Factors affecting the utilisation of cervical cancer screening among women attending health services in the kumasi metropolis of Ghana

Kokuro, Mercy (2017-03)

Thesis (MCur)--Stellenbosch University, 2017.

Thesis

ENGLISH SUMMARY : Background: Cervical cancer is the second-most frequently diagnosed and the fourth commonest cause of cancer death among women worldwide. Almost 70% of the global burden occurs in areas of lower development. Incidence and mortality rates of cervical cancer among women in Ghana are of the highest in the world. According to the Ghana Health Service,16% of cancer mortality is attributed to cervical cancer. It has also been predicted by the World Health Organization that by the year 2025, 5 000 new cases of cervical cancer and 3 361 cervical cancer deaths will occur annually in Ghana. Purpose: This study aimed to determine factors affecting the utilisation of cervical cancer screening among women attending health services in the Kumasi metropolis of Ghana. Methods: A correlational cross-sectional quantitative study design was used. The target population was women of 18 years and above seeking reproductive health services in the Kumasi metropolis during the study period. A total of 369 participants were selected using a multistage sampling technique. Initially, two of the four hospitals were randomly selected. Subsequently, a systematic sampling technique was used in selecting participants to participate in the study. Data was collected using a researcher-designed questionnaire consisting of 38 closed-ended and open-ended questions. The questionnaire was printed in English and in the Twi language. A pilot study was conducted using 20% of the daily average attendance (200) in the four hospitals in the Kumasi metropolis. Ethical approval to conduct the study was obtained from the Health Research Ethical Committee at Stellenbosch University, as well as consent from the institutions under study. Informed consent was obtained from all the participants. Data was analysed using Statistical Package for Social Science (SPSS) Version 23.0 and findings are presented using descriptive and inferential statistics with 0.05 as the significance threshold. Results: Of the 369 participants, 58% were between the ages of 18 and 30 years, 46.1% were single, and 27.9% and 27.1% had primary and tertiary levels as their highest levels of education respectively. Of the participants, 67.5% were employed, 29.3% had only one child followed by 24.1% who had two children. Of the participants, 75.1% had adequate knowledge on cervical cancer with a mean knowledge score of 7.70±2.13 with range, 2–11 and about 88% had a good perception of cervical cancer and cervical cancer screening. The majority (n=300; 81.3%) had never been screened while 69 (18.7%) had been screened before. Of the 69 (18.7%), 17.3% had been screened only once and 1.4% had been screened twice. The majority of participants were not sure whether cervical screening was painful (46.6%) or expensive (32%), and 41.2% strongly agreed that their partners would not want them to have cervical cancer screening. The study found a significant relationship between socio-demographic characteristics and knowledge, perception and the utilisation of cervical cancer screening respectively. Age significantly affected knowledge level (p=0.022). Marital status significantly affected knowledge (p<0.001) and cervical cancer screening utilisation (p=0.040). Education significantly affected participants’ knowledge levels on cervical cancer and cervical screening (p=0.001) and cervical cancer screening utilisation (p=0.003). Work status significantly affected the utilisation of cervical cancer screening by participants (p=0.006). Conclusion: Even though participants had adequate knowledge and positive perception, cervical cancer screening services were not utilised by the participating women. Fear of the screening procedure being painful and expensive may have been part of the reason for the low utilisation of cervical cancer screening. Therefore, all-inclusive health education on the benefits of cervical cancer screening for both women and men should be a priority for stakeholders and all health organisations.

AFRIKAANSE OPSOMMING : Agtergrond: Servikale kanker is die kanker wat die derde meeste gediagnoseer word en dit is ook die vierde algemeenste oorsaak van sterfte weens kanker by vroue wereldwyd. Nagenoeg 70% van die wereldwye las kom voor in gebiede van laer ontwikkeling. Voorkoms en mortaliteit van servikale kanker by vroue in Ghana is van die hoogste ter wereld. Volgens die Ghanese gesondheidsdienste word 16% van kankermortaliteit aan servikale kanker toegeskryf (Ghana Health Service, 2011). Daar word ook deur die Wereldgesondheidsorganisasie voorspel dat daar teen die jaar 2025 jaarliks 5 000 nuwe gevalle van servikale kanker en 3 361 sterftes weens servikale kanker in Ghana sal voorkom. Doel: Hierdie studie het beoog om faktore te bepaal wat ‘n invloed het op die benutting van siftingstoetse vir die vroee diagnose van servikale kanker by vroue wat gesondheidsdienste in die Kumasi-metropool in Ghana bywoon. Metodes: ‘n Korrelasionele deursnee- kwantitatiewe navorsingsontwerp is gebruik. Die teikenbevolking was vroue van 18-jarige ouderdom en ouer in die Kumasi-metropool wat reproduktiewe gesondheidsdienste gedurende die navorsingstydperk bygewoon het. ‘n Totaal van 369 deelnemers is geselekteer met behulp van ‘n meerstadium-steekproefnemingstegniek. Aanvanklik is twee van die vier hospitale lukraak geselekteer. Later is ‘n sistematiese steekproefnemingstegniek gebruik by die seleksie van deelnemers wat ingestem het om aan die navorsing deel te neem. Data is ingesamel met behulp van ‘n vraelys bestaande uit 40 geslote en oop vrae wat deur die navorser ontwerp is. Die vraelys is in Engels en in Twi-taal gedruk. ‘n Loodsstudie is met behulp van 20 deelnemers onderneem. Etiese goedkeuring om die studie te doen was vanaf die Etiese Komitee vir Gesondheidsnavorsing by Stellenbosch Universiteit, asook toestemming van die instellings ter ondersoek verkry. Ingeligte toestemming is van al die deelnemers verkry. Data is geanaliseer deur van SPSS (Statistical Package for Social Science) weergawe 23.0 gebruik te maak en bevindinge word aangebied met behulp van beskrywende en afgeleide statistieke met 0.05 as die beduidenheidsdrempel. Resultate: Uit die 369 deelnemers was 58% tussen die ouderdomme 18 en 30 jaar, 46.1% was enkel, en 27.9% en 27.1% het primere en tersiere vlakke onderskeidelik as hulle hoogste onderwyspeil gehad. Van die deelnemers het 67.5% ‘n werk gehad, 29.3% het slegs een kind gehad, gevolg deur 24.1% wat twee kinders gehad het. Van die deelnemers het 75.1% voldoende kennis van servikale kanker gehad met ‘n gemiddelde kennistelling van 7.70±2.13 (2–11), en ongeveer 88% het ‘n goeie begrip van servikale kanker en sifting vir servikale kanker gehad. Die meerderheid (300; 81.3%) het nooit voorheen ‘n siftingstoets ondergaan nie, en 69 (18.7%) het al tevore ‘n siftingstoets ondergaan. Van die 69 (18.7%) het 17.3% slegs een siftingstoets ondergaan en 1.4% twee toets. Die meerderheid deelnemers was nie seker of die servikale siftingstoets pynlik (46.6%) of duur (32%) is nie, en 41.2% het beslis saamgestem dat hulle maats nie sal wil he dat hulle ‘n siftingstoets vir servikale kanker ondergaan nie. Die studie het bevind daar ‘n beduidende verhouding tussen sosio-demografiese eienskappe en kennis, begrip en die gebruik van siftingstoetse vir servikale kanker bestaan. Ouderdom het ‘n beduidende invloed op die vlakke van kennis gehad (p=0.022). Huwelikstatus het ‘n beduidende invloed op kennis (p<0.001) en die gebruik van siftingstoetsing vir servikale kanker (p=0.040) gehad. Opvoeding het ‘n beduidende invloed op deelnemers se kennisvlakke ten opsigte van servikale kanker en sifting vir servikale kanker (p=0.001) en die gebruik van siftingstoetse vir servikale kanker (p=0.003) gehad. Werkstatus het ‘n beduidende invloed op die gebruik van siftingstoetsing vir servikale kanker deur deelnemers (p=0.006) getoon. Gevolgtrekking: Selfs al was die kennisvlakke en begripsvlakke aansienlik, is siftingstoetsdienste vir servikale kanker nie deur die deelnemende vroue gebruik nie. Die belangrikste rede vir die onderbenutting was ‘n gebrek aan instemming deur hulle mans. Daarbenewens was vrees dat die siftingsprosedure pynlik en duur kan wees waarskynlik ook deel van die rede vir die lae gebruik van siftingstoetsing vir servikale kanker. Allesomvattende gesondheidsopvoeding oor die voordele van siftingstoetsing vir servikale kanker vir beide vroue en mans behoort dus vir belanghebbendes en alle gesondheidsorganisasies ‘n prioriteit te wees.

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