REGARDING PREVENTION OF CANCER CERVIX AMONG MARRIED WOMEN

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EFFECTIVENESS OF INFORMATION EDUCATION COMMUNICATION PACKAGE ON KNOWLEDGE

REGARDING PREVENTION OF CANCER CERVIX AMONG MARRIED WOMEN

Dissertation Submitted To

THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY

CHENNAI

IN PARTIAL FULFILLMENT OF REQUIREMENT FOR THE AWARD OF DEGREE OF

MASTER OF SCIENCE IN NURSING

APRIL 2012.

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A STUDY TO ASSESS THE EFFECTIVENESS OF INFORMATION EDUCATION COMMUNICATION PACKAGE ON KNOWLEDGE REGARDING PREVENTION OF

CANCER CERVIX

AMONG MARRIED WOMEN IN NATHAM AREA, AT KUNDRATHUR, CHENNAI 2011 – 2012

Certified that this is the bonafide work of

Ms. SUGANYA KUMARI. S MADHA COLLEGE OF NURSING

KUNDRATHUR, CHENNAI - 600 069

COLLEGE SEAL

SIGNATURE: _________________

Prof. Mrs.TAMILARASI.B R.N., R.M., M.Sc.(N)., Ph.D

Principal,

Madha College of Nursing, Kundrathur,

Chennai – 600 069, TamilNadu.

Dissertation Submitted To

THE TAMIL NADU DR. M.G.R. MEDICAL UNIVERSITY CHENNAI

MASTER OF SCIENCE IN NURSING

APRIL 2012.

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A STUDY TO ASSESS THE EFFECTIVENESS OF

INFORMATION EDUCATION COMMUNICATION PACKAGE ON KNOWLEDGE REGARDING PREVENTION OF CANCER CERVIX AMONG MARRIED WOMEN IN NATHAM AREA AT

KUNDRATHUR, CHENNAI 2011 – 2012.

Approved by Dissertation Committee on : ______________

Research Guide :________________________________

Mrs. TAMILARASI. B R.N., R.M., M. Sc (N), Ph.D

Principal,

Madha College of Nursing, Kundrathur,

Chennai – 600 069, TamilNadu.

Clinical Guide :________________________________

Mrs. EBIGOLDA MARY. V R.N., R.M., M.Sc.(N),

Head of the department Community Health Nursing, Madha College of Nursing, Kundrathur,

Chennai – 600 069, TamilNadu.

Medical Guide :________________________________

DR. SUNDAR,M.B.B.S Medical officer

Primary health centre Somangalam

Dissertation Submitted To

THE TAMIL NADU DR. M.G.R. MEDICAL UNIVERSITY CHENNAI

MASTER OF SCIENCE IN NURSING APRIL 2012.

03.02.2011

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ACKNOWLEDGEMENT

“I owe my success to the god almighty who showered his and necessary will power, strength, courage and health throughout this endeavor”.

My heartful thanks to Founder Dr. S.Peter, Chairman, Madha Group of Academic Institutions for his support and providing the required facilities for the successful completion of the study.

I express my deep gratitude and immense thanks to Prof. Mrs. B.Tamilarasi, R.N., R.M., M.Sc, (N)., M.Phil, Ph.D., Principal, Madha College of Nursing, Chennai, for her constant supervision, advice and guidance from the early stage of this research as well as giving me extraordinary experience throughout the work. She provided me unflinching encouragement and support in various ways.

I offer my earnest gratitude to Prof. Mrs. Grace Samuel, R.N., R.M., M.Sc (N).,Vice principal, Madha College of Nursing for her constant guidance from the early stage of this research and giving me encouragement and support in various ways.

I am privileged to express my sincere thanks to Mrs. Ebigoldamary, R.N., R.M., M.Sc, (N), Head of the Department, Community Health Nursing, Madha College of Nursing, for guiding and correcting various document of mine with attention and care and she also worked as a root of tree in every step of my project and guided me to bring out the fruitful result and her unending words of encouragement.

I am privileged to express my sincere gratitude to Mrs. Kalaiyarasi, R.N., R.M., M.Sc. (N), Lecturer, Department of Community Health Nursing, Madha College of Nursing for her constant guidance, motivation, support throughout the study.

I wish my sincere thanks to Mrs. Vadhana., R.N., R.M., M.Sc., (N), Department of Medical Surgical Nursing, class Co-ordinator for her encouragement and guidance. I wish to extent my sincere thanks to all the faculty of Madha college of Nursing.

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I feel pleasure to extend my gratitude and sincere thanks to Prof. Lakshmi, R.N., R.M., M.Sc., (N), Principal, Chettinad College of Nursing and Mrs.

Sasikala, R.N.,R.M., M.Sc., (N) Asst. Prof, Sri Ramachandra Medical College of Nursing, for validating my content and also forsss giving me valuable suggestions to improve my study.

I extend my thanks to the Librarian, Madha College of Nursing for their co- operation and their help with assistance in obtaining the literature.

I am thankful to the President .Mrs. Sathyamurthy, Kundrathur to grant me permission to do my project work. My thanks to all Married Women who have participated in the research work.

I also express my thanks to Mr. Tamizhrasan,B.A and Ms. Sheelapriya, B.C.A for their help and untiring patience in printing the manuscript and completing the dissertation work.

I extent my thanks to Mr. Thirukumaran B.Sc., studios for sparing his time for editing my video clipping into a effective manner.

I am proud to acknowledge the support, encouragment and prayers of my dear parents Mr. and Mrs. M. Subramanian and my beloved sister Mrs. S.

Shyamala , FNA, and my dear brother Mr. S. Vinoth, B.E. Csc, Mr. Madhan, Mr. Ajith.

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LIST OF TABLES

TABLE

No. TITLE PAGE No.

1. Frequency and percentage distribution of demographic variables on knowledge regarding prevention of cancer cervix among married women.

28

2. Frequency and percentage distribution of pre test level of knowledge regarding prevention of cancer cervix among married women.

36

3. Frequency and percentage distribution of post test level of knowledge regarding prevention of cancer cervix among married women.

38

4. Frequency and percentage distribution of pre test and post test level of knowledge regarding prevention of cancer cervix among married women.

40

5. Comparison of mean and standard deviation between pre and

post test level of knowledge regarding prevention of cancer cervix among married women.

42

6. Association of pre test level of knowledge regarding prevention of cancer cervix among married women with their demographic variables.

43

7.

Association of post test level of knowledge regarding prevention of cancer cervix among married women with their demographic variables.

45

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LIST OF FIGURES

FIGURE No TITLE PAGE No

1 Conceptual framework. 24

2 Research design. 30

3 Percentage distribution of age among married women 34 4 Percentage distribution of occupational status among

married women. 35

5 Percentage distribution of educational status among

married women. 36

6 Percentage distribution of family income per month

among married women. 37

7 Percentage distribution of religion among married

women. 38

8 Percentage distribution of sources of health

information among married women. 39

9 Percentage distribution of pre test level of knowledge regarding prevention of cancer cervix among married women.

41

10 Percentage distribution of post test level of knowledge regarding prevention of cancer cervix among married women.

43

11 Percentage distribution of pre test and post test level of knowledge regarding prevention of cancer cervix among married women.

45

12 Comparison of mean score between pre and post test level of knowledge regarding prevention of cancer cervix among married women.

47

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LIST OF APPENDICES

APPENDIX TITLE PAGE No.

A Instrument i

B Consent letters xvii

C. Permission letters xix

D Certificate for content validity xx

E Certificate for editing xxi

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ABSTRACT

Cancer is the abnormal growth of cells of the body. Cervical cancer is the abnormal growth of cells in the cervix. Women has live longer with their health and their health has a grater impact on themselves and everyone around them, including their children, parents, and relatives around them.

The study was conducted to assess the effectiveness of information education communication package on knowledge regarding prevention of cancer cervix among married women in Natham area, at Kundrathur, Chennai. The hypothesis stated was there is no significant relationship between the information education communication package and knowledge regarding prevention of cancer cervix.

Extensive review of literature facilitates the investigator to collect the relevant information of facts to support the study. The conceptual frame work used for the study was precede proceed model given by Dr.Lawrence and colleagues.

The study was conducted by adopting a pre-experimental one group pre test post test design. It was carried out with 50 samples who fulfilled the inclusion criteria.

Purposive sampling technique was used to select the samples A structured questionnaire was distributed to the sample, to assess the pre test level of knowledge on prevention of cancer cervix among married women. The questionnaire was explained in detail to the samples, after 30 minutes the questionnaire was collected.

Information education communication package was given. Then after three days the post test level of knowledge was assessed by using the same questionnaire.

The analysis revealed that the mean deviation was increased from 12.32 in pretest to 24.38 in post test and there was decrease in standard deviation from 2.91 to 1.86 and thus indicates the effectiveness of information education communication package.

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INTRODUCTION

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CHAPTER-I

INTRODUCTION

“Prevention is better than cure”

A common phrase which indicates an ounce of prevention is worth a pound of care. Prevention of cancer is defined as active measure to decrease the risk of cancer.

Health is the level of functional or metabolic efficiency of a living being.

The maintainance and promotion of health is achieved through different combination of physical, mental, and social wellbeing. The India’s current population is 1.21 billion, among them 586.5 million, were women. Women tend to live longer, their health has a greater impact on themselves and everyone around them, including their children, parents, everyone else for whom they provide care.

Women’s health was affected by number of factors which results in diseases.

Sexually active women were considered to be the risk factors of cervical cancer, which is usually common among married women and multiple sexual partners.

Cervical cancer is most often diagnosed in middle age women, with half of those diagnosed between the ages of 35 and 55. Cervical cancer was very rarely seen in women less than 20 years of age.

The aim of prevention is to prevent the occurence or minimize the damage from, human problems. The vast majority of cancer risk factors are due to environment including life style factors and many of these factors are controllable.

Thus cancer, is largely considered a preventable disease.

Cancer is uncontrolled growth and spread of cells. It can affect almost any part of the body. The growth often invades surrounding tissue and an metastasize to distant sites. Many cancers can be prevented if detected early, 40% of all cancer deaths can be prevented.

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The incidence of cervical cancer in Delhi, reported that as 26.6 per hundred thousand women of any age group which tops the numbers due to any other women’s cancer. There are a number of risk factors attributed to cervical cancer, they are early age at marriage or early onset of sexual activity, high parity, pregnancies in quick succession, more than one sexual partner, long term use of oral contraceptives malnutrition, poor genital health, individual’s immune status, and smoking or even genetic predisposition. But infection due to high risk human papilloma virus (HPV) types constitute a single most critical virology risk factor in comparison to other socio-economic, demographic or behavioral risk factors .

The development of cervical cancer is usually very slow. It starts as a precancerous condition called dysplasia. This precancerous condition can be detected by a Pap smear and is 100% treatable. That is why it is so important for women to get regular Pap smears. Most women are diagnosed with cervical cancer today have not had regular Pap smears or they have not followed up on abnormal results.

Undetected, precancerous changes can develop into cervical cancer and spread to the bladder, intestines, lungs, and liver. It can take years for precancerous changes to turn into cervical cancer. Patients with cervical cancer do not usually have problems until the cancer is advanced and has spread.

Almost all cervical cancers are caused by HPV (human papilloma virus).

HPV is a common virus that is spread through sexual intercourse. There are many different types of HPV. Some strains lead to cervical cancer. Other strains may cause genital warts, while others do not cause any problems at all.

Cervical cancer is a major problem for Indian women. Nearly 126,000 patients are being diagnosed with the cancer of the uterine cervix with the mortality of 71,000 reported in the year 2000, and it is estimated to reach upto 1,25,000 by 2012.

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India did not take any effort in screening our women in the past 50 years.

The pap test had remained opportunistic laboratory test for invasive carcinoma. As a result, India hardly does quarter of million pap smear tests having nearly 120 million beneficiary women in the age group of 25 to 65.

Cervical cancer is a major cause of death in women around the world.

Cervical cancer is the second most common cancer in women under 45 years. In the UK there are around 2,800 new cases and 1,100 cervical cancer deaths a year.

While in the US there are 10,000 new cases and 3,700 deaths per year. Around the world, every two minutes a women is dying of cervical cancer.

All over the world, over 80 percent of the deaths from cervical cancer occur in the developing world among which sub-Saharan Africa is the worst affected region. In Zambia, cervical cancer strikes almost 63 women in 100,000 which is almost ten times Australia’s rate of 7 per 100,000 women.

In the developed world, potentially dangerous changes in the cervix are usually spotted before cancer emerges which is predominantly attributed to national screening programs. The British system is a good example of a successful screening program. It prevents around 4,500 deaths each year in the UK, by detecting cervical disease when it is still at the easily treatable, pre-cancerous stage. Similar programs in North America, Western Europe and Australia have also seen the number of cervical cancer cases fall dramatically.

In the UK, women are supposed to be called by their General Practitioner and to be screened every three years from the age of 25 onwards, for pap smear tests. Cervical cancer experts warn, however, that in years from the age attendance for cervical smears has fallen. Between 2000 and 2005, the coverage for the screening program among the women between the age group of 25-29 yrs, falls from 77 per cent to 71.6 per cent.

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Smear tests may seem to be straight forward to the health professionals but there is evidence that some women do not know the importance of a smear test, find them embarrassing or even traumatic, and in part this may explain why screening fails to reach everyone who is at risk.

Cervical cancer is most often diagnosed in middle are women with half of those diagnosed between the age group of 35 and 55 yrs. Cervical cancer was very rarely seen in women less then 20 years of age.

Cervical cancer is cancer that starts in the cervix the lower part of the uterus that opens at the top of vagina. Human papilloma virus is the causative organism which will result in cervical cancer. Human papilloma virus can be spread by skin to skin contact and sexual contact. However, physicians believe a women has to infected with HPV before the cervical cancer.

Cervical cancer can be prevented by vaccinating the girls between the age group of 9 and 12yrs with HPV vaccine and also pap smear test. Early detection will lead to earlier treatment with a better positive outcome.

NEED FOR THE STUDY

Cervical cancer kills 1 Indian women for every 7 minutes. Every year cervical cancer is designed in about 500,000 women globally and is responsible for more than 280,000 deaths annually. Pap smear tests have revealed the deaths related to cervical cancer by 3 quarters.

Cervical cancer is a major problem for Indian women. Women are generally infected with HPV in their early teens, twenties or thirties when they first become sexually active. HPV is the most common STD, occurring at some point, in up to 75 percent of sexually active women.

In many women, the interval from becoming infected with the HPV and developing cancer can be from five years to as long as 20 years. So, this is the natural history of cervical cancer development. The vast majority of young women, who become sexually active, frequently become, sexually active, frequently become

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infected with HPV usually without their even knowing it. In over 80 percent of the, the HPV-related changes on the cervix disappear within one to two years.

Dhamiji, conducted a study to assess the knowledge of cervical cancer in the community, in Alipur primary health center, New Delhi, India. Total women interviewed to assess the knowledge towards cervical cancer were 1411. The study brought out that younger women had better awareness and knowledge about cervical cancer and related information. Efforts may be made to innovate ways to reach older and illiterate women at risk of cervical cancer for better awareness in the community.

WHO, stated that inspite of much efforts taken to prevent the occurence of cervical cancer and to treat it at the earliest stages, women still do not participate in the screening programs. Failure in participation may be due to several factors, but an inadequate knowledge and attitude toward screening are thought to be the major factors among women specially in developing countries like India.

A cross sectional study of 250 health care professionals in the state of Morles during 2008, in order to evaluate and quantity their level of knowledge on the impact, etiology, screening, diagnosis treatment of cervical cancer. The result of this study showed that it is necessary to improve educational interventions for health care professionals in improving the knowledge about the cervical cancer.

Cancer pattern and incidence rates for a rural population [3,59,674] resident is 384 villages spread over 2058 kms in Palani and Oddanchathram taluks of Dindugal district, Tamil Nadu, in South India during the period of 1998-2003. In that 783 invasive cancers persons, 310 males and 473 females were registered. In females cervical cancer age standardized incidence rates were 65.4% accounted for more than that of other cancers.

Cancer of cervix is the most common cancer found among the women in India. However, screening by pap smear is considered unsuitable in developing countries like India, where a majority of women are illiterate and poor and the health infrastructure is inadequate. An estimated 13,700 new cases of cervical

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cancer and 4,900 deaths were predicted in the USA in 2008 where as 1,39,000 women are expected to develop carcinoma of India in the year.

The population based cancer registry in Kolkata, the capital city of the state of west Bengal, India for the period of 2008 – 2009 in female the most frequent reported, malignancies were breast and followed by uterine cervix is 17.5% senet (2009). India, one of the developing countries having an inversed incidence of cervical cancer, urgently in needs of to develop future steps for increasing awareness among people regarding the promotive and preventive aspects of cervical cancer.

A new vaccine to prevent cervical cancer is now available. In June 2006, the U.S. Food and Drug Administration approved the vaccine called Gardasil, which prevents infection against the two types of HPV responsible for the majority of cervical cancer cases. The vaccine appears to prevent early-stage cervical cancer and precancerous lesions. Gardasil is the first approved vaccine targeted specifically to prevent any type of cancer.

Practicing safe sex (using condoms) also reduces the risk of HPV and other sexually transmitted diseases. HPV infection causes genital warts. These may be barely visible or several inchs wide. If a woman sees warts on her partner's genitals, she avoid should intercourse with that person.

Regular Pap smears can help detect precancerous changes, which can be treated before they turn into cervical cancer. Pap smears work very well in spotting such changes, but they must be done regularly. Annual pelvic examinations, including a pap smear, should start when a woman becomes sexually active, or by the age of 20 in a nonsexually active women. If abnormal changes are seen, a colposcopy with biopsy should be performed.

Information education communication campaigns on breast, prostrate and oral cancer had raised awareness in communities about the causes and prevention of these diseases.

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This was not the case for cervical cancer for which virtually no information education communication materials or efforts promoted to preventable nature in the vast majority of communities and facilities visited where available, counseling in tertiary facilities for a women was often inadequate or incomplete.

Most community reported familiarity with other forms of cancer, but rarely knew of cervical cancer. Only very few community members and clients who knew someone who had been diagnosed with cervical cancer reported some familiarity with the disease, but also did not know that it was preventable

Recent view is that all women must be considered to be the possible candidate of cervical cancer and should be included in the program of early detection. Once identified as high risk, they can be recommended, for the diagnosis and effective treatment, proper explanation about cervical cancer is essential to remove misconceptions regarding the same.

There is a felt need for educational program regarding cervical cancer which will increase the women’s knowledge of the cervical cancer and its preventive measure.

The investigator conducted a program in order to find knowledge regarding the cancer cervix among rural women. The investigator found that the rural women were having lack of awareness on cancer cervix.

This aroused the interest for the investigator to create awareness among the rural women. Hence, the investigator felt the need to assess the effectiveness of information education communication package on knowledge regarding the prevention of cancer cervix among married women.

STATEMENT OF THE PROBLEM

A study to assess the effectiveness of information education communication package on knowledge regarding prevention of cancer cervix among married women in Natham area, at Kundrathur, Chennai.

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OBJECTIVES

1. To assess the pre test level of knowledge regarding prevention of cancer cervix among married women.

2. To assess the post test level of knowledge regarding prevention of cancer cervix among married women.

3. To determine the effectiveness of information education communication package on knowledge regarding prevention of cancer cervix among married women.

4. To associate the pre test and post test level of knowledge regarding prevention of cancer cervix among married women with their demographic variables.

OPERATIONAL DEFINITIONS

Effectiveness: Refers to a successful outcome of information education communication package on knowledge regarding prevention of cancer cervix.

Information education communication package: Refers to systematically developed instruction in video clips, module and power point presentation is designed to teach prevention on cancer cervix.

Knowledge: Refers to the understanding of married women regarding the cancer cervix, risk factors, signs and symptoms, prevention and management of cancer cervix.

Cancer cervix: Refers to the growth of an abnormal cancer cells in the cervix.

Married women: Refers to the female who got married and within the age group of 20 – 50 years.

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HYPOTHESIS

There is no significant relationship between the information education communication package and the level of knowledge regarding prevention of cancer cervix among married women.

DELIMITATIONS

 The study was delimited to four weeks of data collection.

 The study was delimited to married women.

 The study was delimited to 50 samples.

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CHAPTER – II

REVIEW OF LITERATURE

Review of literature is an essential component of the research process. It is critical examination of a publication related to a topic of interest. Review should be comprehensive and evaluative. Review of literature helps to plan conduct the study in a systematic manner.

Review of literature helps the researcher to build on existing work she should understand what is already known in the topic.

PART – I REVIEW OF RELATED LITERATURE

Cervical cancer is the abnormal growth of cells in Cervix. Human papilloma virus is the Causative organism of cervical cancer in some cases. Cervical cancer was most often diagnosed in middle age women with half of those diagnosed between the ages of 35 and 55. Cervical cancer was very rarely seen in women less than 20 years of age.

Cancer prevention is defined as active measure to decrease the risk of cancer.

The vast majority of cancer risk factor was due to environment including life style factors and many of these factors are controllable. Thus, cancer is largely considered as a preventable disease.

 Literature related to cervical cancer.

PART – II CONCEPTUAL FRAMEWORK

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PART-I

REVIEW OF RELATED LITERATURE

Cervical cancer is one of the most prevalent forms of carcinoma affecting women worldwide It accounts for 12% of all cancers and global data have revealed an estimated 466,000 new cases of the disease annually. The age-standardised mortality rate of cervical cancer in developing countries is 9.6 per 100,000 women, which is twice the rate in developed countries. The disparity in prevalence between the developing and developed worlds can be attributed in part to lack of effective cytological screening programmes.

Cytological screening (the Papanicolaou smear or Pap smear) has been one of the most successful public health measures available for cancer prevention.

Cervical cancer screening is widely available in developed countries and in most cases lesions are detected at the pre-cancer or early cancerous stage. Benefits of cervical cancer screening programmes in developed countries have been well documented. For instance, Denmark recorded a 25% decline in mortality following 40% coverage. In Norway, a 5% coverage achieved a 10% fall in mortality.

However, deaths from cervical cancer are still high in Nigeria and there is also a low level of awareness about cervical cancer and screening for cervical abnormalities.

Causal role of infection with high risk Human Papilloma Virus (HPV) strains in cervical cancer has been targeted in the past two decades. A number of Primary and Secondary preventive approaches have been developed to prevent and treat infection with HPV. High income countries have successfully reduced the cervical cancer burden by over 70 percent using one such approach of organized cytological based pap smears.

A number of preventive strategies are currently being practiced in developed countries including use of two novel prophylactic vaccines and a number of secondary preventive strategies. Most of these interventions are currently not feasible in low income countries because of the already limited health care infrastructure. At the same time it is imperative that our health care professionals are

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aware of these advances and especially of those interventions which can be utilized in low-resource settings.

Despite the active role which health care professionals have to play in preventing and educating about cervical cancer, to our knowledge no such study has been conducted which explores the current awareness about cervical cancer. In this study we aim to access the current knowledge amongst interns and nursing staff about cervical cancer and its prevention. The findings from this study will be useful at the policy level to complement knowledge and awareness about this important public health issue.

Literature related to cervical cancer

Yasmeen. J, clurieshi MA. et, al., (2010) conducted a study to assess the community based screening of cervical cancer in a low prevalence area. The study was conducted in India among 270 married muslim women between the age of 20 -65 years. The results suggested that the majority were married after 19 years of age. There was no evidence of cervical dysplasia or cancer cervix among the screened population is due to absence of promiscuity and male circumcision was noticed in the low prevalence area among muslim women’s.

Paavonen. J (2010) stated that Human Papilloma Virus (HPV) infections cause high disease burden. Primary prevention is by vaccination, HPV vaccines are well tolerated and safe. Vaccines protect unexposed individuals against high grade Carcinoma in Situ and also provide protection against oncogenic HPV types. The target population is young adolescents before their sexual activity and catching up vaccination policy up to the age of twenty six years may facilitate long term health benefits but should not drive resources from vaccinating the primary target population or effective cervical cancer screening programme.

Syed faizenali et,al., (2010) conducted a study to assess the knowledge and awareness on cervical cancer and its prevention in tertiary hospitals. The study was conducted in Pakistan among 400 staff nurse. Interview schedule was used to collect the data. The results suggested that 41% knows that cervical cancer is sexually

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transmitted disease, 1.8% did not know that cervical cancer is a disease and 57.2%

were aware of the cervical cancer, pap smear test and its prevention.

Fait Issan et. al., (2010) conducted a study to assess the knowledge and awareness on signs and symptoms of cervical cancer. The study was conducted in Europe among 170 married women. Semi – structured interview was used to collect the data. The results showed that 65% of women had poor knowledge and awareness regarding cervical cancer and 25% of women had moderate knowledge and awareness regarding cervical cancer and 10% of women had adequate knowledge and awareness regarding cervical cancer.

Hakim (2009) stated that nearly 5,00,000 new cases of cervical cancer and 2,74,000 deaths are occurring worldwide for every year. Each 5 year delay in vaccinating women against Human papilloma virus (HPV) may lead to 1.5 to 2 million women with cervical cancers. Vaccines protections against HPV-16, HPV- 18 and HPV-52, suggests that uneven higher percentage of cervical cancer might be prevented 70% of news of cervical cancers. Hpv-31, HPV-33, HPV-18 and HPV-52 suggests that uneven higher percentage of cervical cancer might be prevented with its use. He concludes that the co-operation between governments, International health organizations and vaccines industry is needed to overcome the barrier and worldwide HPV vaccination and cervical cancer screening should be made an international priority.

J. Paasonen & Harper (2008) stated that HPV vaccination of pre-pubesent girls will be effective for many girls. Vaccinating girls and women older than 12 yrs of age may accelerate the reductions in cervical cancer rates. HPV vaccines are effective for at least 5 years in the prevention of HPV 16 and 18 associated precancerous lesions. Vaccination alone will not aliminate cervical cancer.

Malvi. S et.al., (2009) conducted a study to assess the Human papilloma virus screening program for cervical cancer in India. The study was conducted among rural woman between age group of 30 to 59 years. 52 clusters of village with a total of 1, 31, 776 healthy woman were taken as samples. The result concluded

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that 127 women were affected with Human papilloma virus resulted in cervical cancer.

Spacy et al., (2009) conducted a study to assess the women’s social conditions and their participants in cervical cancer population screening program by giving personal invitation. The study was conducted among 1261 women in Poland between the age group of 25 to 59 years. The results showed 75.2% of the women were participated from urban areas and 24.8% of the women were participate from the rural areas, with regard to the education 28% of the high educated women undergo screening mainly in the private institutions and 60% from the low educated group were not attending the screening program and only 12% of the women were attendee the screening program. The result concluded that the personnel invitation for pap smear examination constitute an ineffective method of increasing the participation. The effectiveness of cervical cancer prophylaxis depends on medical education and information campaigns.

Kwak et al., (2009) conducted a study to assess the stages of adoption of cervical cancer screening program. The study was conducted in Korea among 1224 women within the age group of 30-60 years by adopting transtheoretical model of behavioural change based on cervical cancer screening. The results showed that 57% of the women from the higher income group, married, living in rural areas, exercised regularly were attended the screening program and 43% from the low income group, not exercised regularly were not attended the screening program. The results concluded that age, income status, regular exercise, were significantly associated with the stages of adopting the screening program.

William C et al., (2009) conducted a study to assess the oral contraceptive use and risk of invasive cervical cancer. The study was conducted in Colombia among women. A case control study of 759 invasive cervical cancer patients and 1430 women in control group. The results concluded that there was 40% significant risk in oral contraceptives, 29% significant risk in HPV infection, 20% risk smoking and 11% non – significant elevation in risk.

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A.M.Simons et al., (2009) conducted a study to demonstrate the smoking related DNA damage in cervical epithelium and correlation with HPV type16. The study was conducted in London among women by collecting exfoliated cervical cells. The results showed that 87% of smokers had HPV16 Positive and 13% of smokers had HPV16 negative.

Bietskepy et al., (2009) conducted a study to assess the knowledge on pap smear test among adolescents girls. The study was conducted in Texas among 338 adolescent girls. The results suggested that 62% of girls had inadequate knowledge on pap smear test and 38% of girls had adequate knowledge on pap smear test. The study concluded that the girls need to improve knowledge on pap smear test.

Sait . K et. al., (2009) conducted a study to assess the attitude, knowledge and practices in relation to cervical cancer and its screening among women in Saudi Arabia. The study was conducted in Saudi Arabia among 600 women. The results revealed that knowledge of HPV as etiological agent for cervical cancer was expressed by 72% and 28% was unknown that HPV in an etiological agent of cervical cancer.

Luciani.S (2009) stated that HPV vaccines is a new tool for accelerating prevention of cancer cervix in developing countries. Cervical cancer is the second most common cancer in women, with four-fifths of the case occurring in developing countries. HPV vaccines which have proven immunogenicity, safety, efficacy, commercially available and along with quality screening have the potential to accelerate reductions in cancer cervix mortality rates and save millions of women’s lives. The cost of HPV vaccines and technologies are a major barrier for their widespread implementation. HPV vaccines, new technologies for effective screening to become more available and affordable, especially to poor communities.

Janeja et al., (2008) conducted a study to assess the knowledge on reproductive health and cancer cervix among reproductive age group women. The sample were selected by purposive sampling method. The study was conducted in Australia among 300 reproductive age group women. The result suggested that 67%

having poor knowledge and 33% of women having adequate knowledge on cervical

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cancer and reproductive health. The study concluded that the women need to improve knowledge on cervical cancer and reproductive health.

M.C caffery et al., (2008) conducted a study to assess the attitude on human papilloma virus among school going adolescent girls. The study was conducted in Africa among 50 adolescent girls. The result showed that 70% adolescent girls had anxiety, confusion about human papilloma virus and 30% adolescent girls had the attitude of human papilloma virus. The study concluded that the girls need to have knowledge about human papilloma virus..

Samranuet,al., (2008) conducted a study to assess the knowledge, attitude and practices of cervical cancer prevention in Mulago hospital. The study was conducted in Uganda among 310 medical workers. Self-administered questionnaire was used to collect the data. The results suggested that 40% of medical workers had adequate knowledge, attitude, practices on cervical cancer prevention and 60% of medical workers had inadequate knowledge, attitude, practices related to cervical cancer prevention.

J. Paasonen & Harper (2008) stated that HPV vaccination of pre-pubescent girls will be effective for many girls. Vaccinating girls and women older than 12yrs of age may accelerate the reductions in cervical cancer rates. HPV vaccines are effective for at least 5years in the prevention of HPV 16 and18 associated precancerous lesions. Vaccination alone will not aliminate cervical cancer.

Kim Katherine et al., (2007) conducted a study with the aim of assessing knowledge and practice on menstrual hygiene. The study was conducted in rural schools among 220 adolescent girls. The study showed that 70% of adolescent girls had poor knowledge and 30 % of adolescent girls had adequate on knowledge and practice on menstrual hygiene. The study concluded that the adolescent girls in rural schools need health teaching on menstrual hygiene

Gajalalshmi et al., (2006) conducted a study to assess the knowledge on cervical cancer among reproductive age group women. The study was conducted in Indonesia among 270 reproductive age group women. The results suggested 62% of

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women had poor knowledge on cervical cancer and 38% of women had adequate knowledge on cervical cancer. The results showed that health teaching regarding cervical cancer was essential to improve knowledge on cervical cancer among reproductive age group women.

J.De. Graff et. al., (2005) conducted a study to assess the correlation between cervical cancer and age at marriage. The study was conducted in Netherlands among 100 married women. A case control study was used to collect the data, 50 women as a case with cervical cancer and 50 women were in the control group. The results revealed that the cervical cancer cases were more likely to be married at an early age than the women in the control group.

T.Ramanujam et al., (2005) conducted a study with the aim of assessing knowledge on prevention of cervical cancer. The study was conducted in south India among 180 adolescent’s girls. Interview schedule was used to collect the data. The study showed that 56% adolescent girls had poor knowledge on prevention of cervical cancer and 44% had adequate knowledge on prevention of cervical cancer.

The study concluded that they need to improve knowledge on the prevention of cervical cancer.

Kabir. M. & Iliyasu Z.et.al., (2005) conducted a study to assess the awareness and practice of cervical cancer screening. The study was conducted in Kano among 230 female health workers. The results suggested that 60% of the respondents were able to correctly identify all the important etiological factors associated with cervical cancer and 40% of respondents were not able to identify the etiological factors associated with cervical cancer. The study concluded that the female health workers need to improve their knowledge on the etiological factors of cervical cancer.

J.M.N. Machoki et. al.,(2004) conducted a study to assess the knowledge and attitude in relation to cervical cancer. The study was conducted in Kenya among 262 women. The results revealed that 90% of women had never attended any routine gynecological checkup and had poor knowledge and attitude on cervical cancer and 10% of women had adequate knowledge and attitude on cervical cancer.

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Shuhana et al, (2004) conducted a study with the aim of assessing knowledge and attitude on prevention of cervical cancer. The study was conducted in Taiwan among reproductive age group women. The result suggested that 43% of reproductive age group women had adequate knowledge and attitude 57% of women had poor knowledge and attitude on prevention of cancer cervix. The study concluded that the Taiwan women need to improve their knowledge on prevention of cervical cancer.

Ayinde OA & omigbodun AO, et.al.,(2004) conducted a study to assess the awareness of cervical cancer and pap smear. The study was conducted in university of Ibadan among 421 undergraduates. A self administered questionnaire was used to collect the data. The results showed that among 421 undergraduate students 33.5% were aware of pap smear and cervical cancer and 66.5% had aware of pap smear and cervical cancer. The results showed that undergraduate students need to improve knowledge on pap smear and cervical cancer.

Twinn S & Shiuat, et.al., (2002) conducted a study to assess the women’s knowledge about cervical cancer and cervical screening practice. The study was conducted in Hong Kong university among 467 women. A semi structured interview was used to collect the data. The results showed that among 467 women, 135 women had attended cervical screening and had adequate knowledge on cervical cancer and 332 women not attended cervical screening and had only poor knowledge on cervical cancer.

Rangaswamy sankaranarayanan et, al., (2000) conducted a study to assess the cervical cancer screening awareness in selected rural area. The study was conducted in India among 131,746 women between the age group of 30 to 59 years.

Self structured questionnaire was used to collect the data. The results suggested that 34126 were aware of pap smear testing, 32058 were aware of cytological testing, 34074 were aware of visual inspection of acetic acid, and 31488 were aware of standard care of cervical cancer.

Dickinson & Bannack, et.al.,(1996) conducted a study to assess the knowledge and attitudes regarding cervico-uterine cancer. The study was conducted

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in Spanish among 55 sexually active female health care workers. Questionnaire method was used to collect the data. The results suggested that single or married female doctors under 30, who started their sexual activity after 20 years of age, currently with 3 children or less, and professional experience with utero cervical carcinoma, had a more positive attitude and deeper understanding of this disease and the detection programme.

Bailie R, et.al., (1996) conducted a study to assess the knowledge, attitude and practice on cervical cytology screening among urban married women. The study was conducted in Cape Town among 115 urban married women. Questionnaire method was used to collect the data. The result suggested that 81.3% had poor knowledge, attitude, practices on cervical cytology screening and 18.7% had adequate knowledge, attitude and practice on cervical cytology screening.

Machoki. JH & Rogokao.E,et.al., (1991) conducted a study to assess the knowledge and attitude on cervical cancer among middle aged women. The study was conducted in Kenya among 85 women. Questionnaire method was used to collected data. The results suggested that 90% of women had poor knowledge and attitude on cervical cancer and 10% of women had adequate knowledge on cervical cancer.

Sarita dhamija et, al., (1993) conducted a study to assess the factors associated with awareness and knowledge of cervical cancer. The study was conducted in developing countries among 1411 women. Stratified random sampling technique was used to collect the data. The results suggested that younger women had better awareness and knowledge on cervical cancer than the older women. The literate women had better knowledge on factors associated with cervical cancer and awareness than illiterate women.

Peters RK et.al., (1989) conducted a study to identify the barriers to screening for cancer cervix. The study was conducted in Los Angeles among 200 patients with invasive squamous cell carcinoma and 200 women were selected as control group. The results showed that the cases reports that negative barrier as age and positive barrier of oral contraceptives use, the control group reports that positive

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barrier as years of living in US, both case and control group reports that negative barrier as failure to understand the importance and screening nature of cervical smears and expressed fears of embarassment, positive barriers as urogenital infection and no. of pregnancies during the last five years.

Brinton LA & Hamman R.F. (1987) conducted a study to assess the sexual and reproductive risk factors for invasive squamous cell carcinoma. A case control study of 418 women with invasive squamous cell carcinoma and 704 women were in control group. The results suggested that an infectious etiology was a pronounced effect of multiple sexual partners, have significant threefold excess risk. Multiple sexual births were at significantly increased risk. Contraceptive use of tampons, vaginal deodorants and douching products were not consistently related to risk.

R.W.Harris et, al., (1986) conducted a study to assess the concentration of retinol and beta carotene in serum. The study was conducted in United Kingdom among 113 samples as control group and 113 samples with cervical cancer. The results suggested that among 113 cervical cancer women 32 are with invasive cervical cancer and 81 with pre invasive cancer compared with control group113 women, there is little difference in serum retinol level and the mean beta carotene levels were significantly reduced with women with pre invasive disease compared with control groups.

The above literature showed that the occurrence, prevalence and mortality rate of cancer cervix was very high and there was a lack of awareness regarding prevention of cancer cervix. Regular screening and information education communication package will improve the level of knowledge towards early detection and prevention of cancer cervix. The co-operation between governments, International health organizations and vaccines industry is needed to overcome the barrier and worldwide HPV vaccination and cervical cancer screening should be made an international priority.

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PART - II

CONCEPTUAL FRAMEWORK

One of the important purposes of conceptual framework is to communicate clearly the interrelationship of various concepts. It guides an investigator to know what data needs to be collected and gives directions to the entire research process.

The investigator selected conceptual frame work for this study was based upon the precede proceed model. The precede proceed model was given by Dr.Lawrence Green and Colleagues at Berkeley, Johns Hopkins, the U.S. Public Health Service, the university of Texas in 1980 presented the model as a guide to the health education process.

Precede – Stands for predisposing, reinforcing and enabling cause in educational diagnosis and evaluation.

Proceed – Part of the model supports the health education programme planning that includes policy regulation and organizational construction in education and environment development. The precede proceed model has nine phase:

Precede phases includes

Phase I – Social diagnosis

Phase II – Epidemiological diagnosis

Phase III – Behavioral and environmental diagnosis Phase IV – Educational diagnosis

Phase V – Administrative and policy diagnosis Proceed phase includes

Phase VI – Implementation phase Phase VII -- Process phase

Phase VIII – Impact phase Phase IX – Outcome phase

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PRECEDE PHASE

Phase I - Social diagnosis: which addresses the collection and analyses of objective and subjective data related to the target population. This includes the assets and needs, assets refers mapping the community problem that is lake of awareness regarding prevention of cancer cervix. Need refers to create awareness through information, education, communication package.

Phase II – Epidemiological diagnosis: which address the importance of the target population of the particular area. The epidemiological diagnosis may be obtained from the vital indicators. This includes the incidence and prevalence rate of occurrences of cervical cancer in Tamil Nadu especially in rural area.

Phase III – Behavioural and environmental diagnosis: Behavioural factors are the behaviors of the individual at risk that contribute to the occurrence and severity of the problem. Behavioural factors refer to the lack of self awareness regarding prevention of cancer cervix among married women.

Environmental factors include physical factors, biological factors, social factors. Biological factors includes early marriage, using oral contraceptive pills.

Phase IV – Educational diagnosis: Plan for teaching on prevention of cancer cervix, by considering the following factors that consists of predisposing factors, enabling factors and reinforcing factor.

Predisposing factor – the researcher found that lack of knowledge regarding prevention of cancer cervix among married women.

Enabling factor – are the antecedents to behavior that enable a motivation to realize the promotion of knowledge through Information education communication package.

Reinforcing factor – are the subsequent behavior that provide the community behavior change thus by getting the option or feedback and creating awareness among the public.

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Phase V – Administrative & policy diagnosis: Last phase of the precede phase includes strategy to whom the teaching should be given this involves establishing coordination among married women.

Phase VI- VII – Implementation and process phase: Information education communication package on prevention of cancer cervix among married women to improve awareness regarding prevention of cancer cervix.

Phase VIII – Impact Phase: Assessing the outcome of information education communication package by evaluating the post test level of knowledge.

Phase IX – Outcome Phase: Knowledge gained regarding prevention of cancer cervix which enables the married women to promote health.

Thus the precede proceed model facilitates the appropriate strategy to address the environment and epidemiological influences in plan for teaching. Hence the investigator felt the need to educate the married women regarding the prevention of cancer cervix and thus creating awareness.

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PHASE - V ADMINISTRATIV

E &POLICY RELIGULATION Health education Plan for teaching Programme on prevention of cancer cervix

Administrative and policy regulation

Age, occupation, family income, education,Religion,

sources of health information.

P O S T T E S T P

R E T E S T

Knowledge gained on prevention of cancer cervix.

Moderate and inadequate knowledge on prevention of cancer cervix

Book let

PHASE – VI, VII IMPLEMENTATION

&

PROCESS PHASE IEC package

PHASE - VIII IMPACT PHASE Behavioural & lifestyle

change

PHASE –IX OUTCOME PHASE Knowledge improved

Fig.1 MODIFIED DR.LAWRENCE PRECEDE PROCEED MODEL (1980) PRECEDE

Predisposing factor Lack of knowledge

Enabling factor

IEC on prevention of cancer cervix

Reinforcing factor Feedback opinion from married women

Behavioural & Lifestyle Self awareness created among

married women

Environmental diagnosis Promotion of safe

practices

PROCEED

PHASE – IV EDUCATIONAL&

ORGANISATIOAL DIAGNOSIS Poor knowledge on cancer cervix

PHASE – III BEHAVIOURAL &

ENVIRONMENTAL DIAGNOSIS Early marriage, Oral Contraceptive Pills use

PHASE – II EPIDEMIOLOGICAL

DIAGNOSIS Incidence, prevalence rate of cancer cervix is high in rural area.

PHASE – I SOCIAL DIAGNOSIS

Mapping the community problem – Lack of awareness on prevention cancer cervix.

24

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CHAPTER-III

RESEARCH METHODOLOGY

Research methodology involves systematic procedures with the researcher start initial identification of the problem to its final conclusion. For every piece of research work, the methodology of investigation is of vital importance. The success of any research depends largely upon the suitability of the tools and techniques that the researcher follows to gather adequate data. Research methodology involves systematic procedures which the research starts from initial identification of the problem of its final conclusion. The role of methodology consists of procedures and techniques for conducting a study.

This chapter deals with a brief description of the methodology adopted by the researcher. It includes research design, setting of the study, population, sample, sample size, sample technique, criteria for sample selection, description of the instruments, data collection procedure, data analysis.

RESEARCH DESIGN

The research design used for the study was pre experimental design, one group pre test post test design. This design is used to assess the effectiveness of information education communication package on knowledge regarding prevention of cancer cervix.

SEITING OF THE STUDY

The study was conducted in Natham area, at kundrathur, Chennai. In this area there were about 3150 married women they are getting medical facilities from upgraded primary health centre, Kundrathur.

POPULATION

The population selected for the study was married women who are living in Natham area, at kundrathur, Chennai.

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SAMPLE

The study samples comprises of married women, who fulfilled the inclusion criteria in Natham area, at kundrathur, Chennai.

SAMPLE SIZE

The sample size was 50 married women, within the age group of 20 - 50 years who fulfilled inclusion criteria.

SAMPLING TECHNIQUE

Purposive sampling technique was used to select the sample among the population.

CRITERIA FOR SAMPLE SELECTION Inclusion criteria

 Married women within the age group of 20-50 years.

 Married women who were able to read and write Tamil.

Exclusion criteria

 Married women who were not willing to participate in the study.

 Married women who had previous exposure to education on cancer cervix.

DESCRIPTION OF THE INSTRUMENT

The tool was developed after the literature review and guidance from the experts. The tools for data collection consists of three parts:

PART – I

Demographic variables such as age, occupational status, educational status, family income per month, type of family and sources of health information.

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PART – II

Structured questionnaire was used to assess the level of knowledge on prevention of cancer cervix. Each correct answer was given a score of 1, and the wrong answer was given was score of 0. It can be categorized as

≤50% - Inadequate

51-74% - Moderately adequate

≥75 - Adequate

PART – III

Information education communication package consists of anatomy and physiology of cervix, cancer cervix, risk factors, signs and symptoms, prevention and management of cancer cervix. Information education communication package was given to the married women with the help of audio-visual aids like video clip teaching, power point presentation and book let.

VALIDITY

Validity is the most important methodological criteria for evaluating any measuring instrument. The content validity was obtained from the experts in the field of community health nursing. Appropriate modifications made accordingly and tool was finished.

RELIABILITY

The study was conducted on the effectiveness of information education communication package on knowledge regarding prevention of cancer cervix among married women in Natham area, at Kundrathur, Chennai. Reliability was measured by test - retest method. The correlation coefficient value was found to be 0.9 which represents positive correlation. So the tool was considered highly reliable.

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ETHICAL CONSIDERATION

The study was conducted after the approval of dissertation committee. A formal written permission was obtained from the President of kundrathur. The study purpose was clearly explained to the samples. A formal written consent was obtained from the samples. The usual assurance of the anonymity and confidentiality was obtained.

PILOT STUDY

The pilot study was conducted from 18.04.11 to 24.04.11 in Natham area, Kundrathur. A formal permission was obtained from the president. It was carried out with 5 samples who fulfilled the inclusion criteria. The investigator introduced herself to the married women and explained the purpose of the study to ensure better co-operation. Written consent was obtained from the samples. Purposive sampling technique was used to select the samples.

A structured tool was distributed to the samples, to assess the pre test level of knowledge on prevention of cancer cervix among the married women. The tool was explained in detail to the samples, after 30 minutes the tool was collected.

Information education communication package was given to the samples, after two day the post test level of knowledge was assessed by using the same tool. The collected data were tabulated and statistically analyzed.

DATA COLLECTION PROCEDURE

The investigator was used structured tool to collect the data to assess the level of knowledge regarding prevention of cervical cancer among married women.

A formal written permission was obtained from the president of Natham area, at Kundrathur, Chennai. The data collection period is from 01.06.2011 to 30.06.2011 among married women in kundrathur.

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The study was carried out with 50 samples who fulfilled the inclusion criteria. The investigator was introduced herself to the married women and explain the purpose of the study to ensure better co-operation. Written consent was obtained from the married women. Purposive sampling technique was used to select the sample.

Each day the investigator collected data from 5 samples to assess the knowledge regarding prevention of cancer cervix among the married women. A structured tool was distributed to the samples to assess the pre test level of knowledge regarding prevention of cancer cervix among the married women.

The structured tool was explained in detail to the sample after 30 minutes, the tool was recollected the time taken for each sample to collect the data was 30 minutes. Then information education communication package was given to the married women after three days, post test level of knowledge was assessed by the same structured tool.

DATA ANALYSIS

Demographic variables was computed by using descriptive and inferential statistics. Frequency and percentage distribution was used to determine the demographic variables. Mean and standard deviation was used to assess pre test and post test level of knowledge regarding prevention of cancer cervix among married women. Paired‘t’ test was used to evaluate the effectiveness of information education communication package on knowledge regarding prevention of cancer cervix. Chi-square test was used to associate the level of knowledge regarding prevention of cancer cervix with their demographic variables.

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A study to assess the effectiveness of information education communication package on knowledge regarding prevention of cancer cervix among married women in Natham area, at Kundrathur, Chennai.

Pre experimental one group pre test post test design Research Design

Analysis and Interpretation

Result

Descriptive and inferential statistics

Pretest-Information education communication-

post test Purposive sampling

Demographic variables, structured questionnaire

50 Married women Married women who are

living in Natham area Married women

Sample Size

Sampling Technique

Data collection Procedure Tool for Data Collection

Sample Target Population

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CHAPTER – IV

DATA ANALYSIS AND INTERPRETATION

This chapter deals with the analysis and interpretation of data collected from 50 married women to evaluate the effectiveness of information education and communication package on prevention of cancer cervix at Natham area, in kundrathur, Chennai. Descriptive and inferential statistic was used to analysis data.

As per the objectives of the study the interpretation has been tabulated and organized as follows.

Section A: Frequency and percentage distribution of demographic variables on knowledge regarding prevention of cancer cervix among married women.

Section B: Frequency and percentage distribution of pre test level of knowledge regarding prevention of cancer cervix among married women.

Section C: Frequency and percentage distribution of post test level of knowledge regarding prevention of cancer cervix among married women.

Section D: Frequency and percentage distribution of pre test and post test level of knowledge regarding prevention of cancer cervix among married women.

Section E: Comparison of mean and standard deviation of pre test and post test level of knowledge regarding prevention of cancer cervix among married women.

Section F: Association of pre test level of knowledge regarding prevention of cancer cervix among married women with their demographic variable.

Section G: Association of post test level of knowledge regarding prevention of cancer cervix among married women with their demographic variable.

REGARDING PREVENTION OF CANCER CERVIX AMONG MARRIED WOMEN

EFFECTIVENESS OF INFORMATION EDUCATION COMMUNICATION PACKAGE ON KNOWLEDGE