Cervical Cancer prevention among women in Vlora city:

the influence of fear-related to possible positive outcomes

1*Fatjona Kamberi RN, MSN, PhD Candidate,²Gjergji Theodhosi,²Vjollca Ndreu ,²Enkeleda Sinaj

1Yllka Bilushi, ³Leonard Kamberi

Authors:

1*Department of Public Health, Faculty of Public Health, University ‘Ismail Qemali’ Vlora, Albania

2Faculty of Technical Medical Sciences, Tirana, Albania3Vlora Regional Hospital

Cervical cancer is a largely preventable disease, but worldwide it is one of the leading causes of cancer death in women.

New cases: Cervical cancer ; the fourth most commonly diagnosed cancer in women with an estimated of 527,600 new cases worldwide.

Deaths: Cervical cancer ; the fourth leading cause of cancer death in women worldwide in 2012, with an estimated 265,700 deaths. Nearly 90% of cervical cancer deaths occurred in developing parts of the world.

Global trends: The large geographic variation in cervical cancer rates reflects differences in both the availability of screening, which can detect and allow for the removal of precancerous lesions, and HPV infection prevalence.

In several Western countries, where screening programs have long been established, cervical cancer rates have decreased by as much as 65%. ( ACS, 2015)

Cervical Cancer facts

Problem statement

Cervical cancer, in Albania ranks as the 3rd most frequent cancer among women between 15 and 44 years old.

Refer to International Association Cancer Researchthe incidence and mortality from cervical cancerin Albania, there wererespectively 2.7% and 1.7%. (IARC, 2012)

Cancer diseases in general in Albania are an increasing problem.

Problem statement

The current cervical cancer screening programsand practices in Albania are, however casual or nonexistence. (Poljak at al., 2013)

Even if well-prepared plans and strategieshave been established for switching to organizedscreening in the near future. (Maver at al., 2013)

In the absence of the National Cervical Screening Programcervical cancer is diagnosed in the last stage, therefore incurable with high prevalence in deaths,although the fact that it may detect early. (NCCP 2011, p. 30)

The studyThe objective of this study is :

“ To analyze the influence of fear and anxiety

related to outcome and Pap test uptake”

Method and samplesType of study: Cross–sectional

The sample study: 313 healthy (without a presents of illness, randomly selected) women, with different socio-economic and educational background, who worked to several institutions and private enterprises in Vlora city between January-July in 2015. •The inclusion criteria :Women in the target age group (25-65 years) old without history of hysterectomy.•The exclusion criteria :Women outside the target age group (25-65) years old.

Data collection instrument:self-administered questionnaire adopted in base of

theoretical,conceptual framework Health Belief Model,reference to survey

instrument,the Cervical CAM of Cancer Research UK (2011).

Method and samples

1 •Perceived susceptibility or personal risk

2 •Perceived severity

3 •Perceived benefits

4 •Perceived barriers•(represent beliefs about the material

and psychological costs of taking action)

5 •Cues to action and self-efficacy

Health Belief Model*

*”the most commonly used theory in health education, promotion and screening”. (National Cancer Institute [NCI], 2005; “Theory at a Glance”,2005).

Variables included in the questionnaire

•Socio-Demographic characteristics

•Fear and anxiety related to outcome stratified by socio-demographics

•Can you speak freely about cancer stratified by socio-demographics

•I will be very frightened, if I reveal to have cancer

•Pap test uptake

•Feelings of anxiety & Pap test uptake

Studies based on Health Belief Model

• Fear and financial problems were frequently addressed in previous studies.(Ersin F et al.,2013)

Anxiety and fear were associated with decreased likelihood of having participated

in cervical screening and positively associated with screening barriers. ( Hill EM ,Gick ML 2013)

Screening barriers were elevated among individuals with insecure attachment stylespreoccupied, fearful; and insecure participants were less likely to have engaged in screening compared to secure participants.( Hill EM ,Gick ML 2013)

•Single/divorced/widowed status and women with no children are more vulnerable to cancer screening adherence.(Visanuyothin S et al.,2015)

ResultsFig.1 .Socio-Demographic characteristics, n=313•Age (years) : Mean= 39.17, SD±10.33

Elementary school

High school University degree

Full time Part time Married

Level of Education Employment status Marital status

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

14.33%

30.78%

54.78%

77.28%

22.72%

79.55%

Elementary school

High school University degree

Full time Part time Married0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

71.11%67.37%

73.26%

63.72%

27.64%

80.69%

Fig.2. Fear and anxiety related to outcome stratified by socio-demographic characteristics , p≥0.05

Fig.3. Can you speak freely about cancer stratified by demographic characteristics

0%

10%

20%

30%

40%

50%

60%

70%

80% 60.00%68.29% 65.07% 65.93% 78.26%

62.90%

80.00%

* Odds ratio = 2.5; **=1;***=0.39° Odds ratio = 0.49; °°=0.48

▪ Odds ratio = 0.79; ▪▪=1.22

Yes No0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

87.22%

12.78%

I will be very scared if I reveal to have cancer

ResultsFig.4. I will be very frightened, if I reveal to have cancer

ResultsFig.5. Pap test uptake

Yes No0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

40.26%

59.74%

Results

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

33.33% 37.19% 39.94%

66.67% 62.81%60.66%

Pap test uptake yes Pap test uptake no

Fig.6.Feelings of anxiety & Pap test uptake

*p-value =0.0007

Conclusion & Recommendation

The barrier of fear- related to possible positive outcomes was present in all

women. Part of the perceived barriers identified were statistically significant.

These perceived barriers (as cited in previously studied using the Health

Belief Model) influenced attendance rates at cervical cancer screenings globally.

 Analysis of the qualitative data revealed several psychological barriers to cervical

cancer screening.

The results of the study

suggests that:

The Recognition of general and individual barriers of fear factors and anxiety to cervical screening by health professionals in clinical

practice will increase women’s access to, and acceptance of cervical screening among

women in Vlora city .

Thank you for your attention!