INTRODUCTION:

Ida Jean Orlando in her book says that “Nursing is responsive to individuals who suffer or anticipate a sense of helplessness. It is focused on the processes of care in an immediate experience, it is concerned with providing direct assistance to individuals in whatever settings they are found, for the purpose of avoiding, relieving, diminishing the women and the mother tomorrow, the health and the wellbeing of future generation depend on her. She needs to be viewed as an asset, not a liability.

Attitudes and cultural practices in the society make more significance in life. Lack of appropriate knowledge and sufficient information about dyscrasias to the health of women lead to high morbidity and mortality rate in women, curing the individual’s sense of helplessness”

Cancer is being diagnosed more and more frequently in the developing world. The recent WHO report, stated that 8.5 million people would die of cancer in 2010, and that over 80% of these deaths would be in low and middle socioeconomic countries. The importance of the challenge posed by cancer was reiterated by the World Health Assembly in 2010, in resolution 60.22 on cancer prevention and control, which emphasized the need for comprehensive and integrated action to stop this global epidemic.

Cervical cancer is the second common most type of cancer among women, and was responsible for over 350000 deaths in 2010, approximately 80% of which occurred in developing countries. The achievements of the Millennium Development Goals are the prevention of these deaths by adequate screening and treatment.

Cervical cancer is one of the leading causes of death in women in the developing world. The primary underlying cause of cervical cancer is infection with human papilloma virus (HPV), a very common virus that is found in sexually transmitted diseases. Most HPV infections resolve spontaneously; those that persist may lead to the development of pre cancer and cancer. It usually takes 10 to 20 years for precursor lesions caused by HPV to develop into invasive cancer. Effective interventions against cervical cancer exist, including screening for and treatment of pre cancer and invasive cancer

A survey conducted by WHO in the year 2010 on global and regional patterns of annual death by cause emphasized that in more developed countries cancer had accounted for 21.6% of annual death and in less developed countries around 9.8% had died due to cancer. Now in developing countries the incidence of the disease was increasing and had accounted for 1 in every ten deaths. It was also predicted that by the year 2020 there would be around million new cases registered per year in more developed countries and 9.3 million new cases in less developed countries. Over all, in all the countries around 7.3 million deaths were predicted (WHO Report 2010).

There is considerable excess mortality from cervical cancer in India relative to the world, and the South Asia region. According to IARC estimates, mortality rate is expected that witness a 79% increase from 74,118 deaths in 2002 to 1, 32,745 deaths by 2025 estimated by National Cancer Registry Programme 2009. In developing countries it occurs 80% of cervical cancer. Worldwide, in 2008, it was estimated that there were 3, 23,000 cases of cervical cancer, and 2, 00,000 deaths per year.

PREVENTION OF CERVICAL CANCER:

The aim of the prevention of cervical cancer programme is to reduce morbidity and mortality resulting from cervical cancer.

Get a regular Pap smear.

Limit the amount of sexual partners you have.

Quit smoking or avoid second-hand smoke.

If you are sexually active, use a condom.

Follow up on abnormal Pap smears.

Get the HPV vaccine. The HPV vaccine, Gardasil, was approved by the FDA to give to girls as young as 9. The vaccine is most effective before they become sexually active.

Now vaccine is available to prevent cervical cancer i.e. Human Papillomavirus or HPV vaccine which protects against the virus that causes almost all cervical cancers.

NEED OF THE STUDY:

WHO Summary report on the Human Papilloma Virus (HPV) and cervical cancer statistics in India 2011 set the ball rolling on the absolute need to address the issue. According to the report, 80,000 women die from cervical cancer in India each year. The report says that in all over world highest risk of cervical cancer found in Indian women. About 5,670 women will die from cervical cancer in the United States during 2009. Worldwide, approximately 5, and 00,000 cases of cervical cancer are diagnosed each year.

WHO (2009) Worldwide, cervical cancer is the fifth most deadly cancer in women. It is estimated that there are 4, 73,000 cases of cervical cancer, and 2, 00,500 deaths per year.

Cervical cancer is an important public health problem among the adult women in developing countries, where it is the most common or the second most common cancer among women.

Women need to be sensitized to curb the growth of the disease. “Even the educated classes is not aware of cervical cancer and often link it with the neck. There is a need to explain to them that cervical cancer is caused in the lower part of the body.” The accumulated evidence suggests that cervical cancer is preventable and is highly suitable for primary prevention. Hence researchers felt that to conduct study on prevention of cervical cancer.

OBJECTIVES OF THE STUDY:

1. To evaluate the knowledge regarding prevention of cervical cancer among women before planned teaching.

2. To evaluate the knowledge regarding prevention of cervical cancer among women after planned teaching.

3. To associate the knowledge of the women regarding prevention of cervical cancer with selected demographic variables, such as age and education.

HYPOTHESIS:

· H_o= There is no significant association between knowledge of women regarding prevention of cervical cancer between selected demographic variables such as age and education (for 3^rd objective)

· H₁= There is significant difference between pre-test and post test knowledge of women regarding prevention of cervical cancer.

RESEARCH METHODOLOGY:

RESEARCH APPROACH:

Interventional approach is used in this study.

RESEARCH DESIGN:

In the present study Quasi experimental one group pre-test post test research design was used for the study. A pre-test was administered by means of structural questionnaire depicted as 0₁and then planned teaching given depicted as X. A post test was conducted using the same structured questionnaire depicted as 0₂.

POPULATION:

In this study the population was all the “Women (age above 40 years) in Kasturba Hospital, Sevagram at Wardha district Maharashtra.”

SAMPLE SIZE:

Sample size was 60 Women in Kasturba Hospital, Sevagram at Wardha District, Maharashtra.

SAMPLING TECHNIQUE:

Non probability convenient sampling.

ORGANIZATION OF FINDINGS:

The analysis and interpretation of the data are given in the following section:

· Section A- Distribution of women with regards to demographic variables.

· Section B- Assessment of knowledge regarding prevention of cervical cancer among women before planned teaching.

· Section C- Evaluate efficacy of planned teaching regarding prevention of cervical cancer among women.

· Section D- Association of knowledge score in relation to demographic variables.

SECTION A:

This section deals with distribution of women in Kasturba Hospital, Sevagram at Wardha District, and Maharashtra with regards to their demographic variables. A convenient sample of 60 subjects was drawn from the study population, who were in the women from Kasturba Hospital of Maharashtra.

Table 1: Distribution of women above forty years age according to their demographic characteristics. n =60

Demographic Variables	(Frequency)	Percentage (%)
Age(yrs)
40-45	33	55.0
46-50	27	45.0
Educational Status
Illiterate	0	0.00
Primary	24	40.0
High School	8	13.3
Graduate/PG	28	46.7
Occupational Status
Housewife	39	65.0
Labour	11	18.3
Semi-Professional	1	1.7
Professional	9	15.0
Economic Status (Rs)
< 5000 Rs	22	36.7
5001-10000 Rs	20	33.3
10001-15000 Rs	14	23.3
>15000 Rs	4	6.7
Marital Status
Unmarried	0	0.00
Married	53	88.3
Divorced	2	3.3
Widow/Widower	5	8.3
Habit of smoking
Yes	0	0.00
No	60	100.00
Menstrual Pattern
Menstruating Women	23	38.3
Menopausal Stage	37	61.7
Women using Oral Contraceptive Pills
Yes	5	8.3
No	55	91.7
Knowledge about prevention for cervical cancer vaccine
Yes	8	13.3
No	52	86.7
Previous exposure to information regarding prevention of cervical cancer
Yes	16	26.7
No	44	73.3
Source of information
Professionals	0	0.00
Friends and family members	7	11.7
Mass media	9	15.0

· Majority of women according to their age reveals that 55% of them belonging to the age group of 40-45 years and 45% in the age group of 46-50 years respectively.

· Majority of women according to their educational status shows that 46.7% were graduated and post graduated, 40% of them were educated upto primary, and 13.3% were upto high school.

· Majority of women according to their occupational status reveals that 65% of them were housewives, 18.3% of them were labour, 5% were professional and 1.7% were semi professionals.

· Majority of women according to their economic status shows that 36.7% of them had income below 5000 Rs, 33.33% had income in the range of 5001-10000 Rs, and 23.3% of them had 10001-15000 Rs and 6.7% had income more than 15000 Rs.

· Majority of women according to their marital status reveals that 88.3% of them were married, 8.3% of them were widow/widower and 3.3% were divorced.

· 100% of women had no habit of smoking.

· Majority of women according to their menstrual pattern shows that 61.7% of them had menopausal stage and 38.3% of them were menstruating women.

· Majority of women according to use of oral contraceptive pills reveals that 91.7% of them need not use oral contraceptive pills and 8.3% only use oral contraceptive pills.

· Majority of women according to knowledge about prevention for cervical cancer vaccine shows that 86.7% lack knowledge about the prevention of cervical cancer and only 13.3% of them had knowledge about prevention for cervical cancer vaccine and majority of them

· Majority of women according to previous exposure to information regarding prevention of cervical cancer shows that 73.3% lack knowledge about previous exposure to information about prevention of cervical cancer and 26.7% of them had previous exposure to information regarding prevention of cervical cancer

· Majority of women according to source of information shows that 15% of them had information from mass media and 11.7% of them had information from friends and family members.

SECTION B:

Table 2: Significance of difference between knowledge score in pre and post test of sample in relation to overall and area wise knowledge regarding prevention of cervical cancer.

		Mean knowledge score	SD	Mean percentage	t-value	p-value
Overall	Pre Test	10.90	3.07	36.33	26.16	0.000 S, p<0.05
Overall	Post Test	22.73	2.69	75.77	26.16	0.000 S, p<0.05
Meaning of Cancer	Pre Test	1.66	1.27	27.77	19.06	0.000 S, p<0.05
Meaning of Cancer	Post Test	4.75	0.85	79.16	19.06	0.000 S, p<0.05
Causes and risk factors	Pre Test	1.73	0.91	43.33	12.83	0.000 S, p<0.05
Causes and risk factors	Post Test	3.30	0.72	82.50	12.83	0.000 S, p<0.05
Sign and symptoms of	Pre Test	1.50	0.65	50.00	9.06	0.000 S, p<0.05
Sign and symptoms of	Post Test	2.45	0.59	81.66	9.06	0.000 S, p<0.05
Diagnostic criteria and management	Pre Test	1.28	1.09	32.08	13.16	0.000 S, p<0.05
Diagnostic criteria and management	Post Test	3.41	0.72	85.41	13.16	0.000 S, p<0.05
Prevention	Pre Test	4.71	2.07	36.28	13.16	0.000 S, p<0.05
Prevention	Post Test	8.81	1.56	67.82	13.16	0.000 S, p<0.05

This table shows that the comparison of pre test and post test knowledge scores of the overall and area wise knowledge regarding prevention of cervical cancer. In pre test the overall mean knowledge score regarding prevention of cervical cancer among women was 10.90 and area wise knowledge score regarding prevention of cervical cancer in women was, meaning of cancer: 1.66, causes and risk factors: 1.73, signs and symptoms: 1.50, diagnostic criteria and management: 1.28, prevention of cervical cancer was: 4.71. In post test the overall mean knowledge score was improved to be 22.73 and improvement in knowledge score in each area was, meaning of cancer: 4.75, causes and risk factors: 3.30, signs and symptoms: 2.45, diagnostic criteria: 3.41, prevention: 8.81. Mean, standard deviation and mean score percentage values are compared and ‘t’ value is applied at 5% level of significance. The tabulated value for 59 degrees of freedom was 2.00. The calculated’ value was 26.16 for the overall knowledge regarding prevention of cervical cancer. The calculated’ value are much higher than the tabulated value at 5% level of significance which is statistically acceptable level of significance. In addition the calculated ‘p’ values for all the areas of knowledge regarding prevention of cervical cancer was 0.000 which is ideal for any population. Hence it is statistically interpreted that the planned teaching regarding prevention of cervical cancer was effective. Thus the H₁ is accepted.

Fig 1 - Significance of difference between knowledge score in pre and post test of sample in relation to overall and area wise knowledge regarding prevention of cervical cancer

SECTION C:

Association of Knowledge Score In Relation To Demographic Variables:

It is interpreted that the knowledge score on prevention of cervical cancer is not associated with demographic variables.

IMPLICATION OF THE STUDY:

The findings of this study have implication for nursing practice, nursing administration, nursing education and nursing research.

Nursing practice:

Nursing is an art and science, as a science nursing is based upon a body of knowledge that is always changing with new discoveries and innovations. When nurses integrate the science and art of nursing into their practice, the quality of care provided to clients is at a level of excellence that benefits clients in innumerable ways.

· The findings of the present study emphasis on knowledge regarding prevention of cervical cancer which can be put into nursing practice in early identification of disease and planned teaching can be used as a basis for educating them in prevention of these problems.

· The health care professionals including nurses will be more vigilant and tactful in order to identify and prevent factors that cause high risk of cervical cancer that may alter their physical, social life and well being significantly.

· The findings of the study will help the nursing professionals working in hospital gaining the knowledge and helps in planning and implementation of health teaching.

Nursing education:

The present study emphasis that health education on knowledge regarding prevention of cervical cancer among women. In order to educate the women, it is essential that the nurses are competent and have sound knowledge to improve the level of understanding which can be reflected to the public through education.

· The nursing students develop an insight regarding knowledge of cervical cancer its preventive aspect and implement the knowledge of the same while dealing with clients in various setting.

· The student nurse can use the instrument prepared for this study for collecting information of preventing cervical cancer.

· The findings can be utilized to prepare a module on factors contributing prevention of cervical cancer.

Nursing administration:

· Health administration plays a pivotal role in supervision and management of nursing profession. The nurse administrators can utilize the present tool for assessing the knowledge of women and can implement measures to promote health on the finding of the study. Teaching modules, group discussions and periodical educational sessions can also be arranged for women.

· Knowledge regarding prevention of cervical cancer being concern of medical health care facilities a programme at school and college level for prospective can be planned and implemented countrywide to prevent the occurrence of cervical cancer.

Nursing research:

Research is systematic attempt to obtained meaningful answers to phenomenon or events through the application of scientific procedures. It is an objective, impartial, empirical and logical analysis and according to controlled observations that may lead to the development of generalizations, principles or theories, resulting to some extent in prediction and control of events that may be the consequences or cause of specific phenomenon.

· The findings of the present study can be utilized by nurse researchers to contribute to the profession to accumulate new knowledge regarding prevention of cervical cancer, and can take professional accountability to educate and motivate the women towards health promoting practices. The present study would help nurses and other health care personnel to understand the level of knowledge of women regarding prevention of cervical cancer. Based on this knowledge the nurse researchers may utilize the suggestions and recommendations for conducting further study.

· The nurse researchers can use the findings of this study as baseline data to conduct further interventional research to identify the level of knowledge and to determine the association of other demographic variable as age ,education, occupation, of the samples and to identify the effect of any variable on knowledge of cervical cancer.

PERSONAL EXPERIENCE:

· The entire study gave an enriching experience to the researcher. It helped her develop her skill in critical thinking and analysis and realize the importance of effective communication with respondent.

· The entire study was varied and rich learning experience, which enabled the researcher to develop her skill in dealing with different personalities. The concept clarity about research as a whole was increased. At every stage the researcher received guidance and support from her guide. This boosted confidence to go ahead and carry out the planned activities. The co-operation from study subjects was remarkable. The research was a great learning opportunity for the researcher.

RECOMMENDATIONS:

· A similar study can be carried out on a large scale including community area, general population in order to estimate the level of knowledge regarding prevention of cervical cancer for generalization of findings.

· A comparative study to assess the knowledge regarding cervical cancer among urban and rural population can be conducted.

· Self instructional module (SIM) can be prepared on each aspects contributing to cervical cancer can be done.

· A study can be conducted to evaluate the effectiveness of structured teaching programme versus other methods of teaching on knowledge regarding prevention of cervical cancer.

REFERENCES:

1. Barbara K Timby Nancy E Smith Introductory Medical surgical Nursing 9^th edition, published by Lippincott Willians&Wilkins 1999 page 1007-1009

2. World Health Organization Report 2010 – 2011 (JOURNAL)

3. Abraham A etal; Pediatric Adolescent and Gynecology journal, Knowledge, attitude of women for pap in rural area 2008, Aug.vol.19, page 271-275.

4. Alliance for Cervical Cancer Prevention. “Natural History of Cervical Cancer: Even Infrequent Screening of Older Women Saves Lives”, Cervical Cancer Prevention: Fact Sheet, April2003.Availableathttp://ncd.bvsalud.org/portals/ cervicalCancer/docs/en/RH natural history of cc fs.pdf, last accessed November 18, 2009

5. Dutta, D C Textbook of Gynecology including contraception, 4th edition, published by New central book agency Culcutta, 2007, page 74-77.

6. DivyaKapoor. All about India’s Commonest Cancer: Cervical Cancer; The Time of India, TNN- 4 September 2008. 12:08 a.m. IST

7. By Lisa Fayed, About.com Guide Updated April 30, 2007 About.com Health's Disease and Condition content is reviewed by our Medical Review Board.

8. Schottenfeld D, Fraumeni JFe1996. Cancer Epidemiology and Prevention.2nd ed. New York: Oxford University Press.

9. Lyon JL, Gardner JW, West DW, Stanish WM, Hebertson RM Smoking and carcinoma in situ of the uterine cervix. Am J Public Health. 1983; 73:558–562.

10. Magnusson PE, Sparen P, Gyllensten U Genetic link to cervical tumours. Nature. 1999; 400: 29–30.

11. WHO (Feb. 2008). Fact sheet number 297; Cancer retrieved on 2007-12- 01.

12. NCCC National Cervical Cancer Coalition; retrieved on 2008-07-01.

13. Ferlay J et al. Globocan 2000. Cancer incidence, mortality and prevalence World Wide, version Lyon, International agency for Research on Cancer, 2001(IARC Cancer base no. 5).

14. Incidence of Cervical Cancer in India by Cancer Registry. PMID: 11016150 [Pubmed index for MEDLINE] 1982 –94.

15. Rao RS, et al, “Downstaging for cervical cancer: a community based study in the rural areas of Udupi district, Karnataka, India. Trop Doct. 2007 Apr; 37(2):73-5.

16. Baykal C, etal “knowledge and interest of Turkish women about cervical cancer and HPV Vaccine”. Eur J GynaecolOncol. 2008; 29(1):76-9.

17. WHO, 2009b; GLOBOCAN 2002 database, IARC)

18. Polit.D.and Hungler B.P. Nursing research principles and methods .Philadelphia:j.p Lippincott Company.

19. BT Basavanthappa. Nursing Research; Jaypee Publications; II^ndEdition; 2006: page no.745.

Received on 18.06.2019 Modified on 10.07.2019

Int. J. Nur. Edu. and Research. 2019; 7(4): 539-544.

DOI: 10.5958/2454-2660.2019.00119.4