Medical Journal of Dr. D.Y. Patil Vidyapeeth

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 15  |  Issue : 3  |  Page : 381--386

Awareness and practices regarding cervical cancer among women of self-help groups in rural Puducherry


Abhijit V Boratne, R Angusubalakshmi, Smrithi Maniraj 
 Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India

Correspondence Address:
Abhijit V Boratne
Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry
India

Abstract

Context: India has the highest number of cervical cancer cases in the world and also the second most leading cause of cancer among females. Early diagnosis along with appropriate treatment at an earlier stage is needed to combat the high burden of cervical cancer in our setting. Aim: The aim of the study is to study the awareness and practices about cervical cancer among women of self-help groups (SHGs) in rural Puducherry. Subjects and Methods: Community-based cross-sectional study was conducted among women in SHGs in the four villages under field practice area of Rural Health Training Center, Department of Community Medicine of our teaching hospital. Details on sociodemographic characteristics, awareness regarding cervical cancer, and source of information regarding cervical cancer were collected using a pretested questionnaire. Chi-square test was used to assess the significance of study findings. P < 0.05 was considered to be statistically significant. Results: Majority (57.6%) of the SHG women were homemakers and about one-third (31.2%) of them were involved in farming and daily wage labor activities. Around 37.6% have awareness on cervical cancer and almost all (99.2%) of SHG women have never undergone PAP smear examination nor heard about PAP smear/HPV vaccine. The study revealed that women's education and socioeconomic status were associated with the knowledge of the cervical cancer and the difference was statistically significant. Conclusion: The present study found that awareness about cervical cancer among the respondents was very less. It is found to be associated with maternal education, occupation, and socioeconomic status of the women.



How to cite this article:
Boratne AV, Angusubalakshmi R, Maniraj S. Awareness and practices regarding cervical cancer among women of self-help groups in rural Puducherry.Med J DY Patil Vidyapeeth 2022;15:381-386


How to cite this URL:
Boratne AV, Angusubalakshmi R, Maniraj S. Awareness and practices regarding cervical cancer among women of self-help groups in rural Puducherry. Med J DY Patil Vidyapeeth [serial online] 2022 [cited 2022 Jul 3 ];15:381-386
Available from: https://www.mjdrdypv.org/text.asp?2022/15/3/381/331497


Full Text



 Introduction



The global burden of cancer is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. One in 8 men and one in 11 women die from the cancer annually. Global incidence of cervical cancer is 6.6%, which exceeds far from other type of cancers among women in developing countries.[1] According to the International Agency for Research on Cancer, India has the highest number of cervical cancer cases in the world and also the second most leading cause of cancer among females. India has high incidence rate (14.9%) and mortality rate (9.2%).[2],[3] Human Papilloma Virus (HPV) infection is the foremost cause of cervical cancer. Risk factors which are known to increase the incidence of cervical cancer are age, low socioeconomic status, poor personal hygiene, tobacco smoking, lack of education, multiple sexual partners, early marriage, early child birth, higher parity and long-term use of hormonal contraceptives, immunosuppressed state, co-infection with HIV, Chlamydia trachomatis, and herpes simplex virus type-2.[4],[5] Most cases of cervical cancer are diagnosed at a later and an end stage which in turn will reduce the survival rate of women.[6] Prior knowledge about the disease, screening facilities, practice of approaching health-care facilities will help in reducing the mortality rate. Early diagnosis along with appropriate treatment at an earlier stage is needed to combat the high burden of cervical cancer in our setting. With this background, this study aims to assess the knowledge, attitude, and practice toward cervical cancer.

Objective

The objective is to study the awareness and practices about cervical cancer among women of self-help groups (SHGs) in rural Puducherry.

 Subjects and Methods



Study design

A community-based cross-sectional study.

Place of study

Community-based cross-sectional study was conducted among women in SHGs in the selected villages under field practice area of Rural Health Training Center, Department of Community Medicine of our tertiary care teaching hospital. All the SHGs in the study area have been contacted personally, necessary permission obtained, and prior appointment was fixed for the data collection. The village heads and volunteered members of SHGs helped in coordinating with other members of SHGs during data collection. The purpose of study was explained to the leaders of all SHGs. In the due course, members of SHGs were contacted randomly by house-to-house visit in the above-said area to obtain necessary information.

Study population

Member women of all SHGs who were residing in the villages of rural field practice areas of Department of Community Medicine of our tertiary care teaching hospital were the respondents of the study.

Study period

August–September 2016 (2 months).

Study instrument

A pretested questionnaire has been used for interviewing members of SHGs. This questionnaire had questions related to sociodemographic details, knowledge, attitude and practice regarding cervical cancer among them. Informed consent was obtained from the study participants before the start of study.

Study design

A community-based cross-sectional study.

Sample size

The sample size was calculated using OpenEpi version 3.01 (Manufactured by Java, HTML). A minimum sample size of 250 women was required for the study considering the prevalence of awareness of cervical cancer as 74.6%,[6] absolute error of 6%, alpha error of 5% (95% confidence interval), and 20% nonresponse rate. List of all SHGs and their members was obtained before the start of the study. The required sample size (250 women) has been selected using simple random sampling. In the selected study villages, a total of 375 women were found to be member of SHGs. Computer generated random numbers were used to select the study participants.

Inclusion criteria

Member women of SHGs in the study area who willed and gave consent to participate in the study.

Exclusion criteria

Member women of SHG who were unavailable at the time of data collectionSHG women who did not give consent to participate in the study were excluded.

Data collection procedure

After obtaining necessary permission, women who met the inclusion criteria were included in the study. By visiting the selected villages, quantitative data from the SHG members were collected by interviewing them on one-to-one basis using a pretested questionnaire. Details such as sociodemographic characteristics, awareness regarding cervical cancer, and source of information regarding cervical cancer were collected. If a particular SHG woman was not met during visit, two more visits (three visits in total) were attempted, failing which the SHG woman in the next house was included. SHG women who were ever married and above 18 years of age were included in the study. If there were 2 women in the same house, we chose the elder women who were willing to participate in the study. For the study purpose, families of open castes were considered as forward castes while rest of all castes were included in backward castes.

Statistical analysis

Quantitative data were entered using Microsoft excel and the data were analyzed using Microsoft excel and the Statistical Package for the Social Sciences for Windows (SPSS Inc., Chicago, Illinois, USA) version 17.0. The data have been presented in the form of numbers, distribution, and percentages in tables and figures. Chi-square test was used to assess the significance of study findings. P < 0.05 was considered to be statistically significant.

Ethical consideration

Necessary permission has been obtained from the Institutional Research Committee and Institutional Human Ethical Committee before initiating the study process. All the individual information collected has been kept confidential by the researchers (IEC Project number– ICMR-STS/2016/15 dated 01/08/2016).

 Results



The general characteristics such as sociodemographic profile of the study participants, majority of them were belonging to Hindu religion and backward castes. Nearly half of the SHG women were in the age group of 25–40 years while only 46.4% of women found to have finished their higher secondary education. We found that 57.6% of the SHG women were homemakers and 31.2% of them were involved in farming and daily wage labor activities. The age of marriage was between 18 and 24 years in about 65.2% of SHG women while 24% of them had marriage before 18 years and among them, 31.6% of the SHG women were belonging to family Class IV and 30% in Class III followed by 22.4% in Class V (as per modified B. G. Prasad Classification). The study revealed that majority of the SHG women were having 1–2 children.

The table above says that only 37.6% of women have awareness on cervical cancer and remaining 62.4% are not knowing about cervical cancer. Around 26.5% do not know about symptoms of cervical cancer and 34% of the study participants opted that irregular bleeding was a symptom and around 11.7% told vaginal discharge with tinged blood as a symptom.

Awareness regarding risk factors was not known to 84% of the SHG women. Some known risk factors were having infection in cervix told by 3.1% and unhealthy food by 3.1% and poor personal hygiene by 1.06% [Table 1].{Table 1}

We found that nearly half of the SHG women have gained awareness regarding cervical cancer from TV [Table 2].{Table 2}

It is notable that 99.2% of SHG women have never undergone PAP smear examination, nor heard about PAP smear, nor aware about HPV vaccine, and only around 0.08% have attended the health education about cervical cancer which is less than quarter of the sample size. It is notable that 99.6% women's family is not being discussed on cervical cancer. It was found that none of the participants were vaccinated against HPV.

We could find significant association between the socioeconomic status of women and the awareness about cervical cancer. The study revealed that women's education and socioeconomic status were associated with the knowledge of the cervical cancer and the difference was statistically significant. Women's age, occupation, age of marriage was not found to be associated with awareness of cervical cancer [Table 3].{Table 3}

 Discussion



The present community-based cross-sectional study was conducted among SHG member women regarding their awareness and practices for cervical cancer. We inquired about their sociodemographic characteristics along with their awareness and practices pertaining to cervical cancer. This was necessary to see the current status of awareness among women as awareness is usually followed by change in behavior in long run. In the general characteristics such as sociodemographic profile of the SHG women, majority of them were belonging to Hindu religion and backward caste. Nearly half of the SHG women were in the age group of 25–40 years while 46.4% of women found to have finished their higher secondary education.[7] Similar study done by Shaista and Madhavi from tribal area of Raigad, Maharashtra, revealed that majority SHG women were Hindu from the age group of 21–35 years and were illiterate.[8]

A cross-sectional study on cervical cancer done in rural South India shows 100% literacy rate.[5] This shows that women in South India are more educated than other part of India. Around 57.6% of the SHG women were homemakers and about 31.2% of them were involved in farming and daily wedge labor activities. The age of marriage is between 18 and 24 years in about 65.2% of SHG women. Around 24% of the study participants had marriage before 18 years. This indicates that the early marriages were prevalent and this issue has to be tackled separately. This can be done by involving religious leaders and other stakeholders in the community. When asked about health decision taking person in the family, we found that 56.4% women themselves were taking decision while in 31.6% of cases, husband were playing important role in taking decisions. This might be because of better educational status among women in the study area. It is found that a woman becomes more confident and has a say in family if she is well educated. This supports the idea behind women empowerment though education.

In the present study, it was found that only 37.6% of the respondents were aware about cervical cancer and 62.4% were not aware of the disease. Ramaiah and Jayarama from rural Karnataka found that 65.5% of the study subjects have heard about cervical cancer which is higher than the present study. This variation may be attributed to the difference in literacy rate among the respondents.[9]

Among the respondents who were aware of cervical cancer, we looked for their awareness on symptoms of the same. Around 34% of the respondents were aware that irregular vaginal bleeding is one of the symptoms of cervical cancer but almost one-fourth of the participants that is 26.5% were not aware of the symptoms even though they have heard about the disease. In contrast, study findings of Geeta et al. suggest that almost 72% of the respondents who were aware of the disease cited irregular vaginal bleeding as the symptom of cervical cancer.[10]

The source of information about cervical cancer for the participants in our study was from television (TV) in 48.9% of the participants, around 13.8% have heard it from the friends followed by 7.4% from the doctors. Whereas, a study done in rural area of south Tamil Nadu mentioned that health-care workers were the major source of information in 41.2% of the women followed by family members in 26.5% and from TV in 8.8% of the study population.[5] These findings suggest that it is important to telecast such informative TV advertisements and health talk shows more frequently on television. Furthermore, spreading information constantly through health-care workers and community-based organizations has much more impact on behavioral change of the community.

Almost 99.8% of the study participants from the present study have not heard about PAP smear which is one of the screening modalities for cancer cervix. Only two respondents have undergone PAP smear and were aware about the HPV vaccine. Similar findings were reported by other studies.[10],[11],[12],[13],[14],[15] Even though PAP smear screening is available at all levels of health-care facilities, proportion of people subjected to screening and utilizing the facility is still questionable.

The information regarding health education was found to be poor in study. The health-care providers (HCPs) at public health facilities as well as private hospitals can play important role in providing health education on such issues. Because many times, people are fearful about the procedure and side effects. Hence, HCPs should motivate and encourage the women for the PAP smear and positive deviance approach may be adopted for better community participation.

Awareness about the disease symptoms, risk factors, screening tests, and practice of PAP smear was quite less in the present study. This might be because of the fact that majority of the study population were belonging to backward socioeconomic class and the lower literacy level of the women. SHG member's education and socioeconomic status were found to be associated with their knowledge about cervical cancer. Similar results were documented by Narayana et al.[6] The burden of cervical cancer is enormously high and it is a very important health problem in the present time. This must be discussed among women from all socioeconomic classes. Behavior change must be inculcated among all women through the involvement of community-based organizations. Capacity building of the frontline workers will make them confident in practicing PAP smear. Health education session can be planned in health facility and/or in the community too. Family members and school teachers can play important role in awareness program. Lack of awareness and motivation are the important reasons for the high burden of disease. Planning and conducting information education communication activities on this important issue on a regular basis are extremely necessary.

Limitation

The current study was conducted among selected SHGs of the field practice area of Department of Community Medicine. Thus, the study findings cannot be generalized.

 Conclusion



The present study found that awareness about cervical cancer among the respondents was very less. It is found to be associated with maternal education, occupation, and socioeconomic status of the women.

Acknowledgment

The authors would like to express our thanks to all the member women of SHGs for their kind cooperation and active participation. Furthermore, we would like to acknowledge administrative support from Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute and Sri Balaji Vidyapeeth for providing necessary logistics support during data collection in the community.

Financial support and sponsorship

The study was financially supported by ICMR, New Delhi (ICMR – STS study).

Conflicts of interest

There are no conflicts of interest.

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