To Assess the Effectiveness of Planned Teaching Programme on Knowledge and Attitude regarding Prophylactic Vaccination for preventing Cervical Cancer among nursing students in the College of Nursing, Bathinda, Punjab
Anita Prakasam, Dr. Virendra Singh Choudhary
Adesh University, Barnala Road, Bathinda, Punjab.
*Corresponding Author E-mail: preethi_anita@yahoo.co.in
ABSTRACT:
Background: Cervical cancer is the fourth most common cancer affecting the women worldwide. If women in India undergo periodic screening for cervical cancer, it could be possible to detect the cancer in early stages and thereby reducing mortality and morbidity. Screening would be broadly influenced by knowledge about cervical cancer. Objectives: To assess the level of knowledge and attitude of nursing students regarding prophylactic vaccination for cervical cancer, evaluate the effectiveness of planned teaching programme on prophylactic vaccination for cervical cancer and associate the knowledge and attitude scores of students of selected nursing colleges with their selected sociodemographic variables. Material and methods: A non-experimental descriptive research design was employed for this study. The population of this study includes nursing students those who studying in selected college of nursing in Bathinda. Hundred students who met inclusion and exclusion criteria were included in this study. Eligible subjects were selected by using non-randomized convenient sampling technique by applying inclusion and exclusion criteria. Results: There was a significant difference between the pre-test and post- test knowledge score regarding cervical cancer significant at t= 1.98, p<0.05 and attitude scale regarding cervical cancer significant at t= 1.98, p<0.05. It can be inferred that respondents had inadequate knowledge, moderate knowledge and low and average attitude regarding prophylactic vaccination for preventing the cervical cancer during their pre-test and there was increase in knowledge score and attitude of nursing students after administering planned teaching programme on cervical cancer. Conclusion: The study results show that most of the students had moderately adequate knowledge regarding cervical cancer and its prophylactic vaccination. So it emphasizes the need for increasing student’s knowledge on cervical cancer and its prophylactic vaccination to create awareness and prevent the occurrence of the disease.
KEYWORDS: Cervical cancer, prophylactic vaccination, nursing students.
INTRODUCTION:
It is estimated that in 2015 the number of new cancer cases and deaths due to cancer will be 15 million and 9 million per year, respectively1. Cervical cancer is the third most common cancer and the fourth leading cause of cancer death in women worldwide2. In India, cervical cancer is one of the most common causes of cancer-related deaths. According to National Institute of Cancer Prevention and Research, one woman dies of cervical cancer every 8 minutes in India3. Cervical cancer is the third largest cause of cancer mortality in India accounting for nearly 10% of all cancer-related deaths in the country4. According to WHO about 5, 10,000 new cases of cervical cancer are detected in each year. WHO estimates that each year over 1.30 lakh Indian women were diagnosed with cervical cancer and over 74,000 of women died5. By 2025, the number of new cervical cancer cases in India is projected to increase to 2, 26,0846.
The primary cause of this cancer is infection with human papillomavirus7. Since the cervical cancer is usually asymptomatic in the early stages, screening is important in the early stages8. This cancer is one of the few cancers that can be easily detected at pre-malignancy phase9. Screening for cervical cancer which is known as the Pap test is an effective method for early detection of cervical cancer10. However, a large group of women are reluctant to do the Pap smear because of various reasons11.
According to some qualitative studies, there are a number of barriers for Pap smear screening participation such as lack of awareness, inappropriate beliefs, fear of being diagnosed with cervical cancer, abdominal pain after Pap smear, and an uncomfortable feeling during the test12. On the other hand, most of the quantitative studies have highlighted inadequate knowledge about Pap test13. Cervical cancer can be prevented with a regular Pap smear, limit the amount of sexual partners , quit smoking (or) avoid secondhand smoke, if sexually active use a condom, follow up on abnormal pap smears, and get the HPV vaccine14.
The availability of prophylactic human papillomavirus (HPV) vaccine has provided powerful tools for primary prevention of cervical cancer and other HPV-associated diseases.15
STATEMENT OF THE PROBLEM:
To Assess the Effectiveness of Planned Teaching Programme on Knowledge and Attitude regarding Prophylactic vaccination for preventing the cervical cancer among nursing students in College of Nursing, Bathinda, Punjab.
OBJECTIVES:
1. To assess the pre-test knowledge and attitude of nursing students regarding prophylactic vaccination for cervical cancer.
2. To assess the post-test knowledge and attitude of nursing students regarding prophylactic vaccination for cervical cancer.
3. To evaluate the effectiveness of planned teaching programme on prophylactic vaccination for cervical cancer by comparing pre and post-test knowledge and attitude.
4. To find an association between knowledge score and attitude scale among nursing students with their selected demographic variables.
METHODOLOGY:
Research Design:
Quasi experimental one group pre-test and post-test design
Population:
Nursing students
Target population:
Students those who age 17 -24 years and studying in selected college of nursing.
Sample:
Nursing students are sample
Sampling Technique:
Simple random sampling technique.
Description of the data collection Tool:
In this study the data collection tool was divided into three parts:
Part 1: Socio demographic variables consist of seven items, ie, age (in years), sex, class, religion, and type of family, area of residence and source of information.
Part 2: It consists of 40 knowledge questions to assess the knowledge on prophylactic vaccination for cervical cancer. The participants have given (√) mark for correct answer. Correct answer was given one (1) and wrong answer was given as zero (0).
Part 3: Five point likert scale to measure the attitude of nursing students on Prophylactic vaccination for cervical cancer.
Scoring:
It is measured by using five pointer Likert scales.
Strongly agree = 5, agree = 4, undecided = 3, disagree = 2, strongly disagree =1
Total Score = 110
RESULTS AND DISCUSSIONS:
The data findings have been organized and finalized according to plan for data analysis and results are presented as under the followings.
Section I:
Description of socio demographic characters of nursing students.
Section II:
The level of knowledge and attitude of nursing students regarding prophylactic vaccination for cervical cancer.
Section III:
Effectiveness of planned teaching programme on prophylactic vaccination for cervical cancer by comparing pre and post-test knowledge and attitude.
Section IV:
Association between pre-test knowledge score and attitude score among nursing students with their selected sociodemographic variables.
Section 1:
Description of socio demographic characters of nursing students.
Table No: 1 Frequency and percentage distribution of respondents according to socio demographic variables (N=150)
|
Section-1 Socio Demographic Variables |
Frequency( f) |
Percentage (%) |
|
|
Age (years) |
18-20 |
53 |
35% |
|
21-23 |
95 |
63% |
|
|
24-26 |
2 |
1% |
|
|
Sex |
Male |
42 |
28% |
|
Female |
108 |
72% |
|
|
Class |
B.Sc. Nursing 1st year |
55 |
37% |
|
B.Sc. Nursing 2nd year |
51 |
34% |
|
|
B.Sc. Nursing 3rd year |
44 |
29% |
|
|
B.Sc. Nursing 4th year |
0 |
0% |
|
|
Religion |
Hindu |
14 |
9% |
|
Sikh |
107 |
71% |
|
|
Muslim |
23 |
15% |
|
|
Christian |
6 |
4% |
|
|
Type of Family |
Nuclear Family |
101 |
67% |
|
Joint Family |
33 |
22% |
|
|
Extended Family |
16 |
11% |
|
|
Area of Residence |
Rural |
100 |
67% |
|
Suburban |
20 |
13% |
|
|
Urban |
30 |
20% |
|
|
Source of Information |
Internet |
97 |
65% |
|
Books and journals |
45 |
30% |
|
|
Television |
5 |
3% |
|
|
Newspaper |
3 |
2% |
|
Section II:
The level of knowledge and attitude of nursing students regarding prophylactic vaccination for cervical cancer.
Table No: 2 comparison of the pre-test and post test knowledge score
|
CRITERIA MEASURE OF KNOWLEDGE SCORE (N=150) |
||
|
Score Level |
Pre |
Post |
|
Inadequate (0-13) |
53(35.3%) |
0(0%) |
|
Moderate (14-26) |
97(64.7%) |
20(13.3%) |
|
Adequate (27-40) |
0(0%) |
130(86.7%) |
Maximum=40 Minimum =0
During the pre-test 35.3% (53) of the respondents had inadequate knowledge and 64.7% (97) had moderately adequate knowledge regarding prophylactic vaccination for cervical cancer. It is found in post- test 86.7% (130) respondents had adequate level of knowledge and 13.3% (20) had moderate knowledge. Therefore, the result reveals there has been a progressive increase in the knowledge level of nursing students regarding prophylactic vaccination for cervical cancer.
Figure No: 1 comparison of the pre-test and post-test knowledge score
Table No: 3 comparisons of the pre-test and post- test attitude score
|
CRITERIA MEASURE OF ATTITUDE SCORE (N=150) |
||
|
Score Level |
Pre |
Post |
|
Low (22-51) |
83(55.3%) |
0(0%) |
|
Average (52-81) |
67(44.7%) |
122(81.3%) |
|
High (82-110) |
0(0%) |
28(18.7%) |
Maximum=110 Minimum =22
Table No: 3 shows the attitude scores of respondents during pre-test 55.3% (83) of the respondents had low attitude and 44.7% (67) had an average attitude regarding prophylactic vaccination for cervical cancer. After the post- test 81.3% (122 ) respondents had average attitude and 18.7% (28) had high attitude regarding prophylactic vaccination on cervical cancer. Therefore, the result reveals that there has been a progressive increase in the attitude level among the students regarding prophylactic vaccination for cervical cancer.
Figure No: 2 comparison of the pre-test and post- test attitude score
Section III:
Findings related to Effectiveness of planned teaching programme on prophylactic vaccination for cervical cancer by comparing pre and post-test knowledge and attitude.
Table No: 4 Comparison of pre-test and post-test knowledge and attitude score
|
Paired T Test |
Mean |
S.D. |
Mean % |
Mean Difference |
Paired T Test |
Table Value at 0.05 |
Result |
|
|
KNOWLEDGE |
PRE |
14.41 |
3.259 |
36.02 |
15.4 |
40.61 |
1.98 |
Significant |
|
POST |
29.81 |
2.946 |
74.52 |
|||||
|
ATTITUDE |
PRE |
50.26 |
9.509 |
45.69 |
24.713 |
23.406 |
1.98 |
Significant |
|
POST |
74.97 |
7.726 |
68.16 |
|||||
Knowledge score Maximum = 40 Minimum - 0 Attitude score Maximum= 110 Minimum= 22
Table No: 4 depict the mean, SD and mean percentage of knowledge and attitude scale of pre-test and post-test for group. There was a significant difference between the pre-test and post- test knowledge score regarding cervical cancer, significant at t= 1.98, p<0.05 and attitude scale regarding cervical cancer, significant at t= 1.98, p<0.05. The above table shows that, respondents had inadequate and moderate knowledge. Also low and average attitude regarding prophylactic vaccination for preventing the cervical cancer during their pre-test. But there was an increase in knowledge score and attitude score of participants after administering the planned teaching programme on cervical cancer.
Section IV: Association between pre-test knowledge score and attitude score among nursing students with their selected sociodemographic variables.
Table No: 5 Association between knowledge score with selected socio demographic variable N=150
|
Demographic Variables |
Levels(N=150) |
Association with POST KNOWLEDGE Score |
|||||||
|
Variable |
Opts |
Inadequate |
Moderate |
Adequate |
Chi Test |
P Value |
df |
Table Value |
Result |
|
Age (years) |
18-20 |
|
5 |
48 |
3.186 |
0.203 |
2 |
5.991 |
Not Significant |
|
21-23 |
|
14 |
81 |
||||||
|
24-26 |
|
1 |
1 |
||||||
|
Sex |
Male |
|
6 |
36 |
0.046 |
0.831 |
1 |
3.841 |
Not Significant |
|
Female |
|
14 |
94 |
||||||
|
Class |
B.Sc. Nursing 1st year |
|
9 |
46 |
1.129 |
0.569 |
2 |
5.991 |
Not Significant |
|
B.Sc. Nursing 2nd year |
|
7 |
44 |
||||||
|
B.Sc. Nursing 3rd year |
|
4 |
40 |
||||||
|
B.Sc. Nursing 4th year |
|
0 |
0 |
||||||
|
Religion |
Hindu |
|
1 |
13 |
1.759 |
0.624 |
3 |
7.815 |
Not Significant |
|
Sikh |
|
15 |
92 |
||||||
|
Muslim |
|
4 |
19 |
||||||
|
Christian |
|
0 |
6 |
||||||
|
Type of Family |
Nuclear Family |
|
13 |
88 |
2.417 |
0.299 |
2 |
5.991 |
Not Significant |
|
Joint Family |
|
3 |
30 |
||||||
|
Extended Family |
|
4 |
12 |
||||||
|
Area of Residence |
Rural |
|
13 |
87 |
0.058 |
0.972 |
2 |
5.991 |
Not Significant |
|
Suburban |
|
3 |
17 |
||||||
|
Urban |
|
4 |
26 |
||||||
|
Source of Information |
Internet |
|
11 |
86 |
10.218 |
0.017 |
3 |
7.815 |
Significant |
|
Books and journals |
|
6 |
39 |
||||||
|
Television |
|
3 |
2 |
||||||
|
Newspaper |
|
0 |
3 |
||||||
Table No: 5 shows the association between attitude score with their selected socio demographic variables. In the present study there was no significant association between knowledge scores with their socio demographic variables such as age, sex, class, religion, type of family, area of residence and source of information.
Table No: 6 Association between attitude score with selected socio demographic variable N=150
|
Demographic Variables |
Levels(N=150) |
Association with Post ATITUDE Score |
|||||||
|
Variable |
Opts |
HIGH |
AVERAGE |
LOW |
Chi Test |
P Value |
df |
Table Value |
Result |
|
Age (years) |
18-20 |
10 |
43 |
|
1.332 |
0.514 |
2 |
5.991 |
Not Significant |
|
21-23 |
17 |
78 |
|
||||||
|
24-26 |
1 |
1 |
|
||||||
|
Sex |
Male |
7 |
35 |
|
0.154 |
0.695 |
1 |
3.841 |
Not Significant |
|
Female |
21 |
87 |
|
||||||
|
Class |
B.Sc. Nursing 1st year |
12 |
43 |
|
0.665 |
0.717 |
2 |
5.991 |
Not Significant |
|
B.Sc. Nursing 2nd year |
8 |
43 |
|
||||||
|
B.Sc. Nursing 3rd year |
8 |
36 |
|
||||||
|
B.Sc. Nursing 4th year |
0 |
0 |
|
||||||
|
Religion |
Hindu |
3 |
11 |
|
1.4 |
0.706 |
3 |
7.815 |
Not Significant |
|
Sikh |
20 |
87 |
|
||||||
|
Muslim |
3 |
20 |
|
||||||
|
Christian |
2 |
4 |
|
||||||
|
Type of Family |
Nuclear Family |
17 |
84 |
|
1.898 |
0.387 |
2 |
5.991 |
Not Significant |
|
Joint Family |
6 |
27 |
|
||||||
|
Extended Family |
5 |
11 |
|
||||||
|
Area of Residence |
Rural |
20 |
80 |
|
0.703 |
0.704 |
2 |
5.991 |
Not Significant |
|
Suburban |
4 |
16 |
|
||||||
|
Urban |
4 |
26 |
|
||||||
|
Source of Information |
Internet |
22 |
75 |
|
4.294 |
0.231 |
3 |
7.815 |
Not Significant |
|
Books and journals |
4 |
41 |
|
||||||
|
Television |
1 |
4 |
|
||||||
|
Newspaper |
1 |
2 |
|
||||||
Table No 6: shows association between attitude score with their selected socio demographic variables. In the present study there was no significant association between attitude scores of nursing students with their socio demographic variables such as age, sex, class, religion, type of family, area of residence and source of information.
CONCLUSION:
1. Nursing students had adequate and moderate knowledge on cervical cancer and prophylactic vaccination.
2. The students had average and high attitude on cervical cancer and prophylactic vaccination.
3. No association between knowledge score and attitude with their selected socio demographic variables
RECOMMENDATIONS:
Recommendations keeping in view the finding of the study the following recommendations are made:-
1. Similar study can be done on a larger sample with married women residing in urban and rural area.
2. Study can be replicated in different setting to strengthen the findings.
3. Study can be done on association between various demographic variables which were significant on larger samples.
REFERENCE:
1. Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008.Int J Cancer. 2010; 127:2893–917.
2. Jemal A, Center MM, DeSantis C, Ward EM. Global Patterns of Cancer Incidence and Mortality Rates and Trends. Cancer Epidemiol Biomarkers Prev. 2010;19: 1893–907.
3. Sathiyalatha S, Hemavathy V, Vijayalakshmi R. Cervical cancer kills one Indian woman every 7 minutes. Int J Innov Res Dev 2015; 4:132-4.
4. Sharma A, Kulkarni V, Bhaskaran U, Singha M, Mujtahedi S, Chatrath A, et al. Profile of cervical cancer patients attending Tertiary Care Hospitals of Mangalore, Karnataka: A 4 year retrospective study. J Nat Sci Biol Med 2017;8: 125-9
5. J.Ferly, I.Soerjomataram, M .Ervik, R. Dikshit, S. Eser, C.Mathers, M.Rebelo, D.M.Parkin, D.Forman, F.Bray GLOBOCAN 2012 v 1.0, cancer incidence and mortality worldwide: IARC CancerBaseno.11.
6. WHO/ICO. Human Papillomavirus and Related Cancers in India. Summary Report 2009. Information Centre on Human Papilloma Virus (HPV) and Cervical Cancer (a) 2009. http://www.who. int/hpvcentre/en/
7. Franco EL, Harper DM. Vaccination against human papillomavirus infection: a new paradigm in cervical cancer control. Vaccine. 2005; 23:2388–94.
8. Saraiya M, Ahmed F, Krishnan S, et al. Cervical cancer incidence in a prevaccine era in the United States, 1998-2002. Obstet Gynecol. 2007; 109:360–70.
9. Wright TC Jr, Cox JT, Massed LS, et al. 2001 Consensus Guidelines for the management of women with cervical cytological abnormalities. JAMA. 2002; 287:2120–9.
10. American Cancer Society. Cervical Cancer Prevention and Early Detection. Atlanta: American Cancer Society pub; 2014. [http://www.cancer.org/acs/groups/cid/documents/webcontent/003167-pdf.pdf.]
11. Jalilian F, Mirzaei-Alavijeh M, Emdadi SH, et al. Predicting Factors Related with Pap Smear Results among Women based on Health Belief Model. J Health Syst Res. 2011;7: 1226–34.
12. Shakibazadeh E, Ahmadnia E, Akbari F, Negarandeh R. Barriers and Motivating Factors Related to Cervical Cancer Screening. Hayat. 2009; 14:83–9.
13. Karimy M, Shamsi M, Araban M, et al. Pap Smear Test Structures for Measuring Health Belief Model and Factors Affecting Women in Urban Centers Covered Zarandieh. Qom Univ Med Sci J. 2012;6: 52–9.
14. Lisa Fayed. Reducing your risk of cervical cancer. 6ways to prevent cervical cancer. [URL:http://cancer.about/od/cervicalcancer/a/ preventcervical. htm.]
15. Clifton Rd, Atlanta, Georgia. Human papillomavirus vaccine introduction—the first five years. [URL:http://www.ncbi. nlm.nih. gov/ pubmed]
Received on 16.03.2019 Modified on 05.04.2019
Accepted on 30.04.2019 ©A&V Publications All right reserved
Int. J. of Advances in Nur. Management. 2019; 7(2):143-147.
DOI: 10.5958/2454-2652.2019.00035.0