Knowledge, attitude, and compliance to pap smear among women of reproductive age in two Barangays in the District of Jaro, Iloilo City

Abstract

This study was conducted to determine the knowledge and attitude of women of reproductive age (WRAs) towards cervical cancer and Pap smear and their compliance to Pap smear and the relationship between their knowledge and attitude, their knowledge and compliance and their attitude and compliance to Pap smear. The study also determined whether selected personal characteristics of the WRAs, such as age, civil status, educational attainment, occupation status and income were related each related to their knowledge, attitudes and compliance to Pap smear. A sample survey of covering one rural and one urban barangays in Jaro, Iloilo City was conducted. Trained nurses using a validated structured interview schedule, developed by the researcher, personally interviewed a random sample of 230 WRAs in the two barangays. The instrument was translated in “hiligaynon,” the dialect of the respondents.

Summary of Findings

The respondents were 35.86 years old on the average. Most of them were married, high school-educated, and not gainfully working at the time of the study. In 1998, their average monthly family income was P8, 612.12. On the whole, the WRAs had above average knowledge about cervical cancer and Pap smear (mean score=17.43). Specifically, they had average knowledge about signs and symptoms and about risk factors of cervical cancer, and high knowledge about Pap smear. The women, however, had some misconceptions about cervical cancer and Pap smear. Most of them, for example said that absence of monthly menstruation as a sign of cervical cancer and that exposure to chemicals at work place as a risk factor for cervical cancer. Almost all of the WRAs knew that Pap smear is done in doctor’s clinic or in the hospital. The WRAs had favorable attitude towards Pap smear, the mean attitude score being 4.09. Most of them agreed that Pap smear is needed by every WRA and that going to the doctor for Pap smear is a necessity and not a waste of time. The majority of the women perceived that “a woman has to wash her private parts every day, so she won’t have cancer of the cervix.” Compliance to Pap smear was generally low among the WRAs. Only one in every ten of them had Pap smear in 1996. The number decreased in 1997, but improved to one in ten again in 1998. Age, occupation, civil status and educational attainment are not significantly related to the WRAs’ knowledge about cervical cancer and Pap smear and to their attitude towards and compliance with Pap smear. Likewise, family income was not directly related to knowledge, attitude towards Pap smear and compliance to Pap smear. Compliance, however, was found to be directly related to knowledge, but not to attitude. The relationship between knowledge about cervical cancer and Pap smear and compliance to Pap smear remained stable, even when attitude was controlled.

Conclusions

The study failed to support the hypothesis that women’s age, civil status, occupation and educational attainment are related to their knowledge about and their attitude towards cervical cancer and Pap smear. Except for family income, the WRAs’ characteristics had no significant bearing on their knowledge about cervical cancer and Pap smear. Women with higher income knew more about cervical cancer and Pap smear than those with low income. Higher income may have improved the WRAs’ access to informational sources like the media and health providers. The women’s attitude towards Pap smear was consistently favorable irrespective of their personal characteristics. Like attitude, compliance to Pap smear was also found to have no significant relationship to any of the personal characteristics of the WRAs considered in the study. Regardless of age, civil status, occupation, educational attainment and family income, the women had low compliance to Pap smear. The significant positive correlation between knowledge about cervical cancer and Pap smear and compliance to Pap smear supports the hypothesis that the more women know about cervical cancer and Pap smear, the more likely that they will submit for Pap test is supported by this study. The findings suggest that knowledge of the benefits of Pap smear could enhance compliance among the WRAs. Attitude towards Pap smear was not significantly related to compliance, but the relationship between knowledge about cervical cancer and Pap smear and compliance to Pap smear, however, remained pretty stable even when attitude was controlled. This suggests that an improvement in the women’s knowledge about cervical cancer and Pap smear can enhance their compliance to Pap test. The findings of the study support Fishbein’s and lcek Ajzen’s (Wrightsman, 1982), theory of reasoned action. Knowing and understanding the signs and symptoms of cervical cancer and the benefits of Pap smear in preventing cervical cancer, would likely encourage women to submit to screening for protection. The theoretical argument that a favorable attitude towards an action will lead a person to adopt the behavior failed to gain support from the data. It shows that a change in attitude does not necessarily result to change in behavior.

Recommendations

1. In order to improve the WRAs’ knowledge about the signs and symptoms and risk factors of cervical cancer information campaign about cervical cancer and other forms of cancer must be strengthened. 2. The low compliance to Pap smear, suggests the need to improve and strengthen health service delivery program, especially reproductive health services. The health department must give greater attention to prevention and control of cancer. To encourage more women to submit for Pap test, proper counseling and regular scheduling of Pap tests must be done. 3. To avoid embarrassment and reduce fear of cervical examination, facilities and procedures must be made comfortable and less threatening. Facilities, must therefore be improved, making provisions for privacy and quality care. There’s also a need to educating women on how cervical screening is done, how to reduce discomfort, and what to expect will surely help much. 4. To maintain the favorable attitude of women towards Pap smear current programs on cancer information dissemination must be continued and further enhanced. Health providers should continue educating and encouraging mothers to submit to Pap smear. 5. To improve compliance with Pap smear there is an urgent need for the government to institute programs on cervical cancer screening. Rural health centers must broaden their services for cervical screening reaching even the rural population. The health workers must reach out to the WRAs in the community to erase their fears and anxiety about Pap smear. 6. More studies of the same nature must be conducted in other communities to further validate the result of this study and to determine compliance to cervical screening among women in other places and socio-cultural milieus. Other factors that could possibly explain variations in compliance to Pap smear must be examined, so that interventions, which can possibly improve compliance, can be tried and tested, and later implemented.