The mean age of women in the study population was 34.5 ± 9.23 yr with the age range from 15-50 yr. More than half of the study population (443, 54.8%) were Hindus and a majority (521, 64.4%) had completed high/higher secondary school education. A majority of the women (740, 91.4%) were non-working and most of them (651, 80.4%) were homemakers. Married women comprised 88.4 per cent (715) and over half 60.5 per cent (490) lived in a nuclear family. Most of the women (386, 59.6%) belonged to poor socio-economic status. Different sources of information on cervical cancer were also identified. The most common and important source of information mentioned was media (452, 55.8%) followed by health workers and doctors (273, 33.74%). Family and friends was cited by 119 (14.7%).
Almost three fourths of the study population (584, 72.1%) was aware of cervical cancer as a type of cancer affecting women. Three fourth of the population (600, 74.2%) knew that it could be detected early by a screening test but only 47 (5.8%) could name the Pap test as the screening method of cervical cancer. Though 56 (6.9%) had ever done Pap test, only 5.8 per cent could recall the name of the screening test. Only about half (395, 48.8%) of the women were aware of symptoms of cervical cancer. The cardinal symptoms of cervical cancer mentioned included bleeding (289, 35.7%) and pain (70, 8.6%). Other incorrect responses included lump, stomachache, and pain in legs (9.1%). Majority of respondents (722, 89.2%) did not know any risk factor for cervical cancer and 5.3 per cent gave incorrect responses. Lack of hygiene and multiple sexual contacts were the only two risk factors cited by 3.9 per cent (32) and 1.6 per cent (13) respondents. respectively. On being asked about timing of Pap test, majority of women (726, 89.7%) did not know when it should be done, 23 (2.8%) said it should be done only when there is any problem and 60 (7.4%) said it should be done after age of 30 yr. On periodicity, 12 (1.5%) said it should be done monthly, 20 (2.5%) said 1-2 yearly and 23 (28%) every 2 to 3 years. Scoring of knowledge levels showed that 92.8 per cent had poor knowledge on the various aspects like symptoms, risk factors, screening test, etc.
Of the 809 women studied (56, 6.9%) had undergone screening at some point and about two thirds were not willing to be screened in future also (). About 30 per cent (245) women were desirous of undergoing screening test, but had not done it due to various reasons.
Fig. Distribution of sample population as per their screening status, willingness to undergo screening in future and reasons for not screening. 1. Sample population = 809. 2. Ever screened = 56/809 =6.9%. 3. Never screened = 753/809=93.1%. 4. Not willing to (more ...)
The factors for not screening, reported by these women (n=245) were grouped into knowledge factors 126 (51.4%), resource factors 38 (15.5%) and psychological factors 25 (10.2%). The knowledge factors included no symptoms (91, 37.1%), not being aware of the Pap test (28, 11.4%), not necessary (4, 3.1%). Resource factors included lack of time (18, 7.3%), financial reason (14, 5.7%) and lack of facility in the area (3, 1.2%). Two women said they ‘did not get a chance to do it′. Different psychosocial factors included lack of interest (3, 1.2%), fear of procedure (3, 1.2%), and embarrassment (1, 0.4%). However ,18 (7.3%) did not specify any definite reason.
Predictors for doing Pap test were identified () and a binary logistic regression analysis showed that women, more than 35 yr of age, those who had knowledge of screening for cervical cancer, and Pap test were 3.04 times (CI 1.42-6.506), 2.75 times (CI 1.03-7.33) and 7.098 times (CI 2.999-16.796) respectively, were more likely to undergo screening as compared to their counterparts.
Independent predictors of cervical screening practices in the study population
The determinants of factors affecting non screening were also studied (), and 69 per cent of women with poor knowledge scores cited knowledge factors as compared to only 47.6 per cent with good knowledge score. A multinomial logistic regression confirmed that those with poor knowledge were significantly more likely to cite knowledge factors than psychosocial factors (OR=3.36, CI 1.007-11.218). Similarly those with at least a primary education were less likely to report knowledge factors compared to psychosocial factors (OR=0.347,CI 0.122, 0.198 P<0.05). Those who reported Drs/health staff as the source of information regarding cervical cancer were significantly more likely to report factors related to knowledge (OR=1.60E + 08, CI 1.5E + 07-1.7E +09, P<0.001). The other factors were not found to be significant. The good knowledge scores in the screened was 16 (28.6%), and in unscreened women was 42 (5.6%), those who were willing to be screened in future was 19 (7.8%) demonstrating the importance of specific knowledge.
Independent determinants of reasons for not screening (n=189)