Awareness of Pap testing and factors associated with intent to undergo Pap testing by level of sexual experience in unmarried university students in Korea: results from an online survey

Understanding of Cervical Screening Adoption among Female University Students Based on the Precaution Adoption Process Model and Health-Belief Model

This study aimed to identify the decisional stages for cervical screening and corresponding cognitive factors in female university students. A cross-sectional study was conducted among Korean female university students aged 20-29 years through an online survey. The main outcome was the decisional stage of cervical screening adoption using the precaution adoption process model. The stages were classified into pre-adoption (the unawareness, unengaged, and undecided stages), adoption (the decided to act and acting stages), and refusal (the decided not to act stage). The cognitive factors in each stage were analyzed using the key concepts of the health-belief model. Cervical screening was defined as a clinical Papanicolaou (Pap) smear performed by a physician in a clinic. The final analysis included 1024 students. Approximately 89.0%, 1.0%, and 10.2% were classified as the pre-adoption, refusal, and adoption stages, respectively. Compared to the pre-adoption stage group, the adoption stage group was more likely to be older and have higher self-efficacy and knowledge. Most participants belonged to the pre-adoption stage-those unaware of cervical screening. Furthermore, most had a low level of knowledge and perception of cervical cancer and its screening. Therefore, our study highlighted the need for education to increase awareness and knowledge of cervical screening in this population.

Association of Late Marriage and Low Childbirth with Cervical Cancer Screening among Korean Women: Results from a Nationwide Survey

Simple Summary

Marriage and childbirth may affect adherence to cervical cancer screening. We have examined whether marriage and childbirth were associated with the adherence to cervical cancer screening among young adult women in Korea. Among 3925 women aged 20–39 years, 39.1% undertook cervical cancer screening within two years of eligibility. Compared with unmarried women, married women were more likely to adhere cervical cancer screening (adjusted odds ratio = 2.80, 95% CI: 2.99–3.44). And, as the number of births in married women increased, the adherence to cervical cancer screening increased.

Abstract

This study aimed to identify the association of marriage and childbirth with the adherence to cervical cancer screening among young adult women. Data across four years (2017–2020) of the cross-sectional Korean National Cancer Screening Survey were used. For measuring the adherence to cervical cancer screening, we used the cervical cancer screening rate with recommendation, which was defined as the percentage of women in the population eligible for screening who have had a cervical cancer screening within the past two years. Multiple logistic regression analysis was conducted to identify the association between marriage and adherence to cervical cancer screening. Overall, 3925 women aged 20–39 years were analyzed. Of these, 39.1% were screened for cervical cancer (26.6% unmarried and 57.1% married women). The married women had significantly higher adherence to cervical cancer screening than unmarried women (adjusted odds ratio = 2.80, 95% CI: 2.99–3.44). Compared with unmarried women, adherence to cervical cancer screening was significantly more likely to increase (p for trend, <0.001) in married women with an increased number of births. Our study confirmed that marriage and childbirth influence adherence to cervical cancer screening, suggesting that unmarried women may be vulnerable to cervical cancer.

Barriers and strategies for cervical cancer screening: What do female university students know and want?

OBJECTIVE

This study aimed to identify the distinct barriers and knowledge level of cervical cancer screening among female university students and establish intervention strategies to overcome these barriers.

METHODS

This study used a mixed-methods design with 26 female university students aged 20-29 years. We first conducted a quantitative online survey for the same study participants, divided them into three groups, and conducted focus group interviews (FGIs). Group A: participants who had sexual experience and had undergone cervical cancer screening; Group B: participants who had sexual experience and had not undergone cervical cancer screening; Group C: participants who did not have sexual experience and had not undergone cervical cancer screening.

RESULTS

The participants' ages were 21.92 ± 1.26 years. The knowledge levels for cervical cancer and screening were low to moderate. The four main themes that emerged as barriers to cervical cancer screening through the FGIs were: 1) socio-cultural barrier: conservative social perception of unmarried women's sexual life, 2) knowledge barrier: lack of knowledge and information, 3) psychological barrier: discomfort, and 4) practical barrier: time-consuming. The three themes identified for strategies were: 1) socio-cultural intervention: changing social perceptions and ensuring confidentiality, 2) educational intervention: improvement of knowledge and accessibility, and 3) alternative screening intervention: comfortable screening methods.

CONCLUSIONS

While university students' sexual experience rapidly increased, the socio-cultural perceptions of sexual health remained closed, and they had a reasonably low level of knowledge about cervical cancer screening. Therefore, various strategies sensitive to female university students' culture should be implemented to increase the knowledge level, and social efforts should be made to change the socio-cultural perception of unmarried young women's sexual health.

The effect of physical activity and depressive mood on menopausal symptoms in postmenopausal women

AIMS

The symptoms of menopause in postmenopausal women adversely affect the quality of life. Menopausal symptoms are more severe with comorbid disorders such as depression; it may be lighter in physically active people. The present study aimed to evaluate the relationship between menopausal symptoms and physical activity and depressive mood.

MATERIAL AND METHOD

One hundred and ninety women under 65 years of age who were at least 1 year passed since their last menstrual period participated in the study. Sociodemographic data form, Menopause Symptom Rating Scale, International Physical Activity Questionnaire-Short Form and Beck's Depression Inventory were applied to the participants.

RESULTS

It was seen that 51.6% (98 subjects) of the women who participated in the study had severe menopausal symptoms. 52.6% (100 subjects) of the participants were physically inactive, and their menopausal symptoms increased as the physical activity scale score decreased (P = .001). Menopausal symptoms increased as the Beck's Depression Inventory score increased (P < .001). It was observed that depression inventory scores decreased as the level of physical activity increased (P < .001).

CONCLUSION

Adoption of regular physical activity habits by postmenopausal women and providing treatment to those with depression will contribute to alleviating the severity of menopausal symptoms.

Knowledge and intentions regarding the Pap smear test among Saudi Arabian women

Background

The knowledge of Pap smear and uptake of preventive behaviors to prevent cervical cancer are the most important contributors to the advanced stage of the disease. Knowledge is one of the most leading factors to predict the health behaviors and a helpful factor in performing screening procedures. This study aimed to investigate Saudi Arabian women knowledge of Pap testing in relation to their intention to undergo the test.

Methods

An online survey including demographic characteristics (3 questions), knowledge (13 questions), and intentions (3 questions) towards Pap smear was completed by 467 Saudi Arabian women. Data were analyzed through SPSS version 22, using descriptive statistics and correlation to measure the relationship between knowledge, demographic factors, and intention.

Results

The study found that average level of knowledge was 1.3 which is between high and moderate knowledge, and the average score for the intention was 2.88, to indicate that the intentions to uptake Pap smear among the participants were above the average. The study revealed a significant correlation between demographic factors and intention (p<0.01).

Conclusion

Findings from the current study can inform health care providers about Saudi Arabian women knowledge of Pap smear and the intention to uptake the test. Strategies to motivate women to undergo Pap screening should be introduced.

Sexually transmitted infections and cervical cancer: Knowledge and prevention awareness among female university students in Japan

Aim

To examine the possible association among knowledge regarding cervical cancer, its relationship with STIs and prevention awareness of STIs of female aged 20 years or older who were recommended regular screening for cervical cancer.

Design

A cross-sectional study using anonymous self-administered questionnaires.

Method

The subjects were 3rd- and 4th-year female university students. The association among knowledge about cervical cancer, cervical cancer screening behaviours and sexually transmitted diseases prevention behaviour awareness scale on university students (STDASUS) scores were examined using the Mann-Whitney U test and the chi-squared test. The data collection period was June-August, 2018.

Results

Two hundred sixty-one questionnaires were analysed as valid responses. The study indicated a possible association between understanding that cervical cancer occurs due to a viral infection and that the virus is spread through sexual intercourse and awareness of STI prevention behaviours. Appropriate education concerning the characteristics of cervical cancer, its correlation with STIs and the importance of the screening is essential.

Peer Support as an Ideal Solution for Racial/Ethnic Disparities in Colorectal Cancer Screening: Evidence from a Systematic Review and Meta-analysis

BACKGROUND

Low implementation of colorectal cancer screening in ethnic minorities is the main reason for racial and ethnic disparities in colorectal cancer morbidity and mortality. Peer support is widely used for promoting health care in ethnic minorities. However, whether it improves their acceptance to undergo the screening remains controversial.

OBJECTIVE

We performed a meta-analysis of the currently available studies to further explore its effectiveness.

DATA SOURCES

This meta-analysis was undertaken using PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO for randomized controlled trials.

STUDY SELECTION

We included studies that compared peer support interventions among ethnic minorities versus other interventions to promote uptake of colorectal cancer screening.

RESULTS

Thirteen studies comprising 8090 participants met the eligibility criteria. Peer support intervention can increase colorectal cancer screening implementation and raise awareness and intention to undergo the screening in ethnic minorities more significantly than fecal occult blood test outreach, print, and usual care. Subgroup analysis showed that peer support intervention achieved great results in Asian Americans and intervention of peer counseling.

LIMITATIONS

The results of subgroup analysis had substantial heterogeneity, which may decrease the precision of our estimates.

CONCLUSIONS

Peer support can significantly improve the awareness about and the intention for receiving colorectal cancer screening in ethnic minorities and is an ideal choice for promoting the screening among ethnic minorities, particularly in a diverse community. Peer support intervention is recommended to promote the implementation of screening in Asian Americans. Peer counseling is worth promoting; however, church-based peer counseling programs require enhanced management to maintain their fidelity.

Effects of cervical cancer prevention education in middle-school girls in Korea: A mixed-method study

PURPOSE

The aim of this study was to determine the effects of cervical cancer prevention education (CCPE) among Korean middle-school girls in terms of whether it provided them with a positive perception of the Papanicolaou test (Pap test) and encouraged them to undergo Pap testing in adulthood.

METHODS

A mixed-method design was used to only one group of 15 people, which combined a one-group pretest-posttest design with a qualitative study and a focus group interview (FGI). The CCPE was provided to 15 girls, after which they participated in the FGI. The changes between pretest and posttest were analyzed using the Wilcoxon signed-rank test. The findings of the FGI were analyzed using content analysis.

RESULTS

After being provided CCPE, the girls showed a significant increase in their awareness of the importance of cervical cancer prevention (Z = -3.10, p = 0.002), but there were no significant changes in the perceived importance of their body, their emotional response to the Pap test, their confidence in cervical cancer prevention, or their intention to undergo Pap testing. In the FGI, the girls expressed negative emotions about the Pap test and were aware of the necessity of CCPE.

CONCLUSION

This is the first study to develop CCPE focused on the Pap test targeting Korean middle-school girls. We found that the CCPE was partially effective, in terms of increasing their awareness of the importance of cervical cancer prevention.

Preditores motivacionais de adesão à prevenção do câncer do colo do útero em estudantes universitárias

Resumo Este estudo analisou o papel das variáveis motivacionais na adesão à prevenção do câncer do colo do útero. Participaram da pesquisa 399 estudantes universitárias que responderam a um questionário em que avaliaram fatores de adesão à prevenção do câncer, incluindo variáveis sociodemográficas, nível de conhecimento sobre o câncer e variáveis motivacionais. Os resultados mostraram que as variáveis motivacionais explicam de 34% a 54% da variância (p < 0,001) da intenção de adesão aos comportamentos de prevenção (exames de Papanicolau, uso de preservativo e restrição do número de parceiros sexuais) e são também um preditor significativo do envolvimento efetivo nesses comportamentos (odds ratios: 0,33 – 5,83; p < 0,05). O estudo evidencia a importância de considerar quer as variáveis motivacionais facilitadoras (autoeficácia e construção da intenção de adesão), quer as debilitantes (custos emocionais) no planejamento e avaliação de intervenções de educação para a saúde, com vistas a maximizar a adesão à prevenção do câncer do colo do útero.

Factors associated with cervical cancer screening among young unmarried Japanese women: results from an internet-based survey

BACKGROUND

The prevalence of cervical cancer among women aged 20-30 years has been increasing. A better understanding of the factors correlated with cervical cancer screening is vital to better identify suitable candidates and develop effective interventions. However, few studies have examined factors correlated with cervical cancer screening using a quantitative research design. Thus, this study aimed to assess the prevalence of and factors correlated with cervical cancer screening among unmarried and sexually active Japanese women aged 20-29 years.

METHODS

Seven hundred Japanese women who responded to an internet-based cross-sectional survey conducted by a marketing research company in 2015 were enrolled. Associations between lifetime cervical cancer screening and demographic profile, sexual behavior, and psychosocial factors were assessed via univariate analysis. Variables indicating significance (P < 0.05) were used in the univariate analysis to determine adjusted odds ratios (AOR).

RESULTS

Overall, 383 (54.7%) respondents underwent cervical cancer screening during their lifetime. Multiple regression analysis indicated that age, employment status, income, lifetime number of sex partners, human papillomavirus (HPV) vaccination, receipt of a free coupon for cervical cancer screening from the local government, perceived susceptibility and logistical barriers (cost/time), and confidence of receiving Pap testing from a male physician were significantly correlated with lifetime cervical cancer screening. Individuals aged 28-29 years (AOR = 1.86) and those with full-time employment (AOR = 3.30), income ≥ ¥ 4,000,000($35,000) (AOR = 1.60), > 5 lifetime sex partners (AOR = 1.97), HPV vaccination (AOR = 4.88), coupon from the local government (AOR = 3.14), higher perceived level of cervical cancer susceptibility (middle, AOR = 1.77; high, AOR = 3.23), lower perceived logistical barriers (middle, AOR = 0.55; high, AOR = 0.31), and higher confidence of receiving pap testing from a male physician (AOR = 2.66) were more likely to undergo cervical cancer screening.

CONCLUSIONS

Women who were younger and unemployed and those with lower perceived cervical cancer susceptibility, higher perceived logistical barriers, and lower confidence of receiving Pap testing from a male physician were less likely to undergo lifetime cervical cancer screening. Thus, to increase the cervical cancer screening rate among young women, it may be effective to target younger unemployed women, provide interventions to increase perceived susceptibility, and recommend tests while considering psychosocial barriers.

Factors influencing behavioral intention to undergo Papanicolaou testing in early adulthood: Comparison of Japanese and Korean women

In this study, we identified the factors influencing behavioral intention to undergo Papanicolaou testing among Japanese and Korean women in early adulthood. Their behavioral intentions were compared in this cross-sectional descriptive study. In total, 887 women (Japanese = 498, Korean = 389) aged 20-39 years participated in this study. Using a self-report questionnaire, knowledge, attitudes, subjective norm, perceived behavioral control, and behavioral intention were surveyed. There were significant differences between Japanese and Korean women's scores on all main variables. For Japanese women, all the variables moderately correlated with behavioral intention. In comparison, for Korean women, all independent variables, except for knowledge, moderately correlated with behavioral intention. Through a multiple regression analysis, age, undergoing Papanicolaou testing, attitudes, subjective norm, and perceived behavioral control were identified as significant predictors of behavioral intention among Japanese women. Among Korean women, job status, undergoing a Papanicolaou test, attitudes, subjective norm, and perceived behavioral control were demonstrated as significant predictors of behavioral intention. Health professionals should consider these factors to encourage Papanicolaou testing in women in early adulthood.

The health beliefs of mothers about preventing cervical cancer and their intention to recommend the Pap test to their daughters: a cross-sectional survey

BACKGROUND

Mothers have a primary role in the prevention of cervical cancer in Korea. This study aimed to determine the awareness and health beliefs of mothers about preventing cervical cancer in their daughters, their intention to recommend the Pap test to their daughters, and the factors influencing this intention.

METHODS

A cross-sectional survey design was employed, and the study enrolled mothers (n = 1,581) of pubescent girls aged 13 to 18 years who were living nationwide in Korea. The six health-beliefs variables related to preventing cervical cancer in their daughters, awareness of the importance of cervical cancer prevention methods, and the intention to recommend the Pap test to daughters were investigated. The impacts of these health beliefs of the mothers and the sociodemographic factors influencing their intention to recommend the Pap test to their daughters were assessed using multiple logistic regression analysis.

RESULTS

Almost one-quarter (23.7 %) of the mothers had talked about the Pap test, 69.2 % were intending to recommend the Pap test to their daughters, and 38.5 % considered that the Pap test could be necessary if their daughters became sexually active. The significant health beliefs influencing the intention to recommend the Pap test were the perceived barriers [odds ratio (OR) = 1.47, 95 % confidence interval (95 % CI) = 1.03-2.11] and benefits (OR = 2.25, 95 % CI = 1.55-3.25). The significant sociodemographic factors of mothers were their education (OR = 1.52, 95 % CI = 1.08-2.13), their experience of talking about the Pap test with their daughters (OR = 2.11, 95 % CI = 1.23-3.64), their regularity of undergoing the Pap test themselves (OR = 1.98, 95 % CI = 1.30-3.03), and their age when they first underwent the Pap test (OR = 1.60, 95 % CI = 1.43-0.82).

CONCLUSIONS

The mothers perceived HPV vaccination as the most important of the five methods for preventing cervical cancer in their daughters. Mothers perceived the importance of their daughters undergoing the Pap test regardless of the presence of HPV vaccination, and most of the mothers had an intention of recommending the Pap test to their daughters. Strategies for increasing the intention of mothers to recommend the Pap test to their adolescent daughters could be promoted by increasing their perceptions of the benefits while reducing their perceptions of barriers toward their daughters undergoing the Pap test, and by empowering active communication about the Pap test between mothers and daughters.

Awareness of cervical cancer prevention among mothers of adolescent daughters in Korea: qualitative research

OBJECTIVES

Korean adolescent girls are unprepared for cervical cancer prevention due to the lack of a mandatory policy regarding human papilloma virus (HPV) vaccination and school health education regarding cervical cancer. The aim of this study was to determine how aware mothers are about cervical cancer prevention in their adolescent daughters, with a view to developing strategies for expanding primary cervical cancer prevention for adolescent girls through the mothers' involvement.

DESIGN

A qualitative design was employed. Nine mothers with adolescent daughters participated in this study and were interviewed using open-ended questions. The themes were extracted by content analysis.

SETTING

A general living area in Seoul, South Korea.

PARTICIPANTS

The snowball method was used to select mothers.

RESULTS

Five themes emerged. In general, the mothers' awareness of cervical cancer was not clear, and they exhibited a lack of awareness of the importance of having a regular Papanicolaou screening test. The mothers recognised that they were role models for their daughters, and realised and accepted the necessity of educating their daughters regarding cervical cancer; however, they perceived barriers related to the prevention of cervical cancer in their daughters. The mothers recommended enforcing sex education in schools and the provision of financial support for HPV vaccination.

CONCLUSIONS

The mothers' awareness and preparedness with respect to the prevention of cervical cancer in their adolescent daughters were low and inadequate. Mothers should be informed and motivated to play a role in the education of their daughters regarding cervical cancer prevention. Strategies for disseminating information regarding early cervical cancer prevention for adolescent girls are recommended by communicating with both the girls and their mothers and providing them with education regarding cervical cancer prevention.

Influencing Factors of Intention of Undergoing Pap Testing among Unmarried Nurses

PURPOSE

This study was to assess the intention of undergoing Pap testing and to identify influencing factors of HPV knowledge and their attitude related to Pap test by sexual activity among unmarried nurses.

METHODS

A cross sectional survey design was employed, utilizing a self-administered questionnaire amongst 343 unmarried nurses. Descriptive statistics was utilized to analyze data and inferential statistics used an independent-t test and chi2 test for the differences in measurement variables, and odds ratios for factors on intention of Pap testing by sexual activity.

RESULTS

Nurses not sexually active were significantly higher in intention of Pap testing (chi2=40.15, p<.001) and influencing factors of HPV knowledge (t=3.93, p=.048) than did nurses who were sexually active. Factors influencing intention were regularity of the breast self-examination (Adjusted Odds Ratio [AOR]=4.20, 95% Confidence Interval [CI]=1.93~9.17), HPV knowledge (AOR=2.49, 95% CI=1.36~4.56), and attitudes toward the Pap test(AOR=2.33, 95% CI=1.25~4.34) amongst nurses who never had sexual experience.

CONCLUSION

It is necessary to minimize negative attitudes of Pap testing and to increase HPV knowledge in order to improve intention of Pap testing for women who were not sexually active. More focus would be given to sexually active women to get Pap tested as a preventive measure for cervical cancer.