Cervical Cancer-Related Knowledge, Attitudes, Practices and Self-Screening Acceptance Among Patients, Employees, and Social Media Followers of Major Brazilian Hospital

Abstract

Background Brazil has a high burden of cervical cancer, even though it is preventable, traceable and treatable. Hence, this study evaluated levels of knowledge, attitudes and practices (KAP) related to cervical cancer screening and diagnosis and acceptance of self-screening techniques among women aged 24 and greater. Methods A cross-sectional KAP survey was administered to n = 4206 women and spanned questions relating to cervical cancer, HPV, speculum, Pap test and colposcopy. Questionnaire was disseminated through a major hospital’s social media platforms, intranet and gynecologic-oncology clinics. Logistic regressions evaluated associations between sociodemographic characteristics and knowledge, attitudes, and preventative behaviors against cervical cancer. Participants indicated willingness to try DNA-HPV self-sampling and cervix self-visualization (self-colposcopy). Findings Participants were mostly white individuals (70.5%) with higher education and from social classes A and B. They demonstrated superior levels of KAP than described in the literature, with over 57.8% having answered 80+% of questions correctly. KAP scores were predicted by social class, educational attainment, race, history of premalignant cervical lesions and geographic location. About 80% and 63% would be willing to try DNA-HPV self-sampling and cervix self-visualization, respectively. Interest in self-screening was associated with adequate attitude (OR = 1.85) and inadequate practice (OR = .83). Interpretation Adequate KAP are fundamental for the successful implementation of a self-screening program. Participants were interested in methods that provide them with greater autonomy, control and practicality. Self-screening could address barriers for under-screened women such as shame, discomfort, distance from clinics and competing commitments, enabling Brazil to reach the WHO’s cervical cancer elimination goals. It could also decrease excess medical intervention in over-screened populations by promoting shared decision-making.

The levels of women’s awareness, experience, acceptability and preference for Vaginal Human Papillomavirus (HPV) self-sampling in three provinces of China: a cross-sectional study

“…In the last open-ended question in the questionnaire of our study, participants provided more feedback on the following aspects: (1) the accuracy of the results of selfsampling; (2) the timeliness of the specimen, hoping to accelerate the speed of testing; (3) the comprehensiveness and readability of the test report, hoping to interpret the positive report and give the next step in the treatment; (4) suggestions to increase the frequency of the test, 1 to 2 times a year; (5) suggestions to popularize cervical cancer and HPV screening knowledge; and (6) the accessibility of the test, hoping to reduce the price or free screening. In response to feedback from many participants in our study that they would like to increase the frequency of testing, a similar willingness to screen was reported in a Brazilian study, where 93.8% of the participants felt that cytology should be performed more frequently than recommended [25]. However, it has been demonstrated that HPV testing is more sensitive than cytology or visual inspection based on acetic acid, allowing longer screening intervals.…”

“…Haward et al surveyed Canadian women and discovered that their understanding of HPV self-sampling was inadequate, with a correct knowledge rate of only 20.4% [ 24 ]. In contrast, a cross-sectional survey in Brazil showed that 70% of the participants correctly answered four-fifths of the HPV knowledge questions [ 25 ], which is a high level of knowledge. It is possible that there were large differences in the level of awareness due to the heterogeneity of the questionnaires used to assess knowledge across studies.…”

“…This finding is in line with the majority of the study findings. According to some studies, social class and years of education are related to one’s comprehension of cervical cancer screening [ 25 ]. Professionals (e.g., accountants, lawyers, architects, healthcare professionals, journalists, etc.)…”