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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1. / Name of the candidate and address (in block letters) / SIMMY VARGHESEI YEAR M.Sc. NURSING
BGS COLLEGE OF NURSING
MYSORE
2. / Name of the Institution / BGS COLLEGE OF NURSING
MYSORE
3. / Course of Study and Subject / M.Sc. NURSING
MEDICAL SURGICAL NURSING
4. / Date of Admission to the Course / 30.6.2011
5. / Title of the study
THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE AND ATTITUDE REGARDING CERVICAL CANCER AMONG WOMEN IN SELECTED URBAN AREAS AT MYSORE
6. BRIEF RESUME OF INTENDED WORK
INTRODUCTION
“BE AWARE FIGHT CANCER”
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 inIndiaas non-communicable diseases (48 percent), communicable diseases (42 percent) and injuries (10 percent).1 This revealed the decrease in death rate and the better improvement of quantity and quality health services inIndia. 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.2
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.4
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 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.5
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.6
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.
6.1 Need for Study
“You'll come to learn a great deal if you study the Insignificant in depth”
One out of every five women in the world suffering from this disease belongs to India. It is estimated that there were 112,609 new Cervical Cancers in 2004 and this number is expected to rise to 139,864 in 201510. Cervical cancer ranks as the 1st most frequent cancer among women in India, and the 1st most frequent cancer among women between 18 and 44 years of age. About 7.9% of women in the general population are estimated to harbour cervical HPV infection at a given time, and 82.5% of invasive cervical cancers are attributed to HPVs.7
A study conducted by the New England Journal of Medicine reveals that about 1.3 lakh new cases of cervical cancer are reported every year, in India and about a quarter of the five lakh cases globally. Experts point out that women need to be sensitised to curb the growth of this disease. “Even the educated class are not aware of cervical cancer and often link it with the neck. We have to explain to them that cervical cancer is caused in the lower part of the body," says gynaecologist, Sunita Verma. Cancer Research Foundation of India (CRFI), a recently constituted body is actively involved in spreading awareness. Dr Siddharth Sahni, co-founder, CRFI says, "Awareness, prevention and detection is what we are striving for to deal with cancer. We need to reach out to both grass roots and urban India". Cancer of the cervix has been the most important cancer in women in India over the past two decades. It accounted for 16 per cent of all cancers in women in the urban registries in 2005. Over 70 per cent of the Indian population resides in rural areas; cervical cancer still constitutes the number one cancer among females. In the hospital based cancer registries (HBCRs), the leading site for cervical cancer is Bangalore and Chennai, the second leading site in Mumbai and Thiruvananthapuram and the third leading site in Dibrugarh. The percentage of cervical cancer constitutes 11.4% in Thiruvananthapuram, 30.7% in Chennai, 40% in Bangalore respectively. In spite of having had a diagnosis of cervical cancer in Chennai, Trivandrum and Bangalore it has been reported that they didn’t receive active treatment9. More than three-fourths of these patients are diagnosed at advanced stages leading to poor prospects of long-term survival and cure, despite of health care institutions efforts in introducing lot of screening programs. Incidences has not decreased especially among poor, rural women, who make up the majority of cervical cancer victims due to lack of awareness, knowledge, inaccessibility to screening and cultural barriers.8
Indian government has introduced a variety of a national health programs and screening camps in various states in order to fight against the rising numbers of incidence and mortality among women due to cervical cancer. In spite of all these measures the no of incidences are not coming down rather increasing hence the researcher felt that there is an eminent need to find out, the women, in selected community posses what level of understanding about this dreadful disease and how necessary it is to provide information regarding cancer of cervix and its prevention to women. Hence researcher introduced self-instructional module to evaluate its effectiveness in improving the existing knowledge and bringing up the positive attitude towards it.
6.2 Review of Literature
A review of literature is an essential aspect of scientific research .it helps the investigators to establish support for the need for the study, select research design, developing tools and data collection technique the review of literatures is classified under following headings.
1. Studies related to knowledge
2. Studies related to knowledge and attitude
3. Studies related to awareness and prevention
Studies related to knowledge
A study was conducted to examine knowledge regarding cervical cancer among 400 female workforces in U.K by using knowledge questionnaire on cervical screening treatment for abnormalities and HPV. Four Hundred women returned completed knowledge questionnaires of cervical cancer were good but risk factors for cervical cancer were not well known. Awareness and knowledge of HPV was very limited. It is essential to improve women’s knowledge of cervical cancer and risk factors. 9
An exploratory study was conducted in Australia among 140 females from Sydney University regarding social and psychological impact of HPV in cervical screening among females aged 18-45 years (mean 19yrs, SD 3.3yrs) using purposive sampling. The results were revealed as 25.7% of students reported “having ever heard of HPV”, compared to the 89.3% who reported “having ever heard of genital warts”. When asked whether HPV infection is the main cause of cervical cancer, 11.6% said yes, 5.8% said no, and 82.6% said they didn’t know. The study was concluded with saying that there is low awareness of HPV per se and low awareness of the link between HPV and cervical cancer.10
A survey was conducted in Queen Victoria hospital in Australia to understand women’s current knowledge, attitudes and behaviours related to HPV, the HPV vaccine, cervical screening and cervical cancer. A sample of 1000 women was surveyed via telephone plus five focus groups (young, older, Iraqi, TAFE, nurses). the results concluded with a view that all participants were having positive attitude about cervical screening and the vaccine.10
An exploratory research design was adopted to assess the knowledge and practice regarding cervical cancer among 100 married women between the ages 20 -60 years at Indore (M.P) using purposive sampling. The investigator used a structured questionnaire of 9 items to assess the knowledge regarding early diagnosis and prevention of cervical cancer. Reliability was calculated using split half method and the 'r' value was 0.8. The findings revealed that all of the subjects 100(100%) had no knowledge regarding early diagnosis and prevention of cervical cancer, 86(86%) of the subjects were at low risk for cervical cancer, 14(14%) of them are at moderate risk for developing cervical cancer. Hence the conclusion was made by saying that there is a need to create public awareness regarding the benefits provided by the government through various health schemes and all government hospitals must make these schemes available to the population. Nurses should also be trained through in-service education to spread the health awareness to the individuals and families. 11
Studies related to knowledge and attitude
A study was conducted, to determine the knowledge, attitude and practice related to prevention of cervical cancer among (205) female health workers. The study report showed that doctors had high level of knowledge, surprisingly inadequate among the nurses, predictably low among hospital maids. However 93.2% of respondents have never had pap smear performed. The poor utilization of the test was independent of respondent’s profession, marital status and hospital. The study was concluded with the saying that there is a need to intensify campaign towards prevention of cervical cancer even among health workers11.
A clinical survey was conducted to assess the knowledge, attitudes, and assumption of cervical cancer by women living in Maroua, the capital of the Far North Province of Cameroon. It was a single center study. In a 1-month period, 171 women were surveyed as to their socioeconomic status, sexual habits, prior knowledge of cervical cancer, its prevention, and their attitudes toward cervical cancer. Of 171 women, 48 (28%) had prior knowledge of cervical cancer; they were classified as the "aware group" compared with 123 of 171 (72%) women who were uninformed about cervical cancer and they were classified as the "unaware group" (UG). The UG of women tended to be single mothers, illiterate, housewives, and had their first child before the age of 20 (p < 0.005). Despite the awareness of cervical cancer by 28% of women, only a minority of them, 4 of 48 (8.3%), underwent a preventative screening test. Only 71 of 171 (41.5%) women stated that they would be having a screening test in the future. The awareness of cervical cancer by women in Cameroon is still inadequate. Thus they concluded that, to avoid deaths from cervical cancer, a curable and preventable disease, the need of an aggressive campaign to make Cameroonian women aware of cervical cancer and its prevention is needed12.