Knowledge, attitudes and practices of cervical cancer prevention among Zambian women and men

Abstract

Background In Zambia, cervical cancer screening was started in 2006 and the human papillomavirus vaccine was piloted in 2013. Nevertheless, cervical cancer remains the leading cancer. It is assumed that knowledge, social interaction, health behaviors and religion are factors that can influence screening and vaccination practices. This study addresses the question, what is the relationship between knowledge about cervical cancer, attitudes, self-reported behavior, and immediate support system, towards screening and vaccination of cervical cancer of Zambian women and men. The results of this study serve as a basis for future research, an input for improvement and adjustment of the existing prevention program and build on documented health behavior frameworks. Methods A cross-sectional mixed methods study was conducted from February to May 2016. Two separate questionnaires were used to collect data from women ( N = 300) and men ( N = 300) residing in Chilenje and Kanyama (two townships in the capital city Lusaka). Respondent’s knowledge of cervical cancer was operationalized by grading their ability to correctly identify causes and protective factors if they were aware of cervical cancer. Besides providing descriptive statistics of all study variables, we tested four research hypotheses concerning the link between knowledge, attitudes and practices suggested by the literature, by applying appropriate statistical tests (chi square test, analysis of variance, logistic regression). Results Less than half of the respondents (36.8%) had heard of cervical cancer, 20.7% of women had attended screening and 6.7% of the total sample had vaccinated their daughter. Knowledge of causes and prevention was very low. There was a strong association between having awareness of cervical cancer and practicing screening (odds ratio = 20.5, 95% confidence interval = [9.214, 45.516]) and vaccination (odds ratio = 5.1, 95% confidence interval = [2.473, 10.423]). Social interactions were also found to greatly influence screening and vaccination behaviors. Conclusions The low level of knowledge of causes and prevention of cervical cancer suggests a need to increase knowledge and awareness among both women and men. Interpersonal interactions have great impact on practicing prevention behaviors, for instance, vaccination of daughters. Electronic supplementary material The online version of this article (10.1186/s12889-019-6874-2) contains supplementary material, which is available to authorized users.

Awareness of Cervical Cancer and Attitude Toward Human Papillomavirus and Its Vaccine Among Ghanaians

“…Among the 1,376 participants involved in this survey, 1,240 participants (90.1%) representing 456 males (33.1%) and 784 females (57.0%) were aware of the terminology "cervical cancer." When stratified by gender, women had significantly greater knowledge, compared to men in terms of "cervical cancer being common in middle age (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50) females" (75.5 vs. 67.5%, respectively, p ≤ 0.001). These participants were examined further to test their knowledge on some risk factors and symptoms of cervical cancer, as presented in Tables 2-4.…”

Community groups to increase Human papillomavirus (HPV) vaccination through Participatory Learning and Action, Reducing barriers and increasing community Mobilisation in Zambia (CHARMZ) project.

“…Available data from the rst three years of the vaccination program showed that it failed to meet its target of vaccinating 50,000 girls every year (11). More recently, a study on Zambian parents in Lusaka found that 41% of their participants did not support the vaccination (12), and only 6.7% of participants in another study had vaccinated their daughters (13).…”

“…The disconnect between supply and demand has been attributed to a lack of knowledge surrounding the vaccine's indication, e cacy and safety (13), as well as a lack of community engagement to address concerns and misunderstandings, particularly in rural districts (11,14). Women's limited decision-making power compared to their husbands regarding their daughters receiving the HPV vaccination, coupled with a lack of engagement with male community members during the vaccine's roll-out has also been attributed to low uptake (15,16).…”

“…Participants will be purposively sampled from communities in the district Chongwe in Lusaka province, as Lusaka has the highest incidence of cervical cancer compared to other provinces in Zambia (36) and most research on HPV vaccination hesitancy in Zambia has been conducted there (13,14,37). Furthermore, Chongwe was chosen for its rural setting, where community groups have been shown to be most effective (23).…”

“…Community groups are thought to allow individuals to collectively engage with these social and community-level in uences. This has been witnessed in Zambia, where knowing someone in the community that vaccinated their daughter increased the likelihood that mothers would vaccinate their own daughters (13).…”