Effectiveness of Educational Intervention of Women's Participation in Cervical Cancer Screening by Acetic Acid Application on the Cervix Versus Pap Smear for Screening Precancerous Cervical Lesions

Globally cancer is a major public health problem, one out of 10 deaths occur due to cancer. Worldwide cervical cancer comprises 12% of all cancers in women of the 4, 66,000 cases, estimated to have occurred in the year 2009-developing countries account for 3, 70,000 cases. Around 2, 31,000 women die of cervical cancer every year in the world and over 80% of whom live in developing countries. South East Asia contributes about 25% of the total disease burden.

Cancer of the cervix is the most common cancer among women in India. It has been estimated that 100,000 new cases of cancer of the cervix occur in India every year & 70% or more of these are stage III or higher at diagnosis. This clearly indicates the lack of awareness and facilities for cervical cancer screening in India. In countries like India where a huge section of the population live below poverty line and where awareness among women for cervical cancer control and treatment remain very limited even years after implementation of the national cancer control programme in 1975, and the recent breakthrough in the global war against cervical cancer does not seem to have much impact.

Hence, there is a necessity to bring awareness among women regarding cervical cancer screening which can improve the health seeking behavior by making them to undergo screening. Visual Inspection with Acetic Acid (VIA) is of particular interest to developing countries because it is less expensive and only requires supplies which are locally obtainable and can be competently performed by non-physicians.

Design: The study was conducted in two phases. The I phase was conducted as one group pre and post test only design.

Experimental approach of repeated measures design was used in the II phase of the study.

Setting: Setting of the study was selected villages in Puducherry covered by Villianur Health Center and Community Health Centre, Mannadipet And Thirubhuvani.

Participants: 520 women under the age group of 35-55years from the villages covered by Mannadipet Community Health Centre and Villianur Primary Health centre were selected by stratified simple random sampling with the help of the enumeration register maintained by the field staffs of the concern health centers.

Intervention: The knowledge of the women was assessed by giving pre test followed by teaching intervention (N=520). Educational intervention was given in the form of structured teaching and its impact was tested by giving post test within a week. The health seeking behaviour of the women was identified by their acceptance for screening (N = 204) They were provided with adequate privacy and consent was obtained .Pap smear was taken prior to VIA with the wooden spatula and the smear was spread on two glass slides and preserved in 80 %alcohol solution and was send to lab for analysis.

VIA was done by applying acetic acid over the cervix and the cervix was assessed after 1 minute for aceto white changes.

Measurements and tools: The structured questionnaire was utilized to assess the knowledge before and after health intervention during the I phase of the study. Collected data was analyzed by using descriptive and inferential statistics. Visual scale for color changes due to acetic acid application on the cervix was assessed with photographs was utilized during the II phase of the study.

Findings: The health seeking behavior of women of subjecting themselves for cervical cancer screening is increased by creating awareness by imparting educational intervention.

Statistically there is no significant difference between VIA and Pap smear test. Hence VIA can be used as a primary screening method to detect precancerous cervical lesions.

Key Conclusion: Creating awareness by educational intervention will improve the health seeking behavior of making women by creating awareness to accept cervical cancer screening.

VIA can be used as a primary cost-effective method to screen women for precancerous cervical lesion
in a low resource setting.

Implications for clinical practice: Creating awareness by imparting health education will improve the health seeking behavior of women by making them to undergo cervical cancer screening.

Statistical significance of VIA (visual inspection with acetic acid application) shows that it can be used as a primary method to screen precancerous cervical lesions. Further research is suggested to determine the effectiveness of VIA in screening cancer cervix.