Barriers to Cervical Cancer Screening in India: A Knowledge Attitude Gap Analysis of Nurses in a Tertiary Hospital in Northern India
Abstract
Background: Cervical cancer is potentially one of the most preventable and treatable cancers. Despite the known efficacy of cervical screening, a significant number of women in developing countries like India do not avail themselves of the procedure due to lack of awareness and sociocultural misconceptions.
Objectives: This study was conducted to elicit information on the Knowledge, Attitude and Practice (KAP) regarding cervical screening (Pap test) and to assess barriers to acceptance of the Pap test among nurses in a tertiary care hospital in Northern India. Awareness and acceptance for vaccination for Human Papilloma Virus (HPV) was also assessed.
Materials and Methods: A cross-sectional, descriptive study was conducted with semi-structured, self-administered questionnaire among female nurses. The study subjects were interviewed for KAP regarding risk factors for cancer cervix, Pap test and HPV vaccination for protection against carcinoma cervix. Descriptive statistics were used to characterize the study participants. Association between socio-demographic factors and awareness and practices were assessed using the chi square test. p-value <0.05 was considered significant.
Results: A large no of nurses had good knowledge about the risk factors and the importance of PAP test screening (95.9%). Many of the study subjects had a favourable attitude towards Pap test 92 (93.9%) and vaccination 82 (88.2%), but despite being in a centre with direct access to screening 68 (69.4%) of the study subjects never had a Pap test themselves and the most common reason cited was not finding the need to screen as they felt it was not applicable to them (45.6 %) not finding the need to screen as they felt it was not applicable to them. Acceptance for HPV vaccination was more 58 (59.2%) than Paps test 30 (31.4%).
Conclusion: In spite of good knowledge and attitudes towards prevention of cancer cervix, Pap test and HPV vaccination, practice remained low among the nurses. Acceptance of HPV vaccination was more than Pap test reflecting the lower acceptance of intimately invasive procedures.
References
Ferlay J, Ervik M, Lam F et al. Global cancer observatory: cancer today. International Agency for Research on
Cancer, Lyon, France. Available from: https://gco.iarc. fr/today.
Anttila A, Pukkala E, Söderman B et al. Effect of organised screening on cervical cancer incidence and
mortality in Finland, 1963-1995: recent increase in cervical cancer incidence. Int J Cancer 1999; 83(1):
-65.
Eddy DM. Screening for cervical cancer. Ann Intern Med 1990; 113(3): 214-26.
Gakidou E, Nordhagen S, Obermeyer Z. Coverage of cervical cancer screening in 57 countries: low average
levels and large inequalities. PLoS Med 2008; 5(6): e132.
Ferlay J, Soerjomataram I, Ervik M et al. Cancer incidence and mortality worldwide in 2012. International Agency for Research on Cancer, Lyon, France. GLOBOCAN 2012. Last accessed on 2015 Dec 03.
Krishnan S, Madsen E, Porterfield D et al. Advancing cervical cancer prevention in India: implementation
science priorities. Oncologist 2013;18: 1285-1297.
Rodu B, Cole P. The fifty-year decline of cancer in America. J Clin Oncol 2001; 19(1): 239-241.
Srivastava AN, Misra JS, Srivastava S et al. Cervical cancer screening in rural India: Status & current
concepts. The Indian Journal of Medical Research 2018; 148(6): 687-696.
Jayaraman L, Maheshwari K, Khichi SK et al. Selfperceived risk and barriers to cervical cancer screening
among patients seeking care at a tertiary care teaching hospital in Tamil Nadu. Int J Res Med Sci 2016; 4:
-769.
Sankaranarayanan R, Budukh AM, Rajkumar R. Effective screening programmes for cervical cancer in low- and middle-income developing countries. Bull World Health Organ 2001; 79(10): 954-962.
Swapnajaswanth M, Suman G, Suryanarayana SP, et al. Perception and practices on screening and vaccination for carcinoma cervix among female healthcare
professional in tertiary care hospitals in Bangalore, India. Asian Pac J Cancer Prev 2014; 15(15): 6095-6098.
Kosambiya RJ, Gohil A, Kamdar ZN et al. Knowledge, attitude and practices about cervical cancer and
screening among nurses of a tertiary care centre in Western India. Natl J Community Med 2018; 9(6):
-395.
Damiani G, Basso D, Acampora A et al. The impact of level of education on adherence to breast and cervical
cancer screening: evidence from a systematic review and meta-analysis. Preventive Medicine 2015; 81:281-289.
Singh E, Seth S, Rani V et al. Awareness of cervical cancer screening among nursing staff in a tertiary institution of rural India. Journal of Gynecologic Oncology 2012; 23(3): 141-146.
Gupta MYM, Agarwal N, Arora R. Awareness of cervical cancer screening among para medical staff and students in an institution of Northern India. Natl J Community Med 2013; 4(2): 4-7.
Goyal A, Vaishnav G, Shrivastava A et al. Knowledge, attitude and practices about cervical cancer and
screening among nursing staff in a teaching hospital. International Journal of Medical Science and Public
Health 2013; 2(2): 249-253.
Nilaweera R, Perera S, Paranagama N et al. Screening methods among female health care workers: a Sri
Lankan experience. Asian Pacific Journal of Cancer Prevention 2012; 13(4): 1193-1196.
Awodele O, Adeyomoye AAA, Awodele DF et al. Study on cervical cancer screening amongst Nurses in Lagos
University teaching Hospital, Lagos, Nigeria. J Cancer Edu 2011; 26(3): 497-504.
Dhodapkar SB, Chauhan RC, Thampy S. Knowledge and awareness of cervical cancer and its prevention
among nursing staff of a tertiary care teaching institute in South India. Int J Reprod Contracept Obstet Gynecol
; 3(4): 1056-1060.
Shekhar S, Sharma C, Thakur S et al. Cervical cancer screening: knowledge, attitude and practices among
nursing staff in a tertiary level teaching institution of rural India. Asian Pac J Cancer Prev 2013; 14(6): 3641-3645.
Addah AO, Ojule JD, Fiebai PO. Knowledge, attitude and practice of cervical cancer screening-Papanicolaou
test (Pap smear) among female health care providers in Port Harcourt. African J 2012; 6(1): 74-80.
Oranratanaphan S, Amatyakul P, Iramaneerat K et al. Knowledge, attitudes and practices about the Pap
smear among Medical Workers in Naresuan University Hospital, Thailand. Asian Pacific Journal of Cancer
Prevention 2010; 11(6): 1727-1730.
Thippeveeranna C, Mohan SS, Singh LR et al. Knowledge, attitude and practice of the Pap smear as a screening procedure among nurses in a tertiary hospital in north eastern India. Asian Pac J Cancer Prev 2014; 14: 849- 852.
Mutyaba T, Mmiro FA, Weiderpass E. Knowledge, attitude and practices on cervical cancer screening
among medical workers of Mulago, Hospital, Uganda. BMC Med Edu 2006; 6: 13.
Anantharaman VV, Sudharshini S, Chitra A. A crosssectional study on knowledge, attitude, and practice
on cervical cancer and screening among female health care providers of Chennai corporation, 2013. J Acad
Med Sci 2012; 2: 124-128.
Arulogun OS, Maxwell OO. Perception and utilization of cervical cancer screening services among female
nurses in University College Hospital, Ibadan, Nigeria. Pan Afr Med J 2012; 11: 69.
FOGSI GCPR on screening & treatment of preinvasive lesions of Cervix and HPV Vaccination. FOGSI
gynaecologic oncology Committee, 2018.
Ali SF, Ayub S, Manzoor NF et al. Knowledge and awareness about cervical cancer and its prevention
amongst interns and nursing staff in tertiary care hospitals in Karachi, Pakistan. PLoS One 2010; 5(6):
e11059.
Wamai RG, Ayissi CA, Oduwo GO et al. Awareness, knowledge and beliefs about HPV, cervical cancer
and HPV vaccines among nurses in Cameroon: an exploratory study. Int J Nurs Stud 2013; 50(10): 1399-
Shah V, Vyas S, Singh A et al. Awareness and knowledge of cervical cancer and its prevention among the nursing staff of a tertiary health institute in Ahmedabad, Gujarat, India. E Cancer Medical Science 2012; 6: 270.
Urasa M, Darj E. Knowledge of cervical cancer and screening practices of nurses at a regional hospital in
Tanzania. African Hlth Sci 2011; 11: 48-57.
Tran NT, Choe SI, Taylor R et al. Knowledge, attitude and practice (KAP) concerning cervical cancer and screening among rural and urban women in six provinces of the
Democratic People’s Republic of Korea. Asian Pac J Cancer Prev 2011; 12: 3029-3033.
Khalid S. Attitudes, knowledge, and practices in relation to cervical cancer and its screening among women in
Saudi Arabia. Saudi Medical Journal 2009; 30: 1208-1212.
Thanapprapasr D, Chittithaworn S, Lertkhachonsuk A et al. Female Hospital based healthcare professional’s
knowledge of cervical cancer, HPV and attitudes towards HPV vaccination. Asian Pac J Cancer Prev 2010; 11: 429-433.
