Behaviour among women in the scope of cervical cancer prevention

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1 Origial paper Behaviour amog wome i the scope of cervical cacer prevetio Zachowaia kobiet w zakresie profilaktyki raka szyjki macicy Aleksadra Słopiecka Departmet of Psychology ad Medical Pedagogy, Istitute of Public Health, Faculty of Health Scieces, Ja Kochaowski Uiversity, Kielce, Polad Head of Departmet: Aldoa Kopik PhD Studia Medycze 2013; 29 (): 2292 Key words: wome, uterie cervical eoplasms, cytology, prevetio. Słowa kluczowe: kobiety, owotwory szyjki macicy, cytologia, profilaktyka. Abstract Itroductio: Cytological examiatio is a simple ad iexpesive method used i the prevetio of cervical cacer. I Polad, too low proportios of wome still have the test. Aim of the research: To aalyse the attitudes towards cervical cacer prevetio. Material ad methods: Two hudred ad te hospitalized wome were ivited to take part i the ivestigatio. The research used the diagostic poll method, usig the author s origial questioaire form. The research was carried out i four gyaecological wards. Results: Of the wome who participated i the research, 16.2 by the time of diagosis had ever received a Pap test. I the aalysed group,.2 of wome were ot referred to a specialist for a Pap test. Amog all respodets, oly 35. uderwet cervix cytology regularly, i.e. oce a year or oce every 2 years. Coclusios: The effort made by the wome towards the attitudes of cervical cacer prevetio was isufficiet; still too may wome had ot reported to the specialist for takig material from the cervix, or did ot do so regularly. A sigificat relatio i the behaviour of wome was foud depedig o their level of educatio ad place of residece. Greater activity of urses, midwives ad family physicias i stimulatig Polish wome to participate i prevetio programmes for cervical cacer is advisable. To icrease the health awareess of girls ad wome, it is importat to iclude i the curriculum, especially i secodary schools, the issues of prevetio of female reproductive system cacer. Streszczeie Wstęp: Prostą i taią metodą stosowaą w profilaktyce raka szyjki macicy jest badaie cytologicze szyjki macicy. W Polsce tym badaiem objęty jest adal zbyt iski odsetek kobiet. Cel pracy: Aaliza zachowań kobiet w zakresie profilaktyki raka szyjki macicy. Materiał i metody: Badaą grupę staowiło 210 kobiet hospitalizowaych z powodu chorób w obrębie arządu rodego. W badaiach zastosowao metodę sodażu diagostyczego. Wykorzystao kwestioariusz akiety własego opracowaia. Badaia przeprowadzoo a czterech oddziałach giekologiczych. Wyiki: U 16,2 respodetek do chwili rozpozaia choroby igdy ie pobrao do badaia materiału z szyjki macicy. Aż,2 kobiet w aalizowaej grupie ie było kierowaych a to badaie. Jedyie 35, respodetek poddawało się badaiu cytologiczemu szyjki macicy regularie, tj. raz w roku lub raz a 2 lata. Wioski: Zachowaia w zakresie profilaktyki raka szyjki macicy podejmowae przez badae kobiety były iewystarczające, adal zbyt wiele kobiet ie zgłaszało się a pobraie materiału z szyjki macicy lub robiło to ieregularie. Stwierdzoo istotą zależość aalizowaych zachowań respodetek od ich poziomu wykształceia i miejsca zamieszkaia. Wskazaa jest większa aktywość pielęgiarek, położych i lekarzy rodziych w mobilizowaiu polskich kobiet do udziału w programach profilaktyczych dotyczących raka szyjki macicy. W celu zwiększeia świadomości zdrowotej dziewcząt i kobiet wskazae jest ujęcie w programach auczaia, główie szkół poadgimazjalych, zagadień z zakresu profilaktyki chorób arządu rodego. Itroductio A Papaicolaou (Pap) test is used i the prevetio of cervical cacer as a simple ad iexpesive cervix cytological examiatio. The test allows the lesios to be detected i the early stages [1, 2]. The basic coditio to take material from the cervix is to report to the specialist ad volutarily udergo the medical examiatio. I order to obtai tagible effects, the screeig test i the cytological examiatio should be repeated regularly. The frequecy of havig a Pap Studia Medycze 2013; 29/

2 2 Aleksadra Słopiecka test depeds o the idividual assessmet of a woma s health situatio ad meetig specific eligibility criteria. I Polad, despite the implemetatio of the programme of cervical cacer prevetio, curretly fuded with public fuds i the form of three stages [3], satisfactory results are ot achieved []. Accordig to the specialists, still too low a percetage of Polish wome have a Pap test [6]. This situatio results from various reasos; oe of them is isufficiet kowledge of cervical cacer ad low attedace i the programme []. To uderstad the behaviour of wome ad their lack of recommeded attitudes i the scope of cervical cacer prevetio is a valuable source of iformatio which should be take ito cosideratio i makig some revisio to the programme i the future. It is believed that a importat factor i icreasig wome s participatio i prevetio programmes ca be achieved by improvig their health awareess [10]. Aim of the research The aim of the study was to aalyse the behaviour of wome i the scope of cervical cacer prevetio. Material ad methods The research was coducted with 210 wome, aged 1 to 3 years. The average age for all respodets was 5.5 years. I coectio with the low rate of iterest of respodets i idividual years of age, four age groups were used. Percetages of wome i particular age classes were as follows: 1: 35 years (21.9); 2: 365 years (2.); 3: 655 years (3.6); ad : 56 years (15.). Amog the respodets, 52. of wome had secodary educatio ad post-secodary educatio. The percetages of wome who had a higher educatio (23.), ad primary or vocatioal educatio were the same (23.). Accordig to place of residece, respodets were divided ito three groups: 1 livig i coutry areas (36.); 2 livig i a city of up to 100 thousad ihabitats ( 100 thousad ihabitats) 2.6; 3 livig i a city of over 100 tho u sad ihabitats (> 100 thousad ihabitats) 35.. The research used the diagostic poll method, usig the author s origial questioaire form. The research was carried out i four gyaecological wards i hospitals i Kielce. I the research the followig criteria were used to select respodets: 1) hospitalizatio due to illess or diseases of reproductive orgas (pregat wome ad those who had a miscarriage were excluded from this aalysis); 2) the age of 1 (lawful age); 3) stayig i the ward for at least three days; ) gettig coset to participate i the research. Statistical aalysis Statistical Package for Social Scieces (versio.0) was used to compute statistical aalyses. The sigificace of differeces betwee categorized groups (accordig to place of residece, age ad educatio) was evaluated with the chi-square test of idepedece (c 2 ). A level of p < 0.05 was cosidered statistically sigificat. Results From the aalysis of give aswers as show i Table 1, it follows that 3.3 of wome had a Pap test of respodets by the time of diagosis had ever received a Pap test. I the research sigificat differeces amog participats were foud depedig o educatio (p < 0.05) ad place of residece (p < 0.001). Wome with the lowest level of educatio (primary, vocatioal educatio) ad respodets livig i the coutry more rarely had a Pap test tha wome with a higher educatio ad livig i big cities (> 100 thousad ihabitats). Detailed data are show i Table 1. The group of respodets was asked for ay reasos why the material from the cervix was ever take for a Pap smear. The aalysis showed that.2 of wome had ot reported to a specialist to have a smear test (Table 2).. of participats were referred to a doctor for takig a Pap test but did ot Table 1. Respodets who had a Pap test wome by age, educatio ad place of residece Respodets who had a Pap test Yes No Age groups [years] Educatio Place of residece ad voc. Secod. Higher Coutry Tow Tow > c 2 = 3.33; df = 3 c 2 = 6.06; df = 2 c 2 = 1.6; df = 2 p = NS p < 0.05 p < Studia Medycze 2013; 29/

3 Behaviour amog wome i the scope of cervical cacer prevetio 29 Table 2. Reasos for ot havig a Pap test wome by age, educatio ad place of residece Kids of reasos Woma ot reported to a doctor for takig a Pap test Woma reported to a doctor but did ot wat a Pap test Age groups [years] Educatio Place of residece ad voc Secod. Higher Coutry Tow Tow > Table 3. Frequecy of Pap smear testig wome by age, educatio ad place of residece Frequecy of Pap smear testig Woma who has ever had a Pap test Oce a year or oce every 2 years Every 3 years or less Did ot remember Age groups [years] Educatio Place of residece Tow Tow ad Secod. Higher Coutry > voc c 2 = 10.25; df = 9 c 2 = 1.06; df = 6 c 2 = 2.21; df = 6 p = NS p < 0.01 p < report to the specialist. I the aalysed group were wome livig i coutry areas, aged 655, ad wome with primary, vocatioal ad secodary school educatio. The umbers were small i percetage terms ad did ot allow for a statistical assessmet i the above-metioed group. Of the wome who participated i the research, 35. had received a Pap test regularly, oce a year or oce every 2 years (Table 3) had difficulties to describe whe they had a Pap test (did ot remember). The third group of 16.2 cosisted of wome who have ever had a Pap test. Every 3 years or less tha that, 1. of wome reported to the gyaecologist for a smear test. I terms of the aalysed feature the differeces i the proportio of respodets by age class were ot sigificat. Statistically sigificat relatios occurred betwee respodets who were divided depedig o educatio (p < 0.01) ad place of residece (p < 0.001). Wome with a higher educatio more ofte ad o a more regular basis had a Pap test, i.e. oce a year or oce every 2 years, tha wome with the lowest educatio (primary, vocatioal) 16. Similar results were achieved betwee occupats of villages (1.2) ad big cities (> 100 thousad ihabitats) 50.. The majority of wome who had had a Pap test were those who reported to the doctor for a smear test o the doctor s iitiative (6.), especially the Studia Medycze 2013; 29/

4 290 Aleksadra Słopiecka Table. People o whom iitiative respodets had had a Pap test wome by age, educatio ad place of residece Metioed people Ow iitiative Gyaecologist, family physicia ad urse iitiative Age groups [years] Educatio Place of residece ad voc Secod. Higher Coutry Tow c 2 =.61; df = 3 χ c 2 = 6.23; df = 2 χ c 2 =.29; df = 2 p = NS p < 0.05 p = NS Tow > gyaecologist (61.) (Table ). The family physicia or urse was metioed oly by 3. of respodets. O their ow iitiative 35.2 of wome had a Pap test. The proportio of respodets did ot differ with regard to age ad place of residece, while sigificat differeces were foud betwee participats depedig o educatio (p < 0.05). It was foud that the higher the category of educatio the higher was the percetage of wome who had a pap test o their ow iitiative. Discussio Accordig to the Cetral Statistical Office (GUS) i ,1 Polish wome died because of malicious tumours of reproductive orgas, amog which cervical cacer caused the death of 1, wome []. Compared with 200, idicators metioed above were at a similar level []. Although itesive prevetio has bee coducted for may years agaist cervical cacer, performed i accordace with the rules at a specific period of time [3, 13, 1], radical improvemet of the epidemiological situatio of cervical cacer was ot achieved. Still the umber of deaths per 10 thousad populatio due to cervical cacer for several years has remaied at a high level ( ; ; ) []. The beefits ad advatages of cytology i the prevetio of cervical cacer are cofirmed by may specialists [151]. It is ecessary to remember that to have a Pap test a woma has to report to the doctor. The research showed that by the time of diagosis of the reproductive orga disease 16.2 of wome had ever had a smear test. Similar results were obtaied by Bikowska ad Dębski. I a group of 1,03 Polish wome, aged 55 (chose at radom), almost oe out of four tested wome (2) for more tha 10 years had ot had a Pap test, or some declared that they had ever had oe i their life [1]. Also Kozimala et al. metioed low attedace of wome towards the prevetio of cervical cacer [19]. Two thousad two hudred ad two wome were ivited for a smear test ad oly 5 of them (26.2) had this test. The remaiig 3. of wome did ot take advatage of havig a Pap test [19]. Other authors i their reports also cofirmed the lack of regular ad satisfactory reportig to a doctor by Polish wome to take material from the cervix [10, 20, 21]. Detailed data cocerig the frequecy of reportig to the doctor for a smear test showed the real picture of wome s attitudes towards cervical cacer prevetio. The research showed that 35. of wome, oce a year or oce every 2 years, had reported to the doctor for a Pap test ad that it depeded o educatio ad place of residece of respodets. However, accordig to estimates of Filip et al., i Polad, after several years of the regular screeig programme oly of wome are havig a Pap test [22]. The preseted data have to be recogized as usatisfactory; thus the fuctioig programme eeds to be urgetly modified. It should be oted that oly implemetatio of a log-term atiowide ad populatio survey system of screeig tests ca decrease the icidece of cacer i wome [2123]. I may coutries, as a result of a well-fuctioig screeig programme, morbidity ad mortality rates of wome with cervical cacer have bee radically reduced [2, 9, 10, 16, 2325]. However, i may coutries where due to umerous obstacles ad restrictios wome rarely or ever participate i prophylaxis, the factors metioed above remai at a high level [1, ]. Based o material gathered i the research it must be oted that the actios take by the respodets ad attitudes towards cervical cacer prevetio were isufficiet. It would appear that if the methods which give a woma freedom of choice failed, other ways of icreasig wome s behaviour i cervical cacer prevetio should become widespread. Cosiderable mobilisatio of Polish wome for regular health checks of Studia Medycze 2013; 29/

5 Behaviour amog wome i the scope of cervical cacer prevetio 291 reproductive orgas ca be obtaied by itroducig a obligatio to udergo gyaecological examiatios at the periodic physical examiatio of employees. At least i the subpopulatio of workig wome 100 attedace ca be gaied. It should be oted that each examiatio may also be a opportuity for health educatio, because improvemet of the health situatio of girls ad wome i Polad should be carried out to icrease the level of health awareess. Developig specific skills i the scope of health prophylaxis ad motivatio to take resposibility for wome s ow health could be itroduced to the curriculum of secodary schools. The implemetatio of this pla ca be effective ad girls ca improve their kowledge, educatio, self-cotrol ad idividual activity i the scope of prophylaxis ad therapy. These activities ad other recommedatios have already bee proposed by experts [21, 26]. It is importat to coduct a sustaied iformatio campaig ad various forms of health educatio [1, 2, 9, 26]. The aim of these actios is to icrease the participatio of wome i prophylaxis ad to prevet the morbidity ad mortality caused by cervical cacer. I coclusio, this study should also provide opiios of specialists, which should be regarded as a warig ad a challege for people decidig o the implemetatio of prophylactic programmes i Polad. Cosiderig the above problems, accordig to Didkowska et al., if itesive actio is ot take, wome s health may be jeopardized, as it was i Filad 25 years ago [2]. Also Spaczyński et al. i the Report of the Realisatio of the Populatio Program of Cervical Cacer Early Detectio evaluated the effectiveess of actio take i the scope of this programme. Accordig to the authors, obtaiig effective screeig methods i Polad requires may years of work []. Coclusios The effort made by the wome towards the attitudes of cervical cacer prevetio was isufficiet; still too may wome had ot reported to the specialist for takig material from the cervix, or did ot do so regularly. A sigificat relatio i the behaviour of wome was foud depedig o their level of educatio ad place of residece. Greater activity of urses, midwives ad family physicias i stimulatig Polish wome to participate i prevetio programmes for cervical cacer is advisable. To icrease the health awareess of girls ad wome, it is importat to iclude i the curriculum, especially i secodary schools, the issues of prevetio of female reproductive system cacer. Refereces 1. Mupepi SC, Sampselle CM, Johso TRB. Kowledge, attitudes, ad demographic factors ifluecig cervical cacer screeig behavior of Zimbabwea wome. J Wome Health 20; 20: Hase BT, Hukkelberg SS, Haldorse T et al. 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