Knowledge Regarding Vaccination
against Cervical Cancer among Adolescents
Ms.
Goutami N, Prof. Samata K Jyothi
Shree Siddaganga Institute of Nursing
Sciences, Tumkur, Karnataka.
*Corresponding
Author Email:pandu.narakatla6@gmail.com
ABSTRACT:
The magnitude of the problem of non
communicable diseases in our society is only partially reflected by statistics
on mortality and morbidity. Cancer is one among the major killing disease in
the beginning of the 20th century, cancer is the 6th
cause of death in industrialized countries, and today it stands as second
leading cause of death in the world. Many young adolescent girls in
India, especially those in rural areas, have little or no education: nearly 13
percent of 10 to 14 year-old girls have never attended school, and more than 30
percent have less than five years of schooling. Cervical cancer is the
second most common type of cancer in women. Cervical cancer usually develops
very slowly. This precancerous condition can be detected by a Pap smear and is
100% treatable. Almost all cervical cancers are
caused by human papilloma virus. Human papilloma virus is a common virus that
is spread through sexual intercourse. A vaccine to prevent cervical cancer is now available. Annual pelvic
examinations, including a pap smear, should start when a woman becomes sexually
active, or by the age of 20 in a non-sexually active woman. Human
papilloma virus vaccination is recommended with either vaccine for 12 and 17
year-old girls.
Statement of the problem:
A study to assess the knowledge on
vaccination against cervical cancer among adolescent girls in selected high
schools at Tumkur with a view to develop an Information booklet.
Objectives of the study:
·
To assess
the knowledge on vaccination against cervical cancer among the adolescent
girls.
·
To determine
the association between the level of knowledge with selected socio demographic
variable.
·
To develop
an information booklet on vaccination against cervical cancer.
Methodology:
The research approach adopted for the study
was descriptive approach which was considered as an appropriate research for
the present study. The conceptual frame work is based on modified general
system theory developed by Ludwing Bertalanffy. Research design adopted for the
study was descriptive design. The study was conducted in selected
high schools. Systematic random sampling technique was used to select 200
adolescent girls. A self administered knowledge questionnaire was used for data
collection. The
reliability of the tool was established by split-half test method by using Karl
Pearson’s product moment correlation formula method. The reliability of tool was found to be r
=0.8711 which shows that the tool was reliable. Data gathered was analyzed using descriptive and inferential
statistics in terms of frequency, percentage, mean, standard deviation, and
chi-square test.
Results:
The results of the present study revealed
that majority of adolescent girls 116(58%) were having inadequate knowledge, 79
(39.5%) of them were having moderately adequate knowledge and 5(2.5%) of
them had adequate knowledge on vaccination against cervical cancer with Mean Response of
sample on vaccination against cervical cancer is 19.85 with SD value of 5.109. The analysis was done to find out
the association between the knowledge on vaccination against cervical cancer with
selected Socio demographic variables such as age, religion, educational status
of the mother, educational status of the father, occupation of the mother,
occupation of the father, type of family, total income of the family, place of
residence, family history of cervical cancer vaccination, previous exposure of
knowledge on cervical cancer vaccination, opinion on cervical cancer. The
variable such as educational status of mother, occupation of mother, , total
monthly income of the family , place of residence, opinion on cervical cancer
were found to be significant at P<0.05 level. Variables such as age,
religion, standard of education, educational status of father, occupation of
father, type of family, family history of cervical cancer vaccination, previous
exposure of information on vaccination against cervical cancer has significant
association with level of knowledge on vaccination against cervical cancer at
P< 0.05 level.
Interpretation and conclusion:
The findings of the study revealed that
adolescent girls had inadequate knowledge on vaccination against cervical
cancer. Therefore the findings of the study strongly suggest that there is need
for conducting study using SIM on importance of vaccination against cervical
cancer among adolescent girls
KEY WORDS: Cervical cancer, vaccination, adolescent
girls, an Information booklet.
INTRODUCTION:
“It is not the strongest of species who
survives, nor the most intelligent, but those who are most adaptive to change.”
Charles Darwin
The changing demographic scenario in India
is declining fertility level and increasing life expectancy. High incidence of
non-communicable disease, especially cancer is positively associated with the
percentage of aged population of the country. The “world cancer report”
documents that the cancer rates have set to increase in an alarming rate
globally1.
Cancer is the term that encompasses a
complex group of more than 100 different types of cancerous diseases. Cancer
can affect just about every organ in the human body. An abnormal growth of
cells which tend to proliferate in an uncontrolled way and, in some cases, to
metastasis (spread). Cancer can involve any tissue of the body and have many
different forms in each body area2.
Around 12.7 million new cancer cases were
diagnosed worldwide and around 7.6 million deaths from cancer occurred. 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 cancer. More than 70%
of the cases report for diagnostic and treatment services in the advanced
stages of the disease, which has lead to a poor survival and high mortality
rate4.
According to WHO, HPV and cervical cancer
(2009) in India ,women at risk of cervical cancer is 366.58 millions,1.3 lakhs
of annual cases and 74 thousand annual deaths. Statistical data reveals that
the prevalence rate was highest in Mumbai(3121), Chennai(2550), Pune (1138),Trivandrum
and Karunagappally 284 and 93 respectively5.Unless there is a
dramatic improvement in prevention of cervical cancer and the incidence of the
disease falls by 2050,one million new cases of the disease will be diagnosed
each year5.
There are many kinds of treatment
modalities for treatment like radiation therapy, chemotherapy, surgical
management with lot of adverse effects6.
Worldwide, cervical cancer is the second
most common type of cancer in women. Cervical cancer is the cancer that starts
in the cervix, the lower part of the uterus (womb) that opens at the top of the
vagina. Cervical cancer usually develops very slowly. It starts as a
precancerous condition called dysplasia. This precancerous condition can be
detected by a Pap smear and is 100% treatable. It is so important for women to
get regular Pap smears. Most women who are diagnosed with cervical cancer today
have not had regular Pap smears or they have not followed up on abnormal Pap
smear results7.
Almost all cervical cancers are caused by
human papilloma virus. Human papilloma virus is a common virus that is spread
through sexual intercourse. Risk factors for cervical cancer include: Having
sex at an early age, multiple sexual partners, poor economic status. Early
cervical cancer can be cured by uprooting the precancerous or cancerous tissue.
There are various surgical ways to do this without opening the uterus or damage
the cervix8.
A vaccine to prevent cervical cancer is now
available. The United States Food and Drug Administration approved the vaccines
called Gardasil and Cervarix, which cost around Rs.10000 for 3 shots, which
prevents infection against the two types of human papilloma virus responsible
for most cervical cancer cases. Annual pelvic examinations, including a pap
smear, should start when a woman becomes sexually active, or by the age of 20
in a non-sexually active woman9.
Human papilloma virus vaccination is
recommended with either vaccine for 12 and 17 year-old girls. It is also
recommended for girls and women age 13 through 26 years of age who have not yet
been vaccinated or completed the vaccine series; human papilloma virus vaccine
can also be given to girls beginning at age 9 years10. Hence
knowledge of vaccine in right dose and right time is important.
Human papilloma virus vaccines must be kept
cold in order to maintain their potency. The system of storing and transporting
vaccines at recommended temperatures is known as the “cold chain.” A review of
the system and conversations with key informants confirmed that cold storage is
available at the regional, state, and district levels for human papilloma virus
vaccines, and that the distribution process and reporting systems in India are
strong.
NEED FOR THE STUDY:
An ounce of prevention is worth a pound of
cure:
Henry de Bracton:
In the context of cancer prevention, the
focus has been on primary prevention of cervical cancer among adolescent girls,
and the introduction of vaccination against cervical cancer. The incidence of
cervical cancer is on the rise in India. It afflicts as many as 25 women per
0.1 million, making it the commonest cancer in the country. Researchers
at the Federal Centers for Disease Control and Prevention found at least one in
4 teenage American girls has a sexually transmitted disease.
Cervical cancer is a major and devastating
cause of mortality worldwide with an estimated global incidence of 5 lakhs new
cases and 2.7 lakhs deaths annually among women. It is the second most common
cancer in women between 15 and 45 years of age and the third most common cause
of cancer related mortality in women.
Every year cervical cancer is diagnosed in
about 500,000 women globally and is responsible for more than 280,000 deaths
annually. 80% of the new cervical cancer cases occur in developing countries,
like India, which reports approximately one fourth of the world's cases of
cervical cancer each year. 19.4 to 43.5 per 100,000 women are registered with
cervical cancer in the registries under the National Cancer Registry Programme
.It has been estimated that 100,000 new cases of cancer of the cervix occur in
India every year, and 70% or more of these are Stage III or higher at
diagnosis.
About a third of India’s population is
younger than the age of 15. Many young adolescent girls in India, especially
those in rural areas, have little or no education: nearly 13 percent of 10 to
14 year-old girls have never attended school, and more than 30 percent have
less than five years of schooling. Adolescent girls in India also face frequent
under-nutrition, anemia, and infectious diseases, due in part to poor
environmental sanitation. Given that the human papilloma virus vaccine is
primarily intended for young adolescent girls prior to sexual initiation; it is
worth noting that the median age at first marriage or women is approximately 17
years of age. Nineteen percent of the country’s total fertility rate is
represented by births to young women between 15 and 19 years of age. There is
also growing evidence of premarital onset of sexual activity.
There is a food and drug administration
approved vaccine to protect against the spread of human papilloma virus. This
virus protects against the two most common types of human papilloma virus which
lead to most cervical cancers. There are other types of human papilloma virus,
but the vaccine targets the two largest human papilloma virus variations. It is
vital to complete the entire human papilloma virus vaccine series before young
women reach the age of sexual maturity. It is better to be safe now and start
the vaccine when they are young – before they can start sexual activity. Doing
so can protect our daughters from getting the main two types of human papilloma
virus which lead to most cervical cancers. Pap tests are still recommended for
all women– even girls who have received the human papilloma virus vaccine.
The formative research study was conducted
between July 2007 and March 2008 in the states of Andhra Pradesh and Gujarat.
The states were selected based on cervical cancer disease burden, immunization
coverage, experience with new vaccine introduction, commitment to adolescent
health and cervical cancer prevention, and willingness to participate in the
project, as well as a number of other factors. Study sites were chosen in
consultation with a National Project Advisory Committee composed of
multi-disciplinary experts in immunization and cancer of the cervix, including
representatives from the Ministry of Health and Family Welfare, the state
governments and the World Health Organization. A study revealed to improve
understanding of the complex environment of new vaccine introduction in a large
country from the perspective of adolescents, parents, health workers,
policymakers, and a wide array of community members.
According to Remennick. L.I prevention
measures are cost effective. The awareness regarding the risk factors and
preventive measures help the people to take preventives and promotive care and
can seek medical aid in time. She recommended that a planned teaching programme
regarding cervical cancer helps in individuals to understand or gain knowledge.
She over emphasized that nursing profession is in a unique position to meet the
above needs of the people.
WHO recognizes the importance of cervical
cancer and other HPV related diseases as global public health problems and
recommends that routine HPV vaccination should be included in National
Immunization Programme. Prevention of cervical cancer or other HPV related
disease constitutes a public health priority. Include education about reducing
behaviors that increase the risk of acquiring HPV infection and information
about the diagnosis and treatment of precancerous lesions and cancer.
A study was carried out to determine the
incidence and mortality rate of cervical cancer which reveals that, cervical
cancer is the most common form of cancer among women in India, with an
estimated 100,000 new cases developing annually in the country. 70% or more of
these cases are stage 3 or higher at diagnosis. This paper presents findings
from the analysis of survival data on 2121 patients diagnosed with cervical
cancer in the population of Bangalore, India.
In the light of above, researcher felt the
need to assess the knowledge on vaccination against cervical cancer in order to
promote being vaccinated and prevent the incidence of cervical cancer as it is
the leading cause for deaths among women. The adolescent girls need to increase
the knowledge on vaccination against cervical cancer as our aim is primary
prevention. There is immense need to increase the knowledge on vaccination
against cervical cancer under the first level of prevention. Hence, the
investigator selected the statement for research study.
STATEMENT OF PROBLEM:
A study to assess the knowledge on
vaccination against cervical cancer among adolescent girls in selected high
schools at Tumkur with a view to develop an information booklet.
OBJECTIVES OF THE STUDY:
· To assess the level of knowledge
on vaccination against cervical cancer among the adolescent girls.
·
To determine
the association between the level of knowledge with selected socio demographic
variable of adolescent girls.
·
To develop
an information booklet on vaccination against cervical cancer.
OPERATIONAL DEFINITIONS:
1. Knowledge-In this study the knowledge
refers to the correct response of adolescent girls on vaccination against
cervical cancer as elicited through self-administered knowledge questionnaire.
2. Vaccination–Vaccination refers to the
process of administering weakened or dead pathogens to a healthy person, with
the intent of conferring immunity against the pathogen.
3. Cervical
cancer-Cervical
cancer refers to abnormal growth of premature and functionless cells of cervix
and it may invade to other tissues or organs of the body.
4. Adolescent
girls-In this
study the adolescent girls refer to the girls who are studying in 8th,
9th and 10th standard in selected high schools at Tumkur.
5. Information
booklet-Refers
to a small booklet which contains information regarding vaccination against
cervical cancer to enhance the knowledge among adolescent girls.
Assumption:
It is assumed
that,
• Adolescent
girls may have limited knowledge on vaccination against cervical cancer.
• An
information booklet may improve the knowledge of adolescent girls on
vaccination against cervical cancer.
Delimitation:
The study is limited to selected high
schools at Tumkur
REVIEW OF LITERATURE:
A cross sectional study was done and of all
the interviews conducted on 400 women with an objective to assess the knowledge
regarding cervical cancer. The results revealed that 1.8% did not know cervical
cancer as a disease. Only 23.3% of the respondents were aware that cervical
cancer is the most common cause of gynecological cancer,of these 62% said that
virus is the cause and 61% of the respondents knew that the virus is Human
Papilloma Virus (HPV). Majority recognized that it is sexually transmitted but
only a minority (41%) knew that it can be detected. Only 26% of the study
population was aware of one or more risk factors. Thirty seven percent
recognized Pap smear as a screening test. In total only 37 out of 400
respondents were aware of the human papilloma virus vaccine. A cross sectional
study was conducted on adolescent attitudes about HPV vaccines to educate
adolescents about human papilloma virus and human papilloma virus vaccines.
Studies conducted primarily in adult women to demonstrate that knowledge
generally is poor. Researcher identified several modifiable factors associated
with intention and confidence in one’s ability to receive the vaccine,
including higher perceived severity of cervical cancer and fewer barriers to
vaccination. The recent Studies on adolescent knowledge about human papilloma
virus and attitudes about human papilloma virus vaccines supports the
importance of designing developmentally appropriate educational materials for
adolescents about human papilloma virus and human papilloma virus vaccines.
The descriptive study was conducted to
investigate knowledge and attitude to sexually transmitted infection and
prevention with special focus on human papilloma virus and new vaccine against
HPV among 16 year old high school student s in Swedish context. A study
specific questionnaire was distributed to 572 first year high school students
from five different high schools in a medium sized town in Sweden. The students
lacked in knowledge of HPV and its association with cervical cancer. Similarly,
their knowledge of the new vaccine was limited. The results highlight the
clinical importance for school nurse and personnel at youth clinics to inform
adolescents about HPV and its association with cancer
METHODOLOGY:
Research approach and Research design:
Non-Experimental Design and Descriptive
approach was used in the study.
Setting:
The study was conducted in selected high
schools at Tumkur City
Population:
The population of the study was adolescent
girls.
Independent Variable:
In this study the independent variables
Age, Religion, Standard Of Girl, Education Of Mother, Education Of Father,
Occupation Of Mother, Occupation Of Father, Type of Family, Monthly Income of
the Family, Place of Residence, History of Cervical Cancer Vaccination, Previous
Exposure of Knowledge, Opinion on Cervical Cancer.
Dependent Variable:
Dependent variables in this study are
Knowledge
Sample and Sampling Size:
200 adolescent girls studying in 8th,
9th, 10th standard
Sampling Technique:
In this study the probability systematic
random sampling technique was adopted to select adolescent girls.
Description of the Tool:
Part I:
It consists of thirteen items for obtaining
information about the selected socio demographic variables such as age,
religion, standard of education, education of mother, education of father,
occupation of mother, occupation of father, type of family, income of family,
place of residence, source of knowledge.
Part II:
It consists of knowledge questionnaire on
cervical cancer and vaccination against cervical cancer which includes 40
items.
Ethical clearance:
Ethical clearance was obtained.
Reliability:
·
Reliability
was established from data of 200 samples by split half method.
·
The
reliability was found by using Karl Pearson’s product moment correlation
formula
·
The ‘r’
value for The Professional Life Stress Scale was found reliable (r =0.87)
·
The ‘r’
value of Structured Questionnaire to assess the other selected health problems
was also found reliable (r = 0.89).
·
Hence the
tool was highly reliable.
RESULT:
Majority of the adolescent girls 108 (54%)
were between the age group of 13-14 years, 188(94%) were from Hindu religion,
109 (54.5%) were from 9th Standard, 60 (30%) mothers of adolescent
girls completed primary education, 104 (52%) fathers of adolescent girls
completed Higher secondary education, 121 (60.5%) mothers of adolescent girls
were housewives, 135 (67.5%) fathers of adolescent girls were private
employers, 115(57.5%) adolescent girls were from nuclear family, 83 (41.5%) adolescent
girls total family income per month is 15001 to 20,000/-, 134 (67%) adolescent
girls residing in rural area, 195(97.5%) adolescent girls had no family history
of cervical cancer vaccination, 101(50.5%) adolescent girls have gained
information through mass media, 151(75.5%) adolescent girls opted preventable
opinion on cervical cancer. Majority of adolescent girls 116(58%) had inadequate
knowledge, 79(39.5%) of them had moderately adequate knowledge and 5(2.5%) of
them had adequate knowledge on vaccination against cervical cancer.
Fig. 2: Percentage Distribution of Age of
Adolescent Girls
Fig. 3: Percentage Distribution of Religion
of Adolescent Girls
Fig. 4: Percentage Distribution of Standard
of education of adolescent girl
Fig 5. Percentage distribution of education
of mother of adolescent girls
Fig.6: Percentage Distribution of education
of father of Adolescent Girls
Fig.7: Percentage Distribution of
Occupation of Mother of Adolescent Girls
Fig.8: Percentage Distribution of Occupation
of Father of Adolescent Girls
Fig. 9: Percentage Distribution of Type of
Family of Adolescent Girls
Fig. 10: Percentage Distribution of Monthly
Income of Family Members of Adolescent Girls
Fig. 11: Percentage Distribution of Area of
Residence of Adolescent Girls
Fig. 12: Percentage Distribution of Family
History of cervical cancer vaccination of Adolescent Girls
Fig. 13: Percentage Distribution of
Previous Exposure of Information of Adolescent Girls
Fig. 14: Percentage Distribution of Opinion
on Cervical Cancer of Adolescent Girls
Mean and Standard Deviation of Level of
knowledge on vaccination against cervical cancer. (N=200)
|
Statistics
|
Score
|
|
Mean
score
|
19.85
|
|
Standard
deviation
|
5.109
|
Frequency and percentage distribution of
adolescent girl according to their knowledge N=200
|
Sl.
No
|
Category
|
Score
|
Frequency
f
|
Percentage
%
|
|
1.
|
Inadequate
knowledge (<50%)
|
0 –
20
|
116
|
58
|
|
2.
|
Moderately
adequate knowledge (50-75%)
|
21 –
30
|
79
|
39.5
|
|
3.
|
Adequate
knowledge (> 75%)
|
31 –
40
|
5
|
2.5
|
Fig. 15: Association between the knowledge
level with their selected socio demographic variables:
Variables of educational status of mother (x2=40.03),
occupation of mother (x2=17.76), place of residence (x2=10.781),
monthly income of family members (x2=10.855), opinion on
cervical cancer (x2=9.899) has significant association with
level of knowledge on vaccination against cervical cancer at P< 0.05 level.
Variable such as age (x2=1..085),
religion (x2= 5.897), standard of education (x2=4.231),
educational status of father (x2=14.407), occupation of
father (x2=5.748), type of family (x2=3.048),
family history of cervical cancer vaccination (x2=0.9603) and
previous exposure of information (x2=0.689) were found to be
not significant at 0.05 level.
IMPLICATION FOR NURSING PRACTICE:
·
As a
community nurse, Awareness programmes should be arranged for the school girls
and the whole community regarding cervical cancer and vaccine available to
prevent cervical cancer.
·
Educate
parents and adolescent girls on vaccination against cervical cancer and
motivate for being vaccinated.
·
Paediatric
nurse can educate the parents regarding RCH services availability and its
utility.
·
Educate
adolescent girls regarding reproductive health and menstrual hygiene while
rendering reproductive child health services.
·
Nurses can
take an initiation in educating the adolescent girls and women regarding
healthy sexual practice who are available at clinical setup.
·
Paediatric
nurse can motivate the adolescent girls to undergo cervical cancer screeing.
Implication for nursing education:
·
The findings
of the study can serve guidelines for the nurse educators for planning and
conducting educational programmes for the public.
·
The
identification of current health status of India including morbidity and
mortality rates should be the part of the curriculum in the teaching student in
nursing school and college setup.
·
It is prime
responsibility of nurse educator to motivate Student nurses to participate in
various strategies of prevention of cervical cancer.
·
Nurse
educator should organize continuing nursing education programme to impart
knowledge on vaccination against cervical cancer.
·
Nurse
educators should conduct and participate workshops and conferences to enhance
knowledge on cervical cancer.
Implication for nursing administration:
·
The
administrator should take interest in providing information on specialized area
like cancer, its meaning and causes, signs and symptoms, treatment available,
prevention and vaccine available.
·
The nurse
administrator should plan and organize in service education programme for the
nurses who are working in pediatric and oncology units to improve and apply the
knowledge in day to day life.
·
Information
booklet can be utilized by administrators during in service education
programmes.
·
Getting in
touch with the new findings will strengthen nurse position and improve self
confidence.
Implication for nursing research:
·
The findings
of the study show that the majority of the adolescent girls have inadequate
knowledge regarding cervical cancer and vaccination against cervical cancer.
·
There is a
need of extensive and intensive research in this area, so that strategies for
educating nurses in creating the awareness regarding cervical cancer and
vaccination against cervical cancer among adolescent girls.
·
Finally to
mention, all the research process steps were adopted while conducting the study
and the investigator felt the importance of research methodology in nursing
profession as a challenging one.
Recommendations for further study Based on the findings of the study the following
recommendations are made:
·
A similar
study can be conducted on larger and wider sample for a longer period of time
would be more pertinent in making broad generalization.
·
A study can
be done with experimental approach.
·
A study can
be conducted to evaluate the effectiveness of interventional approach regarding
knowledge and attitude regarding vaccination against cervical cancer.
·
A
comparative study can be conducted between the rural and urban area adolescent
girls.
CONCLUSIONS OF STUDY:
On the basis of the findings, the
investigator concluded that the adolescent girls have inadequate knowledge
regarding cervical cancer and vaccination against cervical cancer. The study
strong suggest that it is very important to enhance the knowledge of the
adolescent girls so that cervical cancer can be prevented.
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