Study of knowledge, attitudes and practices of Armenian women with regard to pap screening

Abstract

Introduction- Cervical Cancer (CC) is an important reproductive health problem among women. It is the third most common cancer in the world and is the second most common cancer in females. In Armenia CC is the second most prevalent malignant tumor and is the second cause of cancer death among women after breast cancer. High mortality and morbidity rates and increased rates of advanced cases in Armenia and other developing countries when compared to low rates in more developed countries can be explained by the lack of effective screening programs and poor secondary prevention. The most widely used screening method for CC is cervical cytology or a Papanicolaou or Pap test. Objective of the study- The aim of this study is to gather in-depth information regarding knowledge, attitudes and practices of Armenian women in Yerevan aged 18 to 65 years in regard to Pap test. Methods- To show the real in-depth picture of the issue of CC secondary prevention utilizing a Pap test in Armenia, an exploratory qualitative study was conducted in Yerevan. Two types of qualitative research techniques were used: key- informant and in-depth interviews. Purposive (judgment) sampling was used to recruit 20 women aged 18 to 65 years for in-depth and 6 gynecologists for key-informant interviews. Data collection was conducted from July 20 to September 24 after approval of the study by the Institutional Review Board of the American University of Armenia. Interviews were carried out after oral consent was obtained in Armenian. Semi-structured field guides with open-ended questions were used for both types of the interviews. Data were analyzed using hermeneutic analysis which involves reading and rereading the transcripts for underlying themes. Data analysis was done by one researcher (principal investigator) with the assistance of a gynecologist. Results – The study found that the knowledge level of Armenian women about CC and its association with a Pap test is low which, may be due to absence of sources of information and educational campaigns. Cultural attitudes of Armenian women as well as the current socioeconomic situation, distrust towards gynecologists, and absence of cytologic services also contribute to low rates of utilization of the Pap test. Moreover, women do not seek to Pap screening services by themselves but rely mostly on their gynecologists’ decisions. However, overwhelming majority of women do not visit gynecologists for preventive purposes. The latter finding contradicts reported attitudes of the interviewed women because they said they believed that regular and frequent visits to gynecologists for preventive check-ups are important. Conclusion– The study found that multiple factors influence the utilization of Pap screening services. Moreover, there is a unique set of these factors for each woman. Therefore, identification of the most important factors that have ability to predispose, enable or reinforce women’s screening behaviors was important. A public approach should be adopted in tackling the problem of CC because this would enable the message to reach a number of women. Recommendations– Based on the results of this study, recommendations include future quantitative research to survey the knowledge and use of Pap tests. Research should be carried out about risk factors of CC in Armenia. The role of mass media and policlinics should be increased in promoting CC prevention. Also, specific procedural changes must be adopted to assure consistent classification of the results of the Pap test. Common technique must be used to obtain specimen in all health care institutions.