Public Health Nursing

Health beliefs and associated factors related to HPV and HPV vaccination in a sample of Turkish women: A cross‐sectional study

AbstractThis study was conducted to determine women's health beliefs about HPV and HPV vaccination and factors associated with health beliefs. This cross‐sectional study was conducted with 300 women aged 21–64 in Turkey. Data were collected using the human papillomavirus (HPV) knowledge scale (HPV‐KS) and the health belief model scale for human papillomavirus and its vaccination (HBMS‐HPVV). The mean age of the women who participated in the study was 35.16 ± 9.52 years. Of them, 72.3% heard of the HPV test, 30.3% had an HPV test, 62% heard of HPV vaccination, and 9.7% had HPV vaccination. Educational level, hearing about the HPV vaccine, and HPV knowledge level were significant predictors of perceived benefit (p < .001). HPV knowledge level significantly predicted perceived susceptibility (p < .001). HPV knowledge level and hearing about HPV tests and vaccines were significant predictors of perceived severity (p < .001). A high level of education, a high level of HPV knowledge, and hearing about HPV tests and the HPV vaccine positively affect women's health beliefs. Health belief model‐based education programs should be used to improve women's HPV knowledge and health beliefs about HPV and the HPV vaccine. In addition to women's health beliefs, cervical cancers can only be prevented by including the HPV vaccine in national immunization programs and increasing the coverage of HPV screening tests.

Determinants of Cervical Cancer Screening Among Rural Women in Zimbabwe

ABSTRACTObjectiveTo identify the determinants of cervical cancer (CC) screening among underserved rural women in Zimbabwe.DesignCommunity‐based cross‐sectional survey.Sample840 rural women (25–65 years).MeasurementsA structured, pretested questionnaire was used to collect data on sociodemographic characteristics and factors influencing screening. The outcome was defined as self‐reported ever screening for CC. Multivariable logistic regression was used to examine the association between CC screening and independent variables.ResultsOf the 840 women included, 33% had a history of screening. Women 25–45 years (adjusted odds ratio (aOR): 0.43; 95% CI: 0.30–0.61) and without medical insurance (aOR: 0.66; 95% CI: 0.45–0.97) had reduced odds of CC screening. Conversely, women who had seen or heard messages on CC screening (aOR: 1.48; 95% CI: 1.03–2.13), were living with HIV (aOR: 1.87; 95% CI: 1.22–2.87) reported recent antibiotic use (aOR: 4.50; 95% CI: 1.47–13.79) and had malaria in the last 6 months (aOR: 2.45; 95% CI: 1.02–5.86) had increased odds of CC screening.ConclusionThere is a need for intensified efforts to improve CC screening uptake, particularly in underserved rural areas with suboptimal screening rates and high CC burden. Strategies should include widespread tailored awareness messaging targeting younger women, women living with HIV, and women without medical insurance.

Epidemiological trends and burden analysis of cervical cancer attributable to unsafe sex: A population‐based study from 1990 to 2019

AbstractBackgroundUnsafe sex is recognized as an important risk factor for cervical cancer (CC). Understanding the global disease burden of CC attributable to unsafe sex can assist policymakers in allocating healthcare resources.MethodsData were obtained from the 2019 global burden of disease database (GBD). We examined global, regional, and national levels of CC mortality, disability‐adjusted life years (DALYs), and age‐standardized rates (ASRs) caused by unsafe sex. ASRs were evaluated using estimated annual percentage changes (EAPCs).ResultsAttributable to unsafe sex, there were 280,479 CC‐related deaths in 2019 and 8,955,013 CC‐related DALYs. In the period 1990–2019, the global ASRs of CC due to unsafe sex decreased around the world; for age‐standardized mortality rate (ASMR) and age‐standardized DALY rate (ASDR), the EAPCs were −0.93 and −0.95. The highest ASMRs and ASDRs were found in central sub‐Saharan Africa and the lowest in Australasia.ConclusionIn the past few decades, the ASMR and ASDR of CC caused by unsafe sexual practices have decreased over time, with significant variations observed among different countries and regions. Increased focus is needed on spreading awareness about sexual health and promoting CC prevention and screening, particularly in low‐ and middle‐income nations.

The relationship between HPV testing attitudes and beliefs, knowledge, and vaccination attitudes: A cross‐sectional study

AbstractObjectiveThis study aims to examine the relationship between human papillomavirus (HPV) testing attitudes and beliefs, knowledge, and vaccination attitudes.DesignThis study was a cross‐sectional design.SampleThis study was conducted between March 15, 2024, and June 2, 2024, through social media platforms such as Facebook, Instagram, Twitter, and Telegram, by sharing on forum pages, and involved 674 women who volunteered to participate.MeasurementsThe research data were collected using the “health belief model scale regarding HPV infection and vaccination (HBMS‐HPVV)” and the “HPV Testing Attitudes and Beliefs Scale (HTABS),” which were developed by the researchers through a literature review.ResultsThe average age of the women participating in the study was 46.59 ± 11.15 years; 81.5% were married, 57.6% had no knowledge about cervical cancer, and 62.2% had no knowledge about the HPV vaccine, a protective vaccine against cervical cancer. The average scores for the subdimensions of severity, barriers, benefits, and susceptibility of the HBMS‐HPVV were 3.19 ± 0.60, 2.96 ± 1.22, 2.29 ± 1.40, and 3.92 ± 0.49, respectively. The average scores for the subdimensions of personal barriers, social norms, confidence, and worries of the HTABS were 31.14 ± 19.27, 7.57 ± 4.47, 30.03 ± 7.18, and 11.91 ± 2.52, respectively. A statistically significant positive relationship was found between all HBMS‐HPVV subdimensions and the HTABS subdimensions (p < 0.001).ConclusionThe study found that as the perceived severity increases, the perceived benefits, susceptibility, and confidence increase, while the perceived barriers, personal barriers, social norms, and worries decrease. Based on these results, it is recommended that women's health nurses provide education and seminars to raise awareness about cervical cancer, early screening and diagnosis programs, and the HPV vaccine.

Self‐collection of samples for HPV testing to increase participation in cervical cancer screening by immigrant women: An integrative review

AbstractObjectiveTo examine methods and results of studies assessing self‐collection of cervico‐vaginal samples for human papillomavirus (HPV) testing by immigrant women for insights into how future research using this method with unique subpopulations of women may improve the rates of cervical cancer screening (CCS) compared to current strategies.Data SourcesFour electronic databases were systematically searched through March 2020, with no limits applied. A manual review of reference lists was also completed.Study SelectionThe search resulted in 63 articles. After removal of duplicates, 36 were reviewed against inclusion criteria. A manual review of reference lists yielded two additional studies. The final sample included 15 relevant publications representing 13 unique empirical studies.Data ExtractionData related to study methodology and empirical results were extracted into table form.Data SynthesisThe methods of the studies were summarized and synthesized, including diversity of participants, community engagement, including collaboration with public health nurses or community health workers. In addition, methods and findings related to the educational components of the studies, and empirical findings related to various cultural groups, were described.ConclusionTo reduce health disparities in CCS, researchers should focus on diverse groups, such as immigrant women, to understand important individual and group‐specific factors that may influence screening, including whether self‐collection of samples for HPV testing along with appropriate education and support for follow‐up will address these factors.

The application of health behavior theories to promote cervical cancer screening uptake

AbstractBackgroundWhile cervical cancer is a major cause of mortality, its progress and survival rate can be improved through screening. Yet despite their wide availability, women's participation in cervical cancer screening (CCS) programs is often suboptimal, especially in low‐ and middle‐income countries. Besides demographic and organizational characteristics, screening uptake is influenced by psychological factors, most of which are included in health behavior theories. This systematic review compared different health behavior theories in terms of their capacity to explain CCS uptake and inform CCS promotion campaigns.MethodsA comprehensive search and analysis of published intervention and non‐intervention (observational) studies that applied at least one health behavior theory to CCS participation.ResultsAfter quality screening, 48 observational and 21 intervention studies were identified that applied the Health Belief Model (HBM), Theory of Reasoned Action (TRA), Theory of Planned Behaviour (TPB), Transtheoretical model (TTM), Social‐ecological Model (SEM), and/or Theory of Triadic Influence (TTI) to CCS. The HBM was most frequently used to explain behavior, whereas the TPB was better at explaining screening intentions. Tailored intervention studies focusing on all theoretical constructs were most effective in modifying perceptions and increasing CCS uptake.ConclusionsDespite their inconsistent use, health behavior theories can explain CCS intentions and behavior and contribute to the development of targeted interventions to promote screening uptake.

Reasons for never receiving a pap test among Brazilian women: National health survey

AbstractObjectiveTo identify reasons among Brazilian women for never having a Pap test.DesignWe designed a cross‐sectional study that used data from the National Health Survey.SampleTwo thousand four hundred and two women 25–64 years old who never had a pap test.MeasuresVariables were age, race, education, marital status, housing condition, primary health care access, health insurance, self‐perceived health, and social support network. We calculated the prevalence of different reasons and odds ratios for each.ResultsThe most frequent reason for never having a test were linked to women thinking the test was unnecessary (42.3%) which had a significant association with marital status (OR = 1.52; 95% CI = 1.07–1.91), age (OR = 1.56; 95% CI = 1.21–1.99), area of residence (OR = 1.15; 95% CI = 1.02–1.39), having a health insurance (OR = 1.18; 95% CI = 1.01–1.36), and self‐perceived health (OR = 1.42; 95% CI = 1.28–1.56). The second most frequent reason was not knowing they needed a test (22.9%) which was associated with age (OR = 1.95; 95% CI = 1.74–2.16) and self‐perceived health (OR = 1.56; 95% CI = 1.33–1.80).ConclusionsThe findings suggest lack of knowledge about cervical cancer and its prevention among Brazilian women. We consider it essential that the health service can provide the test, as well as the necessary guidelines for raising the awareness of the target audience.

The Effect of Cervical Cancer Education Given to Women in Turkey on Knowledge, Attitudes, and Health Beliefs: A Randomized Controlled Study

ABSTRACTObjectiveThe objective of this study was to ascertain the impact of cervical cancer education provided to women in Turkey on their knowledge, attitudes, and health beliefs.DesignThe study was conducted in accordance with the pretest–posttest randomized controlled trial model.SampleThe participants were randomly assigned to either the experimental or the control groups. The study was completed with a total of 105 women, 51 of whom were in the experimental group and 54 of whom were in the control group.MeasurementsThe personal information form, the human papillomavirus (HPV) knowledge scale, and the health belief model scale for cervical cancer and Pap smear test were employed as data collection instruments. The data were analyzed using the SPSS 25.0 package program, and the number, percentage, independent samples t‐test, and paired t‐test were utilized for data analysis.ResultsUpon completion of the training program, the mean scores of the experimental group demonstrated a statistically significant increase in knowledge related to general HPV information, HPV screening tests, general HPV vaccines, and HPV vaccine programs when compared to the control group (p < 0.001). Upon conclusion of the educational intervention, it was determined that the mean scores of cervical cancer sensitivity, caring, health motivation, Pap smear utility, and motivation of women in the experimental group exhibited an increase, while their general perception of Pap smear demonstrated a decrease (p < 0.05).ConclusionThe findings of this study indicate that educational initiatives targeting women regarding cervical cancer have a beneficial impact on their knowledge, attitudes, and health beliefs.Trial RegistrationNCT05990270 registered on https://clinicaltrials.gov/.

Public health nurse perspectives on predicting nonattendance for cervical cancer screening through classification, ensemble, and deep learning models

AbstractObjectivesWomen's attendance to cervical cancer screening (CCS) is a major concern for healthcare providers in community. This study aims to use the various algorithms that can accurately predict the most barriers of women for nonattendance to CS.DesignThe real‐time data were collected from women presented at OPD of primary health centers (PHCs). About 1046 women's data regarding attendance and nonattendance to CCS were included. In this study, we have used three models, classification, ensemble, and deep learning models, to compare the specific accuracy and AU‐ROC for predicting non‐attenders for CC.ResultsThe current model employs 22 predictors, with soft voting in ensemble models showing slightly higher specificity (96%) and sensitivity (93%) than weighted averaging. Bagging excels with the highest accuracy (98.49%), specificity (97.3%), and ideal sensitivity (100%) with an AUC of 0.99. Classification models reveal Naive Bayes with higher specificity (97%) but lower sensitivity (91%) than Logistic Regression. Random Forest and Neural Network achieve the highest accuracy (98.49%), with an AUC of 0.98. In deep learning, LSTM has an accuracy of 95.68%, higher specificity (97.60%), and lower sensitivity (93.42%) compared to other models. MLP and NN showed the highest AUC values of 0.99.ConclusionEmploying ensemble and deep learning models proved most effective in predicting barriers to nonattendance in cervical screening.

Human papillomavirus vaccination and contributing factors of vaccination intention among adolescents and young adults in China from a socio‐ecological perspective: A cross‐sectional study

AbstractObjectivesAdolescents and young adults are the main target population for human papillomavirus (HPV). The study aimed to investigate school students' HPV vaccination intentions and explore the contributing factors from a socio‐ecological perspective.DesignA questionnaire survey was conducted in three secondary schools and three colleges in China.SampleA total of 1756 students aged 14–22 years participated in this study. Among the 1756 participants, 182 students have received the HPV vaccine. For the remaining 1574 students, we analyzed their HPV vaccination intentions and the influencing factors.MeasurementsSurvey items for sociodemographics, knowledge and awareness of HPV, sexual intercourse and sexual knowledge, subjective socioeconomic status, self‐efficacy, eHealth literacy, perceived social support from family, and the availability of HPV vaccine information were measured.ResultsOnly 182 (10.4%) had received the HPV vaccine among the 1756 participants. Among the remaining 1574 students, the majority of the students (1403, 89.1%) were willing to receive the HPV vaccine. Binary logistic regression analysis showed that students who were female, had lower self‐efficacy, scored higher on sexual knowledge, believed vaccination preventing related diseases, worried about side effects after vaccination, thought oneself at risk of contracting HPV, had higher family support, knew the availability of the HPV vaccine in Mainland China from healthcare institutions, and with family residence in rural areas were more willing to receive the HPV vaccine.ConclusionsStudents had high HPV vaccination intentions while had low vaccination rate. Intrapersonal, interpersonal and institutional or community factors predicted HPV vaccination intention. Public health nurses in communities and schools could target the modifiable factors to promote students’ HPV vaccine uptake.

Ovarian cancer awareness of women in Turkey: A cross‐sectional study

AbstractPurposeEarly diagnosis of ovarian cancer (OC) increases survival rates; however, due to low awareness levels, women may be diagnosed with OC at the advanced stage. The aim of this cross‐sectional study is to reveal the OC awareness of Turkish women and affecting factors.MethodsParticipants were invited to study via social media tools between February‐June 2022. Data was collected with Personal Information Form and the “OC Awareness Scale” from 446 women.Results81% of the participants did not recall OC symptoms, 80.8% recognized OC risk factors. The most frequently recalled and recognized OC symptom is pelvic pain (19.8%; 55.8%, respectively). The most frequently recalled and recognized OC risk factors were smoking (43.1%, 67.9%, respectively) and family history (39%, 58.7%, respectively). 2% of the participants felt very confident in recognizing the signs, 72.9% would seek help within 1–2 days when they recognized the signs of OC.ConclusionsThe awareness of OC was higher among women who had advanced age, higher education, family history and were in menopause. Turkish women have low level of awareness and knowledge about OC symptoms and risk factors. There is an urgent need for an OC awareness campaign that takes into account the socio‐demographic characteristics of women. The results of the study may also guide strategies to prevent OC.

Gynecological Cancer Awareness and Determination of Healthy Lifestyle Levels Among Women in Türkiye

ABSTRACT Objective This study aimed to assess gynecological cancer awareness and healthy lifestyle levels among women in Türkiye. Methods A descriptive, cross‐sectional design was applied with 656 women from various Turkish regions. Data were collected using a sociodemographic form, the Gynecological Cancer Awareness Scale, and the Healthy Lifestyle Screening Scale. Results The median gynecological cancer awareness score was 147.00, and the median healthy lifestyle score was 95.00. A positive, significant correlation was found between awareness and healthy lifestyle scores ( r s  = 0.359; p  < 0.001). Awareness differed significantly by education, employment, motherhood, gynecological examination and Pap smear frequency, cancer knowledge, fear of cancer, and age ( p  < 0.05). Healthy lifestyle scores were significantly related to income, smoking, perceived health, and regular exercise ( p  < 0.05). Conclusions Women generally demonstrated above‐average gynecological cancer awareness, and higher awareness was linked to healthier lifestyles. Overall, 1.2% had a very low, 14.6% low, 75.9% good, and 8.3% very good healthy lifestyle level. These findings suggest that nurses should implement educational and counseling programs to enhance women's gynecological cancer awareness and promote healthy lifestyle behaviors.