Abstract
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Objectives
The purpose of this study was to evaluate patient factors such as knowledge, attitude, motivation, perception, socio-economic status and travel time to health facilities and assess how these factors affected patients’ decision to pursue cervical cancer screening with visual inspection with acetic acid (VIA).
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Methods
A total of 80 women of childbearing age who visited Kenjeran and Balongsari Public Health Centers for health assessments were involved in this study. Patients who agreed to participate in the study underwent a verbal questionnaire to evaluate various factors.
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Results
Bivariate analysis concluded that knowledge, attitude, motivation, perception, socioeconomic status, and travel time to health facilities were significantly different between women who received VIA screening and women who did not receive VIA screening (p < 0.05). The factors of knowledge, attitudes, motivation, perception, socio-economic status, and the travel time to health facilities accounted for 2.920-fold, 2.043-fold, 3.704-fold, 2.965-fold, 3.198-fold and 2.386-fold possibility, respectively, of patients to pursue cervical cancer screening with VIA. Multivariate analysis showed that perception, socio-economic status, and travel time to health facilities were the most important factors influencing whether or not women pursued VIA screening.
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Conclusion
Knowledge, attitude, motivation, perception, socio-economic status, and travel time to health facilities appears to affect women’s’ decision to pursue cervical cancer screening with VIA, with the largest intake being the motivational factor.
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Keywords: cervical cancer; screening; early detection; visual inspection with acetic acid
INTRODUCTION
Cervical cancer is the third most frequently diagnosed cancer among women worldwide, and it is the fourth leading cause of death from all cancers. In developed countries, cervical cancer is the second leading cause of death from a variety of diseases among women, and in developing countries, it is the leading cause of death among women [
1,
2]. Cervical cancer accounts for 15% of all cancers worldwide, with southeast Asia contributing 20% to 30% of all cancers [
3].
Unlike many other cancers, cervical cancer tends to affect women early and affects women of reproductive age [
4]. Differences in mortality between sub-Saharan African and North American countries are due to lack of access to effective screening and limited access to early detection and treatment facilities [
5]. Prior to 1996, China experienced an increasing trend of cervical cancer due to Pap smear screening. The incidence of cervical cancer continued to increase after 1996, largely attributed to the high human papillomavirus, lifestyle changes, and changes in sexual behavior among young people [
6–
8].
Cytology-based cervical cancer screening in developing countries is available in limited scope in private medical facilities and in clinics focusing on maternal-child health, eliminating the high-risk age group. Visual inspection with acetic acid (VIA) is a screening exam for cervical cancer that is simple to perform, produces accurate results, is cost-effective, and is readily accepted by women. VIA involves application of 4% acetic acid to the cervix, and can be performed by trained nurses or midwives [
9–
12]. PAP and VIA tests are complementary [
13]. Women who receive VIA for cervical cancer screening once or twice at age of 35 years will reduce their lifetime risk of cervical cancer by 25% and 36% [
11]. Surveys conducted in Indonesia, Malaysia, Philippines, Thailand, and Vietnam demonstrated that the intake screening remained low [
12–
14]. Until recently, no study has evaluated the influence of certain patient factors, such as knowledge, attitude, motivation, perception, socio-economic status, and travel time to health facilities, on the decision to undergo cancer screening with VIA. The purpose of this study was to evaluate these patient factors, and assess how they affect patients’ decision to pursue VIA screening.
MATERIALS AND METHODS
1. Subjects
This study was observational in design. Subjects were women of childbearing age who visited Kenjeran and Balongsari Public Health Centers for health assessments. Patients who agreed to participate in the study underwent a verbal questionnaire to evaluate various factors.
2. Questionnaire
We interviewed patients using a verbal questionnaire to evaluate patient knowledge, attitude, motivation, perception, economic level and travel time to health facilities. We then assessed the degree to which these factors influenced patient decision to undergo cervical cancer screening with VIA. Prior to initiation of our study, the questionnaire was tested for validity and reliability.
3. Ethics
This study was approved by the Ethics Review Board of the Medicine Faculty of Airlangga University Surabaya, East Java, Indonesia (72-KEPK).
4. Statistical analysis
The collected data were tabulated and calculated for frequency distribution. It was then subjected to bivariate and multivariate analyses. The analyses were conducted using IBM SPSS Statistics ver. 23.0 for Windows (IBM Co., Armonk, NY, USA).
RESULTS
This study involved 80 women who visited Kenjeran and Balongsari Public Health Centers for health check. Results showed that knowledge, attitude, motivation, perception, socio-economic status, and travel time to health facilities were significantly different between women who received VIA screening and women who did not receive VIA screening (p < 0.05). The factors of knowledge, attitudes, motivation, perception, socio-economic status, and the travel time to health facilities accounted for 2.920-fold, 2.043-fold, 3.704-fold, 2.965-fold, 3.198-fold and 2.386-fold possibility, respectively, of patients to pursue cervical cancer screening using VIA.
There was a relationship between knowledge, attitude, motivation, perception, economic level, and travel time to health facilities and a patient’s decision to undergo cervical cancer screening with VIA. Perception, socio-economic status, and travel time to health facilities were the most important factors influencing whether or not women pursued VIA screening.
The following factors affected patients’ decision to pursue VIA screening: knowledge, attitude, motivation, perception, socioeconomic status, and travel time to health facilities.
DISCUSSION
Cervical cancer constitutes the disease most often found in poor communities and reflects gender and regional problems. It is not only caused by a disharmony of social and economic development, but also that of human resources and infrastructure for primary care [
15]. Results showed that the factors of knowledge, attitude, motivation, perception, economic level, and travel time to health facilities were significantly different between the group performing VIA screening and that not performing VIA screening (
p < 0.05). This indicates that the decision to screen using VIA in public health centers are determined by the factors of knowledge, attitude, motivation, perception, economic level and travel time to the health facilities. A previous study demonstrated that spousal support and the overriding opinion of the group leader were strong motivating forces for cervical cancer screening [
16]. Another study found that certain cultural taboos may inhibit a woman’s decision to pursue cervical cancer screening [
17]. Among the factors studied, patients who exhibited high motivation were 3.704 times more likely to receive cervical cancer screening with VIA. Thus, maternal motivation is an ideal target for cervical cancer prevention counseling. Our study supports previous study findings that the decision to pursue cancer screening with VIA is influenced by the experience of the provider performing the exam, the acceptance of the procedure by the general population, and the effectiveness of post-cryotherapy [
18].
Multivariate analysis showed that patients who possessed a negative perception, were of low socio-economic status, and experienced increased travel time to health facilities were less likely to pursue cervical cancer screening with VIA. This indicates that a change in patient perception, improved socio-economic status, and increased access to health facilities would likely affect acceptance of VIA screening. This finding is in contrast to that of previous studies in China in which factors such as having children, patient perception of visiting a provider for regular health assessments, and moderate to high levels of knowledge were related to VIA screening [
19]. In the Pacific Islands, patient trust in annual screening, screening-related costs, and varying levels of support for alternative screening were the decisive factors with regard to a patient’s decision to pursue cancer screening [
20]. It is possible that these factors could be controlled by a structured teaching program [
21].
In conclusion, patient knowledge, attitude, motivation, perception, socio-economic status, and travel time to health facilities appears to affect women’s decision to pursue cervical cancer screening with VIA, with the largest intake being the motivational factor.
Article information
CONFLICTS OF INTEREST
No potential conflict of interest relevant to this article was reported.
REFERENCES
- 1. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin 2011;61:69−90. https://doi.org/10.3322/caac.20107.
- 2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015;65:5−29. https://doi.org/10.3322/caac.21254.
- 3. Bal MS, Goyal R, Suri AK, et al. Detection of abnormal cervical cytology in Papanicolaou smears. J Cytol 2012;29:45−7. https://doi.org/10.4103/0970-9371.93222.
- 4. Singh R, Shetty N, Naveed M, et al. Retrospective analysis of patients with carcinoma cervix in a rural/semi-urban setting in Western India. Indian J Med Paediatr Oncol 2016;37:25−7. https://doi.org/10.4103/0971-5851.177011.
- 5. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359−86. https://doi.org/10.1002/ijc.29210.
- 6. Jin F, Devesa SS, Chow WH, et al. Cancer incidence trends in urban shanghai, 1972–1994: an update. Int J Cancer 1999;83:435−40. https://doi.org/10.1002/(SICI)1097-0215(19991112)83:4<435::AID-IJC1>3.0.CO;2-J.
- 7. Hillier SM, Jewell T. Health care and traditional medicine in China 1800–1982. Hoboken: Taylor and Francis; 2013.
- 8. Wang CF, Bao PP, Wu CX, et al. Prevalence and temporal trend of invasive cervical cancer in Shanghai. J Diagn Concepts Pract 2010;9:35−41.
- 9. Carr KC, Sellors JW. Cervical cancer screening in low resource settings using visual inspection with acetic acid. J Midwifery Womens Health 2004;49:329−37. https://doi.org/10.1016/j.jmwh.2004.02.015.
- 10. Nahar KN, Nessa A, Shamim S, et al. Role of VIA in cervical cancer screening in low-resource countries. Mymensingh Med J 2011;20:528−35.
- 11. Goldie SJ, Gaffikin L, Goldhaber-Fiebert JD, et al. Cost-effectiveness of cervical-cancer screening in five developing countries. N Engl J Med 2005;353:2158−68. https://doi.org/10.1056/NEJMsa044278.
- 12. Domingo EJ, Noviani R, Noor MR, et al. Epidemiology and prevention of cervical cancer in Indonesia, Malaysia, the Philippines, Thailand and Vietnam. Vaccine 2008;26(Suppl 12). M71−9. https://doi.org/10.1016/j.vaccine.2008.05.039.
- 13. Domingo EJ, Dy Echo AV. Epidemiology, prevention and treatment of cervical cancer in the Philippines. J Gynecol Oncol 2009;20:11−6. https://doi.org/10.3802/jgo.2009.20.1.11.
- 14. Shastri SS, Mittra I, Mishra GA, et al. Effect of VIA screening by primary health workers: randomized controlled study in Mumbai, India. J Natl Cancer Inst 2014;106:dju009. https://doi.org/10.1093/jnci/dju009.
- 15. Kava S, Rajaram S, Arora VK, et al. Conventional cytology, visual tests and evaluation of P16(INK4A) as a biomarker in cervical intraepithelial neoplasia. Indian J Cancer 2015;52:270−5. https://doi.org/10.4103/0019-509X.176729.
- 16. Lazcano-Ponce E, Alonso P, Ruiz-Moreno JA, et al. Recommendations for cervical cancer screening programs in developing countries. The need for equity and technological development. Salud Publica Mex 2003;45(Suppl 3). S449−62. https://doi.org/10.1590/S0036-36342003000900020.
- 17. Chigbu CO, Onyebuchi AK, Ajah LO, et al. Motivations and preferences of rural Nigerian women undergoing cervical cancer screening via visual inspection with acetic acid. Int J Gynaecol Obstet 2013;120:262−5. https://doi.org/10.1016/j.ijgo.2012.10.011.
- 18. Williams MS, Amoateng P. Knowledge and beliefs about cervical cancer screening among men in Kumasi, Ghana. Ghana Med J 2012;46:147−51.
- 19. Mandelblatt JS, Lawrence WF, Gaffikin L, et al. Costs and benefits of different strategies to screen for cervical cancer in less-developed countries. J Natl Cancer Inst 2002;94:1469−83. https://doi.org/10.1093/jnci/94.19.1469.
- 20. Gu C, Chan CW, Twinn S, et al. The influence of knowledge and perception of the risk of cervical cancer on screening behavior in mainland Chinese women. Psychooncology 2012;21:1299−308. https://doi.org/10.1002/pon.2037.
- 21. Townsend JS, Stormo AR, Roland KB, et al. Current cervical cancer screening knowledge, awareness, and practices among U.S. affiliated pacific island providers: opportunities and challenges. Oncologist 2014;19:383−93. https://doi.org/10.1634/theoncologist.2013-0340.
- 21. Chacko S. Effect of structured teaching programme on VIA test for early detection and diagnosis of cervical cancer. Nurs J India 2014;105:221−4.
Citations
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