Journal of Preventive Medicine

Introduction
Cervical cancer is the fourth most common and deadly cancer among women worldwide. The incidence of cervical cancer in developing countries is very high (>80%). Invasive cervical cancer is known as a preventable cancer due to its long pre-invasive period, availability of appropriate screening systems, and effective treatment of primary lesions. Fast and accurate screening programs are critical so that every woman with cervical cancer can receive the treatment she needed and avoid preventable deaths.

Methods
This analytical cross-sectional study was conducted during 2021-2022 on 810 women aged 15-49 years referred to health centers in Bandar Abbas, Iran. Those who had performed pap smear tests at regular and international standard intervals (according to age and general health) were included in the screening group, while those who did not perform the test or accidentally performed the test during a visit to a gynecologist without prior intention were included in the non-screening group. Inclusion criteria were age 15-49 years, being sexually active non-pregnant women, no cervical cancer, and consent to participate in the study. The exclusion criterion was the return of incomplete questionnaires. Considering the first type error of 5% and the estimation error of 5% using the formula, the sample size was obtained 329. Considering that cluster sampling method was used in this study, the calculated sample size was multiplied by the design effect (2.5) and the final sample size was determined 823. Thirteen questionnaires were excluded from the analysis due to being incomplete; therefore, the data of 810 participants were analyzed. The tool for collecting information was a researcher-made questionnaire with two parts. The first part was a demographic form and the second part was a Knowledge, Attitude and Practice (KAP) questionnaire. knowledge was measured with 14 items, attitude with 16 items, and practice with one item (screening/no screening). To determine the content validity of the tool, it was sent to 5 experts in health education and 5 gynecologists, and their opinions were used to modify the items. To determine the reliability of the tool, the test-retest method was used. The ICC value of 0.80 was obtained and the reliability of the questionnaire was approved. Quantitative variables such as knowledge and attitude were described as mean ± standard deviation. Categorized variables and qualitative variables were described using frequency and percentage. To investigate the relationship between demographic factors and cervical cancer screening, univariate and multivariate logistic regression and odds ratio (effect size) were used. Independent t-test and one-way analysis of variance were used to compare the men score of knowledge and attitude based on demographic variables.

Results
Most of the participants were in the age group of 30-39 years. The likelihood of cervical cancer screening in women with 1-2 children compared to women without children was 25 times higher; in women with 3-5 children compared to women without children was 7.7 times higher; in married women compared to single women was 1.4 times higher; in women with moderate financial status compared to those with poor financial status was 9 times higher; and in women with good financial status compared to those with poor financial status was 23 times higher. One unit increase in knowledge score increased the chance of uterine cancer screening by 40%, and with one unit increase in attitude score, the chance of screening increased by 8%. There was no statistically significant difference in the knowledge score between different age groups (p=0.061). Tables 1 and 2 present the mean knowledge and attitude scores based on the demographic factors.






Discussion
The results of the present study can help to develop a targeted and effective intervention to increase the rate of cervical cancer screening in Bandar Abbas. The results showed that personal factors such as the number of children and financial status can be effective in increasing the rate of cervical cancer screening. Considering the prevalence of cervical cancer among women and the role of the Pap smear test in the early detection of this disease, it is recommended to use appropriate and cost-effective educational methods to promote the knowledge and attitude of women in Bandar Abbas regarding cervical cancer and its prevention methods.

Ethical Considerations

Compliance with ethical guidelines
This study was presented in the Committee of Ethics Council of Hormozgan University of Medical Sciences and after the corrections (Code : IR.HUMS.REC.1401.202).

Funding
This article was done with the financial support of Hormozgan University of Medical Sciences.

Authors' contributions
Study design, supervision of data collection, data analysis and manuscript review: Azin Alavi; Study design, data collection, data analysis and manuscript drafting: Seyed Hesamaddin Banihashemi; Design of the study and review of the manuscript: Saeede Shahsavari; Sample collection, analysis and cooperation in preparing the initial draft of the project: Mahsheed Mahboobi.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors appreciate the financial support of Hormozgan University of Medical Sciences and all the participants in this research.

 

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