A QUASI EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AND

ATTITUDE REGARDING CERVICAL CANCER AMONG WOMEN AT
PRIMARY HEALTH CENTER KANNIVADI, DINDIGUL DISTRICT.

BY: 301423051

A DISSERTATION SUBMITTED TO THE TAMILNADU DR. M.G.R

MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILMENT OF
THE REQUIREMENT FOR THE AWARD OF THE DEGREE OF
MASTER SCIENCE IN NURSING.

OCTOBER – 2016
A QUASI EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF
STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AND
ATTITUDE REGARDING CERVICAL CANCER AMONG WOMEN AT
PRIMARY HEALTH CENTER KANNIVADI, DINDIGUL DISTRICT.

EXTERNAL EXAMINER INTERNAL EXAMINER

A DISSERTATION SUBMITTED TO THE TAMILNADU DR. M.G.R

MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILMENT OF
THE REQUIREMENT FOR THE AWARD OF THE DEGREE OF
MASTER SCIENCE IN NURSING.
OCTOBER - 2016
A QUASI EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF
STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AND
ATTITUDE REGARDING CERVICAL CANCER AMONG WOMEN AT
PRIMARY HEALTH CENTER KANNIVADI, DINDIGUL DISTRICT.

APPROVED BY DISSERTATION COMMITTEE ON:

PROFESSOR IN NURSING
RESEARCH :________________________________
Prof. Mrs. K. THILAGAVATHY, M.Sc (Nsg), P.hD.,
Principal&HOD, Department Psychiatric Nursing,
Jainee college of nursing,
Dindigul.
CLINICAL SPECIALITY EXPERT :________________________________
Mrs. MEERA M. Sc Nursing,
Vice Principal&HOD, Department of OBG,
Jainee college of nursing,
Dindigul.
MEDICAL EXPERT :________________________________

Dr. UMA RAMANATHAN, MBBS, MD.

Meenakshi hospital,
Dindigul.

A DISSERTATION SUBMITTED TO THE TAMILNADU DR. M. G. R

MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILMENT OF
THE REQUIREMENT FOR THE AWARD OF THE DEGREE OF
MASTER SCIENCE IN NURSING .
OCTOBER - 2016
 CERTIFICATE

This is the bonafide work of Mrs. ABIZHA M.sc., Nursing IInd Year
student from Jainee college of Nursing, Dindigul, submitted in partial
fulfillment for the degree of Master of science in Nursing, under the Tamilnadu
Dr. M.G.R medical university, Chennai.

Prof. Mrs. K. THILAGAVATHY, M.sc (Nsg), P.hD.,

Principal, Department Psychiatric Nursing,

Jainee college of nursing,

Dindigul.

Place:

Date :
 TABLE OF CONTENTS

CHAPTER CONTENTS PAGE NO

NO

I INTRODUCTION 1

Background of the study 1

Need for the study 4

Statement of the problem 12

Objectives of the study 12

Hypothesis 13

Operational Definitions 13

Assumptions 14

Limitations 15

II REVIEW OF LITERATURE 16

Studies related to cervical cancer 16

Studies related to Knowledge on cervical
cancer 23
Studies related to attitude on cervical
cancer 31
Studies related to cervical cancer
screening 37
III METHODOLOGY 50

Research Approach 50

Statement of Problem 50

Objectives 51

Research Design 51

Variables 53

Population 53

Sample and Sample size 53

Sampling Technique 54

Sampling Criteria 54

Development of the tool 55

Description of the tool 55

Try Out 56

Reliability 56

Validity of the tool 56

Data collection Procedure 57

Plan for Statistical analysis 57

Ethical Consideration 58
IV DATA ANALYSIS AND

INTERPRETATION 59

The objectives of the study 59

Dependent variables 81

Independent variables 81

Results of logistic regression on change in 81

Knowledge

V SUMMARY, FINDING, IMPLICATIONS,

LIMITATIONS, CONCLUSION AND
RECOMMENDATIONS 88
Summary 88
90
Major findings
90
Objective 1
91
Objective 2
91
Discussion
92
Finding 1
92
Finding 2
93
Implications
94
Limitation
 Recommendations 94

Conclusion 94

REFERENCES 95

APPENDICES 102

ABSTRACT 138
 LIST OF TABLES

SI. NO TABLES PAGE NO

1 Incidence of cervical cancer in India 2010 6

2 Research design 51
3 Social characteristics of women 60
4 Demographic and economic characteristics of
women 62
5 Knowledge and attitude score of women at pre,
post tests and their changes. 76
6 Test of significance of difference between pre
and post test level Score 78
7 Descriptive statistics 78
8 Regression of background characteristics of
women on change in Knowledge of cervical
cancer from pre to post test 80
9 Regression of background characteristics of
women on change in attitude towards cervical
cancer from pre to post test 83
10 Chi–square test regarding association between
Knowledge, attitude post test and back ground
Factors among women 85
 LIST OF FIGURES

SI. NO FIGURES PAGE NO

1 Conceptual frame work based on nursing 49

process model
2 Religious wise frequencies and percentage 64
distribution
3 Education wise frequencies and percentage 65
distribution
4 Occupation wise frequencies and percentage 66
distribution
5 Marital status wise frequencies and percentage 67
distribution
6 Residence status wise frequencies and 68
percentage distribution
7 Age wise frequencies and percentage 69
distribution
8 Age at menarche wise frequencies and 70
percentage distribution
9 Age at marriage wise frequencies and 71
percentage distribution
10 Living children wise frequencies and 72
percentage distribution
11 Income wise frequencies and percentage
distribution 73
12 Cancer history wise frequencies and percentage
distribution 74
13 Source of information on cervical cancer wise
frequencies and percentage distribution 75
 ACKNOWLEDGEMENT

“It is good to give thanks unto the LORD, and to sing praises unto Thy
name O Most high, I Will go before Thee, I, LORD which call thee by thy name,
I am the GOD of Israel”. Isaiah 45:2

I extremely thank our LORD almighty for his leading presence, abiding
grace in abundance and renewing towards the processing of his entire
dissertation.

First and foremost, I would like to express my sincere and heartfelt

gratitude to Mr. SUKUMAR, Director, Jainee college of nursing, Dindigul, for
all facilities he had provided me in his esteemed institution and enabled to do my
research.

This study has been undertaken and completed under the enable
supervision and expert guidance of Mrs. THILAGAVATHY, Principal, HOD,
Nursing research and chief cornerstone, Jainee college of Nursing, for her
unstinted support, Inspiring discussion, untiring efforts, Innovative ideas, Patient
correction, guidance and challenging suggestions for Improvement and for
looking closely at the final version, and bringing this research into shape and
making it worthwhile.

I am extremely thankful to Mrs. Meera, Vice principal&HOD&my guide

Department of OBG, Jainee college of Nursing, for her contribution, support,
Interest and valuable hints she rendered during the course of this study

I express my gratitude and sincere thanks to Mrs. KAVITHA M.sc

Nursing resource person of Jainee college of nursing for her excellent guidance
and encouragement throughout the study period.
 I extend my Special thanks toProf. JAYA SUNDARI M.sc Nursing
professor &HOD department of Pediatrics nursing, for all the support
encouragement and valuable guidance she has rendered during the course of this
study.

I owe, my deep sense of gratitude to the Deputy Director, Dr. Jegaveer

Pandiyan, and Administrator Mrs. Rebeckal Department of primary health,
Dindigul District to gave permission for data collection in Primary health
centre, Kannivadi.

The investigator extends her special thanks to the Medical officers, Health
inspector, Superidentent, staff Nurses of Kannivadi Primary Health centre, for
granting permission to commence this thesis, to do the necessary research work
in their esteemed hospital.

I express my gratitude and sincere thanks to Ms. JANET ANBUMANI

M.sc Nursing Lecturer, Jainee college of nursing for her excellent guidance and
encouragement throughout the study period.

It’s my pleasure and heartfelt thanks to Mrs. Mageswari, M.Sc.,

(Nursing), Lecturer department of OBG, Jainee college of Nursing, for her
suggestions to carry out the study successfully.

I extend my Special thanks to Mrs. SIVAPRIYA M.sc Nursing,

department of OBG, Mrs. RAMYA & Mr. S. BRIGHT SING M.sc
Nursing, department of Pediatrics nursing, for all the support encouragement
and valuable guidance she has rendered during the course of this study.
 I would like express my gratitude to Mrs. Dhana Lakshmi B,sc.,
(Nursing), Nursing tutor, Jainee college of Nursing, for the timely help with her
suggestions.

It is my pleasure and heartfelt thanks to Mrs. Angela Mary, PB.B.sc.,

(Nursing), Nursing Tutor, Jainee college of Nursing, who motivates in all
occasions during the course of study.

I would like to express my gratitude to Dr. SAJEETHA RACHEL

Principal, Department of Education, for valuable guidance and support to carry
out the dissertation work successfully. “The impossible becomes, to the endowed
with resource fullness”.

Dr. C. RAMANUJAN Ph,D., statistician, Gandhigram University,

Gandhigram, Chinnalapatti, deserves a word of thanks for the opinions,
suggestions and guidance he has rendered in the statistical analysis and
interpretation of the data.

Mr. SARAVANAN MA, M. Phil, M.Ed., HOD, K.P.National arts and

science college, Bathlagundu, for Valuable opinion, suggestions and guidance he
has rendered in the literature of this study.

I would like to express my gratitude to the librarian Mr. SARAVANAN

Jainee college of nursing .

The Researcher extends her thanks to LASER POINT, MADURAI, for

rendered their support to make this study as book.

I am deeply indebted to my beloved parents, Mother in law, Father in law,

my brothers, for their constant Prayerful support, who never thought that this
would be possible for me. Besides them, I extend my thanks to my beloved
husband Mr. ALLEN DANIEL for his constant encouragement and continuous
prayers during the course of study.

The Investigator extends her overwhelming gratitude and sincere thanks to

her valuable friend Mrs. SHANA, Mr. RAJESH, Mr. JEROLD for her
support, patient love and her whole hearted encouragement which enabled me to
complete this study.

I am at loss if I do not thank my CLASSMATES, friends, and loved ones

for their encouragement and contributions during the study.

Above all the investigator owes her success to our Almighty LORD and savior
JESUS CHRIST
 CHAPTER - I

INTRODUCTION
 CHAPTER I

INTRODUCTION

"A WIFE OF NOBLE CHARACTER WHO CAN FIND? SHE IS

WORTH FAR MORE THAN RUBIES ".

PROVERBS: 31:10

“I admit I’m weak, But I have a strong God “

In the early nineties when revolution was occurring in health care system
throughout the world, India was facing a lot of deaths due to communicable
diseases. However after independence, the Government of India took lot of
measures to improve the life expectancy of Indian population, these measures gave
fruitful results by showing a massive control in mortality due to communicable
diseases. World Health Report (1999) gives the main causes of mortality
in India as non-communicable diseases (48 percent), communicable diseases (42
percent) and injuries (10 percent). This revealed the decrease in death rate and the
better improvement of quantity and quality health services in India. A report from
united nation world population prospects indicated a shift in demographic profile
from 45 yrs in 1971 to 64 years in 2005-2010. It is estimated that life expectancy
of the Indian population will increase to 70 years by 2021–25. In modern era
where urbanization, industrialization, life style changes and population growth etc
are influencing the disease pattern, we can see a paradigm shift from
communicable disease to non-communicable diseases like cancer, diabetes and
hypertension. Recent times have seen an increase in the incidence of cancer.

1
 Cancer prevalence in India is estimated to be around 2.5 million, with
over 8,00,000 new cases and 5,50,000 deaths occurring each year due to this
disease.3 The last fifty years have seen an exploration in our understanding of this
most fundamental of diseases, and new discoveries are occurring on an almost
weekly basis. A trend analysis of the data on cancer incidence for the period 1975-
2008 has demonstrated that the overall occurrence of cancer is increasing among
females. The greatest increase among females was for cancer of the cervix and
breast.

Cervical cancer is a devastating disease for women around the world.

Nearly 500,000 women suffer from the disease and more than 270,000 die each
year. Globally, cervical cancer is the second-most-common cancer among women.
It is the leading cause of female cancer deaths in developing countries, where 80%
of cervical cancer cases and deaths occur. Tragically, this disease strikes women at
a relatively young age. Many victims of cervical cancer die in their early 40s,
while they are still contributing to the workforce and raising children. Over the
past 50 years, many developed nations have achieved success in reducing cervical
cancer by routinely screening women with Pap tests. Despite this progress, even in
countries with well-established screening programs, many women continue to
suffer and die from cervical cancer. The situation is direr in developing countries,
many of which lack an infrastructure for cervical cancer screening and treatment.
In these countries, most cases of cervical cancer are undetected, resulting in
hundreds of thousands of deaths every year. As the global population ages — with
more women reaching the age when they are at greatest risk for cervical cancer —
cervical cancer rates, if not addressed, will continue to increase. Without a
widespread and sustainable commitment to mobilize change, projections are that
700,000 cases of cervical cancer will occur worldwide in 2020, a 40% increase
2
from the number of cases in 2002. Over the past decade, dedicated scientists,
researchers, clinicians, frontline health workers, community leaders and advocates
have worked tirelessly to bring the scourge of cervical cancer to the world’s
attention and to develop and apply the necessary knowledge and technologies to
reduce the number one cancer killer of women in most developing countries. From
Mumbai to Mexico City, Kampala to Kathmandu, innovative programs have
learned how to successfully deliver effective cervical cancer prevention programs
to the women and girls who need them most.

High-risk regions are Eastern and Western Africa (ASR greater then 30 per
100,000), Southern Africa (26.8 per 100,000), South-Central Asia (24.6 per
100,000), South America and Middle Africa (ASRs 23.9 and 23.0 per 100,000
respectively). Rates are lowest in Western Asia, Northern America and
Australia/New Zealand (ASRs less than 6 per 100, 000). Cervical cancer remains
the most common cancer in women only in Eastern Africa, South-Central Asia
and Melanesia. Between 1955 and 1992, cervical cancer mortality in the United
States declined by nearly 70% and rates continue to drop by about 3% each year.
In low- and middle-income countries, similar success has not yet been achieved.
The disease continues to grow, fanned by gains in life expectancy and population
growth. By 2030, cervical cancer is expected to kill over 474,000 women per year
and over 95% of these deaths are expected to be in low- and middle-income
countries. India has a population of 366.58millions women ages 18 years and older
who are at risk of developing cervical cancer. Current estimates indicate that every
year 134420 women are diagnosed with cervical cancer and 72825 die from the
disease.

3
 This shows that in spite of lot s of effort put by health care sector still there
is lack of knowledge and awareness regarding cervical cancer among women in
our country. This outlook provoked me to take a glance in our society’s female
awareness and attitude regarding cervical cancer and what all measures can be
implemented to shake the hands with the experts who are constantly lending
their support and encouragement to have a women world without cervical
cancer.

NEED FOR THE STUDY:

The cervical cancer shows changes in the epidemiological pattern with a

shift of incidence toward the younger age group. Due to this reason, cervical
cancer ranks foremost among the health problems of women in the socially
reproductive age group. The uterine cervix is the commonest site of malignancy
among females in India, especially among the multiparous and women from
socially background groups.

Awareness of women in rural areas regarding the cervical cancer is less.

By educating them, their attitude can be changed and knowledge can be
improved. Linder Michie (1993) suggest that population based health education
campaigns can create awareness among the rural population regarding cervical
cancer and its prevention through early detection.

It is reported that cancer is the cause for one tenth of all deaths and in
developed countries it is 2nd most frequent cause of death. WHO reports that
without rigorous control measures cancer will become the leading cause of death
and there will be 300 million new cancer cases and 200 million deaths from
cancer in the coming 25 years.

4
 Cervical cancer is the 5th most common cancer worldwide with
approximately 471,000 new cases diagnosed each year. Globally every 2
minutes a women dies of cervical cancer and accounts for up to 300,000 deaths
annually.
In India 366.58 million women are at risk of developing cervical cancer.
Currently every year 134420 women are diagnosed with cervical cancer and
72825 deaths from the disease. Cervical cancer ranks as the 1st most frequent
Cancer among women in India, and the 1st most frequent cancer among women
between 15 to 44 Years age group.
In most of the countries, the incidence of invasive cervical cancer is very
low in women under age 25. Incidence increases at about 35 to 40 years, and
reaches a maximum in women in their fifties and sixties. Data from cancer
registries in developing countries indicate that approximately 80-90 percent of
confirmed cases in these countries occur among women aged 35 or older.

About 80% of the new cervical cancer cases occur in developing

countries, like India, which reports approximately one fourth of the world's cases
of cervical cancer each year. There has been a regular campaign against cervical
cancer for 30 years in India, but this has had little impact on the morbidity and
mortality from the disease, with India ranking fourth worldwide. The number of
deaths due to cervical cancer is estimated to rise to 79,000 by the year 2010. The
cancer mostly affects middle- aged women (between 40 and 55 years), especially
those from the lower economic status who fail to carry out regular health check-
ups due to financial inadequacy. In urban areas, cancer of the cervix account for
over 40% of cancers while in rural areas it accounts for 65% of cancers as per
the information from the cancer registry in Barshi. Eastern and South Africa,

5
Central and South America and the Caribbean’s too report very high incidence of
cervical cancer.

PBRC(population Crude Incidence Age-Adjusted

based registries cancer) Rate Incidence Rate

Bangalore 18.8 21.7

Bharshi 22.7 20.2
Bhopal 42.17 22.4
Chennai 22.2 24.5
Delhi 16.3 22.7
Mumbai 14.6 18.0
Ahmadabad 16.2 13.4
Karunagapally 19.2 15.0
Kolkata 17.4 19.9
Nagpur 19.1 23.2
Pune 20.5 22.5
Thiruvananthapuram 13.1 10.9

Incidence of cervical cancer in India 2010.

The available evidence for control of cervical cancer is through secondary

prevention, namely--early detection through Pap smear. At present in India one
life time screening for women should be done at the age of 45 years. During the
Last 50 years in the United States, the Pap smear tests have reduced the deaths
related to cervical cancer by three-quarters. But at one time cervical cancer was

6
one of the most dreaded cancer and the leading causes of death in women in the
US but now it is the eighth most common cancer.

The exploratory study was conducted to assess the knowledge and beliefs
among 30 women about cervical cancer and Pap smear tests using the Health
Belief Model by administering questionnaire, 18 women who had at least one
Pap smear test in their lifetime, eight (44%) had opportunistic testing as a result
of having gynaecological symptoms. Twelve women (40%) had never had Pap
smear tests. The study revealed that Knowledge of cervical cancer and the Pap
smear test was inadequate among women with low incomes. Pap smear
utilization was also limited among low-income women.
A Cross-sectional study was conducted to find out the prevalence of
perceived morbidity and its confirmation among 435 women who attended
cervical cancer awareness camps. Majority (95.7%) of the women attending the
camp were in the reproductive age group (15-44 years) and illiterate (64.4%).
The study reported cervical erosion (22%), cervicitis (13.1%), vaginitis (8.4%)
and cervical hypertrophy (7.9%) which showed there is a significant association
between high parity and cervical cancer. The study recommended that cancer
cervix screening among the women at regular intervals through camp approach
in the community is needed.
With the evidence of above statistics and studies, the investigator felt the
need to study the knowledge of community women regarding Pap smear as an
early screening of cervical cancer with a view to develop an informational
pamphlet. The present study will help the investigator to gain insight into the
knowledge of Pap smear as an early screening of cervical cancer.

7
 Cervical cancer is the cancer of the area that connects the uterus to the
external female genital tract. The malignancy generally spread through Human
papilloma virus during sexual contact and it has been proved that even
preventive measures like contraceptives cannot stop it from entering womens
body.

ACS (2011) Recent estimates states that in the year 2011 about 12,710
new cases of invasive cancer will be diagnosed and of these about 4,290 deaths
will be recorded.

ACS (2010) Cervical cancer was once known as the most deadly cancer
in America until the years 1955-1992 when it rates decreased by 70% due to
increase in pap smear screening and most awareness among society, it is said to
decline by the year 3% but the numbers still high.

8
 TCHK PAKISTAN(2010) cervical cancer is the one of the leading cause
of mortality and morbidity amongst the gynaecological cancers world wide,
especially in developing countries.It is imperative for atleast health professional
in developing countries like Pakistan to have a sound knowledge about the
disease.

Ronald et al (2009) Cervical cancer is a result of Human Papilloma

Virus which is transmitted through sexual intercourse , in most cases the male is
the carrier of papilloma virus that infects and generates in female. Despite the
risk of the HPV virus both male and females are hardly aware of the virus and
risk it carries.

Godfrey (2007) In America within an estimates of every six minutes a

gynaecological cancer is diagnosed with the majority being cervical cancer
among women of the ages 40-55 years of age. In 2007 the average of about
12,000 – 16,000 Females were diagnosed as cervical cancer.

Powe (2006) Cancer fatalism has continuedto increase among especially

young women , this is the belief that women who have had that diagnosis of
cancer directly translates to inevitable death therefore they find it better to avoid
going for screening and are with no knowledge whatsoever on their health status.
Education and knowledge on cervical cancer has continued to decrease as the
cancer fatalism increases not because there is no available information but
because the women who have been ignorant to enlighten themselves.

WHO (2002) In Finlad 2.23 million women aged 15 years and over are at
risk of getting cervical cancer, current estimation states that out of 164 diagnosed
with cervical cancer per year about 81 of them die as a result of the disease.It is

9
the 15 th most common cancer in Finland and the 4 th common cause among the
women in Finland.

India, China, Brazil, Bangladesh, and Nigeria represent more than half of
the ―Global Burden of cervical cancer deaths‖ says the US based body basing its
study on Global rankings.

Recent data released by Indias health ministry based on the National

cancer registry programme (NCRP) report in 2009 the number of cervical cancer
cases were 101938 which has increased to 107690 in 2012.

In Uttarpradesh a total of 17367 cases were reported in 2009 and it

increased to 18692 in 2012. After Uttar Pradesh the number of cases of cervical
cancer in 2012 which has shown an increasing trend are Maharastra (9892) ,
Bihar (9824) , West Bengal (8396) , Andra Pradesh (7907) , Tamil Nadu (7077),
and others.

Cervical cancer can happen to anyone. Certain women are at greater risk.
These include women who started sexual activity at an early age, had multiple
pregnancies, had multiple partners themselves, or their partners have multiple
partners, said Dr Neeraja Bhatla, professor Department of Obstetrics and
Gynaecology at( AIIMS).

Dr. Bhatla said ―Also women with STIs like Chlamydia, gonorrhea,
Herpes simplex, women with Immune suppression, for example, HIV or
transplant recipients, smokers and prolonged use of oral contraceptives have a
higher risk. There is thought to be a small element of genetic predisposition as
well‖.

10
 ―Cervical cancer, like all cancers, may be asymptomatic in its
precancerous phase and while it is an early cancer.

Symptoms that point to the cancer include inter menstrual and post coital
bleeding, postmenopausal bleeding and persistent vaginal discharge,‖ said
Dr. Bhatla. of cervical cancer.

Recently, Gulam Nabi Azad, Minister of health and family welfare had
responded to a starred question in Lok sabha.

―Data of the Indian council of medical Research (ICMR) of the number

of cervical cancer cases among women has increased in the country. At present
the Government of India is looking for alternative techniques and afford ability
to implement test to be used for detection of cervical cancer.‖ ―The Minister
further added that while health is a state subject, the center has launched the
national programme for prevention and control of cancer, diabetes,
cardiovascular disease and stroke (NPCDCS) in2010 in 100 districts across 21
states.

Strengthening of government medical college and erstwhile regional

cancer centers (RCC) across the country as Tertiary cancer center (TCC) for
providing comprehensive cancer care was also undertaken as well as campaigns
are carried out through print and electronic media ,he said.

As infection with HPV is the most important factor for cervical cancer, it
is important to avoid genital HPV infection. Life style changes to be blamed for
rise in cervical cancer cases. In urban area promiscuous behavior, multiple
sexual partner, overcrowding and bad hygiene. In rural areas early marriage (so
early start sexual activity), poor socio economic status, and poorer health and

11
health care facilities. But mostly lack of knowledge and awareness across the
strata of socities.

Investigator found only few studies was published regarding cervical

cancer knowledge and attitude assessment among mothers. Hence the
investigator felt the need to do a study on knowledge and attitude towards
cervical cancer. Present women are the most important in all over development
of family. So this present study will be useful to prevent the cervical cancer treat
women.

STATEMENT OF PROBLEM

A quasi experimental Study to assess the effectiveness of structured

teaching programme on knowledge and attitude regarding cervical cancer
among women at Primary health center Kannivadi, Dindigul district.

OBJECTIVES:

 To assess the knowledge and attitude regarding the cervical cancer

among women.
 To determine the effectiveness of structured teaching programme
on cervical cancer among women.
 To associate the post test knowledge and attitude on cervical cancer
with their selected demographic variables.
 To correlate the knowledge and attitude, Pre test and Post test score
on cervical cancer among women.

12
HYPOTHESIS:

H1: There will be a significant difference between pre and post test
knowledge and attitude score after structured teaching programme on cervical
cancer among womens.

H2: There will be a significant correlation between Knowledge and

attitude on cervical cancer among womens.

H3: There will be a significant association between the knowledge on

cervical cancer and background features among womens .

H4: There will be a significant association between the attitude on cervical

cancer and background features among womens.

OPERATIONAL DEFINITIONS:

1) Effectiveness:

The degree to which something is successful in producing a desired result

success.

In this study the effectiveness was measured by post test score of

knowledge and attitude regarding cervical cancer among womens.

2) Cervical cancer:

It refers to cancer of cervix which is a part of babys bag ie female

reproductive system.

13
 3) Structured Teaching Programme:

It refers to systematically organized series of teaching content on cervical

cancer which is delivered through power point discussion method for womens in
Kannivadi PHC.

4) Women:

It refers to a female of age 25- 50 years who are attending OPD at

selected Kannivadi PHC.

5) Knowledge:

It refers to knowledge is a familiarity , awareness or understanding of

someone or something such as facts information descriptions or skills which is
acquired through experience or education by perceiving discovering or learning
regarding cervical cancer a mean used by scoring the items in the structured
knowledge questionnaire.

6) Attitude:

It refers to the beliefs of women regarding cervical cancer can measured

by their response to the items in the attitude scale.

ASSUMPTIONS:

 Items in the questionnaire were be adequate to assess the knowledge and

attitude of cervical cancer among womens.
 Womens were respond honestly to the questionnaire Employed for the data
collection.
 Womens were participate in the study honestly.

14
 Information were be provide by the womens were closely reflect their knowledge
and attitude level towards cervical cancer.

LIMITATION:

 A study settings selected was Kannivadi village in Dindigul district.

 Womens who were present at the time of data collection.
 Womens who were willingly participated in the study.

PROJECTED OUTCOME:

By giving structured teaching programme the womens were gained knowledge

and attitude regarding cervical cancer.

15
 CHAPTER - II

REVIEW OF LITERATURE
 CHAPTER II

REVIEW OF LITERATURE

Review of literature is a broad, comprehensive in depth, systematic and

critical review of scholarly publications unpublished scholarly print materials,
audio visual materials and personal communications. It is a continuing process in
which knowledge gained from earlier studies is an integral part of research in
general. Review of literature in this study is organized under the following
headings.

1. Review of literature related to cervical cancer.

2. Review of literature related to knowledge on cervical cancer.
3. Review of literature related to attitude on cervical cancer.
4. Review of literature related to cervical cancer screening.

1. REVIEW OF LITERATURE RELATED TO CERVICAL CANCER:

Jemal et al (2014) there were up to 47,100 new reported cases cervical

cancers and 288000 of these ending up in deaths world wide. About 80% of
these cases were from developing countries in 2008 there were 529,800 new
cases of cervical cancer that were reported. Accounting for 9% of the world wide
cancers and 275,100 deaths making 8% of the cancer deaths. In total 56% for
these cases and 64% of the total deaths from developing countries. Differences
between the mortality rates in deneloping countries compared to developed
countries is highly notable in the table below, this is due to the response to
cervical cancer campaigns that have been carried out. Women in developed
countries are faily expired to much information, medical facilities and vaccines

16
are available. In developing countries however the social economic state dose
not allow the cervical cancer to be a lead consideration factor , however some
significant decrease in mortality may be credited to availed cheaper methods of
screening.

ACCP(2014) Cervical cancer has continuously been striking hard on the

poorest countries such as central and south America, the Caribean, Sub-Saharan
Africa, some parts of Oceania and Asia with rates as high as 30 per 100000
women , compared with North America and Europe that have reports of about 10
per 100,00 cases. approximately 1.4 million women worldwide living with
cervical cancer and India may account for more that one fourth of the total
reporting nearly 132,000 new cases annually. A small population of women from
the poor and developed countries that receive cervical cancer treatments
therefore having a window of 7 million women world wide inclusive of possible
precancerous conditions that have not been identified.

Leyden (2013) cases of invasive cancer were analyzed among members of

seven prepaid omprehensive health plans in the USA diagnosed between 1
January 1995 and 31 December 2000. Medical records were reviewed for the
three years before diagnosis. Demographic charecteristics were independently
associated with the odds of a case being ascribed to failure to screen (patient has
no pap test during the 4-36 months prior to diagnosis). The study identified
these, 24% were age 50-64 and 17% age at diagnosis, older women diagnosis
attributed (3.89-10.79).

Bosch&Mounoz(2012) The involvement of HPV in cancers of the vulva,

anal canal, vagina and penis is currently being identified in addition to these, the
possible infectivity of HPV in cutaneous cancer, oral cancers and other cancers

17
of the upper aero digestive tract is being investigated.In humans, specific
papilloma virus types have been associated with over 99% of cervical cancer
biopsies (Walboomers et al., 1999) These are considered the high risk types and
include in order of prevalence, HPV types 16, 18, 31 and 45. HPVs have also
been associated with other anogenital lesions and carcinomas, oral and
pharyngeal papillomas and skin lesions in a rare genetic disorder called
epidermodysplasia verruciforms. (EV)

Prussia(2012) Retrospective study in Barbodos to determine the types of

paptest abnormalities and their clinical implications in girls aged 18 and under
during the five year period January 1995 to December 1999. Gynaecological
history and histology reports for these patients were analyzed.Two hudred and
sixty-five pap smears were examined from 236 patients. Of the 236 first – visit
samples 94(39.8%) were abnormal with 58(24.5%) reported as atypical cells of
undetermined significance (ASCUS) 33 (14%) reported as low grade sqamous
intra epithelial lesions (LSIL) and three (1%) reported as high grade squamous
intra epithelial lesions (HSIL) . Twenty two (23.4%) of the 94 patients who had
abnormal smears (either ASCUS or LSIL) were re evaluated within 6-12 months
of the initial abnormal diagnosis. Eight of these 22 patients (36.4%) had a
histological diagnosis of LSIL, including cervical intra epithelial neoplasia grade
1 (CIN1) ansd ondylomata. High risk HPV DNA types were detected in two of
these eight patients (25%).

Zurhausen(2012) Cancer of the uterine cervix is one of the leading cancer

among women worldwide , with an estimated 520,000 new cases and 274,000
deaths reported annually (WHO/ ICO) information centre on HPV and cervical
cancer–HPV cervical cancer statistics in India 2010. About 86% of the cervical

18
cancer cases occur in developing countries, which represents13% of all female
cancers (WHO/ICO) Cervical cncer is subdivided into cervical squamous cell
carcinoma and cervical adenoma carcinoma (Snijders et al., 2006). Majority of
the cases of cervical cancer are squamous cell carcinoma (scc) and
adenocarcinomas are rare. Cervical squamous carcinoma (scc) develops
gradually over time from pre- existing non invasive squamous precursor lesions,
also called cervical intraepithelial neoplasia (CIN) or squamous infections to
establishment of cancer may take over a decade .

(Zurhausen 2010) Papilloma Virus infections in humans are known to

cause a variety of benign proliferations; these includes warts, intraepithelial
neoplasia, anogenital papillomas, oral laryngeal and pharyngeal papillomas.

Lowy et al., (2010) Molecular and epidemiological evidence has now

established that HPV types associated with anogenital neoplasms, including
condylomata, cervical dysplasia and cervical carcinoma, are almost always
sexually transmitted.

Bernard et al.,(2010) Papilloma viruses (PVs) are epitheliotrpic viruses

and infect the vertebrates, where they cause neoplasia or exist asymptomatically.
Papilloma virus isolates are identified as ―types‖ when their L1 gene sequence
differs from every other types by atleast 10 percent. the L1 gene is instrumental
for PVs classification , as it is mostly conserved among the PVs , and this is one
of the strong reasons for genom based classification PVs.

(WHO/ICO information centre 2010) In Indian women and about 7.9%

of women in the general population are estimated to harbor persistent HPV
infection at any given time. An estimate suggest number of new cervical cases to
increase by the year 2025 to 2,03,757 and estimated number of deaths in 2025
19
may be 1,15,171 which is almost 70% increase compared to the existing
estimates for persistent HPV infection.

Bosch et al., Bruchell et al., (2009) After studying cervical cancer

patients from 25 countries reported that HPV types 16 and 18 are detected in
more than 70% of cervical cancer cases. The HPV type 16 prevalance in India is
also reported to be high (70%) ( Das et al ., 2008) where as HPV 18 occurrence
differs from 3-20% , followed by other high risk type such as HPV 45, 33, 35,
52, 58,59 and 73 (. The HPV type distribution varies depending on geographical
regions and also cultural variations.

Schifman and Castle(2008) Sankaranarayanan et al., (2009) reported

that the cervical cancer and HPV infection prevalence in India indicate that thye
initiations as well as peak of HPV infection occurs at a slightly older age group
(26-35 years ) women , when compared to the global incidence ( peak in 18-25
years ). It is observed that, while in the developed countries there was significant
decrease of cervical cancer mortality after incorporation effective screening
programs, no reduction in the incidence of cervical cancer was observed during
past three decades in the developing countries.

WHO/ICO (2010) India has a population of 366.58 million women of

ages 15 years or older who may be potentially at risk of developing cancer of
uterine cervix. Current estimates indicate that every year approximately 134,000
women are diagnosed with cervical cancer of which more than half (72, 825) die
from the disease in India. Cervical cancer is the most frequent cancer in India
women and about 7.9% of women in the general population are estimated to
harbor persistent HPV infection at any given time. An estimate suggest number
of new cervical cases to increase by the year 2025 to 2,03, 757 and estimated

20
number of deaths in 2025 may be 1,15,171 which is almost 70% increase
compared to the existing estimates for persistent HPV infection.

J.Obel et al (2014) This study provides the first systematic literature

review of cervical cancer incidence and mortality as well as human papilloma
virus (HPV) genotype prevalence among women with cervical cancer in the
pacific Island countries and territories . the cervical cancer burden in the Pacific
region is substantial , with age standardized mortality rate from 2.7 to 23.9 per
100,000 women per year. The HPV genotype distribution suggest that 70-80%
of these cancers could be preventable by the currently available bi-or
quadrivalent HPV vaccines. There are only few comprehensive studies
examining the epidemiology of cervical cancer in this region and no puplished
data have hitherto described the current cervical cancer prevention initiatives in
this region.

According to Parkin cervical cancer is an important public health problem

for adult women in developing countries. The risk of cervical cancer remains
high in many developing countries mostly due to lack or insufficiency of existing
prevention programmes. This review attempts to give a brief picture about the
scenario of cervical cancer identification and prevention of HPV epidemiology
in India.

Shantha (2013) estimated that India has a population of approximately

1.2 billion and accounts for a significant burden of cervical cancer in the Indian
subcontinent. There is an estimated annual global incidence of 5,00,000 cancers ,
in that India contributes 100,000 ie., one – fifth of the world burden . A total of

21
4304 cervical cancer cases were registered during 1982-89 in the Chennai
registry, India.

In (2004) cervical cancer accounted for 247000 deaths in women

Gajalakshmi in 2005 estimated that twenty percent of all female deaths from
cancer inIndia, were from cervical cancer, amounting to an estimated 6100
deaths.

India is a country with the highest disease frequency of 1,34,000 cases

and 73,000 deaths. The incidence of cervical cancer in Delhi at 26.6 per hundred
thousand women of any age group tops the numbers due to any other womens
cancer. The age distribution of cervical cancer is pyramidal with ahgher
percentage of older women being diagnosed with pre cancer symptom and
invasive disease. The number of cervical cancer deaths in India is projected to
increase to 79,000 by the year 2010. Particularly, in Southern India, carcinoma
of the uterine cervix is the most common form of cancer in females.

According to Curadoand cancer Atlas, it was estimated that, age

standardized cervical cancer incidence rates range from 9 to 40 per 100,000
women in various regions of India. The estimated age standardized cervical
canecr incidence and mortality rates around 2002 were 30.7 and 17.8 per
100,000 women repectively. The peak incidence was observed in older women
55-70 years of age (menopausal women).

In the state Karnataka , of all the cervical cancer 23% accounts to

cervical cancer while that in Bangalore is 30.8%.

A case control study was conducted to evaluate the role of human

papillomavirus (HPV) and other risk factors in the etiology of invasive cervical
22
carcinoma (ICC), in Chennai, Southern India 205 cases (including 12
adenocarcinomas) and 213 frequency age-matched control women were
included. Incidence rates in the country, varied between 11 per 100,000 in
Trivandrum and 30 per 100,000 in Chennai in Southern India. In urban areas
cancer of the cervix accounted for over 40% of the cancers while in rural areas it
accounts for 65% of cancers as per the information from the cancer registry in
India.

Based on a study by Chittaranjan Cancer Institute in Kolkata India,

approximately 14% of the 6,000 new cases reported annually in Kolkata
are cervical cancer. It is important to investigate women’s screening practices.
Currently, there are no national guidelines in India for recommended
cervical cancer screening or screening intervals. Pap tests are performed
predominantly for diagnosis in the presence of problematic symptoms such
as abnormal vaginal bleeding. Continued progress and education about
screening may allow for earlier detection and higher cure rates.

2. REVIEW OF LITERATURE RELATED TO KNOWLEDGE ON

CERVICAL CANCER:

Akshar S et al., (2014) A cross sectional questionnaire based study was

conducted from December 2013 to february 2014 in five primary health clinics
inSharjah, UAE by means of interviews carried out by trained pharmacist with
proper skills. A total of 212 respondents participated in the study. The sample
was calculated by using the built in STATCAL. The inclusion criteria were
married women with the age between 20 to 60 years old. The exclusion criteria
were women less than 20 years old and not married. All the women who gave
23
informed consent to participate in the study were included. The response rate
was 85%. The participants score of knowledge and practice. The participants
median score on knowledge was 2.08 on a scale with a maximum of 6 (range 0-
6) . The participants median score on practice was 3.66 on a scale with a
maximum of 9 (range 0-9). Knowledge level knowledge score range from the
lowest score 0 (11.32%) to the highest score of 6(2.36%) with the normal
distribution. Mean (SD)core is 2.23(1.466). Eighty (37.7%) of respondents had a
good knowledge score while 132(62.26%) 0f respondents had a poor knowledge
score. The correlation between knowledge and practice was (p=0.038)
significant. This finding adds to the growing body of evidences showing that
increased knowledge is automatically translated into changes in attitude and
practices.

B.Agama bansal, AbijithP.Pakhare(2014) Facility-based cross-

sectional study was conducted in an OPD of AIIMS Bhopal during months of
March/April 2014. All patients are subjected to anthropometric and blood
pressure assessment at central measurement station before visiting respective
departments. Every third women aged 15-45 reporting to this measurement
station was approached for participation in the study, and verbal informed
consent was obtained. Consenting women were included in the study and further
interview with pretested structured questionnaire was conducted by one of the
investigators. The questionnaire was comprised of four sections to gather
information regarding the sociodemographic characteristics of the participants,
knowledge, attitude, and practice regarding cervical cancer and its screening.
The sociodemographic characteristics included age, educational status,
occupation, marital status, age of marriage, and per capita family monthly
income.The knowledge was assessed using a 20 points scale which had
24
dichotomous response, that is, correct and incorrect. Each correct response was
scored as 1 and incorrect as 0. A score 50% (≥10 correct responses) was
considered as optimal. Attitude was assessed by 7 statements regarding cervical
cancer screening and risk factors responses to which were categorized as 3-point
scale Disagree, Neutral, and Agree. Attitude was considered as favorable for
screening if four or more ―Agree‖ responses were obtained. Those who had been
screened for cervical cancer through pap-smear were regarded as having good
practice.Sample size estimations were based on assumption that 50% women
will have optimal knowledge score (>50%). Therefore, required sample size to
estimate the proportion of women with optimum knowledge score with 95%
confidence interval (CI) of 50% (95% CI 45-55%) 384. Final sample size with
5% nonresponse rate was 400.Data were entered into Epi-info version 7 (CDC,
Atlanta). Qualitative variables were summarized as counts and proportions and
numerical variables as mean and standard deviation. Univariate analysis using
Chi-square test and t-test as appropriately was done to compare
sociodemographic and other factors among optimal knowledge versus sub-
optimal knowledge group, favorable attitude versus nonfavorable attitude group
and takers of the screening test versus nontakers. We considered P < 0.05 as
statistically significant. We performed binary logistic regression analysis
separately to identify predictors of optimal knowledge, favorable attitude, and
good practices. Independent factors for these three models were statistically
significant variables of optimal knowledge, favorable attitude, and good
practices groups on univariate analysis.

Choudhury(2013) Between April 2012 and February 2013, a

predesigned, pretested, self -administered multiple responses questionnaire
survey was conducted among staff nurses’ working in various hospitals of
25
Sikkim. Questionnaire contained information about their demographics,
knowledge of cervical cancer, its risk factors, screening methods, attitudes
toward cervical cancer screening and practice of Pap smear amongst themselves.
Overall, 90.4% nurses responded that they were aware of cancer cervix. Three
quarter of the staff nurses were not aware of commonest site being cancer cervix
in women. Of the 320 participants, who had heard of cancer cervix, 253 (79.1%)
were aware of cancer cervix screening. Pap smear screening should start at 21
years or 3 years after sexual debut was known to only one-third of the nursing
staff. Age was found to be a significant predictor of awareness of Pap smear
screening among nursing staff. Awareness was significantly more prevalent
among older staff (P < 0.007). Married nursing staffs were significantly more
likely to be aware of screening methods, and nursing staff of Christian and
Buddhist religion were 1.25 times and 2.03 times more likely to aware of
screening methods than Hindu religion respectively. Only 16.6% nurses, who
were aware of a Pap smear (11.9% of the total sample), had ever undergone a
Pap smear test. Most common reason offered for not undergoing Pap smear test
were, they felt they were not at risk (41%), uncomfortable pelvic examination
(25%) and fear of a bad result (16.6%). Knowledge of cancer cervix, screening
and practice of Pap smear was low among Sikkimese nursing staff in India.
There is an urgent need for re-orientation course for working nurses and
integration of cervical cancer prevention issues in the nurses’ existing curriculum
in India and other developing countries.

Singhal.T (2012) A cross-sectional interview-based survey regarding

knowledge levels about cervical carcinoma was conducted among the nursing
staff from one of the tertiary health institutes of Ahmedabad, India. A structured
questionnaire with multiple choices was used for data collection. Provision for
26
open-ended responses was also made in the questionnaire. Department-wise
stratification was carried out, and thereafter 15% of the total nursing staff from
all departments were selected randomly so as to include a total of 100 nurses in
the current study. Data entry was done in Microsoft Excel. SPSS statistical
software was used to generate statistical parameters like proportion, mean,
standard deviation, etc. The Z test was used as a test of significance, and
a P value of <0.05 was considered as the level of significance.

P.Rajkumar (2012) A descriptive study was conducted to assess the

risk factors of cancer in cervix among post menopausal women in Madhya
Pradesh in India 214 women’s examined clinically with cervical erosion 22%,
cervicitis 13.1%, vaginitis8.4% and cervical hypertrophy 7.9% were the most
common pathological condition observed suspicious malignancy and atrophy of
the cervix were found in the 4.2- 8.4% of patient . The percentage of the cases of
diagnosed to the suffering from 1 or other morbidity decreased with increasing at
the marriage and literacy level and also decreasing parity among the risk factors
associated with morbidity of these women age at marriage less 18 years 31.45%,
high parity 30 years. 56% and literacy leading to poor genital hygiene 41% were
observed to the prominent risk factors. Some other studies have also reported a
significant association of cancer cervix with these risk factors.

Musthappa and Abdulkeim(2010) Cervical cancer resulting from prior

infection with human papillomavirus is a significant puplic health threat against
young Japaneese women. A national immunization plan to vaccinate 13-16 year
old female students against HPV infection has been started In Japan since 2010,
and may reach almost full coverage by the end of 2012. Older age females who
may already be sexually active are not targeted by this plan but should follow

27
safer sex practices as well as periodic screening of the cervix cytology to
reduce their risk of developing cervical cancer . HPV vaccination alone dose not
offer full protection either, because only some HPV types are covered by the
vaccine and the long term efficacy of the vaccines hs not been determined yet.
Therefore , we did a survey at an International university in Japan to study the
knoeledge and attitude of female college students towards prevention of cervical
cancer , to examine the age when they start sexual activity and other related
attributes that may influence the risk of cervical cancer. We discuss the result of
our survey and what they imply for the possible impact of an HPV immunization
plan on the risk of cervical cancer in Japan , and conclude by an emphasis on the
nee to increase awareness among Japneese female adolescents and to enhance
the cervical screening rates among older females who are already sexually
active.

Pinky (2010) An evaluative study was conducted to determine

effectiveness of a teaching programme on knowledge about cancer prevention
and early detection of cancer among 99 teacher trainees in College of Education,
UdupiTaluk, Karnataka State. The instruments used for the study were
demographic questionnaire and knowledge questionnaire. The results found that
the pretest score was 43.75% and posttest score was 79.15%. . This clearly
indicated the effectiveness of structured teaching programme.

Zaria& Sabon Gari(2010) This was a cross sectional study to evaluate

the knowledge , and practice of cervical cancer screening among market women.
A total of 260 women were administered with questionnaires which were both
self and interviewer administered. These were analysed using SPSS
version11.Respondents exhibited a fair knowledge of risk factors was poor.

28
There was generally good attitude to cervical cancer screening (80.4%), but their
level of practice was low(15.4%). There was a fair knowledge of cervical cancer
and cervical cancer screening among Nigerian market women in this study , their
practice of cervical cancer screening was poor.

A multicenter descriptive study was conducted in South Korean woman

with cervical cancer to explore the prevention of cervical cancer. This
multicenter descriptive study comprises 968 cervical cancer patients who had
been treated from 1983 through 2004 at six South Korean hospitals. The study
data were obtained through a mail-in self-responses questionnaire that asked
about patients on prevention of cervical cancer. The result found that outof 968
cervical cancer patients, 404 (41.7%) had sought cancer information. When
patients felt a need for information, their information-seeking behavior increased
(overall risk = 4.053,95% confidence interval =2.139-7.680

Ali SF et al., (2009) A cross sectional , interview based survey was

conducted in June , 2009 . Sample of 400 was divided betw een the three tertiary
care centres. Convenience sampling was applied as no definitive data was
available regarding the number of registered interns and nurses at each centre. Of
all the interviews conducted, 1.8% did not know cervical cancer as a disease.
Only 23.3% of the respondent were aware that cervical cancer is the most
common cause of gynaecological cancers and 26% knew it is second rank in
mortality. Seventy eight percent were aware that infection is the most common
cause of cervical cancer, of these 62% said that virus is the cause and 61% of the
respondent knew that the virus is human papilloma virus (HPV) . Majority
recognized that it is sexually transmitted but only a minority (41%) knew that it
can be detected by PCR. Only 26% of the study population was aware of one or

29
more risk factors. Thirty seven percent recognized Pap smear as a screening test.
In total only 37 out of 400 respondents were aware of the HPV vaccine. This
study serves to highlight that ther majority of working health profeesionals are
not adequately equipped with knowledge concerning cervical cancer.
Continuing medical education programme shuld be started at the hospital level
along with conferences to spread knowledge about this disease.

Sheila,Twin. (2005) conducted a study among chinese women from a

total sample of 467 in order to identify the knowledge about cervical cancer.
Evident suggested that women knowledge about cervical cancer and preventive
strategies are significant their screening practices. The need for further
knowledge about the cervical screening and preventive measure was
demonstrated.

Dr.RanajitMandal, a specialist in gynaecological oncology at Calcutta’s

Chittaranjan National Cancer Institute (CNCI) states that more than 130,000 new
cases roughly one-fourth of the global total are reported in the country every
year.18 In addition; an estimated 74,000 Indian women die annually from the
disease, which results from the abnormal growth of cells in the cervix.
Nationwide, the disease accounts for an estimated 24 percent of India’s cancer
cases among women, compared with 20 percent for breast cancer.21 India’s
National Cancer Control Program emphasizes the importance of early detection
and treatment. But the country has no organized screening program, and many
Indian women lack both awareness about the disease and access to prevention
and treatment facilities.These factors put poor and rural women at heightened
risk for cervical cancer. Evidence shows that the disease in India is more
common among the lower economic strata.

30
 A qualitative study was carried out to analyze the role of different social
and cultural factors in the timely detection of cervical cancer. As part of a multi-
level, multi-method research effort, this particular study was based on individual
interviews with women diagnosed with cervical cancer (identified as the
"cases"), their female friends and relatives (identified as the "controls") and the
cases' husbands.The results showed that both: denial and fear are two important
components that regulate the behavior of both the women and their partners.
Women with a small support network may have limited opportunities for taking
action in favor of their own health and wellbeing. Women tend not to worry
about their health, in general and neither about cervical cancer in particular, as a
consequence of their conceptualizations regarding their body and feminine
identify – both of which are socially determined. Furthermore, it is necessary to
improve the quality of information provided in health services.

3. REVIEW OF LITERATURE RELATED TO ATTITUDE ON

CERVICAL CANCER:

Matin M, LeBaron S. Our key informants were five Muslim women who
identified pelvic and Pap smear screening exams as major sources of anxiety for
their community, and therefore major barriers to health care. Three focus groups
were then convened, including 15 women ages 18-25, to discuss these issues in
more detail. Many Muslim women from immigrant backgrounds face challenges
in obtaining adequate health care due to some common barriers of language,
transportation, insurance, and family pressures. Additionally, many Muslim
women resist screening practices that are the standard in the US but which

31
threaten their cultural and religious values. Equally important, many health care
professionals contribute to the women's challenges by making inappropriate
recommendations regarding physical exams and reproductive health. The women
were enthusiastic and candid in discussing these highly sensitive and taboo
topics.

Wong LP, Wong YL, (2012) In this qualitative study, in-depth interviews
were conducted with 20 Malaysian women, ages 21 to 56 years, who have never
had a Papanicolaou (Pap) smear. Respondents generally showed a lack of
knowledge about cervical cancer screening using Pap smear, and the need for
early detection for cervical cancer. Many believed the Pap smear was a
diagnostic test for cervical cancer, and since they had no symptoms, they did not
go for Pap screening. Other main reasons for not doing the screening included
lack of awareness of Pap smear indications and benefits, perceived low
susceptibility to cervical cancer, and embarrassment. Other reasons for not being
screened were related to fear of pain, misconceptions about cervical cancer,
fatalistic attitude, and undervaluation of own health needs versus those of the
family. Women need to be educated about the benefits of cervical cancer
screening. Health education, counseling, outreach programs, and community-
based interventions are needed to improve the uptake of Pap smear in Malaysia.

Zaria (2010) This was a cross-sectional study to evaluate the knowledge,

attitude and practice of cervical cancer screening among market women. A total
of 260 women were administered with questionnaires which were both self and
interviewer administered. These were analysed using SPSS version 11.
Respondents exhibited a fair knowledge of cervical cancer and cervical cancer
screening (43.5%); however, their knowledge of risk factors was poor. There
was generally good attitude to cervical cancer screening (80.4%), but their level
32
of practice was low (15.4%). sThere was a fair knowledge of cervical cancer and
cervical cancer screening among Nigerian market women in this study, their
practice of cervical cancer screening was poor.

Anarado AN, Agunwah E.et al., (2010) The incidence of cervical cancer
has declined in developed nations due to routine use of cervical cancer screening
services. In developing nations opportunistic screening is the practice, and many
women present with late-stage disease. This study was designed to ascertain the
knowledge of the women in Nigeria to cervical cancer, their practice of cervical
cancer screening and factors hindering the use of available screening services. A
cross-sectional study was done with interviewer-administered questionnaire.
Only the consenting women attending an annual Christian religious meeting in
2007 in three towns in Enugu, South Eastern Nigeria participated. Only 15.5% of
the respondents were aware of availability of cervical cancer screening services.
The awareness significantly varied with the level of educational attainment
(P<0.0001). Only 4.2% had ever done Pap smear test and all were referred for
screening. The most important factors hindering the use of available cervical
cancer screening services were lack of knowledge (49.8%) and the feeling that
they had no medical problems (32.0%). There is very poor knowledge and
practice of cervical cancer screening among Nigerian women. Effective female
education and free mass screening are necessary for any successful cervical
cancer screening programme in Nigeria.

A qualitative study was carried out to analyze the role of different social
and cultural factors in the timely detection of cervical cancer. As part of a multi-
level, multi-method research effort, this particular study was based on individual
interviews with women diagnosed with cervical cancer (identified as the

33
"cases"), their female friends and relatives (identified as the "controls") and the
cases' husbands.The results showed that both: denial and fear are two important
components that regulate the behavior of both the women and their partners.
Women with a small support network may have limited opportunities for taking
action in favor of their own health and wellbeing. Women tend not to worry
about their health, in general and neither about cervical cancer in particular, as a
consequence of their conceptualizations regarding their body and feminine
identify – both of which are socially determined. Furthermore, it is necessary to
improve the quality of information provided in health

A descriptive cross-sectional study conducted by Mutyaba etal.

regarding knowledge, attitudes and practices on cervical cancer sreening among
the medical workers of Mulago Hospital,Uganda. About 310 medical workers
including nurses, doctors and final year medical students were interviewed using
a self- administered questionnaire. Response rate was 92%(285).Of these 93 %
considered cancer of the cervix a public health problem and knowledge about
Pap smear was 83% among respondents. Less than 40% knew risk factors for
cervical cancer, eligibility for and screening interval. Of the female respondents
65% did not feel susceptible to cervical cancer and 81% had never been
screened. Of the male respondents only 26% had partners who had ever been
screened. Only 14% of the final year medical students felt skilled enough to use
a vaginal speculum and 87% had never performed pap smear. Medical students
and nurses training curricula needs review to incorporate practical skills on
cervical cancer screening.

A descriptive study conducted by Udigwe G O regarding Knowledge,

attitude and practice of cervical cancer screening(pap smear) among female

34
nurses in Nnewi, South Eastern Nigeria A self administered questionnaire survey
of all the female nurses .Among 140 nurses, 122 (87%) were aware of the
existence of screening services. Although 9.3% had lost relations to cancer of the
cervix, only 5.7% had ever undergone a pap smear. While 52 (37.1%) had no
reason for not screening, 21 (15%) were afraid of the possible outcome and 35
(25%) felt they were not likely candidates for cancer of the cervix. Knowledge of
cervical cancer screening services among female nurses in Nnewi is high while
uptake rate is poor. There is need to further educate the nurses who will play a
major role in enlightening the public on the availability and need for cervical
screening services.

A descriptive study conducted by Nganwai P etal. regarding

Knowledge, attitudes and practices on cervical cancer among registered nurses at
the Faculty of Medicine, Khon Kaen University, Thailand. Systematic sampling
was used and self-administered questionnaires were sent. Out of 149 registered
nurses 133 (89.3%) of whom responded. The respondents' averaged 34.6 years of
age while 54.6% had sexual partners and 61.4% had normal deliveries. About
66.2% would like to have prophylactic HPV vaccines because they thought that
it would prevent HPV infection. Almost all of the registered nurses have a
moderate level of knowledge regarding cervical cancer and HPV but there are
still some major misunderstandings. Thus educational pamphlets, notices and
hospital announcements would be useful in increasing their knowledge.

Raley, JC. (2011) suggested that Human papilloma virus (HPV) is the
causative agent of cervical neoplasia and genital warts. A vaccine has recently
been developed that may prevent infection with HPV. Vaccination for HPV may
become a routine part of office gynecology. Researcher surveyed members of the

35
American College of Obstetricians and Gynecologists (ACOG) to determine
their attitudes to HPV vaccination. A survey was sent to Fellows of ACOG to
evaluate gynecologists' attitudes. Vaccine acceptability was analyzed by using 13
scenarios with the following dimensions and respective attributes: age of patient
(13, 17 and 22 years); efficacy of vaccine (50% or 80%); ACOG
recommendation (yes or no); and disease targeted (cervical cancer, warts or
both). Each scenario was rated by means of an 11-point response format (0 to
100). Responses were evaluated using conjoint analysis. Results of 1200 surveys
that were sent out, 181 were returned and included in our analysis. ACOG
recommendation was considered the most important variable in vaccine
distribution (importance score = 32.2), followed by efficacy (24.5), age (22.4)
and, lastly, disease targeted (20.9). Of these variables, higher efficacy was
favored; preference was given to age 17 years, with a strong disinclination to
vaccinate at age 13 years; and protection against cervical cancer, or genital
warts, or both. Demographic characteristics of the gynecologists (i.e., age of
physician, gender, and practice setting and community size) did not play an
important role in the decision to recommend vaccination. Professional society
recommendation is important for acceptability of a potential HPV vaccine.
Gynecologists are willing to include this vaccine in their practice.

36
4. RVIEW OF LITERATURE RELATED TO CERVICAL CANCER
SCREENING:

A study reported by MNT in 2015 called for urgent changes to the current
cervical cancer screening guidelines; the authors said that the recommendation
for screening to be ceased for women aged 65 and older should be revisited, after
finding women who received regular screening between the ages of 50-64 were
much less likely to develop cervical cancer aged 65-85. Lat year, a study
reported by MNT even found that the HPV test may be more accurate than a Pap
test for cervical cancer screening. study from researchers in India suggesting that
a vinegar test may be a cheap and effective way of detecting cervical cancer

B. Agama Bansal , Abhijit P. Pakhare, (2014) Facility-based cross-

sectional study was conducted in an OPD of AIIMS Bhopal during months of
March/April 2014. All patients are subjected to anthropometric and blood
pressure assessment at central measurement station before visiting respective
departments. Every third women aged 15-45 reporting to this measurement
station was approached for participation in the study, and verbal informed
consent was obtained. Consenting women were included in the study and further
interview with pretested structured questionnaire was conducted by one of the
investigators. The questionnaire was comprised of four sections to gather
information regarding the sociodemographic characteristics of the participants,
knowledge, attitude, and practice regarding cervical cancer and its screening.
The sociodemographic characteristics included age, educational status,
occupation, marital status, age of marriage, and per capita family monthly

37
income. The knowledge was assessed using a 20 points scale which had
dichotomous response, that is, correct and incorrect. Each correct response was
scored as 1 and incorrect as 0. A score 50% (≥10 correct responses) was
considered as optimal. Attitude was assessed by 7 statements regarding cervical
cancer screening and risk factors responses to which were categorized as 3-point
scale Disagree, Neutral, and Agree. Attitude was considered as favorable for
screening if four or more ―Agree‖ responses were obtained. Those who had been
screened for cervical cancer through pap-smear were regarded as having good
practice. Sample size estimations were based on assumption that 50% women
will have optimal knowledge score (>50%). Therefore, required sample size to
estimate the proportion of women with optimum knowledge score with 95%
confidence interval (CI) of 50% (95% CI 45-55%) 384. Final sample size with
5% nonresponse rate was 400. Data were entered into Epi-info version 7 (CDC,
Atlanta). Qualitative variables were summarized as counts and proportions and
numerical variables as mean and standard deviation. Univariate analysis using
Chi-square test and t-test as appropriately was done to compare
sociodemographic and other factors among optimal knowledge versus sub-
optimal knowledge group, favorable attitude versus nonfavorable attitude group
and takers of the screening test versus nontakers. We considered P < 0.05 as
statistically significant. We performed binary logistic regression analysis
separately to identify predictors of optimal knowledge, favorable attitude, and
good practices. Independent factors for these three models were statistically
significant variables of optimal knowledge, favorable attitude, and good
practices groups on univariate analysis.
In 2014, the Food and Drug Administration (FDA) approved the first
HPV test for primary screening of cervical cancer, called the cobas HPV test.

38
This test simultaneously detects 14 HPV types - including HPV-16 and
HPV-18 from DNA. Current recommendations from the US Preventive Services
Task Force (UPSTF), which were updated in March 2012, state that women aged
between 21-65 years should undergo a Pap test every 3 years. Women aged
between 30-65 years can choose to have the Pap test every 3 years, or the Pap
test and an HPV test (carried out the same way as a Pap test) every 5 years.
In 2013, Medical News Today reported on research from the Centers for
Disease Control and Prevention (CDC) that claimed Pap tests are frequently
wasted on women who do not need to undergo screening for cervical cancer.

In 2012, the US Preventive Services Task Force (UPSTF) updated their

screening recommendations based on "sufficient evidence" suggesting that
cervical cancer screening does not reduce the incidence of the disease in certain
groups of women.
Mustapha Mouallif: A cross-sectional descriptive study using an
interview with a structured questionnaire to obtain information regarding
cervical cancer, practice in screening for cervical cancer, and attitudes of female
physicians regarding the HPV vaccine in different health facilities in Saudi
Arabia. The study was performed in the Department of Obstetrics &
Gynecology, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah,
Kingdom of Saudi Arabia, between May and December 2009. Results: Of the
200 respondents, 70 (35%) physicians comprised gynecological doctors (GDs)
group I, and 130 (65%) physicians comprised the non- Limitations of the study
The limitations of the study are the biases inherent to any questionnaire survey
based study which are as follows: Selection Bias: In spite of taking adequate care
to follow the scientifically valid methods of representative samples, selection
bias cannot be ruled out entirely as only a small proportion of the total target
39
population will be studied. Social Acceptability Bias:, the women may not be
truthful all the time in their responses in apprehension of hurting the sentiments
of the interviewers. Recall Bias: The women need to respond to some of the
survey questionnaires based on their memory where there is chance of error.
However, attempts were made to minimize such errors as much as possible
through appropriate research design and methodology. gynecological doctors
(NGDs) group II. The mean age was 36 years. A total of 63 (90%) in group I,
and 87 (60.5%) in group II knew that HPV is a cause for cervical cancer. Forty-
five (64.3%) in group I, and 44 (33.8%) in group II believed that cervical cancer
was curable .

Anarado AN, Agunwah E :(2011)The incidence of cervical cancer has

declined in developed nations due to routine use of cervical cancer screening
services. In developing nations opportunistic screening is the practice, and many
women present with late-stage disease. This study was designed to ascertain the
knowledge of the women in Nigeria to cervical cancer, their practice of cervical
cancer screening and factors hindering the use of available screening services. A
cross-sectional study was done with interviewer-administered questionnaire.
Only the consenting women attending an annual Christian religious meeting in
2007 in three towns in Enugu, South Eastern Nigeria participated. Only 15.5% of
the respondents were aware of availability of cervical cancer screening services.
The awareness significantly varied with the level of educational attainment
(P<0.0001). Only 4.2% had ever done Pap smear test and all were referred for
screening. The most important factors hindering the use of available cervical
cancer screening services were lack of knowledge (49.8%) and the feeling that
they had no medical problems (32.0%). There is very poor knowledge and
practice of cervical cancer screening among Nigerian women. Effective female

40
education and free mass screening are necessary for any successful cervical
cancer screening programme in Nigeria.

Syed A. Aziz (2010) A cross-sectional, interview based survey was

conducted in June, 2009. Sample of 400 was divided between the three tertiary
care centers. Convenience sampling was applied as no definitive data was
available regarding the number of registered interns and nurses at each center. Of
all the interviews conducted, 1.8% did not know cervical cancer as a disease.
Only 23.3% of the respondents were aware that cervical cancer is the most
common cause of gynecological cancers and 26% knew it is second in rank in
mortality. Seventy-eight percent were aware that infection is the most common
cause of cervical cancer, of these 62% said that virus is the cause and 61% of the
respondents knew that the virus is Human Papilloma Virus (HPV). Majority
recognized that it is sexually transmitted but only a minority (41%) knew that it
can be detected by PCR. Only 26% of the study population was aware of one or
more risk factors. Thirty seven percent recognized Pap smear as a screening test.
In total only 37 out of 400 respondents were aware of the HPV vaccine.

Saslow explained that in most areas of the US, cervical cancer screening
rates are very high - at over 80%. But she notes that in some places, screening
rates are very low, and so there should be focus on increasing awareness in these
areas. "Their efforts should focus on less screening of the overscreened,
explaining why they don't need to be screened, and more screening of
women who have not been screened in the past or who have not been
screened recently," Saslow explained.

Sarah Al Akshar (2013) . A crosssectional questionnaire based study was

conducted from December 2013 to February 2014 in five primary health care
41
clinics in Sharjah. Demographic profile of women was noted and questions
pertaining to KAP on screening for cervical cancer were asked. The study
included 212 respondents, of which 29% of respondents knew about the disease,
74.5% had knowledge about the Pap smear test, while only 10% were aware of
one or more of the risk factors. In addition, 2.73% of the participants had never
been screened for cervical cancer. More than 70% of women had a positive
attitude towards screening, however, 59.9% did not know that they can be
vulnerable to cervical cancer. The awareness and practice of the screening
procedure of cervical cancer (Pap smear) among married women in Sharjah,
UAE was low. However, the attitude of women towards screening was positive.
Therefore, there is a need for intensifying health education provision on cervical
cancer screening in the city, by educating women on possible susceptibility to
cervical cancer & the possibility to prevent it by early detection.

Wright & Kuhn, 2012 ,Shi, et al, (2012) VIA screening is the simplest
method of screening with the lowest cost and relative ease f use. The approach
does not require high technology and has been demonstrated to reduce the deaths
of women in developing countries). During VIA, 5% acetic acid or vinegar is
applied to the cervical mucosa. Normal tissue is unaffected by vinegar wash, but
abnormal cells including dysplastic and cancerous cells turn white. The
screening method allows the practitioner to diagnose and treat abnormal cells
almost immediately in a health center, typically using cryotherapy which is the
application of liquid nitrogen or carbon nitrogen to the dysplastic area. The
process is also inexpensive; in a Chinese a study, the cost for VIA was estimated
at $2.64 per test .

42
 Maine, Hurlburt & Greeson, (2011) Cytology or ―Pap‖ smear is the
most effective and common screening method. Cervical cytology consists of
spreading and staining a smear of collected cervical cells and analyzing them
under the microscope to detect lesions. The method enables professionals to
accurately detect and stage high grade lesions. This approach can contribute to
early detection, thereby decreasing the incidence of advanced cervical cancer and
associated mortality. However, PAP smears are challenging to perform in
developing countries because the process requires trained personnel and certified
laboratories that are often unavailable.

Maine et al., (2011) The HPV-DNA test has shown promising results
with high sensitivity and specificity to detect high grade lesions, and therefore is
used as a primary screening test in women aged 30 years or older. Samples can
be either self-collected or provider collected. However, there are some
limitations: the test is expensive, requires a laboratory, and the time needed to
process the test is at least 7 hours. Although suitable for low resource settings, it
requires a sophisticated laboratory to read the samples. Unfortunately, most
developing countries do not have reliable laboratory facilities .

Goldie et al., (2010).The sensitivity of careHPV testing in China was 90%

compared to Visual Inspection with Acetic Acid (VIA) (described below) and
Pap smear at 41% and 85% respectively (Qiagen group, 2009). Unlike CareHPV,
the HPV-DNA test is more costly, requires more technology and time to process.
Costs of testing vary by country; for example, for HPV-DNA, the price ranges
from $ 26-29 per person in India to $ 82 per person in South Africa

43
 Reis et al.,( 2009)A Turkish study explored knowledge, behaviors, and
beliefs related to cervical cancer in Turkish’s women and revealed that the
ineffective use of cervical cancer screening was due to poor knowledge and
impractical behaviors of practitioners. The study indicated that nurse
practitioners are needed to address cervical cancer screening, educate women
and other health workers about attitudes, and explain the truths about cervical
cancer screening .

A descriptive cross-sectional study conducted by Mutyaba etal. regarding

knowledge, attitudes and practices on cervical cancer sreening among the
medical workers of Mulago Hospital,Uganda. About 310 medical workers
including nurses, doctors and final year medical students were interviewed using
a self- administered questionnaire. Response rate was 92%(285).Of these 93 %
considered cancer of the cervix a public health problem and knowledge about
Pap smear was 83% among respondents. Less than 40% knew risk factors for
cervical cancer, eligibility for and screening interval. Of the female respondents
65% did not feel susceptible to cervical cancer and 81% had never been
screened. Of the male respondents only 26% had partners who had ever been
screened. Only 14% of the final year medical students felt skilled enough to use
a vaginal speculum and 87% had never performed pap smear. Medical students
and nurses training curricula needs review to incorporate practical skills on
cervical cancer screening.

HkoLiou, Xueminling. (2009) conducted cross sectional descriptive

design on responses action and health promoting behaviors among rural
Taiwanese women with abnormal Pap test. The result shows that nearly 14%
were diagnosed as precancerous and underwent further treatment. 24%of the

44
women took no action during the 3 month after receiving the result. As many as
96% were not aware about localized cervical cancer. These analyzed results may
prove useful in developing intervention strategies to assist women with positive
Pap test results to choose treatment modalities and adopted health behaviors.

Louie, de Sanjose, Silvia, & Mayaud, (2009). A common cause of

cervical cancer is HPV. HPV- DNA approach is a newer option for cervical
cancer screening. The HPV-DNA testing consists of screening for high-risk
strains of HPV. In some studies, HPV testing has been shown to reduce mortality
in high grade lesions in advanced invasive cervical cancer and even in women
with human immunodeficiency (HIV). Allison Friedman,L. (2008) suggested
that genital human papilloma virus (HPV) infection is the most common
sexually transmitted virus in the united States, causing genital warts, cervical cell
abnormalities, and cervical cancer in women. To inform HPV education efforts,
35 focus groups were conducted with members of the general public, stratified
by gender, race/ethnicity, and urban/rural location. Focus groups explored
participants' knowledge, attitudes, and beliefs about HPV and a hypothetical
HPV vaccine as well as their communication preferences for HPV-related
educational messages. Audience awareness and knowledge of HPV were low
across all groups. This, along with an apparent STD-associated stigma, served as
barriers to participants' hypothetical acceptance of a future vaccine. Although
information about HPV's high prevalence and link to cervical cancer motivated
participants to learn more about HPV, it also produced audience fear and
anxiety. This research suggests that HPV- and HPV-vaccine-related education
efforts must be approached with extreme.

45
 Raley, JC. (2008) suggested that Human papilloma virus (HPV) is the
causative agent of cervical neoplasia and genital warts. A vaccine has recently
been developed that may prevent infection with HPV. Vaccination for HPV may
become a routine part of office gynecology. Researcher surveyed members of the
American College of Obstetricians and Gynecologists (ACOG) to determine
their attitudes to HPV vaccination. A survey was sent to Fellows of ACOG to
evaluate gynecologists' attitudes. Vaccine acceptability was analyzed by using 13
scenarios with the following dimensions and respective attributes: age of patient
(13, 17 and 22 years); efficacy of vaccine (50% or 80%); ACOG
recommendation (yes or no); and disease targeted (cervical cancer, warts or
both). Each scenario was rated by means of an 11-point response format (0 to
100). Responses were evaluated using conjoint analysis. Results of 1200 surveys
that were sent out, 181 were returned and included in our analysis. ACOG
recommendation was considered the most important variable in vaccine
distribution (importance score = 32.2), followed by efficacy (24.5), age (22.4)
and, lastly, disease targeted (20.9). Of these variables, higher efficacy was
favored; preference was given to age 17 years, with a strong disinclination to
vaccinate at age 13 years; and protection against cervical cancer, or genital
warts, or both. Demographic characteristics of the gynecologists (i.e., age of
physician, gender, and practice setting and community size) did not play an
important role in the decision to recommend vaccination. Professional society
recommendation is important for acceptability of a potential HPV vaccine.
Gynecologists are willing to include this vaccine in their practice.

Lawrence Rozendaal, We monitored by cytology, colposcopy, and

testing for high-risk human papillomavirus 353 women referred to
gynaecologists with mild to moderate and severe dyskaryosis. The median
46
follow-up time was 33 months. At the last visit we took biopsy samples. Our
primary endpoint was clinical progression, defined as cervical intraepithelial
neoplasia (CIN) 3, covering three or more cervical quadrants on colposcopy, or a
cervical-smear result of suspected cervical cancer.33 women reached clinical
progression. All had persistent infection with high-risk human papillomavirus.
The cumulative 6-year incidence of clinical progression among these women
was 40% (95% CI 21–59). In women with end histology CIN 3, 98 (95%) of 103
had persistent infection with high-risk human papillomavirus from baseline.
Among women with mild to moderate dyskaryosis at baseline, a second test for
human papillomavirus at 6 months predicted end histology CIN 3 better than a
second cervical smear.

Bradley et al., (2008).In Thailand, patients were very satisfied with the
care they received from nurses. In South Africa, cervical screening was done by
the female nurses from the same ethnic group and this was a key to overcoming
barriers. Women in South Africa, who originally viewed screening as a service
provided by men, were more satisfied when the screening was done by female
nurses. They did not feel frightened or ashamed about challenges and societal
objections to vaginal examinations .

Sherris et al., (2009). In India, studies indicated that HPV testing

reduced cervical cancer incidence and mortality rate up to 50%. The testing is
done either with cervical or vaginal samples collected with a brush by a trained
provider in the case of cervical screening or by the woman herself in the case of
the vaginal sample. The sensitivity of HPV-DNA testing ranged from 66% to
95% for all women tested, but most studies indicated a sensitivity of 85% among
women 30 years old or greater .

47
 Chamaraja Thippeveeranna et al., This cross sectional study was carried
out with a questionnaire survey covering the socio demographic factors, knowledge,
attitude and practices about Pap smear screening among 224 nurses in Regional
Institute of Medical Sciences, Imphal, Manipur, India during December 2011. Two
hundred and twenty one participants (98.6%) had heard about cervical carcinoma
but 18.3% lacked adequate knowledge regarding risk factors. Knowledge about the
Pap smear was adequate in 88.8% of the respondents. Out of these, only 11.6% had
Pap smear at least once previously. The most common reasons for non-participation
in screening were lack of any symptoms (58.4%), lack of counselling (42.8%),
physician does not request (29.9%) and fear of vaginal examination (20.5%).
Conclusion: Although knowledge of Pap smear as a screening procedure for
cervical cancer is high, practice is still low. The nurses who should be responsible
for opportunistic screening of women they care for are not keen on getting screened
themselves. If we can improve the practice of Pap smear screening in such experts,
they should be able to readily provide appropriate and accurate information and
motivate the general population to join screening programs.

S.Santhi,Bharath Sorubha Rani and Jebamani Augustin A quasi-

experimental study conducted by regarding effectiveness of STP on cervical cancer
among women in reproductive age in Milaganoor village, Tamil Nadu. Sample was
50 and collected data by using semi structured knowledge questionnaire and attitude
scale. The finding was overall mean post test Knowledge (17.7) and attitude score
(44.68) was significantly higher than the mean pretest knowledge (10.83) and
attitude score (34.2).1 Public knowledge about cervical cancer and its association
with HPV is limited in many countries. And should conduct community education
campaigns about cervical cancer and HPV are recommended as a strategy for
increasing vaccine acceptance.

48
 Assessment Goal Intervention Implementation Evaluation

Pre test
Selected Factors regarding Post test
Strutured teaching
Womens gain
Knowledge and programme regarding
 Age Knowledge and Gained Knowledge
attitude cervical cancer using power
 Marital status attitude regarding and attitude regarding
Questionnaire point for 20 minutes
 Occupation cervical cancer cervical cancer
(Interview )
 Age at Menarche through STP
 Age at Marriage
 Religion
 Implementation
No of Children
 Family history of
cancer
Feed back
 Locality
 Education

Setting

Primary health centre

at Kannivadi

FIG. 1 CONCEPTUAL FRAME WORK BASED ON NURSING PROCESS MODEL

49
CHAPTER - III

METHODOLOGY
 CHAPTER III

METHODOLOGY
Methodology is a systematic way to solve the research problem
undertaken. Methodology for the study is defined as the way pertinent
information is gathered in order to answer the research question to analyze the
research problem.

This study intended to assess the knowledge and attitude towards cervical
cancer among womens in Kannivadi village at Dindigul district.

This chapter deals with description of the different steps, which were
undertaken by the investigator for the study. It includes the research approach,
research design, variables, settings, population, sample size, sampling technique,
sampling criteria, development of tools, content validity, reliability, pilot study,
data collection procedure, plan for data analysis and ethical consideration.

RESEARCH APPROACH:

Research that explores the interrelationships among variables of interest

without intervention on the part of the researcher is a correlation study. There is
no manipulation of one independent variable s and to determine if there is a
correlation between variables. In the present study, the investigator intended to
correlate the knowledge and attitude.

STATEMENT OF PROBLEM

A quasi experimental Study to assess the effectiveness of structured

teaching programme on knowledge and attitude regarding cervical cancer among
women at Primary health center Kannivadi , Dindigul district.

50
OBJECTIVES:

 To assess the knowledge and attitude regarding the cervical cancer

among womens.
 To determine the effectiveness of structured teaching programme on
cervical cancer among womens.
 To associate the post-test knowledge and attitude on cervical cancer
with their selected demographic variables.
 To correlate the knowledge and attitude Pre- test and post test score
on cervical cancer among womens.

RESEARCH DESIGN:

The research design selected for the present study was quasi experimental
design).

The present study attempts to assess the knowledge and attitude among
womens in PHC , Kannivadi at Dindigul district.

Design О1 X О2

Pre test on Post test on

Structured
Pre experimental knowledge and knowledge and
teaching
design attitude regarding attitude on
programme.
cervical cancer. cervical cancer.

51
 SCHEMATIC REPRESENTATION OF RESEARCH DESIGN

Approach
Asses the effectiveness

Design
Pre experimental design

Population
Womens

Targeted population
Womens with the age group of 25-50 years

Accessible population
Womens with age group of 25-50 years in selected Kannivadi PHC.

Sampling technique
Convenient sampling technique

Sample and sample size

60 womens

Tools , data collection procedure

Interview

Intervention
Post test
Structured teaching programme

Descriptive and inferential statistics Findings Report

52
VARIABLES:

Independent variables :- Structured teaching programme.

Associate Variable :- Age, Marital status, Age at Menarche, Age

at Marriage , Family history of cancer, Religion,
Educational Status, Income, Occupation, No of
children, Source of information, Residence.

Dependent variables : - Cervical cancer

POPULATION:

The entire set of individuals or objects having some common

charecteristics selected for a research study. Target population is the set of
individuals or objects on whom the researcher wishes to generalize the findings.
The target population for the study was the womens. Accessible population is
the portion of the target population that is available to the researcher. Accessible
population was womens with the ge group of 25-50 years in selected kannivadi
village in Dindigul District.

Popultion : Womens

Targeted population : Womens with the age group of 25 – 50 years.

Accessible population : Womens with the age group of 25 – 50 years in

Kannivadi PHC.

SAMPLE AND SAMPLE SIZE:

The samples for the present study were womens in selected kannivadi
village in dindigul district who fulfilled the sample selection criteria. The main
53
purpose of the study was to obtain large enough sample to show statistical
significance and being economical at the same time. The sample size is
arbitrarily decided to be 60 womens from the age group of 25-50 years
considering the availability of time, sample acquaintance of the investigator with
the PHC.

SAMPLING TECHNIQUE:

In this study samples were choosen by non random sampling technique of

convenient sampling.

SAMPLING CRITERIA:

Sampling criteria is the list of characteristics of the elements that we have

determined beforehand that are essential for eligibility to form part of the
sample.

Inclusion Criteria:

 Womens who were with the group of 25-50years.

 Womens who were willing to participate in this study.
 Womens who can able to read and write.

Exclusion Criteria:

 Womens who were diagnosed with cancer.

 Womens who were suffering with abilities, pelvic inflammatory disease.
 Womens who were taking regular hormonal therapy.
 Women who were below 20 years of age and above 50 years of age.
 Women who were not willing to participate .
 Women who cannot able to read and write Tamil.

54
DEVELOPMENT OF THE TOOL:

A modified standardized self administered questionnaire was identified

and used to collect data regarding cervical cancer knowledge and Likert Scale
used for attitude; the questionnaire consisted of 3 sections with a total 72 items.

DESCRIPTION OF THE TOOL:

The study tool consisted of two sections

Section A: Back ground factors

Section B: Knowledge questionnaire on cervical cancer

Section C: Attitude scale on cervical cancer

Section A: Background factors of women

The questionnaire consisted of 12 items seeking general information about

women like age, marital status, age at menarche, age at marriage, family history
of cancer, religion, educational status, income, occupation, no of children, source
of information, locality. Information collected by interview metheod.

Section B: Knowledge questionnaire on cervical cancer

Section C: Attitude scale on cervical cancer

This section seeks the information regarding the attitude on cervical

cancer on 5 point scale; it is considered of 30 items.

55
 0= Undecided

1= Strongly Disagree

2= Disagree

3= Agree

4= Strongly Agree

TRY OUT:

The tool was administered and checked for its clarity and appropriateness.
The subjects chosen were similar in charecteristics to those of the population
under the study. The tool prepared by the researcher and was administered to
twenty womens.

RELIABILITY:

The stability of an instrument refers to the instruments reliability to

produce the same result with repeated testing. Inter rater reliability was done.
The purposive sampling. Two persons who were equally exposed to the caring
of the patients and researcher administered the tool simultaneously. Correlation
coefficient was found r= (0.8). The tool was found highly reliable.

VALIDITY OF THE TOOLS:

The background factors, the knowledge scale, and attitude scale in the
structured questionnaire and the translated tools are sent along with the request
for validation to 3 nursing experts and 2 Obstetrics and Gynaecology doctors.
Suggestions were considered and modification of tool was done according to the
opinion of experts in the back ground factors, the cervical cancer knowledge and

56
attitude Scale. Language experts did translation of the tool into tamil and
retranslation into English was done. The validity was confirmed.

DATA COLLECTION PROCEDURE:

The data on knowledge and attitude towards cervical cancer were collected
from Kannivadi village womens. The data were collected for 4 weeks from the
month of April and may 2016. Permission was sought and obtained from PHC
authoritative . The womens were selected using non random sampling method
among those who fulfilled the sample selection. Initial rapport was developed and
the purpose of the study was explained to them. Informed consent was obtained
from the womens. the questionnaire was administered to the womens regarding
knoeledge and attitude regarding cervical cancer separately. Confidentiality of
the information shared was assured. The womens were co – operative. On an
average, it took 30 minutes to complete one sample. At the end, the tool was
edited for completion.

PLAN FOR STATISTICAL ANALYSIS:

The data collected from the subjects were edited, compared and correlated
using both descriptive and inferential statistics on the basis of objectives and
hypothesis of the study. The analysis was done using statistical package SPSS
version 10. The level of significance was 0. 05.

1. Frequency, percentage distribution were used to describe womens

regarding their back ground.
2. Correlation of knowledge and attitude were analyzed by mean,
standard deviation, range, and ―r‖ value.

57
 3. The association between knowledge and selected back ground
factors were analyzed by linear regression.
4. The association between attitude and selected back ground factors
were analyzed by linear regression.

ETHICAL CONSIDERATION:

The researcher committee approved the research problem and objectives.

Informed consent was obtained from individual womens by orally. The womens
had the freedom to leave the study at her will without assigning any reason. Due
permission from hospital authorities were obtained. Explained regarding the
purpose of the STP was given to the womens involved in the study. Thus the
ethical issues were ensured in this study.

58
 CHAPTER - IV

DATA ANALYSIS AND

INTERPRETATION
 CHAPTER IV
DATA ANALYSIS AND INTERPRETATION

Analysis and interpretation of the data of this study was done by

description and inferential statistics. Analysis was done using SPSS version 24.
A probability value of less than 0.05 was considered to be significant.

This chapter deals with analysis and interpretation of data collected on

knowledge and attitude towards cervical cancer before and after structured
teaching programme.

THE OBJECTIVES OF THE STUDY:

 To associate the post test knowledge and attitude on cervical cancer

with their selected demographic variables.
 To correlate the knowledge and attitude Pre- test and post test score
on cervical cancer among women.

The data collected were edited, tabulated, analyzed, interpreted and findings
obtained were presented in the form of tables, and diagrams under the following
sections.

Section I : Data on background factors of the women.

Section II : Data on knowledge and attitude before and after structured

teaching programme.

Section III : Data on association between the demographic variables and

knowledge, attitude score of post test.

59
 SECTION –I

DATA ON BACK GROUND FACTORS OF THE WOMEN

FREQUENCY AND PERCENTAGE DISTRIBUTION OF WOMENS

REGARDING BACK GROUND FACTORS

Table 1. Social characteristics of women

NO: 60

Table
Characteristics of women Frequency Percent
No.
1.1 Religion
Hindu 50 83.3
Muslim 5 8.3
Chiristian 5 8.3
Total 60 100.0
1.2 Education
Primary 39 65.0
High School 13 21.7
Higher secondary 5 8.3
Degree 3 5.0
Total 60 100.0
1.3 Occupation
Heavy work 33 55.0
Moderate work 12 20.0
Sedentary work 15 25.0
Total 60 100.0
1.4 Marital status
Married 45 75.0
Divorced/Separated 8 13.3
Widow 7 11.7
Total 60 100.0
1.5 Residence
Rural 53 88.3
Urban 7 11.7
Total 60 100.0
60
 Table 1 shows the frequency and percentage distribution of social
charecteristics of women.

Majority (83.3%) of women belongs to Hindu and (8.3%) belongs to each

of Muslim and Christian. As same in (Table 1.1)

Analysis of education of women shows that a higher proportion of women

(65%) studied primary school of education, (21.7%) studied high school, (8.3%)
studied higher secondary and (5%) had degree (Table 1.2)

Regarding occupation of women (55%) are doing heavy work, (25%0

sedentary work, and (20%) Moderate work (Table 1.3)

Three fourths of women were Married, (13.3%) either Divorced or

separated and (11.7%) being in Urban areas (Table 1.4)

Majority of the (88.3%) women respondents were living in Rural areas,

(11.7%) being in urban areas. (Table 1.5)

61
Table 2. Demographic and economic characteristics of women

Table No. Characteristics of women Number Percent

2.1 Age
20-30 years 27 45.0
31-40 years 20 33.3
41-50 years 13 21.7
Total 60 100.0
2.2 Age at menarche
10-12 years 30 50.0
13-15 years 26 43.3
above15 years 4 6.7
Total 60 100.0
2.3 Age at Marriage
13-15 years 19 31.7
16-18 years 24 40.0
19-21 years 9 15.0
above21 years 8 13.3
Total 60 100.0
2.4 No. of living Children
1 18 30.0
2 25 41.7
3 and above 17 28.3
Total 60 100.0
2.5 Annual Income
Below Poverty<5000 55 91.7
Above Poverty> 5000 5 8.3
Total 60 100.0
2.6 Family History of Cancer
Yes 8 13.3
No 52 86.7
Total 60 100.0
2.7 Source of Information on cervical cancer
Medias 50 83.3
Books 4 6.7
Magazine 2 3.3
Friends 4 6.7
Total 60 100.0

62
 Table 2 shows the frequency and percentage distribution of Demographic
and economic characteristics of women.

Analysis of age of women shows that (45%) are in 20-30- years, (33.3%)
in 31-40 years, and (21.7%) in 41-50 years (Table 2.1)

Half of women attained Menarche at the age of 10-12 years, followed by

(43.3%) in 13-15 years, (6.7%) above 15 years (Table 2.2)

More women (40%) Married in 16-18 years, followed by women in 13-

15 years (31.7%), women in 19-21 years (15%) and (13.3%) of women got
married at 21 years and above, about (72%) women got married at less than 19
years (Table 2.3)

Regarding the no of children about (42%) of women are having 2 children,

(30%) of women having one child, and (28%) women were having 3 and above
children. (Table 2.4)

Analysis of annual income of respondent women shows that majority

(92%) were below poverty line of Rs less than 5000, and only (8%) women are
above the poverty line of Rs greater than 5000 (Table 2.5)

Women were enquired whether family members had the history of any
type of cancer (13.3%), women confirmed the family history of cancer and
remaining women are reported family has not experienced any cancer (Table
2.6)

Majority of women came to know about the cervical cancer through

Medias such as TV, News paper, the remaining women came to know through
books, magazine, and friends as seen in (Table2.7)

63
 90
83.3 %

80

70

60

50
50

40

30

20

10 8.3 % 8.3 %
5 5
0
Hindu Muslim Christian

FIGURE 1.1 RELIGIOUS WISE FREQUENCIES AND PERCENTAGE DISTRIBUTION

64
 70

60 65 %

50

40

39
30
21.7 %

20

10 8.3 % 5%
13
5 3
0
Primary High School Higher secondary Degree

FIGURE 1.2 EDUCATION WISE FREQUENCIES AND PERCENTAGE DISTRIBUTION

65
 60 55 %

50

40
33
25 %
30 20 %

20
12
10
Percentage
0 15
Heavy work Frequency
Moderate work
Sedentary work

FIGURE 1.3 OCCUPATION WISE FREQUENCIES AND PERCENTAGE DISTRIBUTION

66
 80
75
70

60

50
45
40

30

20
13.3
11.7
10
8
7
0
Married Divorced/Separated Widow

FIGURE 1.4 MARITAL STATUS WISE FREQUENCIES AND PERCENTAGE DISTRIBUTION

67
 88.3

90

80

70

60

50

40 11.7

30

20
7
53
10

0
Rural Urban

FIGURE 1.5 RESIDANCE STATUS WISE FREQUENCIES AND PERCENTAGE DISTRIBUTION

68
50
45
45

40

35 33.3

30
27

25
21.7
20
20

15 13

10

0
20-30 years 31-40 years 41-50 years

FIGURE 2.1 AGE WISE FREQUENCIES AND PERCENTAGE DISTRIBUTION

69
 50 %
50

45
43.3 %
40

35

30
30
25
26
20

15

10 6.7 %

5
4
0
10-12 years 13-15 years above15 years

FIGURE 2.2 AGE AT MENARCHE WISE FREQUENCIES AND PERCENTAGE DISTRIBUTION

70
 40

35
40
30 31.7

25

20

15
15
10 13.3
19 24
5

0 9 Percentage

13-15 years 8
16-18 years Frequency
19-21 years
above21 years

FIGURE 2.3 AGE AT MARRIAGE WISE FREQUENCIES AND PERCENTAGE DISTRIBUTION

71
 45

40
41.7 %
35

30

30 % 28.3 %
25

20 25

15 18 17

10

0
1 2 3 and above

FIGURE 2.4 LIVING CHILDREN WISE FREQUENCIES AND PERCENTAGE DISTRIBUTION

72
 100

90

80 91.7 %

70

60
55
50

40

30

20

10
5 8.3 %
0
Below Poverty<5000 Above Poverty> 5000

FIGURE 2.5 INCOME WISE FREQUENCIES AND PERCENTAGE DISTRIBUTION

73
 90

80
86.7
70

60

50

40 13.3

30
20 Percentage
10 52
8
0
Frequency
Yes
No

FIGURE 2.6 CANCER HISTORY WISE FREQUENCIES AND PERCENTAGE DISTRIBUTION

74
 90

80 83.3 %

70

60

50
50
40

30

20

6.7 % 3.3 % 6.7 %

10 4 4
2

0
Medias Books Magazine Friends

FIGURE 2.7 SOURCE OF INFORMATION ON CERVICAL CANCER WISE FREQUENCIES AND

PERCENTAGE DISTRIBUTION

75
 SECTION : II

Table 3. Knowledge and attitude score of women at pre, post tests and their

changes.

NO: 60
Table Standard
Characteristics of women frequency Percentage Mean
No. deviation
3.1 Knowledge pre test (score)
1-6 12 20.0
7-10 27 45.0
11-15 21 35.0
Total 60 100.0 8.80 3.256
3.2 Knowledge post test (score)
18-24 21 35.0
25-26 19 31.7
27-30 20 33.3
Total 60 100.0 24.67 3.079
3.3 Change in knowledge of cervical cancer (score)
11-14 21 35.0
15-16 16 26.7
17-24 23 38.3
Total 60 100.0 15.8667 3.08340
3.4 Attitude pre test (score)
43-57 20 33.3
58-64 20 33.3
65-78 20 33.3
Total 60 100.0 60.43 8.083
3.5 Attitude post test (score)
93-99 19 31.7
100-103 18 30.0
104-114 23 38.3
Total 60 100.0 102.27 4.554
3.6 Change in attitude of cervical cancer(score)
22-38 20 33.3
39-44 19 31.7
45+ 21 35.0
Total 60 100.0 41.8333 7.86575

76
 The knowledge level of cervical cancer has been increased from mean
value of (3.8) at pre test to (24.67) at post test (Table 3.1, 3.2)

In the same way the attitude level towards cervical cancer has been
increased from mean value of (60.43) to (102.27) (Table 3.4, 3.5)

While considering the change in knowledge from pretest to post test, the
distribution of change is given in (Table 3.3). Whereas change in attitude
towards cervical cancer is at mean value of( 41.8) (Table 3.6). It seems that the
attitude of women has changed at higher level mean of (41.83) compare to
knowledge mean of (15.87).

77
 TABLE 4
Test of significance of difference between pre and post test level
score
Variable
Standard T-test Significant
and type of Mean
deviation value value
test
Knowledge
Pre test 8.80 3.256
Post test 24.67 3.079 27.543 .01
Attitude
Pre test 60.43 8.083
Post test 102.27 4.554 34.931 .01

DESCRIPTIVE STATISTICS

Std.
N Minimum Maximum Mean
Deviation

ChangeK 60 11.00 24.00 15.8667 3.08340

ChangeA 60 22.00 62.00 41.8333 7.86575

Knowledge pretest 60 1 16 8.80 3.256

Knowledge post test 60 18 30 24.67 3.079

Attitude pre test 60 43 78 60.43 8.083

Attitude post test 60 93 114 102.27 4.554

Valid N (listwise) 60

78
 The difference between pre and post test level in knowledge as well as
attitude is tested using the T- test of significance which is presented in (Table 4).
The difference between pre and post test for both knowledge and attitude is
significant that 1% level which implies that there is a significant effect of
intervention on improving knowledge and positive attitude that is education of
women towards cervical cancer(Table 4).

79
 TABLE 5

Regression of background characteristics of women on change in

knowledge of cervical cancer from pre to post test

Variable and its category B S.E. Wald df Sig. Exp(B)

Age
20-30 years (Reference)
31-50 years .344 .748 .212 1 .645 1.411
Marital status
Married (Reference)
Divorced/Separated/widow -.910 .875 1.084 1 .298 .402
Age at menarche
10-12 yeas (Reference)
13+ yeas .013 .701 .000 1 .985 1.013
Age at marriage 1.792 2 .408
13-15 years (Reference)
16-18 years -.429 1.134 .143 1 .705 .651
19+years -1.104 .935 1.396 1 .237 .331
Religion
Hindu (Reference)
Muslim/Christian 1.194 1.011 1.395 1 .238 3.299
Education
Primary (Reference)
Above primary -.881 .865 1.038 1 .308 .414
Occupation
Heavy work (Reference)
Moderate & sedentary work 1.191 .802 2.203 1 .138 3.289
Source of information
Media (Reference)
Books/Magazine/Friends 2.129 1.099 3.757 1 .053 8.409
Income
Below Poverty< Rs.5000 (Reference)
Above Poverty> Rs.5000 .320 1.119 .082 1 .775 1.378
Residence
Rural (Reference)
Urban .165 1.053 .025 1 .876 1.179

80
No. of living children
1 (Reference) .502 2 .778
2 -.530 .951 .310 1 .577 .589
3 and above .061 .815 .006 1 .940 1.063
Constant -1.910 2.072 .850 1 .357 .148

The influence of socio economic, Demographic and other variables on the

change that happened due to a intervention on knowledge of cervical cancer and
positive attitude towards cervical cancer is assessed by using Logistic Regression
analysis. The following variables are used in the analysis separately for change
in knowledge and change in attitude.

DEPENDENT VARIABLES:

1. Change in knowledge : Less than median value = 0

More than median value = 1

2. Change in Attitude : Less than median value = 0

More than median value = 1

INDEPENDENT VARIABLES:

Age, marital status, educational status, Income, Occupation, Age

menarche Age at marriage, Religion, No of Children , family history of Cancer,
Source of information, residence.

RESULTS OF LOGISTIC REGRESSION ON CHANGE IN

KNOWLEDGE:

Among the independent variables only the source of information change in

knowledge is due to significantly associated with the change in knowledge.

81
 Women exposed to the source of books, Magazine, and friends are (8.4)
times more likely to have knowledge compared women exposed to TV, News
papper (Medias).

Muslim and Chiristian women, womens doing moderate and sedentary

work are (3.3) times more likely to have the knowledge compared to the
respective counter parts.

Women in 31-50 years are 1.4 times more likely to have kn owledge
compared to women in 20-30 years.

Married women , married at early age 13-15 years educated at primary

level , above the poverty line , living in Urban area and having 3 no of children ,
are (1 and little above ) times to have knowledge when compared to counter
parts .

However all the independent variables except source of information is not

significantly associated in knowledge (Table 5).

82
 TABLE 6

Regression of background characteristics of women on change in attitude

towards cervical cancer from pre to post test.

Variable and its category B S.E. Wald df Sig. Exp(B)

Age
20-30 years (Reference)
31-50 years -.120 .706 .029 1 .866 .887
Marital status
Married (Reference)
Divorced/Separated/widow .139 .768 .033 1 .856 1.149
Age at menarche
10-12 yeas (Reference)
13+ yeas .037 .661 .003 1 .956 1.037
Age at marriage 1.776 2 .412
13-15 years (Reference)
16-18 years -1.481 1.132 1.712 1 .191 .227
19+years -1.164 .989 1.383 1 .240 .312
Religion
Hindu (Reference)
Muslim/Christian .410 .851 .232 1 .630 1.507
Education
Primary (Reference)
Above primary .282 .785 .129 1 .720 1.326
Occupation
Heavy work (Reference)
Moderate & sedentary work .071 .718 .010 1 .921 1.074
Source of information
Media (Reference)
Books/Magazine/Friends -.481 .930 .268 1 .605 .618
Income
Below Poverty< Rs.5000
(Reference)
Above Poverty> Rs.5000 .866 1.046 .685 1 .408 2.377
Residence
Rural (Reference)
Urban .892 .950 .882 1 .348 2.439

83
No. of living children .183 2 .912
1 (Reference)
2 -.187 .910 .042 1 .837 .830
3 and above -.315 .738 .183 1 .669 .730
Constant -.294 1.887 .024 1 .876 .745

Women below the poverty line and living in Urban area are 2.4 times
more likely to have positive attitude towards cervical cancer compared to their
counter parts.

Women with the 1 child, having the source of information through media,
women married at 13-15 years, and women aged 20-30 years are little more
likely to have positive attitudes towards cervical cancer compared to their
counter parts.

However none of the background charecteristics of women is significantly

associated with positive attitude towards cervical cancer as seen in (Table6).

84
 TABLE: 7

CHI–SQUARE TEST REGARDING ASSOCIATION BETWEEN

KNOWLEDGE, ATTITUDE POST TEST AND BACK GROUND

FACTORS AMONG WOMEN

Back ground factors and Chi –square Significance

variables value p < 0.05
Age * Change in knowledge of
.123 .94 (NS)
cervical cancer
Age * Change in attitude of
1.964 .375 (NS)
cervical cancer
Age * Knowledge post test 1.964 .375 (NS)
Marital status * Change in
.985 .03 (S)
knowledge of cervical cancer
Marital status * Change in
1.991 .37 (NS)
attitude of cervical cancer
Marital status * Knowledge
1.991 .37 (NS)
post test
Age at menarche * Change in
3.385 .184 (NS)
knowledge of cervical cancer
Age at menarche * Change in
attitude of cervical cancer at 3.808 .149 (NS)
menarche
Age at menarche *
1.321 .517 (NS)
Knowledge post test
Age at marriage * Change in
4.311 .366 (NS)
knowledge of cervical cancer
Age at marriage * Change in
2.956 .565 (NS)
attitude of cervical cancer
Age at marriage * Knowledge
1.47 .832 (NS)
post test
Religion * Change in
1.874 .392 (NS)
knowledge of cervical cancer

85
Religion * Change in attitude
4.454 .108 (NS)
of cervical cancer
Religion * Knowledge post test 1.422 .491 (NS)
Education * Change in
.966 .04 (S)
knowledge of cervical cancer
Education * Change in attitude
4.531 .104 (NS)
of cervical cancer
Education * Knowledge post
1.879 .396 (NS)
test
Occupation * Change in
.793 .673 (NS)
knowledge of cervical cancer
Occupation * Change in
1.964 .375 (NS)
attitude of cervical cancer
Occupation * Knowledge post
1.313 .519 (NS)
test
Source of infomation * Change
4.084 .13 (NS)
in knowledge of cervical cancer

Source of infomation * Change

.136 .934 (NS)
in attitude of cervical cancer
Source of infomation *
1.327 .515 (NS)
Knowledge post test
family H/o Cancer * Change in
.672 .715 (NS)
knowledge of cervical cancer
family H/o Cancer * Change in
5.295 .071 (NS)
attitude of cervical cancer
family H/o Cancer *
2.204 .332 (NS)
Knowledge post test
Income * Change in knowledge
.881 .644 (NS)
of cervical cancer
Income * Change in attitude of
1.749 .417 (NS)
cervical cancer
Income * Knowledge post test 1.749 .417 (NS)

86
 No of Children * Change in
7.591 .108 (NS)
knowledge of cervical cancer
No of Children * Change in
1.931 .748 (NS)
attitude of cervical cancer
No of Children * Knowledge
.931 .923 (NS)
post test
Residence * Change in
4.049 .132 (NS)
knowledge of cervical cancer
Locality * Change in attitude of
2.58 .275 (NS)
cervical cancer
Locality * Knowledge post test 1.316 .518 (NS)

Table 7 shows the association between the post of knowledge, change in

knowledge and attitude with the back ground factors among women based on
chi-square.

It was inferred that there is no significant association between back

ground variables and change in knowledge, change attitude, knowledge post test
value.

There will be a significant association between the knowledge post test

and the Marital status, Education.

87
 CHAPTER - V

SUMMARY, FINDING,
IMPLICATIONS, LIMITATIONS,
CONCLUSION AND
RECOMMENDATIONS
 CHAPTER V

SUMMARY, FINDING, IMPLICATIONS, LIMITATIONS,

CONCLUSION AND RECOMMENDATIONS

The essence of any research project is based on study findings, limitations,

interpretations of the result and recommendations that incorporate the study
implication. It also gives meaning to the results obtained in this study.

SUMMARY

The prime aim of the study was to assess the effectiveness of

structured teaching programme of knowledge and attitude towards cervical
cancer among women 25-50 years in selected PHC, Dindigul.

The objectives of the study were,

1. To associate the post test knowledge and attitude on cervical cancer

with their selected demographic variables.
2. To correlate the knowledge and attitude Pre test and post test score on
cervical cancer among women.

The study attempted to examine the following research hypothesis.

H1:There will be a significant difference between pre and post test

knowledge and attitude score after structured teaching programme on

cervical cancer among women.

H2:There will be a significant correlation between Knowledge and attitude

on cervical cancer among women

88
 H3:There will be a significant association between the knowledge on

cervical cancer and background features among women .

H4:There will be a significant association between the attitude on cervical

cancer and background features among women.

The major assumption of the study include the women were participated
and responded honestly in this study, cooperate with women the investigator
and every women were unique.

The review of literature helped to investigator to develop conceptual frame

work, tool and develop intervention of structured teaching programme
literature review was done for the present study and presented in the following
headings.

1. Review of literature related to cervical cancer.

2. Review of literature related to knowledge on cervical cancer.
3. Review of literature related to attitude on cervical cancer.
4. Review of literature related to cervical cancer screening.

The conceptual frame work adopted for the present study was based on
Nursing process theory.

The research approach adopted for this study was evaluate in nature. The
present study was a quasi experimental study, pre experimental design.
Independent in this study was structured teaching programme (Power point).
Dependent variable was cervical cancer. Associate variable age, marital status,

89
Age at menarche, Age at marriage, Family history of cancer, Religion,
Educational status, Income, Occupaion, No of Children, Source of information,
residence.

The tool was developed and used for data collection was an interview
method to assess the knowledge and attitude towards cervical cancer. The power
point teaching was developed on the basis of related literature. The content
validity of the tool was established by five experts. The tool was found reliable
and feasibile. The reliability, correlation was found high, r= 0.84. The pilot study
was conducted in selected village, Dindigul and study was found feasible.

The main study was conducted in Kannivadi PHC at Dindigul. Convenient

sampling was used to select the samples. Pre test was done to assess the
knowledge and attitude status among womens between the age group of 25-50
years. The intervention on structured teaching programme was administered by
Power point; Post test was done on the first day, third day, and fifth day. The
data gathered were analyzed using SPSS (version 24) software at the level of
0.05 level of significance based on the study objectives.

MAJOR FINDINGS

The findings of the study are presented under the following headings
based on the objective of the study.

OBJECTIVE 1:

To associate the post test knowledge and attitude on cervical cancer with
their selected demographic variables.

90
 1. The obtained chi–square value regarding knowledge, attitude and selected
factors such as age, marital status, Age at menarche, Age at marriage,
Family history of cancer, Religion, Educational status, Income,
Occupation, No of Children, Source of information, residence ( P > 0.05 )
were not significant.
2. The obtained chi-square =0 .985 ( P = 0.03 ) regarding marital status and
knowledge post test, chi square = 0.966 ( P = 0.04 ) regarding education
and knowledge post test of women was significant.
3. Selected factor such as age, marital status, Age at menarche, Age at
marriage, Family history of cancer, Religion, Educational status, Income,
Occupaion, No of Children, Source of information, residence, did make no
difference in the Knowledge and attitude towards cervical cancer among
women.

OBJECTIVE 2:

To correlate the knowledge and attitude Pre- test and post test score on
cervical cancer among women.

1. There was a significant increase in knowledge after the power point

teaching among women between the age group of 25-50 years t = 27.543
(P = 0.05)
2. There was a significant increase in Attitude after the power point teaching
among women between the age group of 25-50 years t = 34.931
(P = 0.05)

91
DISCUSSION

The discussion on the study findings were presented under the following
headings of the study.

FINDING 1:

To associate the post test knowledge and attitude on cervical cancer with
their selected demographic variables.

1. The obtained chi–square value regarding knowledge, attitude and selected

factors such as age, marital status, Age at menarche, Age at marriage,
Family history of cancer, Religion, Educational status, Income,
Occupaion, No of Children, Source of information, residence ( P > 0.05 )
were not significant.
2. The obtained chi-square =0 .985 (P = 0.03) regarding marital status and
knowledge post test, chi square = 0.966 (P = 0.04) regarding education
and knowledge post test of womens was significant.
3. Selected factor such as as age, marital status, Age at menarche, Age at
marriage, Family history of cancer, Religion, Educational status, Income,
Occupaion, No of Children, Source of information, residence, did make no
difference in the Knowledge and attitude towards cervical cancer among
womens.

92
FINDING 2:

To correlate the knowledge and attitude, Pre- test and post test score on
cervical cancer among women.

1. There was a significant increase in knowledge after the power point

teaching among women between the age group of 25-50 years t = 27.543
(P = 0.05)
2. There was a significant increase in Attitude after the power point teaching
among womens between the age group of 25-50 years t = 34.931
(P = 0.05)

The above findings were supported by studies conducted by Askar Set et

al., (2014), Singhal. T (2012), B. Agama Bunsal, Abhijith et al., (2014),
P. Rajkumar (2012), Anarado AN , AGANWAH E, (2011), where they
reported that there was a significant increase in knowledge and attitude on
cervical cancer.

IMPLICATIONS

The study had implications, guidelines and suggestions for nursing

practice and nursing research.

Implications for nursing practice

1. Power point teaching is an effective measure to increase the knowledge

and Attitude. Nurse can use this Power point teaching is an effective
measure to increase the knowledge and Attitude towards cervical cancer.

93
 2. Nurse can plan the goal of pap smear screening of cervical cancer and
enhance the nurse patient relationship and sense of well being to the
patient through the development of mutually agreed the goals.
3. Power point teaching should be made an integral part of preventive
management of cervical cancer among womens .

IMPLICATIONS FOR NURSING RESEARCH

1. The study will be valuable reference for the further research.

2. The findings of the study would help to expand the scientific body of
professional knowledge up on which further research can be conducted.

LIMITATION

1. Period of power point teaching only five days

2. This study has no control group to prove the effectiveness of structured
teaching programme.
3. The samples were selected by non random method limiting the
generalizability.

RECOMMENDATIONS

1. A similar study can be conducted inlarge group of womens.

2. A longer period of intervention can be used studied for more reliability
and effectiveness.
3. A true experimental study with experimental and control groups can be
conducted.

94
CONCLUSION

Structured teaching programme significantly increases the knowledge and

attitude. So future nurses can incorporate structured teaching as a part of nursing
intervention in trating cervical cancer.

95
REFERENCES
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12.Pritchard. Macdonald., “Williams Obstetrics” 7th edition,
International Edition.
13.Sundar Rao. P.S.S and Richard. J., (1997), “An Introduction to Bio
Statistics; A Manual For Health Sciences”, 3rd edition, Prentice Hall
of India Pvt. Ltd.
14.William. W. Beck. Jr., M. D. (1994), “obstetrics and Gynaecology”,
3rd edition, B.I. Wavery Pvt .Ltd, New Delhi.
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edition 2005. Obstetrics Elsever publication New Delhi. Page No
341-345
16. Annamma Jacob (2004) comprehensive text book of midwifery 2nd
edition.R.M. Brothers New Delhi Padubiri 2004 A text book of
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17.Banikarim C, Chacko M D, Kelder S H. Prevalence and impact of
physiological changes on female adolescents. Archieves of obstetrics
and Adolescent Medicine 2000; 154, 1226-29.
18.Basavanthappa BT. Nursing Research.2nd ed. New Delhi: Jaypee
Brothers medical publishers; 2007. George JB. Nursing theories, the
base for profeesions.
19. Ash Monga, Stephen Dobbs, et., al Gynaecology by ten teachers,
19th edition, Taylor & Francis Ltd 2011, 152-155.
20.Jermy J.N .Oats, Suzanna Abraham Liewellyn–Jones Fundamentals
of Obstetrics & Gynaecology, Elsevier health sciences, 10th edition
2016, 231-234.

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JOURNALS:

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cancer‖ 2003, Journal of National Cancer institute …, 03 (31);3-13.
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early ages at first intercourse at high risk, 119 (12) 3-23.
3. LC Harlan, AB Bernstein., ―Pap smear screening intervals and
factors affecting screening‖ American Journal of Public health 94(4)
525-529.
4. GM Clifford, JS Smith., ―Human Pappiloma Virus detected in based
on biopsy Specimens on Cervical Cancer‖ British Journal Of Cancer.,
2003 (88) 63-73.
5. V.Shantha, S.Krishna moorthi., C.K Gajalakshmi., et., al,
―Epidemiology of cancer of the cervix global and national perspective‖
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6. JD. Boice Jr, M Blettneret., al, ―Radiation dose and leukaemia risk in
Patients treated for cervical cancer‖, Journal of the national cancer
institute [2007, 79(6):1295-1311].
7. EE.Calle, W.D.Flanders., ―Proven Screening technologies exist for
cervical cancer‖, American Journal of Public health, Vol 83.
8. C.K Yu, J.Rymer., ― women attitude and awareness of smear testing
and cervical cancer‖ the British Journal of Family Planning , 98(2)
3-13.
9. B.Mossa,., ―The Role Of Neoadjuvant Chemotherapy for Squamous
Cell Cervical Cancer(Ib-IIIb)‖ , European Journal of Cervical Cancer
[03 24 (1) 51-59].

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10.L.Schulmeisfer, D.S. Lifsey ., ― cervical cancer Screening knowledge,
Behaviours, and beliefs‖, Journal of Oncology Nursing, [201026(5)
879-887].
11.E.A. Jacobs., ―Limited English Proficiency and cervical Screening in a
Multi Ethinic Population‖ , American Journal of Public health, August
2015, vol 95, No : 8, 1410-1416.
12.A.K. Sood, Cigrette Smoking & Cervical Cancer meta Analysis and
Critical review of recent studies‖ American Journal of Preventive
Medicine., 2011, 7 (4) 208- 213.
13. E. Burgharelt, Site and origin of Squamous cell cervical carcinoma a
histomorphologic study, Obstetrics & Gynaecology 2013.
14.Sankaranarayanan R, Feralay J (2016) WorldWide burden of
Gynaecological cancer: the size of the Problem. Best pract res clin
Obstet Gynaecol 20: 207-225.
15.Sankaranarayanan R (2016) Overview of cervical cancer in the
developing world. FIGO 6th Annual report on the result of treatment in
Gynaecological cancer. Int J Gynaecol Obstet 95: Suppl 1 S205-210.
16.Feraly JBF, Pisani P, Parkin D (2012) cancer Incidence, mortality
and prevalence world wide, Lyon, France 7.
17.Laikangbam P, Sengupta S, Bhattacharya P, Duttagupta C, Dhabali
SinghT, et al., (2007) A Comparative Profile of the prevalence and age
distribution of Human Papilloma Virus type 16/ 16 infections among
three states of India with focus on North East India. Int J Gynaecol
Cancer 17: 107-117.

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18.Aziz Z, Sana S, Saeed S, Akram M (2003) Instituion based tumour
registry from Punjab, Five year data based analysis. J Pak Med Assoc
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Muslim Community. Asian pac . J. Cancer Prev 5: 77-82.
20.Bhurgri Y (2004) Karachi cancer center Registry Data – Implications
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Patho- epidemiology of cancer cervix in Karachi south . Prev: 8: 357-
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Perceptions and Practices of a Pakistani Populations regarding
cervical cancer screening. Prev: 9 42-44.
23. Wheeler CM (2007) Advances in Primary and secondary interventions
for cervical cancer: Human papilloma virus Prophylactic vaccines and
testing. Nat Clin Pract Oncol4: 224-235.
24.Das Bc, Hussaine S, Nasare V, Bharadwaj M (2011) Prospects and
prejudices of human Papilloma Virus vaccines in India. Vaccine 26:
2669-2679.
25.Nganwai P, Truadpon P, Inpa C, Sangpetngam B, Mekjarasnapa M, et
al., (20013) Knowledge, attitude ,and Practices vis-a- vis Cervical
Cancer Among Registered Nurses at the Faculty of Medicine, Khon
Kaen Uiversity, Thailand. Asian Pac J cancer Prev 9: 15-18.
26.Tebeu P M, Major AL, Rapiti E, Petignat P, Bouchadry c et al., (2010)
The Attitude and Knowledge of cervical cancer by Cameroonian

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North province of Cameroon. Int J Gynaecol Cancer.
27.Appleby P, Beral V, Berrington de Gonzalez A, Colin D, Franceschi
S, et al., (2016) Carcinoma of the Cervix and tobacco Smocking:
Collaborative reanalysis of Individual from 23 epidemiologist studies
118: 1481-1495.
28.Appleby P, Beral V, et al., ( 2014) Cervical Cancer and Hormonal
Contraceptives: Collaborative reanalysis of individual from
epidemiological studies, Lancet 370: 1609-1621.
29.Shapely M, Jordan J, Croft PR (2016) A ystematic review of Post
coital Bleeding and risk of Cervical Cancer. Br. J Gen Pract 56: 453-
460.
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Cervix Cancer , Human Pappiloma Virus (HPV) and HPV Vaccination
at the moment of introduction of the vaccine in women . Arch Gynecol
Obstet277: 291-298.

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102
APPENDICES
 APPENDIX-I
LETTER SEEKING PERMISSION FOR CONTENT VALIDITY

FROM

301423051
II Year Msc Nursing
Jainee college of Nursing,
Aathupatti Pirivu,
Dindigul.
TO
THROUGH
The Principal,
Jainee college of Nursing,
Aathupatti Pirivu,
Dindigul.
Respected Madam,

SUB: Letter requesting consent to validate the tool.

I am 301423051, IInd year M.sc nursing student of Jainee college of

Nursing Dindigul, under the Dr. M.G.R Medical university, Chennai.

As a partial fulfiliment of M.sc Nursing programme, I am conducting

“A quasi experimental Study to assess the effectiveness of structured
teaching programme on knowledge and attitude regarding cervical cancer
among women At Primary health center, Kannivadi Dindigul district”.

Here I am sending the tool for content validity for your expert opinion. I
humbly request yourself to spare a little of your valuable time for me which I
remain ever grateful to you. I would be very kind of you to return the same
undersigned at the earliest.

Thanking You

Place: Yours Sincerely

Date: (301423051)

103
 APPENDIX–II
LIST OF EXPERTS

1. Dr. UMA RAMANATHAN, MBBS, MD, DGO

Meenakshi hospital,
Dindigul.
2. Dr. KAVITHA MD. DGO.
Director,
Velan Hospital,
Dindigul.
3. Mrs.Meera M.sc (Nursing)
OBG department,
Vice Principal,
Jainee college of nursing,
Dindigul.
4. Mrs. Thilagavathy M.sc (Nursing)
Psychiatric department,
Principal,
Jainee college of nursing,
Dindigul.
5. Mrs. Kavitha M.sc (Nursing)
OBG department,
Resource person,
Jainee college of nursing,
Dindigul.

104
 APPENDIX–III
PERMISSION LETTER

FROM

301423051 (G.ABIZHA)
Msc Nursing IInd year,
Jainee College of Nursing,
Veerakkal , Dindigul.
TO

The Deputy Director,

Dindigul.

THROUGH

The Prinicipal,
Jainee college of Nursing,
Dindigul.

Respected madam / Sir

I am G.ABIZHA (301423051) IInd year M.sc nusing student of Jainee

college of nursing Veerakkal, under the Tamil Nadu Dr.M.G.R Medical
University, Chennai. As a partial fulfillment of university requirement for a
award of Master of Science in Nursing degree , I am conducting research on the
following topic. ―A quasi experimental Study to assess the effectiveness of
structured teaching programme on knowledge and attitude regarding cervical
cancer among womens in Kannivadi PHC at Dindigul district.Iwould like to
conduct the research in your esteemed PHC. Please grant permission to the same.

Thanking You

Place: Yours sincerely

Date: (301423051)

105
 APPENDIX IV
CONTENT VALIDATED CERTIFICATE

I here by certify that I have validated the tool of 301423051 M.sc

Nursing II year, who is undertaking , “A quasi experimental Study to assess
the effectiveness of structured teaching programme on knowledge and
attitude regarding cervical cancer among womens in Kannivadi PHC at
Dindigul district”.

Place: Signature of the Expert,

Date:

Designation.

106
 BACKGROUND FACTORS

SECTION: A

Introduction:

The section seeks information regarding back ground factors of the

womens. The interviewer is requested to ask the item and get responses one by
one. Please tick (√) Mark appropriate box.

1. Age

a) 20-30 years
b) 31-40 years
c) 41-50 years

2. Marital status

a) Married
b) Divorced / Separated
c) Widow

3. Age at menarche

a) 10-12 years
b) 13-15 years
c) Above 15 years

107
4. Age at marriage

a) 13-15 years
b) 16-18 years
c) 18-21 years
d) Above 21 years

5. Family history of cancer, if yes who

a) Yes
b) No

6. Religion

a) Hindu
b) Muslim
c) Chiristian

7. Educational status

a) Primary
b) High school
c) Higher secondary
d) Degree

8. Income

a) Below poverty line (less than 50,000/ annum)

b) Above poverty line (50,000 and above/ annum)
9. Occupation

a) Heavy
b) Moderate
c) Sedentary

108
10 . No of children

a) 1
b) 2
c) 3 and above

11.Source of information

a) Media (Tv/ news paper)

b) Books
c) Journals
d) Friends

12.Locality

a) Rural
b) urban

109
 SECTION: B

KNOWLEDGE QUETIONNAIRE ON CERVICAL CANCER

1) Where the cervix is situated?

a) Lower part of the ovary

b) Lower part of Uterus
c) Lower part of vagina
d) Near to fallopian tube
2) What is cancer?

a) An Abnormal rapid growth of cells

b) Rearrangement of cells
c) Displacement of cells
3) What do you mean by cervical cancer?

a) It is an abnormal growth of cancer cells in cervix

b) It is an abnormal growth present in body of uterus
c) It is an abnormal growth present in fallopian tube
d) It is an abnormal growth present in vagina
4) Which one of the following virus causing cervical cancer?

a) Human papilloma virus

b) Staphylococcus
c) Pseudomonas
d) Pneumococcus

110
5) Which one of the following contraception will cause to cervical Cancer?

a) Oral contraceptive pills

b) Copper-T
c) Condom
d) Vaginal sponge

6) Who are all at risk for developing cervical cancer? Except?

a) Giving birth at a very young age

b) Exclusive intake of contraceptive pills
c) Having many sexual partners
e) Certain genetic factors
7) Which is the most common symptom in a woman with cervical Cancer?

a) Continuous vaginal bleeding

b) Bleeding per rectum
c) Fever
d) Redness of vagina

8) Which one of the following is not the warning sign of cervical cancer?

a) Abnormal vaginal bleeding

b) Unusual foul smelling vaginal discharge

c) Pain during urination

d) Pain during sex (dysparenuria)

e) Breast engorgement

111
9) In which stage the cervical cancer symptoms will explore?

a) Stage I
b) Stage III
c) Stage II

10) Which is the early diagnostic procedure for cervical cancer?

a) Haemoglobin in blood
b) Pap smear test
c) Vaginal examination
d) None of the above
11) Which is the confirmatory diagnostic Procedure for cancer cervix?

a) MRI Scan
b) CT Scan
c) Biopsy
d) None of the above
12) Define biopsy?

a) Sample of tissue taken from the affected organ

b) Removal of uterus
c) Removal of any one organ
d) An artificial opening

112
13) When dose the department of health recommended you have a cervical
cancer smear?

a) Atleast every five years once from the age of 30 years

b) Atleast every ten years from the age of 30 years
c) After the age of 40
d) After the age of 50
14) Which age group can have an abnormal cervical smear?

a) 18-25 years
b) 25-35 years
c) 36-50 years
d) Over 50 years
15) What is a pap smear test?

a) Scraping to look for an abnormal cervical cells

b) A microscopical examination
c) seeking the abnormal cells of cervix through ultrasound
d) Is a type of CT scan
16) Women who are undergoing pap smear should avoid intercourse?

a) 24 hours before
b) 48 hours before
c) 3 days before
d) 4 days before

113
17) Which is the best time to undergoing pap smear test?

a) Between 5to 10 days after the first day of last menstrual period.
b) 10 to 20 days after the first day of last menstrual period.
c) 21 to 25 days after the first day of last menstrual period.
d) All the time.
18) Which one of the following treatment available for cervical cancer?

a) Surgery
b) Radiation therapy
c) Chemo therapy
d) none of the above.
19) Which one of the following is most advanced treatment for cervical Cancer?

a) Chemotherapy
b) Radiationtherpy (brachytherapy)
c) Cryosurgery
d) Hysterectomy

20) What is mean by metastasis?

a) It will spread from the affected parts to other parts

b ) It will not spread to other parts
c) It will spread only pelvic area
d) It will spread only vagina

114
21) In cancer cervix which primary organ affected by metastasis?

a) Heart
b) Kidney
c) lungs
d) Stomach
22) Which one is the most common metastasis organ for all cancer?

a) Heart
b) Liver
c) Lungs
d) None of the above
23) What is the important complication of cancer cervix?

a) Frequency of urination
b) Pelvic Pain
c) Abdominal pain
d) None of the above
24) What is mean by HPV vaccine?

a) Human Papilloma Virus vaccine

b) Human polio Virus vaccine
c) Human pertusis virus vaccine
d) none of the above

115
25) What is the route of administration of HPV vaccine?

a) Intra muscular
b) Subcutaneous
c) Intra dermal
d) Intra venous
26) What is the dosage of HPV vaccination?

a) 0.1 ml
b) 2 ml
c) 2.5 ml
d) 0.5 ml
27) Which one of the following is the important method of preventing

cervical cancer?

a) Frequent medical examination

b) Regular Exercise
c) Avoid Stress
d) None of the above

28) Which one of the contraception is help in preventing cervical cancer?

a) Copper –T
b) Vaginal Sponge
c) Condom
d) Oral pill

116
29) Which one of the following is best life style modification to avoid

cervical cancer?

a) Adequate sleep and rest

b) Prefer super foods like (Pappaya, Green tea, Raspberries,
carrots, Turmeric , Cauliflower, Cabbage)
c) Do not smoke
d) Cervical screening

30) Which type of diet help to prevent cervical cancer?

a) Vitamin Aand C
b) Vitamin D
c) Vitamin K
d) Vitamin E

117
 SECTION: C
ATTITUDE SCALE ON CERVICAL CANCER.

Read the sentences carefully And Choose One From these five Options
Strongly Strongly
Undecided Disagree Agree
Items disagree agree
(0) (2) (3)
(1) (4)
1) Cervical cancer is the curse of
God *
2) An abnormal rapid growth of cells
is cancer
3) Women who had family history of
cervical cancer are more likely to
get cervical cancer
4) Prolonged use of orall pills can
cause cervical cancer
5) Grand multiparas may get
cervical cancer
6) Poor personal hygiene and poor
genital hygiene leads to cervical
cancer
7) Cervical cancer symptoms will
explore in IIIrd stage only
8) Confirmatory symptoms will
reveal in IVth stage only
9) Cervical cancer is also caused by
HPV virus
10) Irregular Vaginal bleeding and
foul smelly vaginal discharge is a
early symptoms of cervical cancer
11) Cervical cancer can be identified
by doing pap Smear test

12) There is no treatment for cervical

cancer*
13) HPV vaccination helps to prevent
cervical cancer
14) All women above 30 years should
undergo pap test

118
15) It is essential for women to
attend cancer awareness
programme
16) Prevention of cervical cancer is by
proper use of condoms *
17) cervical cancer will be detected
early.
18) treatment of cervical cancer will
improve the life expectancy of
women
19) Chemotherapy and radiation
therapy is one of the important
treatment of cervical cancer
20) Women who had regular health
check up need not worry about
cervical cancer
21) Cervical cancer is a
communicable disease *
22) Cancer is preventable

23) Cervical cancer cannot be

prevented *

24) Cervical cancer womens are need

to be isolated *
25) Cervical cancer it affects the
other part of the body
26) Cervical cancer it affects your
body image
27) Cervical cancer treatment needs
prolong hospitalization
28) Vitamin A and C rich diet helps to
prevent cervical cancer
29) Using condom during sex helps to
protect from HPV infection
30) Pain during sexual intercourse is
an important symptom of cervical
cancer

Keys: * (* - the score will be reversed)

119
 CERVICAL CANCER

DEFINITION
Cervical cancer is a cancer arising from the cervix. It is due t the
abnormal growth of cells that have the ability to invade or spread to other parts
of the body.

ETIOLOGY:

 Human Papilloma Virus (HPV more than 90% of cases) and the
exact caus is unknown. (Human papilloma virus infection appears
to be involved in the development of more than 90% of cases).
 Human papilloma virus types 16 and 18 are the cause of 75 % of
cervical cancer, while 31 and 45 are the cause of another 10%.

RISK FACTOR:

 Genital Warts (which are a form of benign tumor of epithelial

cells are also caused by various strains of HPV).
 Smoking (Smoking can increase the risk in women a few different
ways, which can be by direct and indirect methods of inducing
cervical cancer.)
 Weakned immune system (people with weakened immune
system, such as those with HIV/AIDS or transplant recipients
taking immunosuppressive medications have a higher risk of
developing cervical cancer.)
 Certain Genitic factors
 Long term mental stress (A women who experiences high levels
of stress over a sustained period may be understanding her ability
to fight off HPV and be at increased risk of developing cervical
cancer it can cause.)
 Giving birth at a very young age (women who gave birth before
the age of 17 are significantly more likely to develop cervical
cancer compared to women who had their first baby when they
were aged 25 or over.)
120
  Several pregenancies (women those who have had seven or more
full term pregnancies have around four times the risk of cancer
compared with women with no pregnancies, and two to three times
the risk of women who have had one or two full term pregnancies.)
 Contraceptive pills (women who have used oral contraceptives for
5 to 9 years have about three times the incidence of invasive
cancer and those who used them for 10 years or longer have about
four times the risk.)
 Other sexually transmited diseases (Chlamydia, Gonorrhea,
Syphilis, HIV)
 Having many sexual partners ( cervical cancer causing HPV
types are nearly always transmitted as a result of sexual contact
with an infected individual)
 Socio – economic status.

SIGNS AND SYMPTOMS:

 Bleeding between periods.

 Bleeding after sexual intercourse.
 Bleeding in post menopausal women.
 Discomfort during sexual intercourse.
 Smelly vaginal discharge.
 Vaginal discharge tinged with blood.
 Pelvic pain.

STAGES:

 Stage: I (Cancer is Strictly confined to the Cervix)

 Stage: II (Cervical cancer invades beyond the Uterus but not in
the pelvic wall)
 Stage: III (The tumour extends to the pelvic wall and half of the
Vagina)

121
  Stage: IV(The Carcinoma has extends beyond the true pelvis or has
involved the mucosa of the Bladder or Rectum)

DIAGNOSIS:

 Pap smear test :

A magnified visual inspection of the cervix aided by using
a dilute acetic acid eg: vinegar solution to highlight abnormal cells
on the surface of the cervix.
 Biopsy:
A small piece of tissue will be taken. This patient will be
anesthetized for this.
 Colposcopy:
A speculum is placed to hold the vagina open and the
gynaecologist looks at the cervix through a colposcope a lighted
magnifying instrument specifically designed for examining the
tissue of the vagina and the cervix.
 Cone biopsy :
A small cone shaped section of the abnormal tissue is
taken from the cervix for examination under a microscope.

 LLETZ :
A diathermy bis used to remove abnormal tissue. The
tissue is sent to lab to be checked
 Blood test :
(Number of Blood cells)
 Computerised tomography scan:
3-D cross – sectional picture of the part of the body and
displays it on the screen. The patient will have to barium drink
beforehand. The barium appears white on the scan. Just before the
scan tampon may be placed into the vagina, and a barium liquid
may be placedinto the rectum. the whole scans takes from 10- 30
minutes.

122
  MRI :
Magnetic Resonance Imaging scan (By using the high
MRI with a special vaginal coil, a technique to measure the
movement of water within the tissue, the researchers may be able
to identify cervical cancer in its early stages.)
 Pelvic ultra sound :
This is a device that uses high frequency sound waves
which create an image on a monitor of the target area. The patient
will be asked to drink plenty of fluids beforehand so that the
bladder is full and a clear picture can be viewed. A trans vaginal
ultrasound device may be inserted into the vagina, or an external
device may be relaced next to the stomach.

PREVENTION:

 Dietary prevention: super foods for preventing cervical cancer-

papaya, Raspberries, Green tea, Asparagus, Carrots, Salmon,
Turmeric,Broccoli, Arugula, fish roe, Horse raddish, cherish,
bbbbrussels sprouts, cauliflower, cabbage.
 HPV vaccine: Gardasil, Cervarix. Three doses over six month
interval.
 Safe sex. (using condom during sex helps protect from HPV
infection.)
 Cervical screening.( Regular cervical screening will make it much
more likely that signs are picked up early on and dealt with before
cancer develops at all or too far.)
 Have one sex partner.
 Delay first sexual intercourse. (The younger a female is when
she has her first sexual intercourse the higher is her risk of
developing cervical cancer. the longer she delays it the lower her
risk.)
 Do not smoke.

123
TREATMENT:

EARLY STAGE:

I. Cone biopsy (conization)-this procedure may also be used to

remve any abnormality. The surgeon uses a Scalpel to remove a
cone – shaped piece of cervical tissue.
II. Laser surgery – a narrow beam of intense light destroys
cancerous and precancerous cells.
III. LEEP (loop electrosurgical excision procedure) - a wire loop
which has an electric current cuts through tissue removing cells
from the mouth of the cervix .
IV. Cryosurgery- cancerous and precancerous cells are destroyed
by freezing them.
V. Hysterectomy- the cancerous and precancerous areas, as well
as the cervix and the uterus are surgically removed. This is not
coomon and is only done in certain cases of noninvasive
cervical cancer.

RADIO THERAPY:

Radiotherapy works by damaging the DNA insideb the tumour cells,

destroying their ability to reproduce. This may be delivered externally or
internally (brachytherapy) by placing radioactive material near the cervix.

CHEMOTHERAPY:

Chemotherapy is the use of medications which is used to

destruction of cancer cells. Cytotoxic medication prevents cancer cells from
dividing and growing.

124
RECENT ADVANCEMENT IN CERVICAL CANCER TREATMENT:

I. Phase ΙΙ trial anti tumour drug that prolong the survival of

women with cervical cancer.
II. Avastin can length the lives of cervical cancer women.
III. Just on HPV vaccine dose “Could be enough” to prevent
cervical cancer.

COMPLICATION:

 Haemorrhage
 Pyelitis, Pyelonephritis, and Hydronephrosis
 Frequency of Urination

METASTASES:

 The first metastases organ of cervical cancer is Kidney.

 Lungs (36%)
 Lymp Nodes (30%)
 Bone (16%)
 Abdominal Cavity (7%)s

125
 kiwKf fhuzpfs;

gFjp: m
Fwpg;Gfs;:
,g;gFjpahdJ fh;g;htha; Gw;WNeha; Fwpj;j ngz;fspd; mwpT (Gyik) kw;Wk;
mZFKiw Fwpj;j kiwKf fhuzpfspd; nra;jpfisnfhz;lJ. Neh;Kfj;Njh;thsh;
Nfs;tpfisf; Nfl;L mjpd; gjpy;fis xd;wd;gpd; xd;whf ngw Ntz;Lk;. kw;Wk;
gjpy;fSf;Fhpa fl;lq;fspy; (√) FwpaPl;il NghlTk;.

1. taJ

m.) 20-30
M) 31-40
,) 41-50
2. jpUkz epiy
m) jpUkzkhdth;

M) tpthfuj;J ngw;wth; / jdpj;jth;

,) tpjit

3. gUtkile;j taJ
m) 10-12
M) 13-15
,) 15 tajpw;F Nky;

4. jpUkzkhd taJ
m) 13-15
M) 16-18
,) 18-21
<) 21 tajpw;F Nky;

5. FLk;gj;jpy; ahNuDk; Gw;WNehahy; ghjpf;fg;gl;lth; ahNuDk; cs;sduh? Mk; vdpy;

ahh; ?
m) Mk;
M) ,y;iy

126
6. kjk;

m) ,e;J
M) ,];yhk;
,) fpwp];jth;

7. fy;tpj;jFjp
m) Muk;gg;gs;sp
M) cah;epiy
,) Nky;epiy
<) gl;ljhhp
8. tUkhd epiy
m) tWikf;Nfhl;lpw;F fPo; ( & 50000 f;F fPo; )
M) tWikf;Nfhl;lpw;F Nky; ( & 50000 f;F Nky;)

9. cq;fs; Ntiy epiy

m) kpfTk; fbdkhdJ
M) kpjkhd fbdkhdJ
,) vspjhdJ

10) vj;jid Foe;ijfs;

m) 1
M) 2
,) 3 kw;Wk; mjw;F Nky;

11) Gw;WNeha; gw;wpa jftiy ePq;fs; vt;thW njhpe;J nfhz;Bh;fs;

m) jfty;njhlh;G rhjdq;fs;
(njhiyf;fhl;rp thndyp nra;jpjhs;)
M) Gj;jfq;fs;
,) gj;jpiffs;
<) ez;gh;fs;
12) ,Ug;gplk;
m) fpuhkk;
M) efuk;

127
 gFjp: M

fh;g;gtha; Gw;WNeha; gw;wpa tpguq;fs; Fwpj;jmwpTnjsptpid

Nfs;tpfs;.
Fwpg;Gfs;:
,g;gfjpahdJ fh;g;gtha; Gw;WNeha; gw;wpa tpguq;fs; Fwpj;j mwpTnjsptpid
Nfs;tpfis nfhz;lJ. Neh;Kfj;Njh;thsh; Nfs;tpfis Nfl;L mjd; gjpy;fis
xd;wd;gpd; xd;whf ngw Ntz;Lk;. kw;Wk; gjpy;fSf;Fhpa fl;lq;fspy; (√) FwpaPl;il
NghlTk;.

1. fh;g;gtha; clypd; ve;j gFjpapy; cs;sJ?

m) Kl;ilg;igapd; fPo;g;gFjpapy;
M) fUg;igapd; fPo;g;gFjpapy;
,) ngz;Fwpapd;; fPo;g;gFjpapy;
<) fUKl;ilFohapd; mUfpy;

2. Gw;W Neha; vd;why; vd;d ?

m) Kuz;ghlhd mrhjhuzkhd nry;fspd; tsh;r;rp

M) nry;fspd; kWthpirg;gLj;Jjy;
,) nry;fspd; ,lg;ngah;rr
; p

3. fh;g;gtha; Gw;W Neha; gw;wp ePq;fs; vd;d epidf;fpwPh;fs;?

m) Kuz;ghlhd fh;g;gtha; nry;fspd; tsh;r;rp
M) Kuz;ghlhd fUg;ig nry;fspd; tsh;r;rp
,) Kuz;ghlhd fUKl;ilFoha; nry;fspd; tsh;r;rp;
<) Kuz;ghlhd ngz;Fwpapd; nry;fspd; tsh;r;rp;

4. fPo;f;fz;ltw;wpy; fh;g;gtha; Gw;W Nehia cUthf;Fk; itu]; fpUkp vJ?

m) `pAkd; Ngg;gpy;Nyhkh itu];

M) ];nlignyhfhf;f];
,) #NlhNkhdh];
<) epANkhfhf;f];
128
5. fPo;f;fz;ltw;wpy; ve;j fUj;jil rhjdk; fh;g;gtha; Gw;W Nehia cUthf;Fk;
xU fhuzpahf nray;gLfpwJ?

m) fUj;jil khj;jpiu
M) fhg;gh-lPP
,); MZiw
<) ngz;Fwp gQ;R

6. fPo;f;fz;ltw;wpy; ve;j xd;W fh;g;gtha; Gw;W cUthtjw;fhd mghak;

my;yhjJ?

m) kpf ,sk; tajpNyNa Foe;ij NgW miljy;

M) mjpfkhf fUj;jil khj;jpiu cl;nfh;s;Sjy;
,) gyUld; clYwT itj;Jf;nfhs;Sjy;
<) rpy guk;giu fhuzpfs;

7. fh;g;gtha; Gw;W Nehapd; kpfg; nghJthd mwpFwp vd;d?

m) ngz;Fwpapy; njhlh; ,uj;jg;Nghf;F

M) Mrd thapy; ,uj;jg;Nghf;F
,) fha;r;ry;
<) ngz;Fwp rpte;J fhzg;gLjy;

8. fPo;f;fz;ltw;wpy; ve;j xd;W fh;g;gtha; Gw;W Neha;ff

; hd mghaj;ij Fwpf;Fk;
mwpFwp; my;y?
m) Kuz;ghlhd ngz;Fwp ,uj;jg;Nghf;F
M) gpwg;GWg;gpy; Jh;ehw;wj;Jld; $ba ePh;f;frpT
,) rpWePh; fopf;Fk; NghJ typ Vw;gLjy;
<) clYwtpd; NghJ typ Vw;gLjy;
c) khh;gfk; tphptiljy;

9. fh;g;gtha; Gw;W Neha; mwpFwpfs; ve;j epiyapy; ntspg;gLk; ?

m) epiy 1
M) epiy 2
,) epiy 3
<) epiy 4

129
10. fh;g;gtha; Gw;W Nehia fz;lwpAk; Muk;gepiy ghpNrhjid vd;d?

; ) ,uj;jg;ghpNrhjid
m
M) Ngg; rpkpah;
,) fh;g;gtha; ghpNrhjid
<) vJTkpy;iy

11. fh;g;gtha; Gw;W Nehia cWjpnra;Ak; ghpNrhjid vd;d?

m) vk; Mh; I ];Nfd;

M) rp lp ];Nfd;
,) jpR ghpNrhjid
<) vJTkpy;iy

12. jpR ghpNrhjid vd;why; vd;d ?

m) ghjpf;fg;gl;l cWg;gpd; xU rpW gFjpia

vLj;J ghpNrhjid nra;jy;
M) fUg;igia ePf;Fjy;
,) clypd; VjhtJ xU gFjpia ePf;Fjy;
<) nraw;ifahf JisNghLjy;

13. Rfhjhu epWtdk; fh;gg

; tha; Gw;W Nehia fz;lwpAk; Ngg; rpkpah; ghpNrhjidia

vj;jid tajpypUe;J nra;J nfhs;s mwpTWj;JfpwJ?

m) 30 tajpw;Fg;gpd; 5 Mz;LfSf;F xU Kiw

M) 30 tajpw;Fg;gpd; 10 Mz;LfSf;F xU Kiw
,) 40 tajpw;Fg;gpd; vg;NghJ Ntz;LkhdhYk;
<) 50 tajpw;Fg;gpd; vg;NghJ Ntz;LkhdhYk;

14. ve;j taij rhh;e;j ngz;fSf;F Ngg; rpkpah; ghpNrhjid KlpT Kuz;ghlhf
fhzg;gl tha;g;G cs;sJ
m) 18-25
M) 25-35
,) 36-50
<) 50 tajpw;F Nky;

130
15. Ngg; rpkpah; ghpNrhjid vd;why; vd;d ?

m) fh;g;gtha; nry;fis Ruz;lp vLj;J

ghpNrhjid nra;jy;
M) ikf;Nuh];Nfhg; ghpNrhjid
,) ];Nfd; ghpNrhjid %yk; fh;g;gthapYs;s
Kuz;ghlhd nry;fis fz;lwpjy;
<) ,JTk; xU tifahd rp. lp ];Nfd;

16. Ngg; rpkpah; ghpNrhjidf;F nry;Yk; Kd; vg;nghOjpypUe;J clYwitj; jtph;f;f

Ntz;Lk;?

m) 24 kzp Neuj;jpw;F Kd;G

M) 48 kzp Neuj;jpw;F Kd;G
,) 3 ehl;fSf;F Kd;gpypUe;J
<) 4 ehl;fSf;F Kd;gpypUe;J

17. Ngg; rpkpah; ghpNrhjid nra;J nfhs;s rhpahd Neuk; vJ?

m) khjtplha; Klpe;j Kjy; ehspypUe;J 5 Kjy;

10 ehl;fSf;F ,ilg;gl;l fhyk;
M) khjtplha; Klpe;j Kjy; ehspypUe;J10 Kjy;
20 ehl;fSf;F ,ilg;gl;l fhyk;
,) khjtplha; Klpe;j Kjy; ehspypUe;J21 Kjy;
25 ehl;fSf;F ,ilg;gl;l fhyk;
<) vg;NghJ Ntz;LkhdhYk;

18. fPo;f;fz;ltw;wpy; fh;g;gtha; Gw;W Neha;ff

; hd rpfpr;ir Kiwfs; vd;d?

m) mwit rpfpr;ir
M) fjph;tPr;R rpfpr;ir
,) fPNkhnjugp
<) vJTkpy;iy

131
19. fPo;f;fz;ltw;wpy; fh;g;gtha; Gw;W Neha;ff
; hd Kd;Ndhf;fpa rpfpr;ir Kiw vd;d?

m) fPNkhnjugp
M) fjph;tPr;R ( gpNuf;fpnjugp)
,) fpiuNah mWit rpfpr;ir
<) fh;g;gg;igia ePf;Fjy;

20. Neha;j;jpR guTjy; (m)Gw;WNeha; guTjy; vd;why; vd;d ?

m) ghjpf;fg;gl;l cWg;gpypUe;J mUfpy; cs;s

cWg;GfSf;F Gw;W nry;fs; gutjy;
M) ghjpf;fg;gl;l cWg;gpypUe;J mUfpy; cs;s
cWg;GfSf;F Gw;W nry;fs; guthJ
,) ghjpf;fg;gl;l cWg;gpypUe;J ,Lg;G vYk;Gf;
fl;Lf;F kl;Lk; guTjy;
<) ghjpf;fg;gl;l cWg;gpypUe;J gpwg;GWf;fpw;F
kl;Lk; guTjy;

21. fh;g;gtha; Gw;W Neha; ve;j Kjd;epiy cWg;Gf;F Kjypy; guTk;?

m) ,jak;
M) rpWePufk;
,) EiuaPuy;
<) ,iug;ig

22. vy;yh tifahd Gw;W NehAk; mjpfkhf guTk; nghJthd Kjd;epiy cWg;G?

m) ,jak;
M) fy;yPuy;
,) EiuaPuy;
<) vJTkpy;iy

23. fh;g;gtha; Gw;W Nehapd; Kf;fpakhd gpd;tpisT vd;d?

m) mlpf;flp rpWePh; fopj;jy;

M) ,Lg;ngYk;Gf; fl;lpy; typ
,) tapw;W typ
<) vJTkpy;iy

132
24. vr;.gp.tp jLg;G Crp; vd;why; vd;d ?

m) `_Akd; Ngg;gpy;Nyhkh itu];

M) `_Akd; NghypNah itu];
,) `_Akd; ngh;l;^rp]; itu];
<) vJTkpy;iy

25. vr;.gp.tp jLg;G Crp; nrYj;Jk; topKiw vd;d?

m) jirapil
M) NjhYf;flpapy;
,) Njhy; topahf
<) ,uj;jehsj;Jf;Fs;

26. vr; gp tp jLg;G+rpapd; msT vd;d ?

m) 0.1 kpyp
M) 2 kpyp
,) 2.5 kpyp
<) 0.5 kpyp

27. fPo;f;fz;ltw;wpy; fh;g;gtha; Gw;W Nehia jLf;Fk; Kf;fpakhd topKiw vd;d?

m) mlpf;flp kUj;Jt ghpNrhjid nra;Jnfhs;Sjy;

M) njhlh;e;j clw;gapw;rp
,) kd mOj;jj;ij jtph;j;jy;
<) vJTkpy;iy

28. fh;g;gtha; Gw;W Neha; tuhky; jLf;f cjTk; fUj;jil rhjdk; ,tw;wpy; vJ?

m) fhg;gh;-lp
M) ngz;Fwp gQ;R
,) MZiw
<) fUj;jil khj;jpiu

133
29. fPo;f;fz;ltw;wpy; ve;j tho;if Kiw khw;wj;jpdhy; fh;g;gtha; Gw;W Nehiaj;
jLffyhk;?

m) Nghjpa Xa;T kw;Wk; cwf;fk;

M) R+g;gh; czT (gg;ghsp> fph_d; B> Nu]; ngh;hp>
fhul>; kQ;rs;> fhyp gpsth;> Kl;il Nfh];)
,) Gif gplpg;gij jtph;j;jy;
<) fh;g;gtha; ghpNrhjid

30. ve;j tifahd czit mjpfkhf cl;n;fhs;tjpd; %yk; fh;g;gtha; Gw;W Neha;
tuhky; jLffyhk;?
m) itl;lkpd; V kw;Wk; rp
M); itl;lkpd; b
,) itl;lkpd; Nf
<) itl;lkpd; ,

134
 gFjp: ,
fh;g;gtha;Gw;W Neha; Fwpj;j mZFKiw mstPLfs;

Fwpg;Gfs;:
,g;gFjpahdJ fh;g;gtha; Gw;WNeha; gw;wpa tpguq;fs; Fwpj;j mZFKiw
mstPLfs; gw;wpa Nfs;tpfis nfhz;lJ. Neh;Kfj;Njh;thsh; Nfs;tpfis Nfl;L mjd;
gjpy;fis xd;wd;gpd; xd;whf ngw Ntz;Lk;. kw;Wk; gjpy;fSf;Fhpa fl;lq;fspy; (√)
FwpaPl;il NghlTk;.

nra;jpfs; jPh;khdpf;f Kw;wpYkhf kWf;fpNwd; Vw;fpNwd; Kw;wpYkhf

Klpatpy;iy kWf;fpNwd; (3) Vw;fpNwd;
(2)
(0) (1) (4)
1) fh;g;gtha;
Gw;WNeha; XU
flTspd; rhgk;
2) nry;fspd;
,ay;G epiyapy;
Vw;gLk; khWgl;l
mjPj tsh;rr ; pNa
Gw;W Neha;
3) Kd;Ndhh;fSf;F
fh;g;gtha; Gw;WNeha;
Vw;gl;lpUe;jhy; me;j
FLk;gj;ij rhh;e;j
ngz;fSf;F
fh;g;gtha;
Gw;WNeha;ff ; hd
tha;g;G mjpfk;
cs;sJ
4)ePz;lehl;fshf
fUj;jil khj;jpiu
gad;gLj;Jtjhy;
fh;g;gtha; Gw;WNeha;
Vw;gl tha;g;G
cs;sJ

135
5) Ie;jpw;Fk;
Nkw;gl;l Foe;ij
NgW mile;j
ngz;fSf;F
fh;g;gtha; Gw;WNeha;
Vw;gl$Lk;
6) jd; Rj;jk;
kw;Wk;
gpwg;GWg;G Rfhjhuk;
Mfpatw;iw
NgzhkypUg;hJ
fh;g;gtha;
Gw;WNehia
Vw;gLj;jf; $Lk;
7) fh;g;gtha;
Gw;WNeha;ff ; hd
mwpFwpfs; %d;whk;
epiyapy;jhd;
ntspg;gLk;
8) ehd;fhtJ
epiyapy;jhd;
fh;g;gtha;
Gw;WNeha;ff ; hd
cWjpahd
mwpFwpfs;
ntspg;gLk;
9) vr;.gp. tp itu];
fpUkp fh;g;gtha;
Gw;WNehia
cUthf;Fk;
10) xOq;fw;w
,uj;jg;Nghf;F
kw;Wk;
Jh;ehw;wj;Jld;
$lpa
nts;isgLjy;
Mfpait fh;g;gtha;
Gw;WNeha;ff ; hd
Muk;g mwpFwpfs;

136
11) Ngg; rpkpah; ghpNrhjid %yk; vspjpy;;
fz;lwpa KlpAk;

12) fh;g;gtha; Gw;WNeha;f;fhd Kiwahd

rpfpr;ir fpilahJ

13) vr;.gp. tp jLg;G+rp fh;g;gtha; Gw;WNeha;

tuhky; jLf;f cjTfpwJ

14) 30 tajpw;F Nkw;gl;l ngz;fs;

midtUk; Ngg; rpkpah; ghpNrhjid
nra;J nfhs;s Ntz;Lk;

15) Gw;WNeha;ff; hd tpopg;Gzh;T

epfor;rpfspy; fye;J nfhs;tJ mtrpak;

16) MZiwfis rhpahf gad;gLj;JtJ

fh;g;gtha; Gw;WNeha; tuhky; jLf;f
cjTfpwJ

17) fh;g;gtha; Gw;WNehia Muk;g

epiyapNyNa fz;lwpa KlpAk;

18) fh;g;gtha; Gw;WNeha;f;fhd Kiwahd

rpfpr;ir %ykhf ghjpf;fg;gl;lth;fspd;
tho;ehl;fis e_l;lpf;f KlpAk;
19) kUe;J kw;Wk; fjph;t_r;R rpfpr;ir
Mfpait fh;g;gtha; Gw;WNeha;ff ; hd
Kf;fpakhd rpfpr;ir KiwfshFk;
20) tof;fkhf clw;ghpNrhjid
nra;Jnfhs;gth;fs; fh;g;gtha; Gw;WNehia
Fwpj;J gag;glj; Njitapy;iy

21) fh;g;gtha; Gw;WNeha; XU njhw;W

tpahjp

22) Gw;W Neha; tuhky; jLf;ff;$lpa XU

Neha;

23) Gw;W Neha; tuhky; jLf;f KlpahJ

24) fh;g;gtha; Gw;WNeha; jhf;fg;gl;l
ngz;fs; jdpik gLj;jg;gl Ntz;Lk;
25) fh;g;gtha; Gw;WNeha; clypd; kw;w
cWg;GfisAk; ghjpf;Fk;

137
26) fh;g;gtha; Gw;WNeha; clypd;
mikg;ig r_h;Fiyf;Fk;
27) fh;g;gtha; Gw;WNeha; ghjpg;G
Vw;gl;lhy; e_z;lehs; kUj;Jtkidapy;
jq;Fk; epiy Vw;gLk;
28) itl;lkpd; V kw;Wk; rp epiwe;j
czTfs; fh;g;gtha; Gw;WNeha; tuhky;
jLf;Fk
29) clYwtpd; NghJ MZiw
gad;gLj;Jtjd; %yk; vr;.gp. tp itu];
fpUkp njhw;W tuhky; jLf;f KlpAk;
30) clYwtpd; NghJ typ Vw;gLtJ
fh;g;gtha; Gw;WNeha;ff
; hd Kf;fpakhd
mwpFwp

138
ABSTRACT
 ABSTRACT

A quasi experimental Study to assess the effectiveness of structured

teaching programme on knowledge and attitude regarding cervical cancer among
womens in Kannivadi PHC at Dindigul district, as partial fulfillment of the
requirement for the award of the degree of Master of science in nursing was done
by 301423051 from Jainee College of Nursing , affiliated to the Tamilnadu
Dr. M. G. R University, Chennai.

The objectives of the study were 1) To associate the post test knowledge
and attitude on cervical cancer with their selected demographic variables.2) To
correlate the knowledge and attitude on cervical cancer among womens.

The hypothesis of the study were , H1: There will be a significant

difference between pre and post test knowledge and attitude score after
structured teaching programme on cervical cancer among womens.H2: There
will be a significant correlation between Knowledge and attitude on cervical
cancer among womens. H3: There will be a significant association between the
knowledge on cervical cancer and background features among womens. H4:
There will be a significant association between the attitude on cervical cancer
and background features among womens.

The investigator organized the review of literature under various aspects

on studies related to cervical cancer , studies related to knowledge on cervical
cancer, studies related to attitude on cervical cancer, studies related to cervical
cancer screening.

139
The conceptual frame work for the study was based on Nursing process model.
The research design was used pre experimental design .Sample size was 60
womens between the age group of 25-50 years. The samples were selected by
using convenient sampling method.

The tool developed and used for data collection was an observational
schedule. Five expert validated the tool. Reliability was established by interrator
reliability, (r=0.8). The main study was conduted in Kannivadi Primary health
centre , Dindigul. The data were collected, tabulated, analysed and interpreted by
using SPSS packages (version 24).

Inferrential statistics was used to evaluate the effectiveness of structured

teaching programme on knowledge and attitude of cervical cancer among
womens between the age group of 25-50 years. The result showed that there was
a significant increase in both the knowledge and attitude towards cervica cancer
among womens between the age group of 25-50 years, and there was a
significant association in relation to selected factors that Marital status, education
with their knowledge. The structured teaching programme was independently
effective among womens between the age group of 25-50 years in knowledge
and attitude towards cervical cancer. The implications, recommendations, and
conclusion have been stated adequately.

140