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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 15  |  Issue : 3  |  Page : 438-443

Verbal, written, and video-based health education on prevention and early detection of cervical cancer


1 Department of Obstetrics and Gynecological Nursing, Symbiosis College of Nursing, Symbiosis International Deemed University, Pune, Maharashtra, India
2 Department of Obstetrics and Gynecological Nursing, MGM New Bombay College of Nursing, Navi Mumbai, Maharashtra, India

Date of Submission29-Nov-2019
Date of Acceptance20-Apr-2020
Date of Web Publication1-Feb-2021

Correspondence Address:
Dr. Seeta Devi
Symbiosis College of Nursing (SCON), Symbiosis International (Deemed University), Senapati Bapat Road, Pune - 411 004, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_200_19

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  Abstract 


Background: In India, the incidence of cervical cancer significantly rises among the age of 45 years and peaks at 55 years of age. The proportion of the range is raised up from 15% to 55% female cancers from diverse parts of India. Nearly 80% of the women with cervical cancers reported in the clinics in advanced stage of cancer. Objectives: The objective of this study was to assess the participation of women for cervical screening before and after verbal, written, and video-based health education. Methodology: The research design was a one-group pretest–posttest quasi-experimental design. Samples were the women in the age group between 30 and 60 years attending gynecology OPDs. The total sample size was 501, and samples are selected using a multistage sampling technique. A structured questionnaire was used to collect the data using interview techniques. Results: Across all three study groups, majority of the participants were observed in the age group between 30 and 45 years. Most of the participants did never have the information regarding cervical cancer and screening procedures before the interventions. Majority of the participants (97%) had never screened for cervical cancer. In all three study groups, there is a significant association between participation of women in screening before and after intervention as P < 0.0001. Conclusion: A key strategy to reduce the prevalence of cervical cancer is to educate the women regarding prevention of cervical cancer by using various kinds of educational instructional methods.

Keywords: Cervical screening, participation, prevention and early detection, verbal, written, and video-based health education


How to cite this article:
Devi S, Dasila PK. Verbal, written, and video-based health education on prevention and early detection of cervical cancer. J Datta Meghe Inst Med Sci Univ 2020;15:438-43

How to cite this URL:
Devi S, Dasila PK. Verbal, written, and video-based health education on prevention and early detection of cervical cancer. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Feb 25];15:438-43. Available from: http://www.journaldmims.com/text.asp?2020/15/3/438/308558




  Introduction Top


Multiple health issues affect women's health throughout their life cycle. Although attention to women's health is essential in all phases of their life, health among middle-aged and elderly women has given the least priority by researchers and policy-makers. The government has launched various health awareness programs, schemes for improving the teenager's health, maternal woman's health, etc., to decrease the morbidity and mortality. On the contrary, the middle-aged women health is not paid similar attention.[1]

In cervical cancer, sluggish, progressive changes are taken place in the cells on the surface of the cervix. These changes are called a cervical intraepithelial neoplasia and considered to be precancerous lesions. If it is not treated, these precancerous lesions are converted into overt malignancy within the span of 5–10 years. The mortality rates due to cervical cancer can be reduced if the cervical screening programs are effective, with suitable referral and treatment options.[2]

According to the global statistics, cervical is the third highest frequently detected cancer and fourth foremost reason of cancer deaths in women with probable 570,000 fresh cases in 2018 representing 6.6 of all female cancers. Nearly 90% of deaths due to cervical cancer had occurred in low- and middle-income nations. India accounts for one-fourth of cervical cancer cases and deaths worldwide. The incidence of cervical cancer cases in India accounts for 23% (122,844) worldwide, and India is the second positioned populated country in the world, responsible for 27% (67,477) of the entire cervical cancer bereavements.[3] In India, cervical cancer ranks second place among all female cancers: more than 200 women die every day, eight women die every hour, and one woman dies every 8 min. As per 2012 statistics, after Uttar Pradesh, Maharashtra has shown the increasing trend in the sum of cases with cervical cancer.[4]

Persistent infection of human papillomavirus (HPV), a sexually spread binary fixed DNA virus, is considered the most important causative agent for the growth of cervical cancer. Till date, out of 140 human and animal HPV genotypes, HPV-16 and HPV-18 types are the most significant proved by many of the molecular and epidemiological studies. In addition to HPV infection, risk factors such as high parity, sexual exposure at initial age, poor genital hygiene, smoking, poor nutrition, obesity, multiple sexual partners, immunosuppression, and family history are the responsible causes for the progress of cervical cancer.[5]

Cervical cancer has the maximum potential for secondary prevention; nevertheless, it remains a significant cause for morbidity and mortality in Indian women. This disease is noticeably preventable and curable but, in some regions, terrifyingly very high.[6]

The principal positive outcome of screening is to drop down the number of cervical cancer cases by recognizing and treating the patients with precancerous lesions before they convert into overt malignancy. Moreover, screening can discover cervical cancer in women at primary phase, where there are high probable chances to treat women successfully.[7]

There are mainly three types of screening tests available to detect the abnormal cells on the cervix, namely (1) HPV DNA test, (2) Visual Inspection with Acetic acid, (3)  Pap smear More Details test, this method of screening is highly practiced in India to find the malignant cells on the cervix.[8]

In India, several studies revealed that women are not equipped with adequate knowledge and information about cervical cancer and its preventive measures such as HPV vaccination and cervical screening. In review, a researcher has identified that there is no adequate educational material available to the public about cervical cancer, especially in their local regional language. Therefore, the researcher has taken a keen interest to prepare different types of educational materials in terms of verbal, video, and written in the regional language to convey the information about prevention and early detection of cervical cancer and to motivate the women to take part in the cervical screening. The researcher also proposed to send the reminders by telephone call, written letters, and SMS to women who do not participate in the screening on the day of the intervention.


  Methodology Top


The research design adopted in this study was a one-group pretest–posttest quasi-experimental design. The main objectives of the study were to assess the knowledge and attitude of women regarding the prevention and early detection of cervical cancer and to assess the participation of women for cervical screening before and after verbal, written, and video-based health education among three experimental groups. The samples in this study were the women fallen in the age group between 30 and 60 years attending gynecology OPDs. A multisampling technique was used.

Ethical clearance

The Institutional Ethics Committee of SIDU has approved the Research work proposed to be carried out at Symbiosis College of Nursing, Symbiosis International Deemed University, Pune Date: 27th Jan 2017 with Reference no SIDU/EC/2017/48.


  Result Top


Process of sampling technique

There were total eight hospitals selected from Pimpri Chinchwad Muncipal Corporation (PCMC) and out of these, two hospitals were selected by using simple random sampling technique to collect samples. Total 501 samples selected from these two hospitals by executing systematic random sampling technique. An average attendance to the gynecology OPD per day was 150, and an average attendance of women to the gynecology OPD in a 2-month duration was 7800. This was divided by sample size 501, and the kth sample was 15. The first 15th sample was allotted to the verbal group, the second 15th sample was detailed to the written group, and the third 15th sample was allotted to the video group; in this way, 167 samples selected in each group, respectively [Figure 1] and [Figure 2].
Figure 1: Distribution of participants based on the source of information n = 167 in each group

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Figure 2: Participation of women in cervical screening before and after the intervention

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A structured questionnaire was administered to collect the data using interview techniques. The value of Cronbach's alpha as evaluated for the scored questions pertaining to aforesaid factors of this study is 0.98, which can be interpreted as “excellent” as per predefined value ranges and their interpretations [Table 1],[Table 2],[Table 3],[Table 4],[Table 5],[Table 6],[Table 7],[Table 8],[Table 9],[Table 10].
Table 1: Distribution of participants based on demographic characteristics n=167 in each group

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Table 2: Distribution of participants based on marital history in percentages (n=167) in each group

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Table 3: Distribution of participants based on sexual and obstetrical history (n=167) in each group

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Table 4: Responses of participants with regard to screening for cervical cancer (n=167) in each group

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Table 5: Distribution of participants based on knowledge regarding prevention and early detection of cervical cancer

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Table 6: Overall mean knowledge score among three experimental groups

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Table 7: Comparison of pre- and posttest knowledge score between three study groups

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Table 8: Distribution of participants based on attitude regarding cervical cancer

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Table 9: Overall mean attitude score among three experimental groups

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Table 10: Participation of women in cervical screening before and after educational intervention

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Procedure for data collection

It was the most time-consuming step of the research process, which involved direct or indirect interaction with participants to gather the information pertaining to the topic under the study. Formal administrative permission was obtained from the ethical committee of the institution for conducting the final study. Then investigators have officially visited the hospital authorities to obtain the formal permission and cooperation to execute the thesis. The procedure of the project was described to the medical director, and an assurance was given that no changes will be done in routine OPD functions by the conduct of the present study. The data collection process began from June 1, 2017, to December 31, 2017. Individuals who met the inclusion criteria were determined. Written consent was taken from participants, explained about pretest, posttest questionnaires and time duration was explained to the study samples; the scoring system was explained to the individuals. They were also given assurance regarding the confidentiality of their scores and reports.

An investigator approached the individuals when they have visited the gynecology OPD. An interview technique was implemented to collect the data and filling of the questionnaires. Face-to-face education was done for the verbal group, video-based education was done for the video group, and the distribution of information modules to the written group was executed. Invitation letters were given to all the participants for cervical screening program on the day of intervention. Pap smear was collected from the participants who showed the willingness. The smear samples were sent to the pathology department for further examination and the reports of tests sent to the participants by calling them to the hospital. The individuals of abnormal Pap were sent for referral.


  Discussion Top


In the verbal group, 77.84%, in the written group, 62.27%, and in the video group, 64.67% of the participants had the poor knowledge in pretest. Similar findings were seen in a study conducted by Agam et al., 65.5% of the women heard about cervical cancer, and 35.25% and 39.75% of the participants were known only one symptom and one risk factor of cervical cancer, respectively. Only 34.5% of the participants had heard about Pap test.[9]

In the present study, pretest results revealed that across three experimental groups, women had poor knowledge regarding risk factors of cervical cancer includes teenage pregnancy, multiple sex partners, smoking and high parity. These results are supported by a study conducted by Dhodapkar et al.[10] These results are supported by a study conducted by Dhodapkar et al. are young age at first intercourse, multiple sex partners, cigarette smoking, high parity, and lower socioeconomic status were correctly responded by 13%, 48%, 16%, 9%, and 13% of the participants, respectively, as risk factors for cervical cancer.[10]

In this study about 97% of the participants have never undergone with cervical screening, similar findings were seen in a study conducted by Narayana et al. the results showed that majority of women have never done the cervical screening. However, in this study, most of the participants have never participated in the cervical screening program.[11]

In the present study, in the verbal group, 47% of the participants had a positive attitude regarding cervical screening tests. Similar results are showed in another study conducted by Yitagesu et al. that about 46.3% of participants had poor knowledge. Only 9.9% of the participants had participated in cervical screening. About 34.8% of the participants had a negative attitude.[12]

In the present study in written and video groups, in the pretest, only 17% of the participants have shown a positive attitude toward cervical screening procedures. Similar findings were noticed in a study conducted by Ashwini Nayak et al., the results showed that the attitude of women was highly unfavorable regarding cervical screening.[13]


  Conclusion Top


Awareness regarding cervical cancer among the women found was very poor. Majority of the participants had never participated in cervical screening before attending intervention. None of the participants knew about the HPV vaccine. In the present study, about 17 participants from 354 had abnormal atypical cells on the cervix, and 2 cases were found with cervical malignancy, whereas 3 were diagnosed with high-grade squamous intraepithelial lesions on the cervix. These results showed that the prevalence of cervical cancer is quite high. More than 80% of cancers in India present in the OPD at advanced stages. Precancerous lesions take many years around 5–10 years to convert into overt malignancy; therefore, screening is recommended for every woman aged between 30 and 60 years. The WHO also mentioned that, nations to make sure, targeted women in the age group among 30–49 years are screened minimum once in their lifetime.

A key strategy to reduce the occurrence of cervical cancer, women and her family need to be educated about primary and secondary preventive measures of cervical cancer using multimedia communication either by verbal, written, and video-based educational methods. Thus, the women and her family will be motivated for HPV vaccination for their daughters and encouraged themselves for cervical screening. Therefore, high-risk women are diagnosed at precancerous stage, and systematic treatment can be started to achieve the aim to prevent cervical cancer.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Recent Government of India Schemes for the Upliftment of Women; 2017. p. 5.   Back to cited text no. 1
    
2.
World Health Organization. Comprehensive Global Monitoring Framework, Including Indicators, and a Set of Voluntary Global Targets for the Prevention and Control of Noncommunicable Diseases. Revised WHO Discussion Paper; 25 July, 2012. p. 1-23.   Back to cited text no. 2
    
3.
Vizcaino AP, Moreno V, Bosch FX, Muñoz N, Barros-Dios XM, Borras J, et al. International trends in incidence of cervical cancer: II. Squamous-cell carcinoma. Int J Cancer 2000;86:429-35.  Back to cited text no. 3
    
4.
Bruni L, Barrionuevo L, Albero G, Serrano B, Mena M, Gomez D, Munz J. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in the World. Summary Report 27 July, 2017.   Back to cited text no. 4
    
5.
Nasiell K, Roger V, Nasiell M. Behavior of mild cervical dysplasia during long-term follow-up. Obstet Gynecol 1986;67:665-9.  Back to cited text no. 5
    
6.
Riklan M, Levita E, Zimmerman J, Cooper IS. Thalamic correlated of language and speech. J Neurol Sci 1969;8:307-28.  Back to cited text no. 6
    
7.
World Health Organization. A guide to Essential Practice a Healthier Future for Girls and Women. Report No: 480. Switzerland: Publishers of World Health Organization; 2014. p. 142-8.  Back to cited text no. 7
    
8.
Devi S. Impact of different health educational modalities in screening for cervical cancer. J Nurs Health Sci 2014;3:26-31.  Back to cited text no. 8
    
9.
Bansal AB, Pakhare AP, Kapoor N, Mehrotra R, Kokane AM. Knowledge, attitude, and practices related to cervical cancer among adult women: A hospital-based cross-sectional study. J Nat Sci Biol Med 2015;6:324-8.  Back to cited text no. 9
    
10.
Dhodapkar SB, Chauhan RC, Thampy S. Cervical cancer and its prevention among. Int J Reprod Contracept Obstet Gynecol 2014;3:1056-60.  Back to cited text no. 10
    
11.
Narayana G, JyothiSuchitra M, Dasaratha RJ, Kumar P, Veerabhadrappa KV. Practice toward cervical cancer among women. Indian J Cancer 2017;54:481-7.  Back to cited text no. 11
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12.
Yitagesu H, Aweke H, Ayanto SY, Ersado TL. KAP on cervical cancer prevention and control. PLoS One 2017;12:1.  Back to cited text no. 12
    
13.
Ashwini Nayak U, Murthy SN, Swarup A, Dutt V, Muthukumar V. Current knowledge, attitude, and practice about cervical cancer. Int J Med Sci Public Health 2016;5:1554-58.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]



 

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