A STUDY TO ASSESS THE KNOWLEDGE AND

AWARENESS REGARDING PREVENTION AND EARLY

DETECTION OF CERVICAL CANCER AMONG WOMEN
VISTING GYNAE OPD OF SELECTED HOSPITAL OF DELHI

BY

INTERNS

[GROUP -2] BATCH: 2014-2018

BSC. (HONS.) NURSING 4TH YEAR

AHILYA BAI COLLEGE OF NURSING

LOK NAYAK HOSPITAL

Group Research Project Report submitted to UNIVERSITY OF DELHI

as mandatory requirement in semester VIII.

BSC. (HONS.) NURSING

Under the guidance of

Dr(Mrs.) Neelam Makhija
Rn.,Rm.,MN,PhD
AHILYA BAI COLLEGE OF NURSING
UNIVERSITY OF DELHI
[2014-2018]
 Group Research Project Report submitted to UNIVERSITY OF DELHI

as mandatory requirement in semester VIII.

BSC. (HONS.) NURSING

BY

KOMAL

KIRAN

KUNIKA

KUNJAM

MADHURI

MANJEET

MOHINI

MONIKA

NEHA V.K

NEHA SINGH

NISCHAL

PRATIBHA

PREETI

Ms. Ellen beck

BSc., Msc.(Psychiatry Nursing)
THE PRINCIPAL
AHILYA BAI COLLEGE OF NURSING
LOK NAYAK HOSPITAL, NEW DELHI
 A STUDY TO ASSESS THE KNOWLEDGE AND AWARENESS REGARDING
PREVENTION AND EARLY DETECTION OF CERVICAL CANCER AMONG WOMEN
VISITING GYNAE OPD OF SELECTED HOSPITAL OF DELHI.

BY

INTERNS

[GROUP-2]

Group research project report Submitted as mandatory requirement in

semester VIII

Signature of the guide

Dr. (Mrs.) Neelam Makhija

RN, RM, MN, PhD

AHILYA BAI COLLEGE OF NURSING

UNIVERSITY OF DELHI
2018
 ACKNOWLEDGEMENT

The study has been undertaken and completed under the guidance and supervision
of Mrs. Neelam Makhija, Sister tutor, Ahilya Bai College Of Nursing.

The investigators express their sincere gratitude and thanks for her expert guidance,
valuable suggestions, constant encouragement and her immense patience throughout
the research.

We express our heartfelt thanks to Ms. Ellen beck, Principal and Ms. Surekha
Sama, Vice Principal of Ahilya Bai College Of Nursing for extending facilities
and support for the study.

The investigators acknowledge gratefully the contribution of the experts from

various fields for content validation of tools.

Grateful acknowledgement is expressed to Dr. J.C. Passey, Medical

Suprintendent, Lok Nayak Hospital, New Delhi for granting the permission to
conduct final research study.

With his continuous support and cooperstion, the investigators could successfully
complete the research.

We are obliged to our class teacher Dr. Sneh lata Manocha for help and
arrangement made throughout the study.

Special thanks to Mrs. Sweena Gambhir, the librarian of Ahilya Bai College Of
Nursing for extending library facilities throughout the project.

Our most sincere thanks to all the women who sincerely participated in the study.

We appreciate their keen interest and cooperation shown during the conduct of the
research.

Our sincere appreciation is extended to library of Rajkumar Amrit Kaur College Of

Nursing, which was immense use. Our loads of thanks to them as well.
Above them all, our most sincere gratitude to God almighty with the help of whom
everything could be possible and investigators could submit the research project
successfully.

Interns (Group-2)

B.Sc (Hons.) Nursing

A.B.C.O.N
S. NO. CONTENT PAGE NO.

1 CHAPTER- 1 INTRODUCTION

1.1 Background of the study 1

1.2 Need for the study 9

1.3 Problem statement 10

1.4 Objectives 10

1.5 Hypothesis

1.6 Operational definition

1.7 Assumption

1.8 Delimitation

1.9 Conceptual framework

1.10 Organization of work

2 CHAPTER-2 LITERATURE REVIEW

2.1 Introduction

2.2 Literature related to knowledge, prevention

and early detection of cervical cancer

3 CHAPTER-3 METHODOLOGY

3.1 Introduction

3.2 Research design

3.3 Research approach

3.4 population

3.5 Sample and sampling techniques

3.6 Sample size

3.7 Time, place and settings of the study

3.8 Methods of data collection

3.9 Validation of research tool

3.10 Pilot study

3.11 Ethical considerations

3.12 Plan for data analysis

3.13 summary

4 CHAPTER-4 ANALYSIS AND

INTERPRETATION OF DATA

4.1 Introduction

4.2 objectives

4.3 Organization of study findings

4.4 Description of sample findings

5 CHAPTER-5 SUMMARY AND CONCLUSION

5.1 Objectives

5.2 Hypothesis

5.3 Findings of the study

5.4 Implications

5.5 Limitations

5.6 Recommendation

5.7 Conclusion

6 APPENDICES

7 REFERENCES

8 ABSTRACT
 LIST OF TABLE
CONTENT PAGE NO.
TABLE NO.
Demographic data
1

LIST OF FIGURES
S. NO. CONTENT PAGE NO.
1 Graph-1 represents the
percentage of knowledge of
women about cervical cancer
2 Graph -2 continuation......

3 Figure-1 represents mean

percentile of knowledge of
women about cervical cancer.
4 Graph-2 represents the
percentage of knowledge of
women related to prevention
of cervical cancer.
5 Figure-2 represents mean
percentile of knowledge of
women related to prevention
of cervical cancer.
6 Graph-3 represents the
percentage of knowledge of
women related to early
detection of cervical cancer.
7 Figure- 3 represents mean
percentile of knowledge of
women related to early
detection of cervical cancer.
 LIST OF APPENDICES

S. NO. TITLE PAGE NO.

1. Letter for content validity

2. Letter seeking permission for data

collection
 To the Medical director.
 To the Nursing
Superintendent.

3. List of Experts.

4. Questionnaire
 In English
 In Hindi

5. Master data sheet

“All progress is born of inquiry. Doubt is often better than
overconfidence, for it lead to inquiry, and inquiry leads to
intervention”

BACKGROUND OF THE STUDY.

According to WHO guidelines,

Cancer is one of the leading causes of mortality and morbidity worldiwde, with
approximately 14 million new cases in 2012.

The number of new cases is expected to rise by about 70% over the next 2 decades.
Cancer is the second leading cause of death globally, and was responsible for 8.8 million
deaths in 2015. Globally, nearly 1 in 6 deaths Is due to cancer.

Approximately 70% of death from cancer occur in low and middle income countries.

Around one-thirds of death from cancer are due to the 5 leading behavioral and dietary
risks; high body mass index, low fruit and vegetable index, lack of physical activity,
tobacco use, and alcohol use.

Tobacco use is the most important risk factor for cancer and is responsible for
approximately 22% of cancer deaths.

Cancer causing infections, such as hepatitis and human pappiloma virus (HPV), are
respnsible for upto 25% of cancer cases in low and middle income countries.

Late stage presentation and inaccessible diagnosis and treatment are common. In 2017,
only 26% of low income countries reported having pathology services generally available
in public sector.
Only 1 in 5 low and middle income countries have the necessary data to drive cancer
policy.

Cancer is the leading cause of death worldwide accounting for 8.8 million deaths in 2015.
The most common causes of cancer deaths are cancer of breast cancer (571,000 deaths);
cervical cancer (266,000 deaths); lung cancer (1.69 million); liver cancer (788,000 deaths)

According to GLOBOCAN cancer facts sheet

Cervical cancer is the fourth most common cancer in women, and the seventh overall,
with an estimated 528,000 new cases in 2012. As with liver cancer, a large majority(
around 85%)of the global burden occurs in the less developed regions, where it accounts
for almost 12% of all female cancers. High risk regions, with estimated ASRs over 30 per
100,000 include eastrern africa (42.7), melanesia (33.3), southern (31.5) and middle
africa(30.6)

There were an estimated 266,000 deaths from cervical cancer worlwide in 2012,
accounting for 7.5% of all female cancer deaths. Almost 9 out of 10 (87%) cervical cancer
death occur in less developed regions. Mortality varies 18-fold between the different
regions of world, with rates ranging from less than 2 per 100,000 in western asia, western
europe, and australia/new zealand to more than 20 per 100,000 in melanesia(20.6),
middle(22.2) and eastern(27.6) africa.

Beacause the disease progress over many years an estimated 1.4 million women
worldwide are living with cervical cancer, and 2-5 times more ; upto seven million
worldwide may have precancerous conditions that need to be identified and treated. If it
is not detected and treated early, cervical cancer is nearly always fatal. The disease, which
affects the poorest and most vulnerable women, sends a ripple effect through families
and communities that rely heavily on women’s roles as providers and caregivers.

The magnitude of cervical cancer in india:

As per GLOBOCAN database, 2002, the 1 year prevelance of cervical cancer in india was
101,583 and 5 year prevelence was 370,243, accountimg for approximately 26% of global
prevelence and 83% of total prevelence in south central asia. In india, the age adjusted
incidence of cervical cancer per 100,000 women 132,082 incidence cases is highest
relative to that of all other types of cancer, and is higher than the average for the south
central asia region ( GLOBOCAN 2002 database, IARC 2009). By 2025, the number of new
cervical cancer in india is projected to increase to 226,084 (WHO/ICO information centre
on HPV and cervical cancer).

Cervical cancer is the leading cancer among women in terms of incidence rates in 2 out
of 12 population based cancer registeries (PBCRs) in india, and has the second highest
incidence rates after breast cancer in the rest of PBCRs ( national cancer registry program
and WHO). The age adjusted incidence is highest in chennai, metropolitan city in the
south, and lowest in thiruvananthpuram, the capital of kerala. There is high incidence belt
in the north eastern disricts of tamil nadu, as well as in the two districts in the north
eastern regions of the country.

The indian council of medical research initiated a network of cancer registeries under
national cancer registry program (NCRP) in 1981 and data collection commenced in these
registeries from january 1982. Since then, the registeries have provided information on
incidence and pattern of cancer that in terms of quality and validity meet international
standards. In india, the cancer registry perhaps is the only program for reliable incidence
and mortality rates. The NCRP data helps in undertaking cancer reserarch whether it is
epidemiological, basic and or clinical and for planning cancer control.

Cervical cancer policy and programme in india;

Policy and program for cervcial cancer and control and prevention india has a national
cancer control program (NCCP), established in 1975-76 and revised a decade later. There
are 5 schemem under this progeam, namely, the recognition of new regional cancer
centres RCCs, development of oncology wings in government medical college and
hospitals, the running of the disrtict cancer control program, and the establishment of a
decentralised NGO schemes under which NGO are to be provided with grants for
conducting capital IEC activities (national control program). Despite this however, there
is a substantial shortage of cancer treatment facilities in the country, which is further
magnified by regional disparities. In terms of palliative care, oral morphine has been made
available for cancer patients number of states through modification rules implemented
sience 1991. However, even now morphine cannot be prescribed for pain among cancer
patient in 21/28 states in India.
Cervical cancer

Cancer of cervix [cervical cancer], develops in the tissue of cervix, which is a part of the
uterus. Uterus is an organ belonging to female reproductive system. The cervix connects
to the upper part of the uterus, i.e., body of the uterus to vagina. It is divided into two
portions – endocervix [ the upper part of the cervix which is close to the body of uterus
and is covered by glandular columnar cells], and exocervixor ectocervix [the lower part of
the cervix which is in close proximity to the vagina and is covered by squamous cells]. The
transformation zone refers to the place where these two regions of the cervix meet. The
anatomy and developmental stages of these regions of cervix are shown in Fig.1.
Cervical cancer is classified according to the site of the origin, whether developing from
ectocervix or endocervix. Cancer that develops in the ectocervix arises from squamous
cells and hence is called squamous cell carcinoma and is the most common type of cervical
cancer accounting for approximately 80-90% of cervical cancer cases globally. This also
matches with the incidence in India where it accounts for more than 90% of cases. Cancer
that develops in the endocervix is an adenocarcinoma as it originates from the columnar
epithelial cells. In addition, a small percentage of cervical cancer arises from mixed version
of the above two, and is called adenosquamous carcinomas or mixed carcinomas.

Some other rare types of cancer also arise from cervix uteri, e.g., small cell carcinoma,
neuroendocrine carcinoma, etc.

The rest of the factsheet will focus on the first two types, as they constitute the greatest
burden, globally as well as in India.

Cancer of cervix is not synonymous with cancer of uterus and is a different entity. Cancer
of cervix originates from cervix of uterus while cancer of uterus arises from the body of
the uterus which is the upper part of the uterus and is the area where placenta is
implanted and fetus is grown up during pregnancy. The differences between cancer of
cervix and that of uterus according to the site of origin are shown in fig.2.
 Figure 2- Differences in origin of cancer cervix and uterus

Figure 3- Stages of development of cancer cervix

ETIOLOGY

There are few causes and risk factors for cervical cancer :

1. Human pappiloma virus [ HPV]

2. Multiple sexual partners and early sexual activity
3. Smoking
4. Immunosuppression
5. Genetic mutations
6. Mental stress
7. Giving birth at a very young age

8. Multiple pregnancies

9. Oral contraceptive pills

 10. Other sexually transmitted diseases [STD]

SYMPTOMS

During the early stage of carcinoma cervix, affected woman may remain asymptomatic.
Hence women especially perimenopausal, should undergo regular cervical smear tests.
The most common symptoms are:

Bleeding between periods

Bleeding during or after sexual intercourse [ contact bleeding]

Bleeding in post menopausal women

Discomfort during sexual intercourse [ dyspareunia]

Foul smell vaginal discharge

Sanguineous vaginal discharge [ discharge tinged with blood]

Pelvic pain

PREVENTION

Avoidance of infection by human pappiloma virus [HPV]

HPV is one of the main causes of carcinoma cervix [ invasive and precancerous stages];
avoidance of exposure to HPV can prevent this disease. HPV can be transmitted sexually
[ spread during sex- including vaginal intercourse, anal intercourse, and oral sex] and
this is the main mode of transmission

Vaccination

HPV vaccines are recommended to women in the age group 9 to 26 years as the vaccine
is only effective if given before infection occurs. Efficacy of the vaccine lasts for at least
4-6 years and it is believed that it may be effective for a longer period. Several countries
has initiated or in process of starting programs to fund HPV vaccine.

Condoms
Barrier methods of sexual intercourse are expected to confer protection against sexually
transmitted diseases like HIV, HPV etc. Condoms are also a type of barrier protection
during sexual intercourse. Level 1 and level 2 evidences for protective roles of condoms
in prevention of HPV infection are lacking in literature, however, they may offer
protection against the development of genital warts and the precursor lesions of
cervical cancer. Condoms also provide protection against other STDs, such as HIV and
chlamydia, which are other risk factors for development of cervical cancer.

Nutrition

Vitamin A offers protection against cervical cancer.

NEED FOR STUDY

Cervical cancer is one of the most common cancer worldwide. In india, it is one of the
leading causes of mortality among woman accounting for 23.3% of all cancer deaths. India
accounts for about 20% of cervical cancer cases reported from the world. More than 3/4 th
of these patients are diagnosed in advanced stages leading to poor prospects of long term
survival and cure. Early detection of cervical cancer is possible with Pap smear tests. The
proportion of woman who undergo pap smear testing ranges from 2.6 % to 6.9% among
woman in communities.

Singh T , 1981 did a retrospective study of cervical carcinoma to evaluate possible factors
of causation of cancer. It was found that detection of cervical erosions and their proper
treatment can effectively prevent development oof cervical cancer. Also, in this study it
was found that cancer cervix uteri is a very common cancer amongst indian women and
most of them report in late stages of disease, when the chances of cure are very remote.
Cancer cervix uteri has very high cure rate when treated the early stages apart frm being
preventable cancer education should be goal directed towards motivating the woman for
early detection, as it would help to cure the disease or prevent it.

In 1980, WHO reported that women’s perception of morbidity often varied in relation
their individual perception and whether treatment was sought. Most women don’t
percieve gynaecological problems as a threat to their life and even if they percieve it to
be normal, they may conceal it out of guilt or shame.
PROBLEM STATEMENT

A study to assess the knowledge and awarenesss regarding prevention and early
detection of cervical cancer among women visiting gynae OPD of selected hospital of
Delhi.

OBJECTIVES

[1] to assess the knowledge of women regarding cervical cancer.

[2] to assess the knowledge regarding the prevention and early detection of cervical
cancer in women.

[3] to find out correlation between the knowledge of women and early detection
regarding cervical cancer.

HYPOTHESIS

Research hypothesis is a predictive statement, capable of being tested by scientific

methods, that relates an independent variable to some dependent variable.

Acc to lundberg,

‘’ hypothesis is a tentative generalization based on the data to vague on inadequate that

it is not at the time demonstrate in the objective terms’’.

HO- there will be no significant relationship between the knowledge and awareness in
women about cervical cancer and its prevention.

H1- there will be a significant relationship between the knowledge and awareness in
women about cervical cancer and its prevention.

OPERATIONAL DEFINITION

A study to assess the knowledge and awareness in women regarding prevention and
early detection of cervical cancer at OPD of selected hospital.

Knowledge- information regarding prevention of cervical cancer.

Women- reproductive females coming to OPD of LNJP hospital

Prevention- measures taken to prevent the occurrence of cervical cancer.

Early detection- knowledge regarding the symptoms and measures taken for early
diagnosis of cervical cancer.

Cervical cancer- cervical cancer is a disease In which the cells of the cervix become
abnormal and start to grow uncontrollably, forming tumors.

DELIMITATIONS

[1] women who are willing to participate in the study.

[2] only pre-test observation of knowledge and awareness of women regarding cervical
cancer.

[3] restricted to only one selected area i.e. OPD.

[4] the study is limited to one out patient department. Others areas could not be
included in the study. Thus, the generalizing of data could be limited.

[5] time period i.e. 4-5 months for the research is limited.

CONCEPTUAL FRAMEWORK

Conceptual framework for analyzing the determinants of cervical cancer and cervical
cancer screening due to low level of knowledge about the disease and inadequate
cervical cancer prevention. Improving uptake of cervical cancer screening will reduce
the burden of cervical cancer.

The conceptual framework consists of modified perceptions about cervical cancer and
cervical cancer screening, modifying factor [ knowledge] and health system
components.

Modifying factors

Knowledge, age, culture, educational level, marital status , parity, social status affect
perceptions about cervical cancer.

Perceived suspectibility

Perceived suspectibility to cervical cancer is the belief about being at risk of cervical
cancer. A woman may not be interested in cervical cancer screening unless considers
herself susceptible to this disease.
Perceived severity

Perceived severity of cervical cancer is a woman’s feeling about the medical harm [
death, disability, pain] or social damage [ effect on work, family and social life] for
developing cervical cancer or not utilizing cervical cancer screening/ treatment.

ORGANIZATION OF REPORT

CHAPTER- 1 : Introduction deal with Background of the study, need for the study,
problem statement, objectives, hypothesis, operational definition, delimitations,
conceptual framework.

CHAPTER-2 : This chapter would be presenting the overview of literature reviewed and
related studies.

CHAPTER-3 : Methodology deals with methodology and plan for data analysis

CHAPTER-4 : would deal with analysis ,interpretations and discussion of the study.

CHAPTER-5: this chapter is devoted to summary , conclusion, implications of the study

and recommendations. In this section, investigations have summarized the study by
giving conclusion based on findings and their implications for nursing limitation of the
study and important recommendations, suggestions for further are also given. The
report for study and work are selected list of references an appendices.
 CHAPTER -2

REVIEW OF LITERATURE

A research literature review is a written summary of the state of evidence of research

problem. The major step in preparing a written research review include formulating a
question, devicing a research strategy, concriding a research, retribing relevant sources
and abstracting and coding information, criticizing studies, analyzing the aggregated
information and preparing a written synthesis.

The review of literature is defined as a broad, comprehensive, In depth, systematic and

critical review of scholarly publications, unpublished print materials, AV materials and
personal communications. The purpose of review of literature is to generate questions to
identify what is known and not known about the topic, to identify a conceptual and
traditional within the bodies of literature and to describe method of inquiry used in earlier
work including their success and shortcomings.

Literature review usually precedes a research proposal and result section. Its ultimate
goal is to bring the reader up to date with current literature on a topic and forms the basis
for another goal, such as future research that may be needed in the area.

HN Harsha Kumar and Shubham Tanya (June 2012) conducted a cross sectional study on
knowledge and screening for cervical cancer among women in Mangalore city (sample
size =83) by using questionnaire. The study revealed that majority of women have poor
knowledge about cervical cancer i.e. 81.9% (68/83) and its screening 85.55% (71/83), only
6 out of 83 women had undergone screening. The need is to conduct community based
study to know the practices of doctor and assist if they are educating and offering
suggestion for screening.

Murthy,N.S et al (2005) in hi study he noted that cervical cancer is the most common
cancer among Indian women. The age – specific incidences rated for cervical cancer
revealed that the disease increases from 35 years and reaches a peak between the ages
of 55-64 years. Most of the cervical cancer cases were detected with regional spread of
the disease and a very small proportion was diagnosed at a localized stage. In India, an
organized mass screening programme with pap smear for early detection of cervical
cancer is not in practice. The data suggests an urgent need for initiation of community
screening and educational programmes for the control and prevention of cervical cancer.

Sheila, twin (2005) conducted a study among Indian women from a total sample of 467
in order to identify the knowledge about cervical cancer. Evident suggest that women’s
knowledge about cervical cancer and preventive strategies are significant to their
screening practices. The need for further knowledge about cervical screening and
preventive measures was demonstrated.

Fransceschi, et al (2003) conducted a study to evaluate the role of human papilloma virus
(HPV) and other risk factors in the etiology of invasive cervix carcinoma (ICC). A total of
205 ICC cases and 213 frequency age matched control women were included. 23 different
HPV types were found. HPV 16 was the most common type, followed by HPV 18 and 33.
Other than HPV infection, high parity, husband’s extra marital relationship and early
menopause were significantly associated with invasive cervical carcinoma.

Ruffin MT (2003) conducted a study to determine family physician knowledge of risk

factors for cervical cancer and the perceived importance of risk in screening women. The
study showed that family physician havea limited understanding of risk factors for cervical
cancer. This was true regardless of age,gender, training,race,geographic location or
practice setting of responding physician. Female physician reported significantly more risk
factors than male physician. Only 10% of physician indicated that they perform a
papsmear at the same interval regardless of risk of women.

Koskela Pal(2000) During their study done in Finland on risk factors for invasive cervical
cancer result finding shows infection with trachomatus ----------on increased risk for
subsequent development of invasive squamous cell carcinoma of uterine cervix.

Singh T (1981),A retrospective study of cervical carcinoma was carried out to evaluate
possible factor in causation of cancer. Some of the findings came out with fact that the
carcinoma of cervix uteri was mainly prevalent in the lower socio economic classes. It did
occur in the richer classes also quite frequently. It shows that however, never seen in the
university educated women. This shows that education bring some positive change in
health behavior of the individual.

Other factors are the genital hygiene in the female and possibly in the male partners,
acenterated by the trauma of coitus and child birth, setup a process of chronic infection
in the endocervix. This causes a low grade infection acting over a prolonged period on a
particularly susceptible epithelium. Inducing a pathological phenomenon called erosion.
The detection of their cervical erosions and their proper treatment can effectively prevent
development of cervical cancer.

Cancer cervix uteri is a very common cancer amongst Indian women, and most of them
report in the late stages of the disease, when the chances of cure are very remote. Cancer
cervix uteri has very high cure rate when treated the early stages apart from being
preventable cancer education should be goal directed towards motivating the women for
early detection, as it would help to cure the disease or prevent it.

A community based case control study was carried out to assess multiple risk factors for
invasive cervical cancer in Taiwan by Hseih, CY. (1999). The investigator interviewed 183
confirmed cervical cancer cases and 293 healthy controls. The study reported that the
higher the number of vaginal delivery, higher increased cervical cancer risk was also
significantly associated with the history of chronic cervicitis. Thee use of diaphragm for
contraception was found to be associated with a decreased risk of cervical cancer.

Mioclec, C. (1999) conducted a qualitative study with focus group (no. of samples = 102)
by using 11 question drive formed health model. Focus group revealed that there was
misinformation and lack of knowledge about cervical cancer. The women therefore were
confused about causative factors and preventive strategies related to cervical cancer. The
finding shows that major structural barriers were economic and time barriers. The main
psychological barriers were fear, denial, confusion thinking. Participants stated that
medical advice and education would influence them to undergo pap test.
Recommendations were made to reduce certain barrier and to increase knowledge and
motivation.
Varghese, C et al (1999) conducted a study In Kerala and confirmed the importance of
genital hygiene in the fight against infections that have a role in the development of
cervical dysplasia and cancer. Many women can’t afford sanitary napkins, while adequate
facilities for washing after coitus are often unavailable. Health education, satisfactory
living standards and the empowerment of women are pre-requisite for reducing the
incidence of cervical dysplasia.

Buga,GA(1998) conducted a survey among female university students to access their

knowledge related to awareness about cervical cancer and their willingness to utilize
cytological services for treatment and followup. Findings showed that 93% of respondent
were young and single, 86.9% were sexually active and having initiated sexual activities
at mean age of 17.27 years and 73.6% had multiple sexual partners. Their overall
knowledge about cervical cancer was poor. Majority of respondents were able to identify
the major risk factors from the given list. This group of women was at higher risk of
cervical cancer and would benefit from cervical screening program to increase the level
of awareness and knowledge of cervical cancer and its prevention.

Biswas et al (1997) Studied sexual risk factors for cancer of cervix among rural Indian
women.There result indicated the age at first coitus: extramarital sex partners of women:
and time interval since first exposure are at main risk factors in the Indian women.

A study was carried out InHest Virginia by Tubuliner, steven J. et al (1996)among 279
tenth grade for assessing knowledge, attitude and behaviorsrelated to cervical cancer and
pap smear. Results revealed that 84% had heard of cervical cancer and 83% had heard of
pap smear. Sexual intercourse with multiple partners and cigarette smoking were risk
factors identified by 65% and 40% of these students. The most common barriers to obtain
a pap test reported by those sexually active (48%) were embarrassment (64%),pain or
discomfort (57%), fear of cancer (27%), fear of parents discovering sexual activities (25%)
and cost (13%).

Prabhakar and Menon ICMR Delhi (1995)In their study he found that the age of marriage
is recognized as a major risk factor associated with cervical cancer. The study indicated
that it will take a long time to expect a significant reduction in the incidence of cervical
cancer. The primary prevention of rising the age at marriage about 18 years is adopted as
a strategy of control of cervical cancer.
WHO (1989)Reported that women’s perception of morbidity often varied in relation to
then individual perception and whether treatment was sought. The type of treatment
sought may be depend on their perception only. Many women consider most of the
gynecological problem as normal and a part of their destiny. They may not seek treatment
or may not report their symptoms. If they perceive it to be abnormal,they may conceal it
out of guilt or shame,or believe it or a punishment. Further in India health services are
often limited to women have no way to knowing their disease condition which can be
cure.
Chapter 3

RESEARCH METHODOLOGY
INTRODUCTION
If you are not certain of where you are going you may very well end up somewhere else

[and not even know it]

The methodology of research indicates the general pattern for organizing the procedure for
gathering valid and reliable data for an investigation. The present chapter provides a brief
description of different steps taken to conduct the study.

It includes design, data collection techniques, settings, development of tool, sampling

techniques, procedure of data collection and plan for data analysis.

The present study was carried out to assess the knowledge of the patients about cancer cervix.

The problem statement selected for study by our group for research was:

A study to assess the knowledge and awareness in women regarding prevention and early detection of
cervical cancer visiting gynae OPD at selected hospital in Delhi.

RESEARCH DESIGN
It refers to the overall plan for addressing a research question, including specifications for
enhancing the integrity of the study. The research design spells out the basic strategies that the
researcher adopts to develop information that is accurate and interpretable.

The research design helps the researcher in selection of subjects, manipulation of independent
variables, observation and the type of statistical analysis to be used to interpret data.

The descriptive survey method was selected for the study. It is an retrospective study where
subject recall past events while responding to the investigations questions. The aim of the
descriptive survey method is to obtain accurate meaningful description of the phenomenon
under study.

In this study the information related to factors which led to cancer cervix and factors which effect
in seeking medical treatment.
Patient related factors identified as attribute variable in the study were age, education, religion,
socio-economic status, geographical areas, exposure to mass media.

The study was designed to determine the variations existing between the groups in terms of
education, income and age.

Several variables influencing development of cancer are identified in present study. It is indented
to find our relation of cancer cervix with selected variables.

RESEARCH APPROACH
Research approach is the vehicle for answering questions. It indicates the basic procedures of
conducting research. It involves a plan as well as structure and strategy.

To accomplish the objectives of the study, research approach was considered to be most
appropriate.

Polit and Hungler [ 1999] stated that evaluative research is an applied form research. Its goal is
to assess and evaluate the success of programme.

Polit and Hungler [1999] stated that the classical approach for the conduct of evaluation research
consist of four broad phrases viz,

[1] determining the objectives of the problem

[2] developing a means of measuring and attainment of those objectives.

[3] collecting data

[4] interpreting the data vis-à-vis the objectives.

Our research problem is ‘’descriptive survey approach’’, as It is designed to gain more

information about the characteristics within particular field of enquiry.

It is undertaken to describe the frequency of occurrence of a phenomenon rather than to study

a relationship.

POPULATION
According to Polit and Hungler [1999], ‘’ population refers to the entire aggregation of cases that
meet a designated criteria’’.
According to Best and Khan [1992], ‘’ a population is any group of individuals that have one or
more characteristics in common and are of interest to researcher’’.

In the present study the population consist of women attending gynae OPD.

The present study incorporates factors like education, income, age and related aspects on the
basis of exploratory strolls in the review of literature.

The population for the present study comprised of women visiting gynae OPD.

SAMPLE AND SAMPLING TECHNIQUES

Polit [1999] says :- although there is no simple equation that can automatically tell the researcher
how large a sample is needed but one should be always use the largest sample. The larger the
sample the more the representative of the population it is likely to be and larger the sample , the
smaller the sampling.

In the present study, the sample size comprised Polit and Hungler [1999], stated that sampling
is the process of relating a portion of population to present the entire population. Sampling is
necessary because it is more economical and efficient to work with small group of clients.

(i) Criteria for selecting sample subjects :-

[1] subjects who were visiting gynae OPD of selected Delhi govt. hospital.

[2] subjects whose physical and mental condition permitted participation in the study.

[3] subjects who were willing to participate in the study.

SAMPLE SIZE
For the present study, 50 reproductive women were selected for the study.

TIME, PLACE AND SETTING OF THE STUDY

According to Polit and Hungler [1999], ‘’setting is the physical location and conditions in which
data collection takes place in the study’’. The selection of the appropriate setting is important
because the setting can influence the way people believe or feel and how they respond.

The present study was conducted in gynae O.P.D of selected hospital of Delhi government
hospital.

The rationale for selecting the setting were:

(i) Familiarity with the setting

(ii) Availability of sample subjects

(iii) Feasibility of conducting the study

(iv) Easy access to the subjects

(v) Cooperation and administrative approval for conducting the study.

The dates for data collection of the data for our research was 16 March, 20 March, 22 March, 26 March,
29 March and 30 March 2018.

METHODS OF DATA COLLECTION

According to Treece and Treece [1986], ‘’ the instruments selected in research should as far as
possible be the vehicle that would best contain data for drawing conclusions pertinent to the
study. Most important and crucial aspects of any investigations is the collection of appropriate
information, which will provide necessary data to answer the question raised in the study.

The questionnaire technique is one of the most common tools used for collecting data. Through
it, the researcher may stimulate the subjects to greater insight into her own experience and
thereby explore significant areas not anticipated in the original plan of investigation developing
a feeling of confidence in the respondent also helps in eliciting accurate feelings.

Therefore, questionnaire technique was selected to collect the data from the population.

(i) Development of tools :-

On the basis of the objectives and the design developed for the study, a review of literature was
done extensively and was prepared to study ‘’the assessment of knowledge and awareness of
early detection and prevention of cervical cancer in the selected hospital of Delhi.

The questionnaire schedule was developed after :

 [1] extensive review of research and non-research literature related to the cervical cancer.

[2] consultation with the guides of experts in the related field.

[3] discussion with peer group

[4] researcher professional experience.

(ii) Preparation of Data collection:-

Part 1 no. of questions

The questions are based on background data, general information, age, religion, types of family,
socio-economic status, health habits, mass media exposure.

Part 2 : items added to deal with assessment of knowledge of sample subject related to cervical
cancer, its diagnostic procedures, treatment, risk factors, signs and symptoms.

For each items collected score [1] is given, no negative marking is done.

(iii) Procedure of data collection :-

Administrative approval was obtained from medical officer, nursing superintendent of selected
hospital of Delhi.

A sample of 50 reproductive were selected using purposive sampling technique. Women were
explained about the nature of the study and their expected participation in the study before data
collection. The individual women were questioned. The confidentiality of the responses, was
assured to the subjects and maintained. Plan for data collection remain same as per pilot study.

VALIDATION OF RESEARCH TOOL

Treece and Treece [1986], defined validity as, ‘’ an instruments ability to actually test what it is
supposed to be measured’’.

According to Polit and Hungler [1983], ‘’ the content validity of tool is the degree to which the
items in an instrument adequately represent the universe of content’’.

The content validity of the tools for the present study was established by giving it to the experts
from nursing and medical fields.
Experts were requested to judge the items on the basis if their relevance, clarity, feasibility,
appropriateness and organization of the items included in the study. Few suggestions were given
to modify some items.

PILOT STUDY
According to Treece and Treece [1986], ‘’ pilot study is the miniature trial run of the methodology
planned for the major project. The purpose of the pilot study is two fold :

[1] to make improvements in the research projects.

[2] to detect problems that must be eradicated before the major study is attempted.

It was done to assess clarity of items feasibility of conducting the study. Findings showed that it
was feasible to conduct the final study.

Pilot study was conducted on 9th march and 10th march at selected hospital of Delhi. Some
reproductive women were questioned. One questionnaire took about 35-40 minutes to
complete. It was found feasible to conduct the study. No problems were encountered during
pilot study.

ETHICAL CONSIDERATIONS
(i) A basic responsibility of the researcher and those assisting in carrying out project is to
protect all the researcher participants from harm and while they are participating in
an investigation or as a result of study.
(ii) We need to take permission from regulatory bodies for conducting research
investigations, mainly when subjects are human being.
(iii) Our responsibility is to maintain confidentiality that is to protect all the data gathered
within the scope of project from being divulged to others.
(iv) Anonymity should be maintained that is keeping individual’s nameless relation to
their participation in our research project.
(v) The process of providing an individual with sufficient understandable information to
regarding her participation in a research project should be kept in mind participation
in a research project should be kept in mind. It includes providing potential
participants with the information about their rights and responsibilities within the
project and documenting the nature of agreements.
(vi) All the informed consents need to assure the potential participants in their right to
withdraw from research study at any time.
PLAN FOR DATA ANALYSIS
The data obtained would be analysed in terms of the objective of the study and using descriptive
statistical methods.

Part 1:- it includes preparation of datasheet, analysis and presentation of data according to the
objectives of the study. Use of descriptive and inferential statistical for data analysis collected
data could be analyzed in the terms of frequency and percentage in relation to selected
background i.e., age, religion, socio-economic, mass media etc.

Part 2:- of the tool selection ‘A’ was analyzed to assess the knowledge of the sample related to
the cancer cervix size, symptoms, detection and prevention in the form of mean, median and
standard deviation.

SUMMARY
This chapter dealt with the methodology adopted for the study. It presented the research
approach, research design, variables under the study, setting, population, sample and sampling
techniques, development and description of the tool, content validity, tryout and reliability, pilot
study, procedures for data collection, and plan for data analysis. The next chapter presents the
analysis and presentation of data.
 ANALYSIS AND INTERPRETATION

INTRODUCTION

This chapter presents the analysis and interpretations of data collected to assess ‘’ the
knowledge and awareness regarding prevention and early detection of cervical cancer
among women visiting gynae OPD of selected hospital of Delhi’’.

The data was collected questionnaire, administered to 50 samples of visiting women

gynae OPD in selected hospital of Delhi, which consists of parts containing Part-1 as
demographic data and Part-2 as [a] knowledge regarding cervical cancer [b] knowledge
regarding prevention of cervical cancer [c] knowledge regarding early detection of
cervical cancer.

The data was analyzed by using statistics.

[1] Polit and Hunger [1999] described analysis as ‘’a process of organizing and
synthesizing data in such a way that research question can be answered and
hypothesized and tested. The purpose of data analysis is regardless of the types, of data
one has, is to impose some order on a large body of information so that data can be
synthesized, interpreted and communicated.

[2] David J. Fox defined analysis as a procedure for categorizing of verbal or behavioral
data for the purpose of classification, summarization, tabulation.

[3] Abdellah and Lerins mentioned that interpretations means as adequate exposition
of true meaning of the material presented in study being reported, throwing light on the
real significance of the material presented in the content when it is founded.

The purpose of the study was to determine the knowledge related to cancer cervix,
healthy habits and practices relevant to health care services utilization for an early
detection, prevention and treatment in selected group of samples and to make the
analysis of their relationship with selected factors, like socio-economic status, and
empower to most media and married status.

OBJECTIVES OF STUDY

[1] To assess the knowledge and awareness of women regarding cervical cancer.

[2] To assess knowledge of women regarding early detection of cervical cancer.

ORGANISATION OF STUDY

The data was collected by using structured questionnaire and checklist. The data and
findings has been organized and presented under the following sections :-

[1] Description of sample characteristics

[2]Findings related to knowledge of women about cervical cancer.

[a] knowledge of women regarding prevention of cervical cancer.

[b] knowledge of women regarding early detection of cervical cancer.

DESCRIPTION OF SAMPLE CHARACTERISTICS

This part includes item on personal data on people. Sample of 50 reproductive women
were selected, visiting gynae OPD in selected hospital of Delhi by purposive sampling
techniques.

The sample is obtained in terms of age , education, religion, sources of income,

occupation and any obstetric history.

The sample/tool obtained has 2 parts

Part 1- demographic data

[comprised of personal data and background factors]

Table 1- demographic data

Demographic data includes FACTORS [i.e. age, religion, residence, family type, family
income, source of media, age of menarche, age of menopause, marital status, duration
of married life, age of first intercourse, have you ever been diagnosed with UTI, use of
contraceptive]
FACTORS CATEGORIES PEOPLE PERCENTAGE

[1] Age 15-24 12 24%

25-34 30 60%
35-44 05 10%
45 and above 03 6%
[2] Religion Hindu 30 60%
Muslim 20 40%
Christian 00
Others 00
[3] Residence Urban 44 88%
Rural 06 12%
[4] Family type Nuclear 16 32%
Joint 34 68%
[5] Family income < 15,000 36 72%
16,000-25,000 07 14%
26,000-35,000 02 4%
>35,000 05 10%
[6] Source of media Family and friends 09 18%
Health agency 21 42%
Mass media 05 10%
Others 15 30%
[7] Age of Below 13 years 18 36%
menarche Above 13 years 32 64%

[8] Age of 45-50 years 2 4%

menopause 51-55 years 1 2%
56 and above 0 0%
Not reached 47 94%
[9] Marital status Married 47 94%
unmarried 03 6%
[10] Duration of <1 year 1 2.1%
married life 1-5 years 18 38.2%
6-10 years 21 44.68%
>10 years 7 14.89%
[11] Age of first 16-20 years 21 44.68%
intercourse 21-25 years 21 44.68%
26-30 years 5 10.63%
31 and above 0 0%
 [12] Have you ever Yes 4 8%
been diagnosed No 46 92%
with UTI
[13] Use of None 26 52%
contraceptive Oral contraceptive 2 4%
Condom 16 32%
Cu-T 6 12%

Table 1 concluded that the majority of women [i.e 60%] who participated in the
research belonged to the age group of 25-34 years, while the minority [ i.e 6%]
remained between the age group of 45-54 years. 24% of women were from the age
group of 15-2 years and only 10% of women were from the age group of 35-45 years.

Majority of women i.e 60%, who participated in the research were from hindu religion,
while the remaining 40% of women belonged to the muslim religion. No women from
any other religion were encountered during the process of research.

Data also revealed that majority of women i.e 88% of the total women who participated
In research were residing in urban areas, while the rest 12% of women were residence
of rural area.

The collected data also depicts that 68% of women who participated in the research had
an active role in living conditions of a joint family, while the remaining 32% women
belonged to a nuclear family.

The data also revealed that majority of women [i.e 72%]; who participated in the
research belonged to low socio-economic group i.e. with monthly income lower than Rs
15,000, while only 10% of women belonged to high socio-economic group i.e. with
monthly income more than Rs 35,000. The remaining women belonged to socio-
economic group of Rs 16,000-Rs 25,000 [i.e. 14%] and Rs 26,000-Rs 35,000 [i.e. 4%]
respectively.

The data revealed that 42% of women participating in the research became aware about
cervical cancer from one or another health agency, 18% of women received information
from family and friends while 10% of women received information from mass media,
the remaining 30% of women became aware from other sources of information.
Age of menarche of majority of women [i.e. 64%] was found out to be above 13 years,
while the age of menopause was not reached by majority of women [94%]. This shows
that the majority of women who participated in the research were of reproductive age.

The marital status of majority of women [i.e. 94%] who took part in the research was
married i.e. they were indulging in an active sexual life.

The data revealed that the majority of women [i.e. 44%] were already married for 5-15
years of duration.

Age of first intercourse of majority of women [ i.e. 89.63%] found to be between the age
of 16-20 years. [i.e. 44.68%]; 21-25 years [ 44.68%] and the remaining 10.6% first had
sexual intercourse ate the age of 26-30 years.

The collected data also revealed that 92% of women i.e. majority of women were never
diagnosed with urinary tract infection, while the remaining 8% of women had an
episode of UTI at least once in her lifetime.

Majority of women i.e. 52% preferred not using any type of contraceptive method,
while 4% of women used oral contraceptive, 32% of women used condoms and only
12% of women used cu-T as a method of contraception.
 70

60

50
percentage

40

30

20

10

0
(A) (B) (C) (D) (E) (F)
Knowledge of women about cervix cancer

Graph -1:- Related to knowledge of women about cervical cancer shows that :

A. Only 36% of women have heard about cervical cancer remaining 64% of women
were totally unaware about cervical cancer.
B. Only 64% of women knows that having sexual relationship at young age would
lead to cervical cancer.
C. The percentage of women who had a perception that cervical cancer is
communical was found out to be 26%.
D. The percentage of women who thinks that cervical cancer is preventable was
found out to be 64%.
E. It was also found that 28% women thinks that cervical cancer can cause infertility
F. The percentage of women who thinks that chances of cervical cancer increases
with multiple sexual partners was found out to be 64%
 80

70

60

50
percentage

40

30

20

10

0
(G) (H) (I) (J) (K) (L)
Knowledge of women about cervix cancer

Graph 2:- Continuing with knowledge of women about cervical cancer shows:

G. It was found that only 76% women said cervical cancer is treatable.
H. Women [48%] thinks that STDs have relation with cervical cancer.
I. The percentage of women who believes smoking is also a cause of cervical cancer
is 68%.
J. Data revealed that 60% women thinks HIV will increase the chances of cervical
cancer.
K. Only 36% women knows that bleeding after coitus or bleeding on touch is an
indicator of development of cervical cancer.
L. It was found that only 18% women said blood in urine is an indication of cervical
cancer.
Figure 1: The data analyzed for knowledge of women participated in research, regarding
cervical cancer is depicted via pie chart 1.

According to the findings of the data analyzed it was found that only 47.6% of women
were aware about the knowledge related to cervical cancer and the remaining women
were fully unaware about the knowledge of cervical cancer.

100

90

80

70

60
percentage

50

40

30

20

10

0
(i) (ii) (iii) (iv) (v) (vi)
knowledge of women regarding prevention of cervix cancer
Graph 3:- Related to knowledge of women regarding prevention of cervical cancer depicts
that :

[1] Only 2% women knows that HPV injection is given to prevent cervical cancer.

[2] Only 12% women knows that regular pap test can be started at the age of 21 years
and stopped at the age of 45 years.

[3] It was found that 68% women thinks that use of condoms helps in prevention of
cervical cancer.

[4] The perception of women who knows that keeping genital organs clean is necessary
to prevent cervical cancer was found out to be 88%.

[5] The perception of women who said that continuous use off oral contraceptive will
increase the probability of cervical cancer is 52%.

[6] It was found that 58% women thinks having annual pap smear test is the best
protection against cervical cancer.

The Figure 2 reveals that the data regarding knowledge of women related to prevention
of cervical cancer shows that 47.6% of women population were aware about the
preventive measures of cervical cancer and the other 52.4% women are completely
unaware about the preventive measures of cervical cancer like use of condom,
maintaining personal hygiene, avoiding use of oral contraceptives.

100

90

80

70

60
Percentage

50

40

30

20

10

0
(I) (II) (III) (IV) (V) (VI) (VII)
Knowledge of women regarding Early Detection of cervix cancer

Graph 4 :- Related to knowledge of women regarding early detection of cervical cancer

found that :

[1] Only 12% women are aware about HPV vaccine

[2] Only 12% women know about pap test.

[3] It was found that only 18% women know that HPV vaccine should be started at the
age of 13 years.
[4] Data revealed that 16% women thinks that ultrasound do helps in early detection of
cervical cancer.

[5] The percentage of women who said contact bleeding is the primary symptom of
cervical cancer was found out to be 58%.

[6] Only 12% of women know that wetting, foul smelling discharge from vagina is an
indication for development of cervical cancer.

[7] Data revealed that 86% women thinks regular gynaecological examination will help in
early detection of cervical cancer.

The figure 3 regarding the knowledge related to early detection of cervical cancer shows
that only 30.5% of women were aware about the measures of early detection for the
prevention of cervical cancer while remaining 69.5% women were totally unaware about
the early detection of cervical cancer as there are various facilities like PAP test, regular
gynaecological examination available.

Therefore, mean knowledge about the study done shows that less than 50% women were
unaware about the cervical cancer. They were least aware of knowledge, prevention and
early detection of the cervical cancer.
CHAPTER 5

SUMMARY AND CONCLUSION

The present study was conducted with the aim of assessing the knowledge and
awareness of women regarding cervical cancer.

OBJECTIVES

[1] To assess knowledge and awareness of women regarding cervical cancer.

[2] To assess the knowledge of women regarding early detection of cervical cancer.

HYPOTHESIS

[1] There will be no significant knowledge and awareness in women regarding cervical
cancer.

[2] There will be significant knowledge and awareness in women regarding cervical
cancer.

The review of related research and non-research literature helped the investigators to
develop tool and content for knowledge and awareness regarding prevention and early
detection of cervical cancer in women. The literature reviewed further established the
investigator to develop a conceptual framework, methodology of the study and plan for
data analysis.

Conceptual framework consist of modified perception about cervical cancer screening

modifying factor [knowledge] and health system components.

The model has 3 points i.e. modifying factor perceived suspectibility and perceived
severity.

 The research approach adopted for the study is ‘’ descriptive survey approach ‘’
as it is designed to gain more information about characteristics within particular
field of enquiry.
The study was conducted in Gynae OPD of selected hospital of Delhi. A sample of 50
women was selected. The purposive sampling technique used to select the subjects for
the study. The tool developed and used for data collection was questionnaire. The
questionnaire has 2 parts i.e.

PART 1- demographic data contains 14 questions.

PART 2- [1] knowledge regarding cervical cancer contains 13 questions. [2] knowledge
regarding prevention of cervical cancer contains 7 questions. [3] knowledge regarding
early detection of cervical cancer contains 6 questions.

FINDNGS OF THE STUDY

Our study conducted on cervical cancer shows that :-

1. About 60% of the samples belonged to age group 25-34yrs.
2. Majority(88%) women were from urban population.
3. Majority of women(72%) belonged to families with per capita income of Rs. >
15000.
4. About 52% of the women did not use any contraceptive method.
5. 65% women think that the risk of cervical cancer is increased by having sex with
multiple partners.
6. About 47.3% were aware regarding cervical cancer.
7. 47.6% women are aware about the prevention of cervical cancer.
8. Only 30.5% women has knowledge related early detection of cervical cancer.

Study shows that less than 50% of women are aware about cervical cancer.

IMPLICATIONS
Findings of study has some implications for nursing practice, nursing education,
nursing administration, nursing research and general education.
[1] NURSING PRACTICE
Findings of this study indicates that sample subjects prefer physical and
gynaecological examination done by female doctors than males. Nurses are the
key persons who works in small clinics, family planning clinics, occupational
health units and as health personnel are in a position to offer timely information
about cervical cancer, they are also In a position to stress the value of screening
and encourages all women to do so, if attention is paid to facilitate the early
detection then cancer cervix can be controlled for early detection and control.
The nurse has an important role to render effective services. The nurse must be
aware of the incidence of the disease its early signs and symptoms and be able to
identify high risk groups. If nurses are prepared for taking vaginal pap smear,
many cases can be detected in a very early stage of disease.
[2] NURSING EDUCATION
There is a need to include teaching procedure for early detection, and students
may be allowed to take certain numbers of smear, prepare slides and send it for
cytological examination. There is a need to help students from beginning to look
into such patients problems and help them in the earliest possible stage.
[3] NURSING ADMINISTRATION
More work needs to be done to increase the competency of nursing personnel in
primary and secondary prevention. Cancer cervix for in service education
programme can be planned for health team working in hospital or health centers,
to emphasis, preventive aspects of cancer cervix and some provision can be made
so that nurses can get opportunity to identify high risk patients and plan
appropriate programme for this category. There is a need to provide more
facilities for early detection and control of cancer cervix.
Each nurse in urban and rural area needs to supported by authority to improve
the efficacy in cancer detection programme and nurse may also be taught to do
the smear test.
[4] NURSING RESEARCH
Findings of this study indicates that traditional approach to educating public for
early signs and symptoms may not be adequate. There may be need for health
professional to re-orient their thinking to encourage people :-
[1] to avoid risk factors
[2] to reduce exposure to risk factors
[3] to participate In screening programme
[4] to have checkups and adopts newer approaches to cancer prevention and
control

[5] GENERAL EDUCATION

Education has an opportunity to play an important role in changing health
practices behavior. There is an need to include in the 10th standards school
curriculum about good hygiene practices, predisposing factors, early signs and
symptoms of the cancer cervix so that the primary prevention can be taken care
off.
 LIMITATIONS
Some limitations can be recognized in conducting the study :-
 As no standardized tool could be readily located the tool used for the data
collection was prepared by the investigators for the purpose of the study.
 Sample was purposive.
 Selection of sample was limited to a patient population drawn from hospital. This
limits the granulations that can be made.
 Structured questionnaire limited the information which could be obtained from
the subjects.
 Time period i.e. 4-5 months for the research is limited.

RECOMMENDATIONS
On the basis of present study and suggestions of the study subjects further
recommendations can be taken for research :-
 Similar studies can be carried on the large samples, to validate the findings and
make generalizations.
 A study can be conducted to assess the level of stress and strategies of women
during cervical cancer.
 A study can be done to find the correlation between knowledge of women and
early detection regarding cervical cancer.
 Same study could be done on rural population in order to make comparative
study and to assess the knowledge of rural population.
 Structural education programme can be prepared and tested on different types
of population who select appropriate educational program in their respect with
different settings.
 Various programme could be prepared and tested for general population which
could be used through mass-media by government agencies.

CONCLUSIONS

On the basis of above findings of the study following could be drawn :-

 There is deficiency of knowledge in women regarding cervical cancer, its
prevention and early detection.
But they are willing to know about cancer cervix and shoes interest in gathering
information regarding pap smear test and prevention of cervical cancer.
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APPENDICES
 LETTER REQUESTING CONTENT VALIDATION OF TOOL
To
.......................
.......................
.......................

Subject: Request for validation of tool for our group project.

Respected Sir/Madam,

This is to bring to your kind notice that we the students of Bsc. (Hons.) Nursing,
Interns, Ahilya Bai College of Nursing have selected the below mention topic for our
group project to be submitted to Delhi University as a partial fulfillment of the
university requirement for award of our Bsc. (Hons.) Nursing degree.
TOPIC: "A study to assess the knowledge and attitude of pregnant women with
regard to condom use visiting Antenatal OPD of selected hospital of Delhi."
OBJECTIVE: 1.To assess the knowledge and attitude of pregnant women regarding
condom use.
2. To find the correlation between the knowledge and attitude of pregnant women
regarding condom use.
3. To find the association of knowledge and attitude of pregnant women regarding
condom use with selected demographic variables.
We request you to kindly go through the content of the tool and give your valuable
suggestions. Your cooperation and expert judgment will be appreciated.

Thanking you,

Yours sincerely,

(Group Leader)
Name of group leader: Sonam

(Guide)
Name of the guide: Dr. Sneh Lata Manocha
 PART -1

Demographic data

1. Age in years

a. 15-24 years b. 25-34years

c. 35-44 years d. 45 and above

2. Religion

a. Hindu b. muslim

c. Christian d. others

3. Area of residence

a. Urban b. rural

4. Type of family

a. Nuclear b. joint

5. Family income(monthly)

a. <15,000 b. 16,000-25,000
c. 26,000-35,000 d. >35,000

6. Source of information

a. Family and friends b. health agency

c. Mass media d. others

7. Age of menarche

a. Below 13 years b. above 13 years

8. Age of menopause

a. 45-50 years c. 56 and above

 b. 51-55 years d. Not reached

9. Marital status (married since)

a. Married b. unmarried

10. If married ; duration of married life

a. <1 year
b. 1-5 years
c. 6-10 years
d. >10 years

11. Obstetrical status

a. No. of pregnancies __________

b. No. of abortions __________
c. No. of deliveries __________
d. No. of living children __________

12. Age of first intercourse

a. 16-20years

b. 21-25years

c. 26-30years

d. 31 and above

13. Have you ever been diagnosed with UTI

 a. Yes

b. No

14. What contraceptive methods do you use

a. None

b. Oral contraceptive

c. Condom

d. Cu-T

QUESTIONNAIRE

Part – 1
(Questionnaire regarding knowledge of women related to Cancer)

Question Yes No Don’t know

Q1. Have you ever heard about cervical
cancer before?
Q2. Having sexual
relationship at a young age, would
lead to cervical cancer.

Q3. Is cervical cancer communicable?

Q4. Is cervical cancer preventable?

Q5. women with cervical cancer are

infertile?

Q6. chances of cervical cancer increases with

multiple sexual partners?

Q7. Is cervical cancer treatable?

Q8. STDs have relation with cervical

Cancer?

Q9. Smoking have relation with

occurrence of cervical cancer?

Q10. HIV will increase the chances of

cervical cancer?

Q11. Bleeding after coitus or bleeding

on touch is the indication for
development of cervical cancer?

Q12. Blood in urine is an indication of

cervical cancer?

Questions related to Prevention of cervical cancer

 Question Yes No Don’t know
Q1. Do you know about an injection given to
prevent cervical cancer?

Q2. Regular pap test can e started at age of

21 years and stopped at age of 65 years?

Q3. Do condoms help in prevention of

cervical cancer?

Q4. keeping genitals clean is necessary to

prevent cervical cancer?

Q5. The continuous use of oral

contraceptive will increase the
probability of cervical cancer?

Q6. Best protection against cervical cancer is

provided by having annual pap smear test?

Questions related to early detection

Question Yes No Don’t know

Q1. Are you aware about HPV vaccine?

Q2. Do you know about pap test?

Q3. HPV vaccine should be started at age of

13 years?

Q4. Do ultrasound help in early detection of

cervical cancer?

Q5. Contact bleeding is the primary symptom

of cervical cancer?

Q6. Wetting, foul smelling, discharge from

vagina is the indication for development of
cervical cancer?

Q7. Regular gynaecological examination will

help for early detection of cervical cancer?
 जनस ां ख्यिकीय डे ट

1. स ल में उम्र
a. 15-24 स ल
b. 25-34 स ल
c. 35-44 स ल
d. 45 और उससे ऊपर
2. धमम
a. ह ां दू
b. मुख्यिम
c. ईस ई
d. दू सर ां
3. हनव स क क्षेत्र
a. श री
b. ग्र मीण
4. पररव र क प्रक र
a. एकल
b. सांयुक्त
5. प ररव ररक आय (म हसक)
a. <15000
b. 16000-25000
c. 26000-35000
d. >3500
6. ज नक री क स्र त
a. पररव र और द स् ां
b. े ल्थ एजेंसी
c. म स मीहडय
d. दू सर ां
7. म हसक की आयु
a. <13 स ल
b. > 13 स ल
8. म हसक की र क की उम्र
a. 45-50 स ल
b. 51-55 स ल
 c. 56 और उससे ऊपर
d. न ीां हुआ
9. वैव ह क ख्यथिहत
a. हवव ह त
b. अहवव ह त
10. यहद वैव ह क, हवव ह त जीवन की अवहध
a. <1 स ल
b. 1-5 स ल
c. 6-10 स ल
d. >10 स ल
11. प्रसूहत ख्यथिहत
a. गर्मध रण की सांि
b. गर्मप त की सांि
c. प्रसव ां की सांि
d. जीहवत बच् ां की सांि
12. प ले सम गम की उम्र
a. 16-20 उम्र
b. 21-25 उम्र
c. 26-30 उम्र
d. 31 और उससे ऊपर
13. क्य तुमने कर्ी मूत्र पि के सांक्रमण के स ि क हनद न हकय गय ?
a. ाँ
b. न ीां
14. आप हकस गर्महनर धक तरीक ां क इस्ेम ल करते ैं ?
a. कुछ न ीां
b. ओरल गर्महनर धक
c. कांड म
d. कॉपर-टी
सव म इकल कैंसर के स ि मह ल ओां क ज्ञ न

प्रश्न ाँ न ीां पत न ीां

Q1 । क्य आपने कर्ी सव म इकल कैंसर के ब रे
में प ले सुन ै ?

Q2. कम उम्र में यौन सां बांध ने से सव म इकल

कैंसर क क रण बन ज एग ?

Q3. ग्रीव कैंसर सांच री ै ?

Q4. क्य सव म इकल कैंसर हनव रक ै ?

Q5. गर् म शय ग्रीव के कैंसर के स ि मह ल ओां

क ऊसर ैं ?

Q6 कई यौन र् गीद र ां के स ि गर् म शय ग्रीव

के कैंसर की सां र् वन बढ़ ज ती ै ?

Q7. ग्रीव कैंसर इल ज ै ?

Q8. एसटीडी गर् म शय ग्रीव के कैंसर के स ि

सांबांध ै ?

Q9. धूम्रप न गर् म शय ग्रीव के कैंसर की घटन

के स ि सांबांध ै ?

Q10.एचआईवी गर् म शय ग्रीव कैंसर की

सांर् वन बढ़ ज एगी?

Q11. स व स के ब द रक्तस्र व य स्पशम पर

रक्तस्र व गर् म शय ग्रीव के कैंसर के हवक स के
हलए सांकेत ै ?

Q12. मूत्र में रक्त ग्रीव कैंसर क सांकेत ै ?

गर् म शय ग्रीव के कैंसर की र कि म से सांबांहधत प्रश्न

प्रश्न ां न ीां पत न ीां ै

Q1. क्य आप सव म इकल कैंसर से बच व के हलए हदए गए

एक इां जेक्शन के ब रे में ज नते ैं ?

Q2. हनयहमत पीएपी परीक्षण कर सकते ै 21 स ल की

उम्र में शुरू हकय और 65 स ल की उम्र में बां द कर
हदय ?

Q3. क्य कांड म गर् म शय ग्रीव के कैंसर की र कि म में

मदद करते ैं ?

Q4. जनन ां ग ां क स फ रखन गर् म शय ग्रीव कैंसर क

र कने के हलए आवश्यक ै ?

Q5. ओरल गर्महनर धक के हनरां तर उपय ग से गर् म शय

ग्रीव के कैंसर की सांर् वन बढ़ ज एगी?

Q6. गर् म शय ग्रीव के कैंसर के ख्यखल फ सवम श्रेष्ठ सां रक्षण

व हषम क पीएपी परीक्षण ने से प्रद न की ज ती ै ?
गर् म शय ग्रीव के कैंसर क शीघ्र पत लग ने से सांबांहधत प्रश्न

प्रश्न ां न ीां पत न ीां ै

Q1. क्य आप एचपीवी वै क्सीन के ब रे में ज नते ैं ?

Q2. क्य आप पीएपी टे स्ट के ब रे में ज नते ैं ?

Q3. एचपीवी वै क्सीन 13 स ल की उम्र में शुरू हकय ज न

च ह ए?

Q4 क्य अल्ट्र स उां ड गर् म शय ग्रीव के कैंसर क जल्दी

पत लग ने में मदद करत ै ?

Q5. सांपकम रक्तस्र व गर् म शय ग्रीव के कैंसर क प्र िहमक

लक्षण ै ?

Q6 गील , गलत गांध, य हन से मुख्यक्त गर् म शय ग्रीव के

कैंसर के हवक स के हलए सांकेत ै ?

Q7. हनयहमत स्त्रीर ग ां परीक्ष गर् म शय ग्रीव के कैंसर क

शीघ्र पत लग ने में मदद हमलेगी?

ABSTRACT
A study to assess the knowledge and awareness in women regarding prevention and early
detection of cervical cancer visiting gynae OPD at selected hospital of Delhi.

NEED FOR STUDY

Cervical cancer is one of the most common cancer worldwide. In india, it is one of the
leading causes of mortality among woman accounting for 23.3% of all cancer deaths. India
accounts for about 20% of cervical cancer cases reported from the world. More than 3/4th
of these patients are diagnosed in advanced stages leading to poor prospects of long term
survival and cure. Early detection of cervical cancer is possible with Pap smear tests. The
proportion of woman who undergo pap smear testing ranges from 2.6 % to 6.9% among
woman in communities.

OBJECTIVES OF THE STUDY

1. To assess the knowledge of women regarding cervical cancer.

2. To assess the knowledge regarding the prevention and early detection of cervical
cancer.
The conceptual framework consists of modified perceptions about cervical cancer
and cervical cancer screening, modifying factor [ knowledge] and health system
components.

Research approach adopted for the study was descriptive survey approach. The study
was conducted on 50 women attending gynae OPD in LNJP hospital.

The tool used for data collection was a structured questionnaire. The validity of tool was
established by 11 experts in nursing and medical fields.

The data was collected from 16 march, 20 march, 22 march, 26 march, 29 march and 30
march ,2018.

Data obtained was analysed in terms of objective of the study and using descriptive
statistical method.

FINDINGS OF THE STUDY

Significant findings of the study were the percentage of the women regarding the
knowledge, prevention, early detection of cervical cancer.
Following were the findings:-

9. About 60% of the samples belonged to age group 25-34yrs.

10. Majority(88%) women were from urban population.
11. Majority of women(72%) belonged to families with per capita income of Rs. >
15000.
12. About 52% of the women did not use any contraceptive method.
13. 65% women think that the risk of cervical cancer is increased by having sex with
multiple partners.
14. About 47.3% were aware regarding cervical cancer.
15. 47.6% women are aware about the prevention of cervical cancer.
16. Only 30.5% women has knowledge related early detection of cervical cancer.
RECOMMENDATIONS

On the basis of present study and suggestions of the study subjects further
recommendations can be taken for future research:-
 Similar studies can be carried on the large sample to validate the findings
and generalisation.
 A study can be conducted to assess the level of stress and strategies of the
women during cervical cancer.
 A study can be done to find the correlation between knowledge of women
and early detection regarding cervical cancer.
 Same study could be done on rural population in order to make
comparative study and to assess the knowledge of rural population.
 Structured educational programs can be prepared and tested one different
types of population who selected appropriate educational program in their
respect with different settings.
 Various programs could be prepared and tested for general population
which could be used through mass-media by government agencies.