Assessment of women`s knowledge regarding infectious risk factors

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(59-64)
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OF
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PUBLIC
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59
Assessment of women’s knowledge regarding
infectious risk factors for cervical cancer
(Ocena wiedzy kobiet na temat infekcyjnych czynników
ryzyka raka szyjki macicy)
M Sulima 1,A,D, M Lewicka1,F, K Wiktor 2,E, G Bakalczuk 1,B, H Wiktor 1,C
Abstract - Introduction. Literature on the subject provides that
5 Polish women die every day as a result of cervical cancer.
Purpose of the study. Assessment of women’s knowledge regarding infectious risk factors for cervical cancer.
Materials and methods. 200 women formed the study group –
they came from the cities of Lublin and Radom and from the
village of Jabłonna. The study was conducted using the diagnostic survey method with the authors’ own survey questionnaire made especially for this study.
Results. A statistically significant relationship has been found
between the studied women’s knowledge about HPV as a risk
factor for cervical cancer and age (p=0.007), civil status
(p=0.002), education (p=0.02) as well as the form of professional activity (p=0.00001). A statistically significant relationship has been found between the respondents’ knowledge
about genital herpes as a risk factor for cervical cancer and age
(p=0.02), civil status (p=0.001), place of residence (p=0.004)
and the form of professional activity (p=0.00005). However,
no statistically significant relationship has been found between
the respondents’ knowledge about the human immunodeficiency virus (HIV) as a risk factor for cervical cancer and age
(p=0.17) or education (p=0.13).
Conclusions. Women do not possess a suitable knowledge
regarding the infectious risk factors for cervical cancer. Women over 40 years of age, married women, the ones with elementary and vocational education as well as inhabitants of villages
should be offered a special educational programme because
they have the least knowledge concerning the infectious risk
factors for cervical cancer.
kwestionariusza ankiety własnego autorstwa opracowanego dla
potrzeb niniejszej pracy.
Wyniki. Stwierdzono istotną statystycznie zależność pomiędzy wiedzą badanych kobiet na temat HPV, jako czynnika
ryzyka raka szyjki macicy a wiekiem (p=0,007), stanem cywilnym (p=0,002), wykształceniem (p=0,02) oraz formą aktywności zawodowej (p=0,00001). Stwierdzono istotną statystycznie
zależność pomiędzy wiedzą badanych kobiet na temat
opryszczki płciowej, jako czynnika ryzyka raka szyjki macicy a
wiekiem (p=0,02), stanem cywilnym (p=0,001), miejscem
zamieszkania (p=0,004) oraz formą aktywności zawodowej
(p=0,00005). Nie stwierdzono natomiast statystycznie istotnej
zależności pomiędzy wiedzą badanych kobiet na temat wirus
upośledzenia ludzkiej odporności (HIV), jako czynnika ryzyka
raka szyjki macicy a wiekiem (p=0,17) oraz wykształceniem
(p=0,13).
Wnioski. Kobiety nie posiadają odpowiedniego zakresu wiedzy odnośnie infekcyjnych czynników ryzyka raka szyjki macicy. Kobiety: po 40 roku życia, mężatki, posiadające wykształcenie podstawowe lub zawodowe, mieszkanki wsi powinny być objęte szczególnymi działaniami edukacyjnymi z
powodu posiadania najmniejszego zakresu wiedzy odnośnie
infekcyjnych czynników ryzyka raka szyjki macicy.
Key words - cancer, cervix, human paillomavirus, genital herpes virus, human immunodeficiency virus.
1. Department of Obstetrics, Gynaecology and Obstetrical Gynaecological Nursing Faculty of Nursing and Health
Sciences, Medical University, Lublin.
2. Department of Gynaecology and Gynaecological Endocrinology Faculty of Nursing and Health Sciences, Medical
University, Lublin
Streszczenie – Wprowadzenie. Literatura przedmiotu podaje,
że z powodu raka szyjki macicy umiera dziennie 5 polskich
kobiet.
Cel pracy. Ocena wiedzy kobiet na temat infekcyjnych czynników raka szyjki macicy.
Materiał i metoda. Badaniami objęto 200 kobiet pochodzących
z Lublina i Radomia oraz wsi Jabłonna. Badania przeprowadzono metodą sondażu diagnostycznego z zastosowaniem
Słowa kluczowe - rak, szyjka macicy, wirus brodawczaka
ludzkiego, wirus opryszczki płciowej, wirus upośledzenia
ludzkiej odporności.
Author Affiliations:
Authors’ contributions to the article:
A. The idea and the planning of the study
B. Gathering and listing data
C. The data analysis and interpretation
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D. Writing the article
E. Critical review of the article
F. Final approval of the article
Correspondence to:
Magdalena Sulima MD, PhD Department of Obstetrics, Gynecology and Obstetrical - Gynecological Nursing, Faculty of
Nursing and Health Sciences, Medical University, Chodźki 6
Str., PL-20-093 Lublin, Poland, e-mail: [email protected]
Accepted for publication: March 6, 2015.
I.
INTRODUCTION
n Poland, cancer of the female reproductive organs is
a serious problem of both medical and social nature.
Cervical cancer is the second most frequent, after
breast cancer, malignant neoplasm affecting the female
genitals [1,2]. Every day, 5 Polish women die of cervical
cancer. Cervical cancer morbidity and mortality rates in
Poland are among the highest in Europe mainly due to
the inconsiderable participation of women in periodic
medical examinations and late diagnosis at an advanced
stage of the disease [3,4].
Viral infections are the main aetiopathogenetic factor
for cervical factor. The human papillomavirus (HPV),
especially types 16, 18 and 45, is the main aetiological
factor of over 70% of squamous cell cervical cancer cases and 90% of cervical adenocarcinoma cases [5-7].
Herpes simplex virus type II is also a risk factor for cervical cancer. Moreover, a relationship has been found
between infection with the human immunodeficiency
virus (HIV) and the development of cervical dysplasia
[8,9].
An appropriate level of knowledge among women regarding the infectious risk factors for cervical cancer as
well as regular prophylactic examinations are the essential factors reducing the risk of developing this type of
cancer [10-13].
The purpose of the study was to evaluate the women’s
knowledge regarding the infectious factors for cervical
cancer.
I
II.
MATERIALS AND METHODS
200 women coming from the cities of Lublin and Radom as well as from the village of Jabłonna were examined. The study was conducted using the diagnostic survey method with the authors’ own survey questionnaire
made especially for this study. Participation in the study
was of a voluntary and anonymous nature.
60
The results obtained were subjected to statistical analysis. The risk of inference error was adopted at 5% and
the value of p<0.05 was considered statistically significant.
The respondents’ age ranged from 20 to 66. Within
the study group, 92 women (46.0%) were aged 20-30, 22
(11.0%) were aged 31-40, 57 (28.50%) were aged 4150, 21 (10.50%) from 51 to 60 and 8 (4.0%) were over
60 years of age.
In the study group, 108 women (54.0%) had obtained
higher education, 65 (32.50%) secondary education, 19
(9.50%) vocational education, whereas 8 women (4.0%)
had elementary education.
53 women (26.50%) lived in the capital of the province, 94 (47.0%) respondents lived in the district capital
and 53 women (26.50%) lived in the countryside.
Among the women studied, 92 (46%) were married, 82
(41.0%) were single, 18 (9.0%) were divorced and 8
(4.0%) were widowed. Professionally active were 97
women (48.50%), 14 (7.0%) remained unemployed, 24
respondents (12.0%) were pensioners and 65 (32.50%)
were students.
III.
RESULTS
Table 1 presents the correlation between the
knowledge of the women examined about the human
papillomavirus as a risk factor for cervical cancer and
the socio-demographic factors.
The highest percentage of respondents aware of the
fact that the human papillomavirus is a risk factor for
cervical cancer was formed by women aged 20-30 years
(n=49, 53.26%), single women (n=47, 57.32%), women
with higher education diplomas (n=47, 43.52%), inhabitants of the voivevodship capital (n=27, 50.94%) and
students (n=44, 67.69%).
In turn, the highest percentage of respondents who did
not know that the human papillomavirus was a risk factor for cervical cancer was formed by women aged 4150 years (n=38, 66.67%), married women (n=61,
66.30%), women with vocational education (n=13,
68.42%), inhabitants of villages (n=33, 59.66%) and
pensioners (n=16, 66.67%).
A statistically significant relationship has been found
between the respondents’ knowledge regarding HPV as a
risk
factor
for
cervical
cancer
and
age (p=0.007), civil status (p=0.002), education (p=0.02)
and the form of professional activity (p=0.00001).
Nevertheless, no statistically significant relationship
has been found between the respondents’ knowledge
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factor for cervical cancer and the place of residence
(p=0.02), civil status (p=0.0003) and the form of professional activity (p=0.02).
However, no statistically significant relationship has
been found between the respondents’ knowledge regarding the human immunodeficiency virus (HIV) as a risk
factor for cervical cancer and age (p=0.17) or education
(p=0.13).
Over 60
years
Total
Civil status
Single
Married
Divorced
Widowed
92
100%
8
5
9
22
36.36%
22.73%
40.91%
100%
15
4
38
57
26.32%
7.02%
66.67%
100%
5
3
13
21
23.81%
14.29%
61.90%
100%
3
0
5
8
37.50%
0.00%
62.50%
100%
80 (40.00%)
47
18
(9.00%)
7
102
(51.00%)
28
200
(100.00%)
82
57.32%
8.54%
34.15%
100%
20
11
61
92
21.74%
11.96%
66.30%
100%
9
0
9
18
50.00%
0.00%
50.00%
100%
4
0
4
8
50.00%
0.00%
50.00%
100%
80 (40.00%)
18
(9.00%)
102
(51.00%)
200
(100.00%)
Total
Education
Elementary
Vocational
Secondary
Higher
0
3
5
8
0.00%
37.50%
62.50%
100%
5
1
13
19
26.32%
5.26%
68.42%
100%
28
3
34
65
43.08%
4.62%
52.31%
100%
47
11
50
108
43.52%
10.19%
46.30%
100%
80 (40.00%)
18
(9.00%)
102
(51.00%)
200
(100.00%)
Place of residence
Total
Province
capital
District
capital
Countryside
27
7
19
53
50.94%
13.21%
35.85%
100%
36
8
50
94
38.30%
8.51%
53.19%
100%
17
3
33
53
29.96%
10.38%
59.66%
100%
80 (40.00%)
18
(9.00%)
102
(51.00%)
200
(100.00%)
Total
Employed
Unemployed
Pensioner
Student
Total
26
10
61
97
26.80%
0.31%
62.89%
100%
5
0
9
14
35.71%
0.00%
64.29%
100%
5
3
16
24
20.83%
12.50%
66.67%
100%
44
5
16
65
67.69%
7.69%
24.62%
100%
80 (40.00%)
18
(9.00%)
102
(51.00%)
200
(100.00%)
Chi2=21.01
p=0.007
51-60 years
37
40.22%
Chi2=26.52
p=0.002
41-50 years
6
6.52%
Chi2=15.48
p=0.02
Age
31-40 years
49
53.26%
Chi2=8.00
p=0.09
20-30 years
HPV as a risk factor for the development of
cervical cancer
I don’t
Yes
No
Total
know
n %
n%
n%
n%
Chi2=34.05
p=0.00001
Socio-demographic
factors
Statistical
analysis
Table 1. Correlation between the respondents’ knowledge
about the human papillomavirus as a risk factor for cervical
cancer and the socio-demographic factors
Form of professional activity
about HPV as a risk factor for cervical cancer and their
place of residence (p=0.09).
Table 2 presents the correlation between the
knowledge of the women surveyed regarding the genital
herpes virus as a risk factor for cervical cancer and the
socio-demographic factors.
The highest percentage of respondents aware of the
fact that the genital herpes virus is a risk factor for cervical cancer were women aged 20-30 (n=33, 35.87%),
divorcées (n=7, 38.88%), women with elementary education (n=3, 37.50%), dwellers of the province capital
(n=20, 37.74%), and students (n=30, 46.15%).
In turn, the highest percentage of respondents who did
not know that the genital herpes virus was a risk factor
for cervical cancer were women aged 41-50 years (n=38,
66.67%), married women (n=60, 65.22%), women with
vocational education (n=12, 63.16%), unemployed
women (n=11, 78.57%), and inhabitants of the countryside (n=33, 62.26%).
The study has shown a statistically significant relationship between the respondents’ knowledge regarding
the genital herpes virus as a risk factor for cervical cancer and age (p=0.02), civil status (p=0.001), place of
residence (p=0.004) and the form of professional activity
(p=0.00005).
However, no statistically significant relationship has
been found between the knowledge of the women surveyed concerning the genital herpes virus as a risk factor
for cervical cancer and their education (p=0.63).
Table 3 presents the correlation between the respondents’ knowledge regarding the human immunodeficiency
virus (HIV) as a risk factor for cervical cancer and the
socio-demographic factors.
The highest percentage of respondents aware of the
fact that the human immunodeficiency virus (HIV) is a
risk factor for cervical cancer was formed by women
aged over 60 (n=3, 37.50%), widows (n=5, 62.50),
women with secondary education (n=20, 30.77%), students (n=21, 32.30%) and women inhabiting the capital
of the province (n=21, 39.62%).
In turn, the highest percentage of respondents who did
not know that the human immunodeficiency virus (HIV)
was a risk factor for cervical cancer was formed by
women between 51 and 60 years of age (n=13, 61.90%),
married women (n=57, 61.96%), women with elementary education (n=7, 87.50%), unemployed women (n=9,
64.29%), and inhabitants of the countryside (n=36,
67.92%).
A statistically significant relationship has been found
between the knowledge of the women surveyed regarding the human immunodeficiency virus (HIV) as a risk
61
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Total
Education
Elementary
Vocational
Secondary
Higher
Place of residence
Total
Province
capital
District
capital
Countryside
Form of professional activity
Total
Employed
Unemployed
Pensioner
Student
Total
200
(100.00%)
Married
Divorced
Widow
Total
Elementary
Vocational
Secondary
Higher
Total
Province
capital
District
capital
Countryside
Total
Employed
Unemployed
Pensioner
Student
Total
n
%
n
%
n
%
26
28.26%
24
26.09%
42
45.65%
92
100%
8
36.36%
7
31.82%
7
31.82%
22
100%
16
28.07%
6
10.53%
35
61.40%
57
100%
6
28.57%
2
9.53%
13
61.90%
21
100%
3
37.50%
1
12.50%
4
50.00%
8
100%
101
(50.50%)
35
42.68%
57
61.96%
7
38.88%
2
25.00%
101
(50.50%)
200
(100.00%)
82
100%
92
100%
18
100%
8
100%
200
(100.00%)
59
40
(29.50%) (20.00%)
20
27
24.39%
32.93%
24
11
26.09%
11.95%
10
1
55.56%
5.56%
5
1
62.50%
12.50%
59
40
(29.50%) (20.00%)
1
12.50%
0
0.00%
7
87.50%
8
100%
5
26.32%
1
5.26%
13
68.42%
19
100%
28
43.08%
53
49.07%
101
(50.50%)
65
100%
108
100%
200
(100.00%)
20
17
30.77%
26.15%
33
22
30.56%
20.37%
59
40
(29.50%) (20.00%)
21
39.62%
14
26.42%
18
33.96%
53
100%
28
29.79%
19
20.21%
47
50.00%
94
100%
10
18.87%
7
13.21%
36
67.92%
53
100%
101
(50.50%)
200
(100.00%)
56
57.73%
9
64.29%
97
100%
14
100%
14
58.33%
22
33.85%
101
(50.50%)
24
100%
65
100%
200
(100.00%)
59
40
(29.50%) (20.00%)
28
28.87%
3
21.42%
13
13.40%
2
14.29%
7
3
29.17%
12.50%
21
22
32.30%
33.85%
59
40
(29.50%) (20.00%)
Statistical analysis
101
(50.50%)
Single
n
%
Chi2=11.63,
p=0.17
44
(22.00%)
Age
55
(27.50%)
20-30
years
31-40
years
41-50
years
51-60
years
Over 60
years
Total
Total
Chi2=25.009
p=0.0003
Widow
92
100%
22
100%
57
100%
21
100%
8
100%
200
(100.00%)
82
100%
92
100%
18
100%
8
100%
200
(100.00%)
8
100%
19
100%
65
100%
108
100%
200
(100.00%)
53
100%
94
100%
53
100%
200
(100.00%)
97
100%
14
100%
24
100%
65
100%
I don’t
know
Chi2=9.96
p=0.13
Divorced
40
43.48%
8
36.37%
38
66.67%
12
57.14%
3
37.50%
101
(50.50%)
28
34.15%
60
65.22%
10
55.56%
3
37.50%
101
(50.50%)
5
62.50%
12
63.16%
30
46.15%
54
50.00%
101
(50.50%)
15
28.30%
53
56.38%
33
62.26%
101
(50.50%)
61
62.88%
11
78.57%
13
54.17%
16
24.62%
No
Chi2=12.25
p=0.02
Married
19
20.65%
10
45.45%
9
15.79%
3
14.29%
3
37.50%
44
(22.00%)
23
28.05%
17
18.48%
1
5.56%
3
37.50%
44
(22.00%)
0
0.00%
4
21.05%
16
24.62%
24
22.22%
44
(22.00%)
18
33.96%
19
20.22%
7
13.21%
44
(22.00%)
18
18.56%
2
14.29%
5
20.83%
19
29.23%
Yes
Chi2=15.14
p=0.02
Civil status
Single
33
35.87%
4
18.18%
10
17.54%
6
28.57%
2
25.00%
55
(27.50%)
31
37.80%
15
16.30%
7
38.88%
2
25.00%
55
(27.50%)
3
37.50%
3
15.79%
19
29.23%
30
27.78%
55
(27.50%)
20
37.74%
22
23.40%
13
24.53%
55
(27.50%)
18
18.56%
1
7.14%
6
25.00%
30
46.15%
Civil status
Total
n
%
Sociodemographic
factors
Education
Over 60
years
n
%
Human immunodeficiency virus (HIV) as
a risk factor for developing cervical cancer
Place of residence
51-60 years
n
%
Table 3. Correlation between the respondents’
knowledge about the human immunodeficiency virus
(HIV) as a risk factor for cervical cancer and the sociodemographic factors
Form of professional
activity
41-50 years
n
%
Chi2=18.31
p=0.02
Age
31-40 years
Total
Chi2=21.84
p=0.001
20-30 years
I don’t
know
Chi2=4.36
p=0.63
No
Chi2=15.48
p=0.004
Yes
Socio-demographic
factors
Chi2=29.49
p=0.00005
Genital herpes virus as a risk factor for
developing cervical cancer
Statistical analysis
Table 2. Correlation between the respondents’
knowledge about the genital herpes virus as a risk factor
for cervical cancer and the socio-demographic factors
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IV.
DISCUSSION
The human papillomavirus (HPV) belongs to the Papillomaviridae family and it is considered to be the main
aetiological factor for cervical cancer. The period in
which the viral infection leads to neoplasm in the cervix
depends on the HPV genotype. Types 16 and 18 are
highly oncogenic. The medium-risk group is formed by
types: 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68,
whereas types 6, 11, 42, 43 and 44 belong to the low-risk
group. [13-18. Chin et al. have discovered that, in the
group of 43 patients hospitalized for cervical cancer,
98% had the HPV DNA in pap smear. Also, in another
study conducted by the above-mentioned authors in a
group of 98 women treated for cervical cancer, the HPV
DNA was found in 97.0% of pap smears.
Research by Makwe and Anorlu [19] conducted in a
group of 178 nurses has shown that 70.1% of the respondents did not know that the human papillomavirus
was an aetiopathogenetic factor for cervical cancer. In
turn, research by Ezenwa et al [20] in a group of 290
women – mothers of adolescent girls – has shown that
27.9% of the women surveyed did not have knowledge
regarding HPV infections, whereas 34.5% of the respondents knew that HPV was a risk factor for cervical
cancer. Moreover, research conducted by Czechowska
[21] in a group of 120 women from Jelenia Góra district
demonstrated that 55.0% of women had knowledge that
the human papillomavirus was a factor for cervical cancer. Furthermore, Cichońska et al [12] found that 66%
of the respondents knew that HPV infection was a risk
factor for cervical cancer. Krajewska et al [22] found
that 26.0% of female respondents aged 20-30, 36.0% of
women aged 31-50 and 20% of women aged 51-70 did
not know that HPV infection was a risk factor for cervical cancer. Finally, a study conducted in a group of 100
women by Pacewicz et al [3] revealed that 51.0% of the
women examined did not posses knowledge concerning
the influence of HPV on developing cervical cancer.
Herpes simplex virus type II is a persistent and recurring viral infection being the most frequent cause of ulcerations affecting genitals. It also constitutes a risk factor for becoming infected with other sexually transmitted
diseases as well as for the development of cervical cancer. In a group of women found to be infected with HPV
(type 16 or 18) and HSV- 2, the risk of developing an
invasive form of cervical cancer is twice as high as in
women infected with only one type of the virus [23,24].
Research carried out by Cichońska et al [12] has
shown that merely 36.0% of the respondents knew that
the herpes virus was a risk factor for cervical cancer.
63
In turn, research by Pacewicz et al [3] has demonstrated
that women are aware of the fact that infection with
HSV-2 is a risk factor for cervical cancer. The authors’
own research has shown that only 27.50% of the respondents knew that the herpes simplex virus was a risk
factor for cervical cancer. Yet, 50.50% of the women
surveyed did not know that HIV-2 was a risk factor for
this type of cancer.
Infection with the human immunodeficiency virus
(HIV) and the Acquired Immunodeficiency Syndrome
(AIDS) still poses a serious health problem to women. A
relationship has been found between seropositivity for
HIV and the development of cervical dysplasia. The
incidence of cervical dysplasia in HIV-positive women
is approx. 40%. Also, the course of the disease has been
observed to be worse for HIV-positive women in comparison to HIV-negative women. [24-28]. The authors’
own study has demonstrated that 50.50% of the female
respondents did not posses knowledge regarding the
relationship between HIV and the risk of developing
cervical cancer, 29.50% of the respondents knew that
infection with HIV could predispose to the development
of cervical cancer and 20.00% of the women surveyed
believed that infection with HIV did not contribute to the
risk of developing this disease.
This study has made it possible to determine the group
of women with the least knowledge about the infectious
risk factors for cervical cancer. Educational programmes
conducted in this group of women may contribute to
increasing the number of women participating in prophylactic examinations as well as to reducing the morbidity
and mortality rates among women as a result of cervical
cancer.
V.
CONCLUSIONS
1.
Women do not have a suitable knowledge regarding the infectious risk factors for cervical
cancer.
2.
Women over 40 years of age, married women,
women with elementary or vocational education
and inhabitants of the countryside should be subjected to special educational programmes due to
the fact that they possess the least knowledge regarding the infectious risk factors for cervical
cancer
●●JOURNAL
JOURNALOF
OFPUBLIC
PUBLICHEALTH,
HEALTH,NURSING
NURSINGAND
ANDMEDICAL
MEDICALRESCUE
RESCUE●●No.2/2015
2/2014 ● ●
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