Improving knowledge, attitudes, and uptake of cervical cancer prevention among female students: A systematic review and meta-analysis of school-based health education

Lack of knowledge about the human papillomavirus vaccine among Brazilian adolescents: A cross-sectional study

To analyze the distribution and factors associated with lack of knowledge about the human papillomavirus (HPV) vaccine among Brazilian adolescents.Cross-sectional study using the 2019 National School Health Survey among 17,805 Brazilian students of public and private schools, aged 13-17 years. The outcome variable was "lack of knowledge about the HPV vaccine" and the explanatory variables were sociodemographic, behaviors, knowledge, and health conditions. Logistic regression model was used to calculate Odds Ratio (OR) and 95% confidence intervals (95%CI). Spatial analysis techniques were used to determine the formation of clusters in the federated units with similar proportions of adolescents who were unaware of the vaccine. The lack of knowledge about the HPV vaccine was reported by 45.54% of Brazilian students. There was a higher chance of lack of knowledge having had sexual intercourse (OR 1.43; 95% CI 1.20-1.70); attending public school (OR 1.72; 95%CI 1.47-2.02) and located in the Northeast Region (OR 1.35; 95%CI 1.08-1.69). The lower chance of lack of knowledge were female gender (OR 0.41; 95% CI 0.35-0.48), higher maternal education (OR 0.62; 95% CI 0.50-0.77) self-rated health as Poor/very poor (OR 0.64; 95% CI 0.49-0.86) and receiving contraceptive counseling (OR 0.77; 95% CI 0.65-0.91). The proportion of lack of knowledge about the HPV vaccine was higher with the formation of High-High spatial clusters in the states of Maranhão, Piauí, and Pernambuco. Sociodemographic, health, and behavioral conditions and knowledge of students, as well as school characteristics, were associated with lack of knowledge about the HPV vaccine. A higher frequency of lack of knowledge about the HPV vaccine among adolescents was found in the states of the Northeastern Region.

EMR-Based Interventions on HPV Vaccination Initiation, Completion, and Receiving the Next Dose: A Meta-Analytic Review

Despite the acknowledged importance of Human Papillomavirus (HPV) vaccination in reducing HPV-related diseases, the influence of electronic medical records (EMR) on HPV vaccination uptake (HVU) remains underexplored. This study aimed to evaluate the efficacy of EMR-based interventions on HVU. A systematic review and meta-analysis of randomized controlled trials were performed, focusing on studies that primarily used EMR-based interventions to measure initiation rates, completion rates, and receipt of the next required vaccine dose. Subgroup analyses were conducted to assess the differential effects of supplementary strategies, provider feedback, and parental education or reminders on these outcomes. The results of the comprehensive analysis provided robust evidence for the significant role of EMR interventions, demonstrating an average increase of 4.7% in vaccine initiation, 6.6% in vaccine completion, and 7.2% in receipt of the next HPV vaccine dose. Additionally, the subgroup analyses indicated that provider feedback and parental education could further enhance the effectiveness of EMR-based interventions. These findings support the broader adoption of digital health technologies in vaccination programs, offering vital insights for healthcare providers, policymakers, and researchers, and emphasizing the need for continued technological innovation to improve public health outcomes.

Enhancing cervical cancer knowledge among women of reproductive age: a dialogue-based community health education intervention in rural Kisumu County, Kenya

BACKGROUND

Cervical cancer is a leading cause of cancer death among women of reproductive age despite being treatable if it is diagnosed early. Early diagnosis is possible through regular screening through the public health system. However, screening rates remain low in many low- and middle-income countries, including Kenya, where the screening rate currently stands at 16-18%. The low screening rates are attributed to, among other factors, low knowledge about cervical cancer and the available screening options among women of reproductive age. The current study evaluated the effectiveness of dialogue-based community health education by trained community health volunteers (CHVs) in improving cervical cancer knowledge among women of reproductive age (WRA) in rural Kisumu County.

METHODS

This was a longitudinal pre- and post-intervention study with a control group. The knowledge of women of reproductive age was assessed at baseline in both the intervention and control groups, followed by dialogue-based community health education in the intervention arm. A final end-line knowledge assessment was performed. The scores at baseline and at the end of the study were compared to assess changes in knowledge due to the intervention. The proportion of WRA with improved knowledge was also calculated, and statistical significance was considered at p ≤ 0.05.

RESULTS

There was no significant difference between the participants in the two arms, except for the level of education (p = 0.002). The knowledge of the WRA in the intervention arm improved significantly (p < 0.001) following the dialogue-based educational intervention by the trained CHVs. None of the demographic characteristics were associated with knowledge.

CONCLUSION

Dialogue-based educational intervention significantly improved the knowledge of the WRA in the intervention arm, showing its potential to address the knowledge gap in the community.

Low uptake of Pap test as a cervical cancer screen among Saudi women: Findings from a national survey

OBJECTIVE

The present study aimed to assess the current knowledge and uptake of Papanicolaou (Pap) tests for cervical screening among Saudi women, including barriers to undergoing the test and the availability of related services.

METHODS

A cross-sectional study was conducted using a health questionnaire administered through the Absher portal between April 1, 2019, and March 31, 2020. The questionnaire consisted of five questions and took less than 5 min to complete. Descriptive and inferential statistics were employed to analyze demographic variables, and chi-square tests were used to examine the association between these variables and Pap test uptake.

RESULTS

The questionnaire included 8194 Saudi women, with the majority from Makkah (24.40%), Riyadh (21.92%), and Eastern (14.44%) regions. Only 22.52% of respondents had ever received a Pap test, and among them, 17.48% did so based on their physician's recommendation. Private clinics accounted for 10.73% of Pap test locations, while public clinics accounted for 8.97%. The primary reasons for not undergoing the test were lack of knowledge regarding its importance (40.24%) and lack of information from physicians (16.96%). Knowledge of the Pap test as a cervical screening method was significantly associated with marital status, Saudi region, and age group.

CONCLUSIONS

This study revealed low awareness of the Pap test for cervical screening among Saudi women, particularly in younger age groups. Targeted educational initiatives are essential to increase awareness and emphasize the significance of regular screenings, especially among younger individuals, to enhance early detection and reduce the burden of cervical cancer in Saudi Arabia.

Prevalence and Correlates of Cervical Cancer Prevention Knowledge Among High School Students in Ghana

INTRODUCTION

Cervical cancer is a preventable yet highly prevalent disease in Africa. Despite female adolescents and young women being a target group for cervical cancer prevention strategies, little research has examined their knowledge of how to prevent the disease. The study aimed to describe: (a) knowledge about cervical cancer prevention and (b) sociodemographic, social, and systemic factors associated with and interacting with knowledge among female senior high school students in Ghana.

METHODS

A cross-sectional survey assessed knowledge about (a) risk factors and (b) primary and secondary prevention of cervical cancer among 2,400 female students from 17 public senior high schools in the Ashanti region, Ghana. Descriptive statistics were used to describe knowledge. Linear mixed-effects regression models were used to examine factors associated with knowledge scores.

RESULTS

Knowledge gaps were observed for at least two-thirds (>65%) of students. Most students (mean age = 17) did not know that early sexual debut (before 18 years) is a risk factor for cervical cancer (72%) and that a blood test cannot detect cervical cancer (71%). Students in later stages of senior high school education and those who received sexual health education from teachers and parents had significantly greater cervical cancer knowledge scores than their counterparts. Interactive effects showed that school-based sexual health education was associated with higher knowledge scores than home-based education among students.

CONCLUSIONS

Most female senior high school students had gaps in knowledge about cervical cancer prevention. Finding new ways to strengthen the capacity of schools and parents to deliver accurate cervical cancer prevention information is warranted.

Knowledge about cervical cancer in young Portuguese women: a cross-sectional study

Introduction

Health literacy is crucial to adherence to medical interventions in therapeutics, prevention, and diagnosis. The basis for literacy is knowledge. To accomplish the goals for the elimination of cervical cancer, one of the most prevalent and preventable cancers, we must understand the determinants of non-adherence and address them specifically to ensure patients' active participation.

Aim

To determine women's knowledge regarding the manifestations of cervical cancer and its prevention.

Materials and methods

We conducted a cross-sectional study in an urban population from northern Portugal. Women aged 18 to 30 years were randomly assigned to answer the Cervical Cancer Awareness Measure questionnaire, including questions of knowledge about the causes and symptoms of cervical cancer, prospecting for individual and social-related determinants.

Results

The total number of participants was 270, with a mean age of 24.7 years. Knowledge about symptoms scored 5.4 ± 2.6, with a maximum of 12 points, and knowledge about the causes scored 5.7 ± 1.9, with a maximum of 11 points. The correlation between both was 0.334. High education, high socio-economic status, self-perception of one's capacity to recognize symptoms, and knowledge about the HPV vaccine were associated with better knowledge.

Discussion

Portuguese women present low knowledge about cervical cancer, potentially affecting their health through exposure to risk situations and non-adherence to routine screening.

Improving cervical cancer continuum of care towards elimination in Ethiopia: a scoping review

BACKGROUND

Cervical cancer is the second-leading cause of death among all cancers in Ethiopia. Ethiopia plans to eliminate cervical cancer as a public health problem by 2030, following the World Health Organization's call for action. A scoping review was conducted on the status of the cervical cancer continuum towards elimination in Ethiopia.

METHODS

We searched articles in PubMed, Scopus, and Google Scholar. All studies conducted on cervical cancer in Ethiopia, from first date of publication to March 15, 2023, type of article, or language of publication, were included. However, conference abstracts, commentaries, and letters to the editors were excluded. We used EndNote X9 software to merge articles from different databases and automatically remove duplicates. Screening of titles, abstracts, and full texts was performed independently by two co-authors. The cancer care continuum was employed as a framework to guide data synthesis and present the findings.

RESULTS

Of the 569 retrieved articles, 159 were included in the review. They found that most of the articles focused on knowledge, attitude, and practice. However, there were few studies on health-seeking behavior, perception and acceptability of cervical cancer services, as well as the availability and readiness of a screening program. The review identified inadequate knowledge, attitude, and perception about cervical cancer, and highlighted that screening for cervical cancer is not widely utilized in Ethiopia. Knowledge, attitude, education status, and income were repeatedly reported as precursors influencing cervical cancer screening. Most studies concluded that there is a high prevalence of precancerous lesions and cervical cancer, as well as high mortality rates or short survival times. The review also identified significant heterogeneity in findings across time and geographic settings within each component of the cancer care continuum.

CONCLUSIONS

Overall, there is inadequate knowledge, perception, health-seeking behavior, screening, and treatment services, indicating that the country is falling behind its targets in eliminating cervical cancer, despite the availability of effective interventions and tools. We argue that implementation research is necessary to identify implementation issues, challenges, and strategies to scale up both primary and secondary prevention services. By doing so, Ethiopia can address cervical cancer as a public health problem and work towards its elimination.

Cognition of the warning symptoms and risk factors for cancer among Chinese college students: a cross-sectional study based on a summer social practice activity

BACKGROUND

To investigate the cognition of cancer warning symptoms and cancer risk factors among Chinese college students, analyze the influencing factors, and explain the correlations between cancer cognition and cancer symptom discrimination, cancer fear and psychological distress.

METHODS

Chinese college students were recruited in this cross-sectional study funded by a summer social practice activity in Yunnan Province, China. Cognition rates of cancer warning symptoms and cancer risk factors were evaluated using Cancer Warning symptoms Cognition Questionnaire (CWSCQ) and Cancer Risk Factors Cognition Questionnaire (CRFCQ), respectively. Factors associated with cognition of cancer warning symptoms, and factors associated with cognition of cancer risk factors were evaluated using multiple linear regression analysis. Interactions between cancer cognition, cancer symptom discrimination, psychological distress, and cancer fear were evaluated by structural equation modeling.

RESULTS

There were 846 effective samples, with an effective rate of 80.9%. The cognition rates of cancer warning symptoms were from 47.9% to 84.4%, which were affected by cancer symptom discrimination, education, attitudes towards cancer screening, living expenses, drinking history, and ways to obtain cancer knowledge (p < 0.05). The cognition rates of cancer risk factors were from 46.3% to 91.3% in participants, which were affected by education, cancer symptom discrimination, psychological distress, attitudes towards cancer screening, life satisfaction, cancer history in relatives and friends, ways to obtain cancer knowledge, smoking history, and nursing history for cancer patients (p < 0.05). Cancer cognition and cancer symptom discrimination showed intermediary effects on psychological distress and cancer fear (p < 0.001).

CONCLUSIONS

The overall cancer cognition situation among Chinese college students is not optimistic, which highlights the necessity of improving the cancer health literacy among Chinese college students. With the increasing morbidity and mortality rates of cancer, it is necessary to raise awareness of early detection, and early treatment of cancer among the general public. Health education interventions are helpful to improve cancer health literacy.

Preference For Cervical Cancer Education: A Multisite Cross-Sectional Survey of Female Senior High School Students in Ghana

Cervical cancer incidence continues to rise in Ghana. To enhance knowledge and prevention of cervical cancer among young people in Ghana, there is a need to better understand their education preferences. The study aimed to describe female senior school students' preferences for receiving cervical cancer education. A cross-sectional survey of students from 17 schools in the Ashanti Region of Ghana assessed the strength of preference for receiving cervical cancer education from a range of sources, settings and delivery mediums. Of the 2400 participants (aged 16-24 years), the majority endorsed doctors (87%, 95%CI: 85-88%), nurses (80%, 95%CI: 78-82%) and credible health organisations (78%, 95%CI%: 76-79%) as their preferred source of education, and hospitals 83% (95%CI: 81-84%) as the preferred setting. Nearly all students (92%) endorsed at least three cervical cancer education delivery mediums, with at least three quarters endorsing television (78%, 95%CI: 77-80%), one-on-one health consultation in-person or online (77%, 95%CI: 75-79%; 75%, 95%CI: 73-77%), and health information websites (75%, 95%CI: 73-77%). Findings suggest that cervical cancer education efforts among female senior school students in Ghana should consider the use of a range of more resource-intensive individualised approaches to low-cost anonymous, generic approaches from credible sources and institutions.

Systematic review and meta-analysis comparing educational and reminder digital interventions for promoting HPV vaccination uptake

Global Human papillomavirus (HPV) vaccination rates remain low despite available WHO-approved vaccines. Digital interventions for promoting vaccination uptake offer a scalable and accessible solution to this issue. Here we report a systematic review and meta-analysis examining the efficacy of digital interventions, comparing educational and reminder approaches, for promoting HPV vaccination uptake (HVU). This study also identifies factors influencing the effectiveness of these interventions. We searched PubMed, PsycInfo, Web of Science, and the Cochrane Library from each database's inception to January 2023. Three raters independently evaluate the studies using a systematic and blinded method for resolving disagreements. From 1929 references, 34 unique studies (281,280 unique participants) have sufficient data. Client reminder (OR, 1.41; 95% CI, 1.23-1.63; P < 0.001), provider reminder (OR, 1.39; 95% CI, 1.11-1.75; P = 0.005), provider education (OR, 1.18; 95% CI, 1.05-1.34; P = 0.007), and client education plus reminder interventions (OR, 1.29; 95% CI, 1.04-1.59; P = 0.007) increase HVU, whereas client education interventions do not (OR, 1.08; 95% CI, 0.92-1.28; P = 0.35). Digital intervention effectiveness varies based on participants' gender and the digital platform used. Interventions targeting male or mixed-gender participants demonstrate greater benefit, and reminder platforms (SMS, preference reminders, or electronic health record alerts) are more effective in increasing HVU. Digital interventions, particularly client and provider reminders, along with provider education, prove significantly more effective than client education alone. Incorporating digital interventions into healthcare systems can effectively promote HPV vaccination uptake. Reminder interventions should be prioritized for promoting HVU.

A favorable impression of vaccination leads to a better vaccination rate for the human papillomavirus vaccine: A Japanese questionnaire survey investigation

Background

The Japanese vaccination rate for infants and children is seemingly excellent, except for the human papillomavirus (HPV) vaccine. Regardless of its efficacy, the inoculation rate in Japan has dropped to approximately 1 % since 2013 because of negative information about vaccine side effects. We aimed to demonstrate the factors that lead to low vaccine acceptance rates (e.g., caregiver attitudes, popular misconceptions) to inform the relevant target demographic of a stronger intention to immunize and to facilitate recovery of HPV vaccine coverage.

Methods

We conducted this study using data from two questionnaire surveys. Statistical analyses of factors affecting vaccine impressions and mediation effects of HPV vaccine impressions were performed. The difference in the knowledge about each vaccine was evaluated.

Results

Of the respondents, 95.9 % reported their intent to vaccinate their infants, whereas 58.2-78.3 % felt that they sufficiently understood the aims, efficacy, and risks of vaccination and 66.6 % had a positive impression of vaccines. Overall, 21.3 % of parents responded that they planned to have their child vaccinated against HPV, and 25.8 % had a favorable impression of this vaccine. Among factors affecting vaccine impressions, we found that parents had anxiety about vaccines when they felt that their knowledge of vaccines was insufficient. Additionally, impressions of the HPV vaccine had a mediating effect on the association between the impressions of infant vaccines and parents' intent to provide the vaccine to their children.

Conclusion

These findings show that as a society, we need to improve impressions and knowledge regarding vaccines, including but not exclusively the HPV vaccine. Moreover, although the recovery of HPV vaccine coverage is strongly desired for improving public health, simply improving impressions about the HPV vaccine or educating parents with substantive knowledge is insufficient. Instead, improving impressions and understanding of the vaccination itself is necessary.