An Assessment of Awareness, Barriers in Perception of Cervical Cancer and Effect Estimation of Educational Intervention Programme in Females

Background: Women of all races and ethnicities are at risk of cervical cancer. India, around 0.95 million new cases are detected yearly with high burden of 0.63 million. India bears about one fifth of the world’s burden of cervical cancer. Although fatality is high but cancers are largely preventable by effective screening programmes. Design: The present quasi-experimental study was conducted among female students studying in degree colleges from Feb. 2013 to Sept. 2013. Intervention: Educational intervention was conducted through sessions of participatory learning approach which included lectures using power-point, chalk and talk and question-answers method. Data was collected twice by administering predesigned questionnaire and conducting focus group discussion. Data Analysis: Data entered and analyzed using Epi Info 2000. To analyze qualitative information Atlas ti software was used. Paired t-test was used to measure the effect of intervention. Results: Total 149 students were the part of the study and successfully followed. Mean age of the participant was 18.5 years. Out of the 149 participants 4.1% had family history of the cancer. In the study it was observed that 18.8% had not ever heard about the cancer. In the post intervention test significant improvement was seen in all three parameters viz knowledge, attitude and practices. Conclusion: Continuing Educational interventions should be started at all level which highlights the importance of screening and prevention of cancer in women. Key-wordsCervical Cancer, Women, Perception Barriers, Effectiveness INTRODUCTION Cancer is leading cause of mortality among adults with new cases are increasing all over the world. It is expected by 2020 the world population will increase to 7.5 billion; of this, approximately 15 million new cancer cases will be diagnosed and 12 million cancer patients will die. [1] Women of all races and ethnicities are at risk of cervical cancer. In India yearly around 0.95 million new cases are detected with 0.63 million deaths. cervical cancer accounts for 8.5% deaths yearly and most of which occur in developing countries. Cervical cancer is the single largest killer of middle-aged women in India. Access this article online Quick Response Code Website: www.ijlssr.com DOI: 10.21276/ijlssr.2017.3.6.15 India bears about one fifth of the world’s burden of cervical cancer. [2-3] Although fatality is high but cancers are largely preventable by effective screening programmes. [4] Papanicolaou smears (Pap test) provide a simple, basic and inexpensive technique for detection of early cancerous and precancerous lesion in otherwise asymptomatic women. [18] Decision to participate in such cancer screening programs depends upon the knowledge, beliefs and attitudes about the disease and the screening tests. A study done in Kolkata among female students reflected low level of knowledge of cervical cancer and its risk factors and only 11% and 15% were aware of Pap smear and HPV respectively. [4] Moreover many women still go unscreened, even where screening is freely available. [5] Unfortunately, in a developing country like India there is a lack of awareness about risk factors and early detection through screening and treatment of precancerous lesions. RESEARCH ARTICLE Int. J. Life. Sci. Scienti. Res., 3(6):1516-1521 November 2017 Copyright © 2015-2017| IJLSSR by Society for Scientific Research is under a CC BY-NC 4.0 International License Page 1517 It’s well documented that Religious and cultural differences that shape perceptions about health prevention may reduce the incidence of screening practices. [6] Jayant et al. [7] and Saha et al. [8] were recommended that increasing awareness motivates symptomatic individuals to seek medical consultation and treatment in the early stages, which result in better survival. MATERIALS AND METHODS Study DesignThe present quasi-experimental study was conducted among female students studying in degree colleges (Engineering, Polytechnic College, Melmaruvathur and Arts and Commerce college Vandhawasi, Dist: Kanchipuram, India) in and around the field practice area of the Department of Community Medicine Adhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur. Study duration was from 1 February 2013 to 30 September 2013. Data collection was done twice as before and after educational intervention. Meantime educational interventions were carried out. And posttest data was collected at least 30 days after carrying out the intervention. Saha et al. [8] documented 11% of level of awareness among female students attending degree colleges. With prevalence of awareness as 11% and based on 95% of confidence interval, with 5% of absolute error the total sample size comes to 144. Considering non response up to 10%, final sample size was 158. But we could not follow all the students till the post test and after thorough verification researcher could analyze data for 149 students. The total numbers of students from each college were determined by PPS sampling and further systematic sampling was employed at college level. Inclusion CriteriaThose who were willing to participate and providing written consent. Exclusion CriteriaStudents who were not willing to participate and unable to give the consent. Institutional Ethical committee approval and informed consent of the subjects was obtained prior to the start of the study. Permission to undertake study among students was obtained from the respective college Principal (Engineering, Polytechnic College, Melmaruvathur and Arts, and Commerce college Vandhawasi, Dist: Kanchipuram, India) Pre-TestTo evaluate different aspects of basic knowledge and awareness on cervical and breast cancer students were offered a structured questionnaire to collect information. Confidentiality was ensured by asking them not to write their names. All the students were asked to write the questionnaire voluntarily and independently. In the First part data was collected for age, socioeconomic status and family size. The second part contained questions pertaining to knowledge of aetiology, symptoms, screening methods and prevention of cancer. To identify the barriers and misconceptions among the participants, Focused Group Discussion sessions were conducted. InterventionEducational intervention was conducted through sessions. The training was conducted by participatory learning approach which included lectures using power-point, chalk and talk and questionanswers method. The topics discussed were related to prevalence, causation of cervical cancer, symptoms, risk factors, screening methods and prevention. Focus group discussion was conducted under following FrameworkBefore starting up the focused group discussion Aims and Objectives of the study were informed and duly consent was sought. FrameworkCmmon topics discussed during the Hospital meetings/ visits. Question design like, If they know about the Common Health Ailments women suffers from? Have they heard about cancers? Can they name few of them? Their Perception about common cancers among females during talk observed. Information received about Cervical cancer from them. Perception about Cervical Cancer Screening (Pap’s Smear). Perceived role of the Cancer Screening in preventing deaths from the diseases. Perception about early detection of the cancer through cancer screening. Impression about Cancer screening services. Perceived reasons for poor utilization of the available Screening services. Suggestions or ways that screening uptake can be improved were the information collected from female. Post-test: The same questionnaire was administered to the study subject one month after completion of their training sessions. Statistical AnalysisData entered and analyzed using Epi Info 2000. To analyze qualitative information Atlas ti software version 5.0 was used. Univariate analysis was done to analyze descriptive data whereas to identify association bivariate analysis was done. Paired t-test was used to measure the effect of intervention. Background Characteristics of the ParticipantsMean age of the participant was 18.5 Years (SD ±0.78). Maximum no of the participants 51.4% (n=76)were in the age group of 18-19 years followed by 39.9% (n=59) in the age group of 19-20 years. Most of the participants were from low income group accounting for 39.9% (n=58) followed by middle income group 32.9% (n=49) and others 16.1% (n=24). Out of the 149 participants 4.1% had family history of the cancer. In the study it was observed that 18.8% had not ever heard about the cancer. Knowledge regarding Cervical CancerTable 1 has shown the comparison between pretest and post test responses of knowledge regarding cervical cancer. It was observed that 10.1 % of the participants ever heard about cervical cancer. When asked about causative agent for cervical cancer only 2.1% were able to give correct answer which rose to 97.9% after intervention. Similarly 10.1% had knowledge of risk factors, 9.4% knowledge of symptoms and 0.7% about preventive measures like HPV Int. J. Life. Sci. Scienti. Res., 3(6):1516-1521 November 2017 Copyright © 2015-2017| IJLSSR by Society for Scientific Research is under a CC BY-NC 4.0 International License Page 1518 vaccine which increased to 90.6%, 93.3% and 94.3% respectively. Table 1: Knowledge regarding Cervical Cancer among Participants Knowledge Based Questions on Cervical Cancer Pre-Test Response Post-Test Response