INTRODUCTION:

Cervical cancer is a leading cause of death among women in worldwide. But the condition is preventable through regular screening of those at risk. Although screening facilities are available in India, the incidence and mortality from cervical cancer remains very with many women getting health facility with late stages diseases. According to National Cancer control programmed cancer has become one of the ten leading causes of death in India.

It is estimated that there are nearly 2 - 2.5million cancer cases at any given point of time.

In the early nineties when revolution was occurring in health care system throughout the world. India was facing a lot of deaths due to communicable diseases. However after independence the government of India took lot of measures to improve the life expendably of Indian population, these measures gave fruitful results by showing a massive control in mortality in as non-communicable disease (48%) communicable disease (42%) injuries (10%). A report from United Nation World population prospects indicated a shift in demographic profile 45 years in 1971to 65yrs in 2005-2010¹.

Cervical cancer prevalence in India is estimated to be around 2.5million with over 8,00,000 new cases 5, 50,000 death & occurring each year due to this disease. The last fifty years have seen an exploration in our knowledge understanding of this most fundamental of disease. New discoveries are occurring on an almost weekly incidence for the period of 1975 - 2008 has demonstrated. That the overall occurrence of chances is increasing among women’s. The greatest increase among women’ s was for cancer of the cervix².

Risk factors for cervical cancer include early age at first intercourse, multiparty, sexually transmitted infections and multiple sexual partners. Human papilloma virus infection has been identified as one of the main risk factors for cervical cancer. But it is considered as one of most prevented through early papanicolae (PAP) test screening and appropriate management. This is important for developing countries like India because this cervical cancer mortality rate is higher as compared to developed countries. Papanicolae cytological testing (PAP smear) can reduce the incidence of cervical cancer mortality. Lack of communication between health care workers and community people regarding availability and benefits of the screening lack of knowledge regarding cervical cancer screening method and lack of laboratory infrastructure to perform papsmear has been reported as major barriers of cervical cancer screening. In many developing countries women has lack of knowledge of cervical cancer³.

It is possible to prevent deaths due to cervical cancer through various strategies that target women >30 yr for screening and treatment. The introduction of the Papanicolaou test led to a significant reduction in mortality and morbidity in developed countries where proportion of women who are screened by Pap test vary from 68 to 84 per cent. On the other hand, the screening coverage in Asian countries is low and varies from 50 per cent in Singapore which has an existing Cancer Screening Programme to 2.6-5 per cent in India. Despite existence of national guidelines the screening coverage in India is appalling and is mainly attributed to inequality between infrastructure, resources and outsized population. As a result, very often diagnosis of cervical cancer is based on opportunistic screening or after the onset of symptoms. Though data from the 20 populations based cancer registries in India indicate a steady decline in cervical cancer incidence rates over the last two decades, it still occupies number two position and the risk of disease is still high. These registries are predominantly urban and in the rural cancer registry in Barshi the risk of cancer of cervix was considerably high compared to urban Mumbai registry and it accounted for half the cancer burden⁴

Cervical cancer screening through Pap smear testing is extremely useful in detecting cervical neoplasia at a very early stage. Visual methods of screening include visual inspection with 3-5% acetic acid (VIA), VIA with low-level magnification (VIAM), and visual inspection with Lugol’s iodine (VILI). In addition, the use of Human papilloma virus (HPV) vaccines, the use of condoms during sexual intercourse, avoidance of smoking, and higher intake of fruits, vegetables, and vitamin C are identified as other methods for preventing cancer cervix. Major barriers to cervical cancer screening are lack of knowledge about the disease, lack of familiarity with the concept of prevention, geographical and economic inaccessibility of care, poor quality of services, and lack of support from husbands and families. Strategies in low-resource settings should be socially and culturally appropriate in order to minimize these barriers⁵

NEED FOR THE STUDY:

Cervical cancer is a major and devastating cause of mortality Worldwide with an estimated global incidence of 5 lakh new cases and 2-7 lakh deaths annually among women.

Every year cervical cancer is diagnosed in about 500,000 women globally and is responsible for more than 280,000 deaths annually 80% of the new cervical cancer cases occur in developing countries like India. Which reports approximately one-fourth of the world’s cases of cervical cancer each year 19.4 to 43.5 per 100,000 women are registered with cervical cancer in the register under the national cancer Registryprogramme. It has been estimated that 100,000 new cases of cancer of the cervix occur in India every year. One out of every five women in the world suffering from this disease belongs to India. It is estimated that there were 112,609 new Cervical Cancers in 2004 and this number is expected to rise to 139,864 in 2015^.Cervical cancer ranks as the 1^st most frequent cancer among women in India, and the 1st most frequent cancer among women between 18 and 44 years of age. About 7.9% of women in the general population are estimated to harbor cervical HPV infection at a given time, and 82.5% of invasive cervical cancers are attributed to HPVs⁶

A study conducted by the New England Journal of Medicine reveals that about 1.3 lakh new cases of cervical cancer are reported every year, in India and about a quarter of the five lakh cases globally. Experts point out that women need to be sensitised to curb the growth of this disease. “Even the educated class are not aware of cervical cancer and often link it with the neck. We have to explain to them that cervical cancer is caused in the lower part of the body," says gynaecologist, SunitaVerma. Cancer Research Foundation of India (CRFI), a recently constituted body is actively involved in spreading awareness. Dr Siddharth Sahni, co-founder, CRFI says, "Awareness, prevention and detection is what we are striving for to deal with cancer. We need to reach out to both grass roots and urban India". Cancer of the cervix has been the most important cancer in women in India over the past two decades. It accounted for 16 per cent of all cancers in women in the urban registries in 2005. Over 70 per cent of the Indian population resides in rural areas; cervical cancer still constitutes the number one cancer among females. In the hospital based cancer registries (HBCRs), the leading site for cervical cancer is Bangalore and Chennai, the second leading site in Mumbai and Thiruvananthapuram and the third leading site in Dibrugarh. The percentage of cervical cancer constitutes 11.4% in Thiruvananthapuram, 30.7% in Chennai, 40% in Bangalore respectively. In spite of having had a diagnosis of cervical cancer in Chennai, Trivandrum and Bangalore it has been reported that they didn’t receive active treatment. More than three-fourths of these patients are diagnosed at advanced stages leading to poor prospects of long-term survival and cure, despite of health care institutions efforts in introducing lot of screening programs. Incidences have not decreased especially among poor, rural women, who make up the majority of cervical cancer victims due to lack of awareness, knowledge, and inaccessibility to screening and cultural barriers⁷

A study conducted to assess the knowledge of cervical cancer vaccination among adolescents revealed that, adolescent girls had inadequate knowledge of vaccination against cervical cancer. Therefore the findings of the study strongly suggest that there is a need for conducting a study using SIM on the importance of vaccination against cervical cancer among adolescent girls⁸

A research study explored the view that current HPV infection in a case is almost infection in a control may be a recently acquired transient infection. The existence of a current HPV infection in a middle aged woman gives little information about lifetime infection history. Which is the information required to fully interpret the findings on sexual behavior⁹

Findings of the study to identify the risk factors of cervical cancer concluded that, 65(65%) women were at moderate level of risk of cervical cancer and 31(31%) at severe level and 4(4%) were at mild level of risk. there was a significant association found between education and age of the women at marriage (8.279), age at first child birth (14.949), number of children (30.451), regular menstruation (15.932), perineal hygiene practice (11.931) at p<0.05. Association was also found between occupation of the women and number of children (20.813), regular menstruation (11.794), practice of perineal hygiene (5.725), gynaecological consultation (4.071) at p<0.05¹⁰

A study was conducted to examine knowledge regarding cervical cancer among 400 female workforces in U.K by using knowledge questionnaire on cervical screening treatment for abnormalities ad HPV. Four hundred women returned completed knowledge questionnaires of cervical cancer were good but risk factors for cervical cancer were not well known. Awareness and knowledge of HOV was very limited. It is essential to improve women’s knowledge of cervical cancer and risk factors¹¹

The study finding revealed that the women had 35(70%) inadequate knowledge and 15(30%) had moderate knowledge regarding cervical cancer. Some of the demographic variables like educational status, religion and source of information are significantly association at (p<0.05) with knowledge score of women¹²

In aCross-Sectional, interview based survey with a sample of 400, 1.8% did not know cervical cancer is a disease. Only 23.3% the respondents were aware that cervical cancer is the most common cause of gynaecological cancers and 26% knows it is second in rank in mortality, 78% were aware infection is the most common cause of cervical cancer 62 said that virus cause and 61% responds virus is HPV. Majority recognized that it is STD. Only 26 % of the population was aware of one or more risk factors. 37% recognized Pap smear as a screening test. In total only 37 out of 400 respondents were aware of the HPV vaccine¹³

A study was conducted on assessing the knowledge on prevention of cervical cancer among women residing in selected urban and rural community in Sikkim.The finding reveals that out of 50 total samples from urban community, 35 were aware of cervical cancer. Out of 35(100%) majority 45.73% have good knowledge, 42.85% have average knowledge and minimum 11.4% have poor knowledge. In rural community out of 50 total samples 48 were aware of cervical cancer. Out of 48(100%) majority 75% have average knowledge, 18.75% have good knowledge and minimum 6.25% have poor knowledge regarding cervical cancer and its prevention. The study also reveals that there was no significant difference between knowledge score of urban and rural community women. There was no significant association between knowledge of both the community women with selected variables. Pamphlet was distributed on cervical cancer and its prevention to all the participants regardless of their knowledge level¹⁴

In a cross sectional survey among 2500 adolescents in India, Bangladesh, Nepal and Sri Lanka, the prevalence of human papillomavirus (HPV) infection among the general populations varies from 7-14% and the age-specific prevalence across age groups is constant with no clear peak in young women. This observation may be the result of a low clearance rate of incident infections, frequent re-infection/reactivation, limited or no data in target high-risk age groups (teenagers), and sexual behavioural patterns in the population. High-risk HPV types were found in 97% of cervical cancers, and HPV-16 and 18 were found in 80% of cancers in India¹⁵

A study aimed to assess the existing awareness regarding cervical cancer among married women. Design: Descriptive survey method was used. Participants: 200 married women residing at selected rural areas of Ahmadabad district. Methods: Probability Multi stage sampling technique through systemic random sampling technique for selecting 200 samples by Dichotomous structured questionnaire. Result: Total mean score was 11.40 and mean percentage was 38.01%. Major finding of the study were 115(57.5%) samples had poor level of awareness, 73(36.5%) samples had average level of awareness while 12 (6%) samples had good level of awareness regarding cervical cancer. Conclusion: The Study concluded that community staff nurse should make the awareness to the rural women regarding cervical cancer and encourage for do PAP smear test and for the making of aware to the rural women regarding cervical cancer health education programme were effective¹⁶

A descriptive study to assess the knowledge regarding cervical cancer among selected rural areas of Gurugram, Haryana.The objective was to assess the level of knowledge regarding cervical cancer. To determine the association between knowledge score regarding cervical cancer with selected demographic variables. Findings revealed that 36% women were in the age group of 30-40 years. Majority of the women (36%) were illiterate. Most of the women (70%) were married. All (100%) women were belongs to Hindu religion. Majority of the women 59% menarche age was 14-17 years. Majority of women (47%) were having duration of menstruation three to four days. Majority of the women (35%) were having three or more children. Most of the women (67%) were not having previous knowledge about cervical cancer. Most of the women 44% have got the information from the other sources than mass media, textbook and special program¹⁷

In a pre-experimental design of one group pre and post - test design, it was found that, the health seeking behaviour of women of subjecting themselves for cervical cancer screening is increased by creating awareness by imparting educational intervention. Key Conclusion: Creating awareness by educational intervention will improve the health seeking behaviour of making women by creating awareness to accept cervical cancer screening. Implications for clinical practice: Creating awareness by imparting health education will improve the health seeking behaviour of women by making them to undergo cervical cancer screening¹⁸

In a study to assess the factors affecting the non-utilization of cervical cancer screening services among women attending in Nemam primary health centre, out of 50 sample reveals that the age distributions were 25-35 years 24(48%), Religion 30(60%) were Hindus, Education 15(40%) were having no formal level of education, occupation 39(78%) were housewife, income of the family per month 24(58%) were Rs.5000-10,000, marital status 50(100%) were married, parity 38(68%) were 2-4 children. Conclusion: This study indicates that the majority of women have moderate knowledge of cervical cancer screening services¹⁹

Cervical cancer, the second most common cancer among women and remains one among the major worldwide health concern. It is estimated that more than 500,000 and 300000 women’s develop and die annually from cervical cancer. Human papillomaviruses (HPVs) are the main cause for the origin of >99% of cervical cancers and are considered to be the major etiologic factor besides environmental and hormonal. Since the number of women reporting with cervical cancer is increasing annually better screening as well as diagnostic methods are to be initiated. Pap smears, as of now considered, to be a successful means for early detection of cervical cancer precursors but is limited in its use in countries with developed health care systems. Current approaches for treating cancer have limited success. In this line, as of studies reported so far on treatment for cervical cancer, is chemotherapy, radiation therapy along with surgical treatments²⁰

STATEMENT OF PROBLEM:

A study to assess the knowledge regarding cervical cancer among women residing at Rajanagaram

OBJECTIVES:

The study was aimed

1. To assess the knowledge of women regarding cervical cancer.

2. To find out the association between knowledge with selected demographic variables regarding cervical cancer among women.

Hypothesis:

H: There is a significant association between knowledge and the selected demographic variables.

Delimitations:

1. The study was delimited to the knowledge aspects of cervical cancer.

2. The setting was delimited to the Rajanagaram area.

MATERIALS AND METHODS:

Research approach:

The research approach adopted for the study was a quantitative evaluative approach.

Research design:

The research design adopted for the present study was a community-based cross-sectional descriptive research design.

Setting of the study:

The setting selected for the study was Surya Raopeta, Rajanagaram which is located at a radius of about 15 kilometers from the researchers’ institution. The setting was selected on the basis of the availability of adequate samples and the researchers' familiarity with the area.

Population:

The population of the present study was women (in the age group 20-50 years) residing in the Surya Rao Peta, Rajanagaram.

Sample size:

The sample size for the present study was 150 women aged between 20-50 years of age

Sampling technique:

The sampling technique used for the study was the Non-Probability convenient sampling technique

Study period:

The study period was for one year and the data was collected over a period of three months.

Criteria for selection of sample:

Inclusion criteria:

Women who were

· Willing to participate in the study.

· Available at the time of data collection

Variables:

· Research variables: knowledge of women regarding cervical cancer.

· Demographic variables: In this study, the demographic variableswere Age, Educational Status, Occupation, Religion, Family Income per Month, Number of children, Type of Family, and Source of Information on cervical cancer.

Development of the tool:

The knowledge checklist was developed from anextensive review of literature like as books, journals, the internet and guidance from the experts. The experts were requested to give their opinions and suggestions regarding the adequacy and appropriateness of the study. The final tool consisted of 45 items regarding cervical cancer.

Plan for data analysis:

The data was analyzed by using descriptive and inferential statistics. Descriptive statisticsused were Frequency, Percentage, Mean, and Standard Deviation. The Inferential statistics used was Chi-Square to determine the association between knowledge and selected demographic variables

Ethical implications:

Permission was obtained from institutional research and the Ethical and Research committee of the institution. Permission was also obtained from the Medical Officer of the concerned PHC, Rajanagaram.Informed consent was taken from the women who were participating in the study. The purpose and objectives of the study were explained to the participants. Confidentiality was ensured to the participants.

RESULTS:

All statistical analysis was performed by SPSS trial version -16 and MS-Excel 2007 quantitative variables were expressive in mean±standard deviation and qualitative variables were expressed in percentage Fisher’s exact test (Chi-square) was used for finding the quantitative variables. For all statistical analysis, p< 0.05 was considered as a statistically significant.

The results showed that, 2% of women have adequate knowledge, 28.67% are having moderately adequate knowledge, and the majority 69.33% were having inadequate knowledge on cervical cancer. (Table-1).

Table 3: Association of knowledge of samples with their demographic variables (N=150)

S. No	Demographic variables	Knowledge			Chi square (χ²)
		Knowledge			Chi square (χ²)			P	Inference
		Adequate	Moderately adequate	Inadequate	C.v	T.v	Df	Value
1	Age in years
	a)≤30	2	24	31
	b)31-40	1	12	34	11.7	9.49	4	0.02	S
	c)41-50	0	7	39
2	Educational status
	a) Illiterate
	b) Primary	0	11	52
	c) Secondary	1	12	22	24.1	12.59	6	0	S
	d)Graduation and above	1	19	29
		1	1	1

3	Occupation
	a) House wife	1	29	81
	b) Employee	2	9	16	8.82	12.59	6	0.184	NS
	c) Business	0	4	3
	d) Labourer	0	1	4

4	Religion
	a) Hindu	0	15	28			6
	b) Muslim	0	2	9	3.13	12.59		0.536	NS
	c) Christian	3	26	67
	d) Others.......	0	0	0
5	Family income per month in rupees
	a) ≤ 5,000/-	0	23	60
	b)5,001/- to 10,000/-	3	17	34
	c)10,001/- to20,000/-	0	3	10
	d) Above 20,001/-	0	0	0	6.18	12.59	6	0.186	NS
6	Number of children
	a) 0
	b) 1	1	8	3
	c) 2	1	9	13	18.3	12.59	6	0.006	S
	d) 3 and above	1	14	38
		0	12	50
7	Type of family
	a) Nuclear	2	30	58
	b) Joint	1	13	46	2.54	9.49	4	0.281	NS
	c) Extended	0	0	0
8	Source of information
	a) No information
	b) Mass Media	0	9	15
	c) Family members	1	10	35	2.96	12.59	6	0.814	NS
	d)Health personnel	1	15	30
		1	9	24

The data in table 3interprets that, there was statistically significant association between knowledge and demographic variables, such as age, educational status and number of children. There was no statistically significant association between knowledge and demographic variables such as occupation, religion, family income per month in rupees, type of family, and source of information

DISCUSSION:

The first objective of the study was to assess the knowledge regarding cervical cancer among women. The results showedthat, the majority, 69.33% had inadequate knowledge, 28.67% had moderateknowledge, and 2% of the participants had adequate knowledge.The test mean was 13.61, standard deviation was 5.27.

The second objective of the study was to determine the association between knowledge with selected demographic variables. The results showed that the demographic variables such as Age, Educational status and Number of children showed significant association with knowledge.

The present study was supported by other similar studies.

D. Souza et al (2014) conducted a study to assess the risk of cervical cancer among women. The study revealed that 65(65%)women were at moderate level of risk of cervical cancer and 31(31%) at severe level and 4(4%) were at mild level of risk there a was a significant association found between education and age of the women at marriage (8.279) age at first childbirth (14.949) number of children (30.451), regular menstruation (15.932) perineal hygiene practice (11.931) at P<0.05 Association was also found between occupation the women and number of children (20.812) regular menstruation (11.794) practice of perineal hygiene (5.725), Gynaecological consultation (4.071) at P<0.05 the finding of the study helps the investigator to identify the risk factors cervical cancer.

Bhatia N et.al (2013) conducted a cross sectional survey among 2500 adolescents in India, Bangladesh, Nepal and Sri Lanka where there are gaps in knowledge on the distribution and determinants of the disease in these countries. Prevalence of human papillomavirus (HPV) infection among the general population varies from 7-14% and the age-specific prevalence across age groups is constant with no clear peak in young women. This observation may be the result of a low clearance rate of incident infections, frequent re-infection/reactivation, limited or no data in target high-risk age groups (teenagers), and sexual behavioural patterns in the population. High-risk HPV types were found in 97% of cervical cancers, and HPV-16 and 18 were found in 80% of cancers in India.

CONCLUSION:

Cervical cancer remains one of the leading causes of mortality and morbidity among women. The study results showed that the majority of women had inadequate knowledge regarding cervical cancer and the rate of screening tests for cervical cancer remains to be very low in developing countries. Essential steps should be taken to bring awareness in women regarding the causes, importance of screening tests, and the treatment modalities for cervical cancer

STUDY IMPLICATIONS:

The study findings have several implications in the field of Nursing.

Nursing practice:

Health education on cervical cancer should be made an integral component of nursing practice. Strategies should be developed to educate women about cervical cancer.

Nursing education:

Teaching modules should be introduced into the curriculum at primary levels of nursing education on cervical cancer. The students should be trained in putting their efforts to reduce the occurrence of morbidity and mortality by improving the knowledge of women regarding cervical cancer. Nursing personnel working in community health departments, PHC, and sub-centers should be given in-service education to update and improve their activities in terms of knowledge of women and to plan, implement, and educate by health education programsto the women.

Nursing research:

Research activities on cervical cancer should be promoted at all levels

Nursing administration:

There should be an increase in the proportion of healthcareorganizations to provide health education to women regarding cervical cancer. The nurse administrator should take an interest in providing information regarding the need for organizing health education programs on cervical cancer.

RECOMMENDATIONS:

A similar study can be replicated with a large sample.

Comparative studies can be carried out to assess the knowledge of rural and urban women regarding cervical cancer.

A study can be conducted to assess the knowledge of women regarding HPV vaccination

ACKNOWLEDGMENT:

The authors wish to thank the institutional authorities and the participants of the study

CONFLICT OF INTEREST:

None.

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Received on 04.09.2023 Modified on 24.09.2023

Int. J. of Advances in Nur. Management. 2023; 11(4):237-244.

DOI: 10.52711/2454-2652.2023.00054

S. No	Level of knowledge			Frequency (f)	Percentage (%)
S. No	Level	Knowledge Score	Percentage of knowledge score	Frequency (f)	Percentage (%)
1	Adequate knowledge	31-45	≥ 67%	3	2%
2	Moderate knowledge	16-30	34% -66%	43	28.67%
3	Inadequate knowledge	0-15	≤ 33%	104	69.33%

Category	Mean	Standard deviation
Knowledge	13.61	5.27