinas using an expanded
theory of planned behavior model. Behav Med 2013;39:66‑72.
8. Vallikad E. Cervical cancer: The Indian perspective. Int J Gynecol
Obstet 2006;95:S215‑33.
9. Vora K, McQuatters L, Saiyed S, Gupta P. Knowledge, attitudes,
and barriers to screening for cervical cancer among women in
India: A review. World Cancer Res J 2020;7:e1504.
10. Dahiya N, Aggarwal K, Singh MC, Garg S, Kumar R. Knowledge,
attitude, and practice regarding the screening of cervical cancer
among women in New Delhi, India. Tzu‑Chi Med J 2019;31:240‑3.
11. Bansal AB, Pakhare AP, Kapoor N, Mehrotra R, Kokane AM.
Knowledge, attitude, and practices related to cervical cancer
among adult women: A hospital‑based cross‑sectional study.
J Nat Sci Biol Med 2015;6:324‑8.
12. DhivyaB, Balakrishnan PR. Cervical cancer screening: Knowledge,
attitude and practices in a primary health centre in rural India.
J Evid Based Med Health Care 2015;2:4530‑9.
13. Thulaseedharan JV, Frie KG, Sankaranarayanan R. Challenges
of health promotion and education strategies to prevent cervical
cancer in India: A systematic review. J Educ Health Promot
2019;8:216.
14. Mary B, D’Sa JL. Evaluation of an educational program on cervical
cancer for rural women in Mangalore, Southern India. Asian Pac
J Cancer Prev 2014;15:6603‑8.
15. Pirzadeh A, Mazaheri MA. The effect of education on women’s
practice based on the health belief model about pap smear test.
Int J Prev Med 2012;3:585‑90.
16. Shojaeizadeh D, Hashemi SZ, Moeini B, Poorolajal J. The effect
of educational program on increasing cervical cancer screening
behavior among women in Hamadan, Iran: Applying health belief
model. J Res Health Sci 2011;1:20‑5.
17. Perkins RB, Langrish S, Stern LJ, Simon CJ. A community‑based
education program about cervical cancer improves knowledge
and screening behavior in Honduran women. Rev Panam Salud
Pública 2007;22:187‑93.
18. Daryani S, Shojaeezadeh D, Batebi A, Charati JY, Naghibi A. The
effect of education based on a health belief model in women’s
practice with regard to the Pap smear test. J Cancer Policy
2016;8:51‑6.
19. ParsaP, SharifiF, Shobeiri F, KaramiM. Effects of group counseling
based on health belief model on cervical cancer screening beliefs
and performance of rural women in Kaboudrahang, Iran. Asian
Pac J Cancer Prev 2017;18:1525‑30.
20. Khademolhosseini F, Noroozi A, TahmasebiR. The effect of health
belief model‑based education through telegram instant messaging
services on Pap smear performance. Asian Pac J Cancer Prev
2017;18:2221‑6.
21. Shobeiri F, Javad M, Parsa P, Roshanaei G. Effects of group
training based on the health belief model on knowledge and
behavior regarding the pap smear test in Iranian women:
A quasi‑experimental study. Asian Pac J Cancer Prev
2016;17:2871‑6.
22. Tabeshian A, Firozeh F. The effect of health education on
performing pap smear test for prevention of cervix cancer in
teachers of Isfahan city. Med Sci J Islamic Azad Univ 2009;19:35‑40.
23. Samami E, Seyedi‑Andi SJ, Bayat B, Shojaeizadeh D, Tori NA. The
effect of educational intervention based on the health belief model
on knowledge, attitude, and function of women about Pap smear test at Iranian health centers: A randomized controlled clinical
trial. J Educ Health Promot 2021;10:22.
24. Abdullah F, Su TT. Applying the transtheoretical Model to
evaluate the effect of a call–recall program in enhancing Pap smear
practice: A cluster randomized trial. Prev Med 2013;57:S83‑6.
25. Krok‑Schoen JL, Oliveri JM, Young GS, Katz ML, Tatum CM,
Paskett ED. Evaluating the stage of change model to a cervical
cancer screening intervention among Ohio Appalachian women.
Women Health 2016;56:468‑86.
26. Thompson B, Carosso EA, Jhingan E, Wang L, Holte SE, Byrd TL,
et al. Results of a randomized controlled trial to increase cervical
cancer screening among rural Latinas. Cancer 2017;123:666‑74.
27. Singh M, Ranjan R, Das B, Gupta K. Knowledge, attitude and
practice of cervical cancer screening in women visiting a tertiary
care hospital of Delhi. Indian J Cancer 2014;51:319‑23.
28. Siddharthar J, Rajkumar B, Deivasigamani K. Knowledge,
awareness and prevention of cervical cancer among women
attending a tertiary care hospital in Puducherry, India. J Clin
Diagn Res 2014;8:OC01–3.
29. Aswathy S, Quereshi MA, Kurian B, Leelamoni K. Cervical cancer
screening: Current knowledge & practice among women in a rural
population of Kerala, India. Indian J Med Res 2012;136:205‑10.
30. Nene B, Jayant K, Arrossi S, Shastri S, Budukh A, Hingmire S,
et al. Determinants of women’s participation in cervical cancer
screening trial, Maharashtra, India. Bull World Health Organ
2007;85:264‑72.
31. Sankaranarayanan R, Rajkumar R, Arrossi S, Theresa R, Esmy PO,
Mahé C, et al. Determinants of participation of women in a cervical
cancer visual screening trial in rural south India. Cancer Detect
Prev 2003;27:457‑65.
32. Roy B, Tang TS. Cervical cancer screening in Kolkata, India:
Beliefs and predictors of cervical cancer screening among women
attending a women’s health clinic in Kolkata, India. J Cancer Educ
2008;23:253‑9.
)