Cervical cancer is the second most common cancer among women in India. Every year about 96,000 new cases are diagnosed, and about 60,000 women die due to the disease (WHO, 2018). As vaccination against the human papilloma virus (HPV) that causes cervical cancer remains a challenge due to socioeconomic and cultural factors (Sengupta and Nundy, 2005), early detection through screening provides a scope for treatment and better prognosis for the nearly 470 million women in India who are at risk for developing cervical cancer (WHO, 2006). As per recent reports only 22% of the Indian women aged 15-45 years have undergone examination of cervix (NFHS4, 2017). To date, there is no nationwide organised
Background: While cervical cancer is a major cause of mortality, its progress and survival rate can be improved through screening. Yet despite their wide availability, women's participation in cervical cancer screening (CCS) programs is often suboptimal, especially in low-and middle-income countries. Besides demographic and organizational characteristics, screening uptake is influenced by psychological factors, most of which are included in health behavior theories. This systematic review compared different health behavior theories in terms of their capacity to explain CCS uptake and inform CCS promotion campaigns. Methods: A comprehensive search and analysis of published intervention and nonintervention (observational) studies that applied at least one health behavior theory to CCS participation. Results: After quality screening, 48 observational and 21 intervention studies were identified that applied the Health Belief Model (HBM), Theory of Reasoned Action (TRA), Theory of Planned Behaviour (TPB), Transtheoretical model (TTM), Socialecological Model (SEM), and/or Theory of Triadic Influence (TTI) to CCS. The HBM was most frequently used to explain behavior, whereas the TPB was better at explaining screening intentions. Tailored intervention studies focusing on all theoretical constructs were most effective in modifying perceptions and increasing CCS uptake. Conclusions: Despite their inconsistent use, health behavior theories can explain CCS intentions and behavior and contribute to the development of targeted interventions to promote screening uptake. K E Y W O R D S beliefs, cancer, health behavior theories, health behaviors, interventions, public health nursing education, screening, women's health 1 BACKGROUND Cancer of the cervix uteri is the fourth most common cancer among women worldwide, and accounts for 7.5% of all female cancer deaths (Ferlay et al., 2015). The projected number of deaths due to cervical cancer by 2030 is estimated at approximately 80%, with the highest mortality occurring in low-middle-income countries (LMICs). While vaccination is increasingly practiced in economically developed countries, most LMICs restrict cancer prevention to screening. Screening helps to detect and treat infections that may progress into cancer at an early stage, which results in a better prognosis and higher survival rate (Edge & Compton, 2010). Yet, despite the wide availability of screening, the participation of women in CCS programs is often suboptimal, especially in LMICs (Islam et al., 2017).
Health literacy is a key topic in public health. Several measurement tools exist that operationalize health literacy, but only a few standard tools measure health literacy at a population level, and none of those are currently available for the Indian context. This study aimed to develop and validate an Indian version of the short form of the European Health literacy Questionnaire (HLS-EU Q16). Following the translation of the English version of the questionnaire in Hindi and Kannada by language experts and confirmation of the item content by health literacy experts, the questionnaire was administered to 158 Hindi speaking and 182 Kannada speaking individuals, selected via purposive sampling. Pearson’s correlation was used to confirm test–retest reliability, and confirmatory factor analysis was used to assess the construct validity of the scales in both languages. Cronbach’s alpha was calculated for the scales and their sub-domains, and item-total correlations were used to calculate item discriminant indices. Discriminant validity was examined by comparing scores of participant groups based on educational status and training in health care. Cronbach’s alpha for the Hindi version of the tool (HLS-IND-HIN-Q16) was 0.98, and for Kannada version (HLS-IND-KAN-Q16) 0.97. Confirmatory factor analysis produced fit indices within acceptable limits. The results allowed us to conclude that the two Indian language questionnaires allow valid and reliable measurements of health literacy among the Hindi and Kannada speaking population of India.
Background Cervical cancer represents a very high burden of disease, especially in Low- and Middle-income economies. Screening is a recommended prevention method in resource-poor settings. Cervical cancer screening (CCS) uptake is influenced by various psycho-social factors, most of which are included in behavioural models. Unlike demographic characteristics, these factors are modifiable. While few studies have compared these models in terms of their capacity to predict health behaviour, this study considers three health behaviour theories to assess and compare the predictors of CCS behaviour and intention. Methods A survey was conducted among 607 sexually active women in the South Indian state of Karnataka. Data was collected regarding socio-demographic factors, health literacy, knowledge on CCS, and the socio-cognitive factors related to CCS that are represented in the Health Belief Model (HBM), Theory of Planned Behaviour (TPB) and Theory of Care-Seeking Behaviour (TCSB). Logistic regression analyses tested to what extent each of the theoretical models explained cervical cancer screening (CCS) intention and regular screening behaviour, comparing the variance explained by each of the models. Results CCS intention was best explained by the TPB, followed by the HBM. Of the constructs included in these models, positive attitude towards the screening procedure and perceived benefits contributed most significantly to screening intention, followed by fear, anxiety or embarrassment related to the disease or screening procedure, and context specific barriers. Conclusion Health behavioural models such as the TPB and HBM can help to identify the main socio-cognitive factors explaining the intention of women to participate in CCS. As such, they can inform interventions to target specific determinants of screening intention and behaviour, and enhance their effectiveness by addressing women’s screening attitude, perceived benefits, and emotions as well as reducing context specific barriers to screening.
Background Cervical cancer represents a high burden of disease. Many women in low- and middle-income countries face opposition from their partners and families to undergo cervical cancer screening. Identifying the social, cultural, and psychological factors that underly the opposition to screening by male partners is an important step towards reducing barriers for men to support their wives’ participation in cervical screening. This study explored the role of structural and psychological factors deriving from theoretical models as determinants of Indian men’s opposition to their partners being screened for cervical cancer. Methods A survey among 500 sexually active males was conducted between April 2020 and August 2020 to measure knowledge of cervical cancer and screening, awareness of screening possibilities, attitude towards screening, perceived barriers to screening, and health literacy. Regression analysis was performed to assess which of the potential factors contributed to the intention to support their wives’ screening. Results The majority of participants had very poor knowledge and awareness about cervical cancer and screening procedures, tended towards a negative attitude towards screening, and perceived several structural barriers. Attitude towards the screening procedure and routine participation in general screening significantly predicted their intention to support their wives’ screening for cervical cancer. Education moderated the association between knowledge and awareness and the intention to support their wives’ screening. Conclusion As women often rely on their spouses’ financial and emotional support of cervical screening, there is a need for men to be encouraged to support their wives’ screening participation. Programs to encourage men to support their wives’ cervical screening should focus on their attitude towards screening, educate about cervical cancer and screening procedures, and reduce perceived barriers.
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