Project – Knowledge and acceptability/practice of cervical cancer screening among females
CHAPTER ONE
INTRODUCTION
- Background to the Study
Cervical cancer remains a major public health concern globally, particularly in low- and middle-income countries (LMICs), where over 85% of related deaths occur (World Health Organization [WHO], 2022). Despite being largely preventable through early screening and treatment of precancerous lesions, uptake of cervical cancer screening services remains low. One of the most significant barriers identified in the literature is a general lack of knowledge and awareness about cervical cancer, its risk factors, and the importance of regular screening (Yimer et al., 2021). Many women are unaware that the human papillomavirus (HPV) is the primary cause of cervical cancer, or that simple procedures like Pap smears can detect early changes that can prevent the disease.
The level of knowledge about cervical cancer screening has been shown to vary significantly depending on sociodemographic factors such as education, income, and urban-rural residence. A study conducted in Ethiopia found that women with higher education levels were more likely to have adequate knowledge of cervical cancer and its screening methods (Gebreegziabher et al., 2019). Similarly, research in Nigeria and India has shown that women with secondary or higher education had better understanding of cervical cancer symptoms, risk factors, and the importance of regular screening (Ezechi et al., 2013; Agrawal et al., 2017). This knowledge gap highlights the need for targeted educational interventions, particularly in communities with lower literacy levels.
Even when knowledge is present, it does not always translate into practice. Several studies have found a disconnect between awareness of cervical cancer screening and actual uptake of services. For instance, in a study among female university students in Ghana, while 74% had heard of cervical cancer, only 12% had ever undergone screening (Awua et al., 2022). This discrepancy suggests that factors beyond knowledge—such as fear, stigma, accessibility, and cultural beliefs—also significantly impact screening behavior. Women often cite fear of a cancer diagnosis, embarrassment during the procedure, and discomfort with male healthcare providers as reasons for avoiding screening (Mingo et al., 2012).
Acceptability of screening methods also plays a crucial role in determining uptake. Pap smears remain the most widely known method, but newer techniques such as visual inspection with acetic acid (VIA) and HPV DNA testing have been introduced, especially in resource-limited settings. A systematic review by Catarino et al. (2015) found that women were more likely to accept screening when they received proper counseling and when the methods were perceived as less invasive or painful. The introduction of self-sampling for HPV testing has also shown promise in improving participation, particularly among women who feel uncomfortable with clinician-based procedures (Racey et al., 2013).
Cultural and religious beliefs can significantly shape attitudes towards cervical cancer screening. In some communities, topics related to reproductive health are considered taboo, making it difficult for women to seek information or access services. A qualitative study in rural Uganda revealed that many women believed cervical cancer was a result of infidelity or a punishment for immoral behavior, further discouraging screening (Mwaka et al., 2014). Addressing these deeply rooted beliefs requires culturally sensitive health promotion strategies that engage community leaders and use appropriate messaging.
In conclusion, improving knowledge and changing attitudes toward cervical cancer screening requires multifaceted interventions. Education alone may not be sufficient; efforts must also focus on making screening services accessible, affordable, and culturally acceptable. Health systems must prioritize awareness campaigns, provider training, and community engagement to enhance both knowledge and practice of cervical cancer screening. Further research should continue to explore the barriers and facilitators to screening uptake in various sociocultural contexts to design more effective public health interventions.
1.2. Statement of the Problem
Cervical cancer is one of the most preventable and treatable forms of cancer when detected early through regular screening and appropriate follow-up. Despite the availability of effective screening methods such as the Papanicolaou (Pap) smear, Visual Inspection with Acetic Acid (VIA), and HPV testing, cervical cancer continues to be a leading cause of morbidity and mortality among women, particularly in low- and middle-income countries (LMICs). Globally, more than 600,000 new cases are diagnosed annually, and over 340,000 women die from the disease each year, with the majority of deaths occurring in regions where screening services are either underutilized or unavailable (World Health Organization, 2022).
A significant factor contributing to the high burden of cervical cancer is the low level of awareness and knowledge among women about the disease and the importance of regular screening. Numerous studies have revealed that many women are not familiar with the causes of cervical cancer—particularly its strong association with persistent infection with high-risk types of human papillomavirus (HPV)—or the need for routine screening even in the absence of symptoms. This lack of knowledge often translates into poor health-seeking behavior, resulting in late-stage diagnosis when treatment outcomes are less favorable.
Moreover, even in settings where women possess some knowledge of cervical cancer, many do not practice regular screening. The gap between awareness and practice is influenced by a complex interplay of factors, including cultural beliefs, fear of diagnosis, limited access to healthcare services, cost, and a lack of perceived susceptibility. For example, some women avoid screening due to misconceptions about the procedure, embarrassment, or stigma associated with reproductive health issues. Others may live in areas where screening facilities are inaccessible, under-resourced, or not culturally sensitive, further reducing uptake.
In addition to these individual and structural barriers, the acceptability of cervical cancer screening methods also plays a crucial role. The conventional Pap smear, though effective, may be viewed as invasive or uncomfortable, leading to reluctance to participate. While newer technologies like self-sampling for HPV testing offer promising alternatives, their adoption is still limited due to lack of information, provider bias, and regulatory hurdles in many regions. Without addressing these concerns, scaling up screening efforts remains a major challenge.
The persistence of low screening rates despite the proven benefits of early detection highlights a critical gap in public health intervention. While multiple awareness campaigns have been implemented in various countries, their impact on behavior change remains inconsistent. This underscores the need for deeper understanding of the knowledge, attitudes, and practices surrounding cervical cancer screening among different female populations, particularly in underrepresented or vulnerable groups. Addressing these issues is essential to inform the development of tailored strategies that can effectively promote screening uptake and reduce cervical cancer incidence.
In light of these challenges, it becomes imperative to investigate not only the level of knowledge and awareness among females regarding cervical cancer screening but also their attitudes, beliefs, and barriers to practice. Such an investigation will provide valuable insights into the specific factors influencing screening behavior and help guide the design of more effective health education programs, community outreach strategies, and policy interventions aimed at increasing screening rates and ultimately reducing preventable deaths from cervical cancer.
1.3. Aim and Objectives of the Study
The aim of the study is to examine Knowledge and acceptability/practice of cervical cancer screening among females in Benue state university teaching hospital Makurdi. The specific objectives are:
- To assess the level of knowledge among females regarding cervical cancer screening.
- To determine the factors influencing the acceptability of cervical cancer screening among females.
- To evaluate the current practices of cervical cancer screening among females in the hospital.
- To identify barriers to accessing cervical cancer screening services in the hospital.
1.4. Research Questions
The research questions are buttressed below:
Sure! Here are the research questions based on the objectives you provided:
- What is the level of knowledge among females regarding cervical cancer screening?
- What are the factors that influence the acceptability of cervical cancer screening among females?
- What are the current practices of cervical cancer screening among females in the hospital?
- What are the barriers to accessing cervical cancer screening services in the hospital?
1.5. Research Hypothesis
The hypothetical statement of the study is buttressed below:
Ho: The level of knowledge among females will not affect cervical cancer screening
H1: The level of knowledge among females will affect cervical cancer screening
1.6. Significance of the Study
This study is significant because it addresses a major global health concern—cervical cancer—that remains a leading cause of death among women, especially in low- and middle-income countries. Despite the availability of effective screening and preventive measures, cervical cancer continues to claim thousands of lives each year due to late diagnosis and poor access to healthcare. Understanding the knowledge, attitudes, and practices surrounding cervical cancer screening is essential for identifying the gaps that hinder early detection and treatment. By exploring these factors, this study contributes to the broader public health goal of reducing preventable cancer-related deaths among women.
The findings of this study will provide valuable insights for healthcare policymakers and public health authorities. Data on knowledge levels and screening practices among women can inform the design and implementation of targeted awareness campaigns. Public health programs often fail due to a lack of contextual understanding of community-specific barriers. This research can help tailor interventions to be culturally sensitive, demographically appropriate, and responsive to the real concerns of the population, thereby improving the effectiveness of cervical cancer screening campaigns.
Healthcare providers and professionals will also benefit from this study by gaining a deeper understanding of the reasons why women may be hesitant or unwilling to undergo cervical cancer screening. This knowledge can enhance patient-provider communication and guide healthcare workers in delivering more compassionate, nonjudgmental, and informative care. Moreover, it can help identify training needs for providers, ensuring that they are equipped to educate patients, reduce stigma, and address fears associated with screening procedures.
The study has academic and scholarly value as it contributes to the existing body of literature on women’s health, preventive care, and cancer control. It can serve as a reference for future researchers interested in women’s health behavior, especially in the context of reproductive cancers. Additionally, it may identify new areas of investigation, such as the role of digital media, peer education, or religious beliefs in influencing screening behavior, thus opening new avenues for multidisciplinary research.
At the community level, the study promotes health empowerment among women by highlighting the importance of early detection and encouraging health-seeking behavior. Women who become more informed about cervical cancer and its prevention are more likely to take responsibility for their health and influence others in their community to do the same. This ripple effect can ultimately lead to greater health awareness, stronger community engagement in health programs, and a more proactive approach to disease prevention at the grassroots level.
Finally, this study supports global health initiatives such as the World Health Organization’s strategy to eliminate cervical cancer as a public health problem. By contributing local or national data, the research aligns with international efforts to increase screening coverage and vaccination against HPV. The findings can guide resource allocation, advocacy, and policy decisions that prioritize women’s health and ensure equitable access to life-saving preventive services for all females, regardless of socioeconomic status or geographic location.
1.7. Scope of the Study
The study examines the Knowledge and acceptability/practice of cervical cancer screening among females in Benue state university teaching hospital Makurdi.
1.8. Operational Definition of Terms
Knowledge: Knowledge refers to the awareness, understanding, and information that individuals have about cervical cancer and its screening. In this context, it includes familiarity with the causes (such as HPV), risk factors, symptoms, prevention methods, and the importance of regular screening for early detection.
Acceptability: Acceptability is the extent to which individuals are willing to undergo or support cervical cancer screening based on their perceptions, beliefs, cultural norms, and comfort with the screening process. It reflects how favorable or unfavorable they feel about the screening methods (e.g., Pap smear, VIA, HPV testing), the healthcare environment, and the perceived benefits or harms of the procedure.
Practice: Practice refers to the actual behavior of undergoing cervical cancer screening. It includes whether and how often females participate in screening services, the methods they use, and their adherence to recommended screening intervals. It is the practical application of knowledge and attitudes toward screening.
Cervical Cancer Screening: Cervical cancer screening is a preventive health service used to detect early signs of abnormal cell changes in the cervix that may lead to cervical cancer. Common methods include the Pap smear test, Visual Inspection with Acetic Acid (VIA), and Human Papillomavirus (HPV) testing. The goal of screening is early detection and timely treatment to prevent the development of invasive cervical cancer.
Females: Females in this study refer to individuals biologically identified as women, particularly those within the recommended age range for cervical cancer screening (usually 21–65 years), who are at risk of developing cervical cancer. This may include adolescents, adults, and older women, depending on the context of the study