Lupine Publishers | Journal of Medical Sciences
Introduction
The cervical cancer (CC) is one of the main threats against women life; it is estimated that right now in the world, this disease affects over one million women and most of them have neither been diagnosed or have access to a treatment that could save them or extend their life. In 2012, the World Health Organization (WHO) reported that it was diagnosed 528 000 new occurrences, and 266 000 women died of this disease, over 90% of them happened in countries with medium to low income. It is predicted, without immediate attention, the deaths caused by CC could raise by 25% in the next ten years; this same data is reported by the Pan American Health Organization (PAHO) (WHO/PAHO [5] as mortality indexes due to CC.
The CC is closely
related with the presence of the Human Papiloma Virus (HPV) mainly those
identified as high risk; the two that cause with higher frequency are types 16
and 18, which together, are responsible for an approximate of 70% of CC cases
around the world PAHO [6]. In the female population, CC is the main death cause
by malignant neoplasm, especially in the range of 25 to 64 years old, this
according to the Mexican Official Norm (NOM- 014SSA2-1994).
In Mexico it is
recommended that all the female population with active sexual life should
perform the Papanicolau (PAP) each year, each three years for those who have
had a negative result to infection by HPV in the last two PAP, dysplasias or
cancer; women infected by VPH, dysplasia or cancer should be traced by a
dysplasia clinic and, when they are released by the hospital, they should begin
again with PAP with an annual frequency; those who have positive PAP results
due to non-specific inflammatory processes or additional findings should
receive medical treatment and continue with annual PAP until there are two
straight negative results, according with the Mexican Official Norm
NOM-014-SSA2-1998 for prevention, detection, diagnosis, treatment, control and
epidemiological surveillance of CC Minister of Health [1]. There is a low
prevalence of the usage of this test and the found factors related with its
limited use are the modesty, lack of information about the usefulness of the
test or lack of approval by the partner Sagarduy [7].
This topical has
generated multiple controversies by the stretch relationship it has with the
different cultures that the human being has; including that, nowadays women
have the false believe that if they do not have a background of developing the
CaCU disease, they do not have the necessity of performing PAP. Some barriers
to not entering a periodical screening is to not know the age in which the test
must be performed and with which frequency it should be done, they also mention
that they do not come to their control due to fear of being diagnosed with
cancer, also as shame to be examined in the genitals, and never had any
children. Other beliefs are that they should have an active sexual life, being
that CaCU is a serious health problem and it can take them to perform a
chemotherapy, a hysterectomy or even death, and because of this, if she has 21
years old, the woman can perform the cytological exam.
The main action that
drives women to come and perform an PAP is by the indication of a medical
doctor or a nurse, because they heard it on television or radio, and because
family members mentioned the topic in relationship with received benefits,
being the most important health care Urrutia [8]; however, the majority of
women have the belief that they will be hurt in the moment of performing the
PAP, or that they will experiment pain during the exploration; this can have a
reason in a lack of appropriate information by the medical staff about the
realization of the test; they also refer this fear or shame to being male the
one who is going to perform the test and that young women who live with their
parents have fear of being revealed that they have an active sexual life. Other
of the mentioned barriers mentioned by women are that they do not come to
perform the test due to the lack of time or the long await to receive the
result of the test, or the lack of consent by the couple, which is very common
in the Mexican population by the still perceived machismo.
Material and Methods
The design of this study
was descriptive, transversal in a population conformed by women in fertile age
in the independence health center in the city of H. Matamoros, Tamaulipas,
Mexico. The sampling was by convenience, it included all women who manifested
the intention and availability to participate in the study, obtaining a final
sample of 150 woman. To collect personal identification data, it was used the
personal identification card (PIC) which included information related with age,
level of education, civil status, type of relationship with the couple and
previous results of papanicolau. The variable beliefs about PAP and CC was
measured with an instrument developed and validated with Chilean population
based in the health beliefs model descripted by Rosenstock [9]. To answer the
objective, it was applied an instrument developed and validated based in the
health beliefs model descripted by Rosenstock [9] which presents 6 dimensions
divided in: 1. Barriers, which contains 9 items. 2. Benefits, which contains 3
items. 3. Severity, which contains 4 items. 4. Susceptibility, which contains 3
items. 5. Signals of action, which contains 6 items and 6. Requirements, which
contains 3 items.
For this research, it
was only used the dimension of barriers, composed by 9 items and which is
subdivided into three dimensions: fear to find having cervical cancer, waiting
time to being attended and shame to be observed in the genitals, which an
answer range type Likert of 5 points which ranges from completely agree to
completely disagree, Items 2,3,4,5,9 are about time and schedules that the
patients have to perform the Pap, item 1 is about the lack of knowledge that
the patients have with respect to the age where they should begin the
monitoring and performing of the Pap, item 6 is about the fear the patients can
have by the news of having cervical cancer. Item 7 is about shame that women
can have to have somebody inspecting their genitals, since it is a very
intimate body part, and item 8 is about the bad treatment that the patients can
have by the medical staff working in the health center where the women come.
For the capture and data analysis, it was used the statistical package SPSS
(Statistical Package for the Social Science) version 20, where a descriptive
statistic was used. The results presented are liability of 96 through the Alpha
of Cronbach.
Results and Discussion
The
socio-demographic profile presented by the women participating in the study
corresponds to an average age of 34.7 years (SD=7.01), in relationship with the
level of education, 43.3% reported middle school level and a low percentage
(10%) reported being currently studying at a university. The bigger proportion
reported a marital status of being married with an 57.3% and the 89.3% of the
participants reported having a stable sexual partner, and in the PAP results,
the PAP class II (normal) with a 96.0 (Table 1) prevailed. These results
coincide with multiple studies where the average age is 35 years old and women
are in a stable sexual relationship Urrutia [4], Sagarduy [7].
Results are presented in relationship with the study variables where it can be
observer that women do not know in which age is necessary to perform the PAP
and with which frequency it is necessary to come to perform the test with
averages ranging from 2.62 (SD=1.64) to 2.77 (SD=1.39); results that differ from
the study performed by Huamani [10] where it was reported that participants
from its study presented a high knowledge, where 64.8% knew about how it is
performed the PAP and 65.2% knew the optimal frequency to perform the PAP,
highlighting that in a 38.5% the level of studies was university, where we can
observe that a lower education level and an inadequate history of PAP are
associated with poor knowledge and a negative attitude towards the performance
of Papanicolau Huamani [10]. In relationship with the barriers to the practice
of the papanicolaou, women agree that they do not take the PAP because when
they attend, it takes a large amount of time to be attended by medical staff
and they do not have that time, results with averages ranging from 2.52 (SD=1.37)
and 2.55 (SD=1.40) (Table 1). Similar results are reported by Polo-Peña [11]
where in its study, it was mentioned that the time availability was a main
cultural factor, which constructs barriers to the realization of cytology in
the 95% of its participants.
Another important factor
are those related with fatalists thoughts and machismo that might be present as
barriers to perform this test in a periodical manner, in the present study, the
women that do not take PAP due to fear to a cancer diagnostic and being ashamed
to have their genitals being examined are averages ranging from 2.50 (SD=1.41)
to 2.48 (SD=1.41) (Table 1); these results match with previously analyzed
literature where multiple authors report that shame, fear and lack of time are
barriers against the perform of Papanicolau, as it is also the lack of
information about age to take the exam Urrutia [4] Sagarduy [7] Mosavel [12-
14].
Conclusion
In relationship with the
obtained results, it can be concluded that there still exists false beliefs
about PAP and CC, where the most relevant ones are that the population does not
know in which age it is necessary to take PAP [13] it also does not know the
frequency in which it should be taken, they do not take the PAP due to a long
time to being attended in the medical center and do not have that time to take
the test, fear of knowing to have cancer and shame to be examined in the
genitals. It is very important data to consider by the professionals in the
preventive health field, where providing brief information is not enough to
achieve woman empowerment and adhere to perform the Papanicolau test.
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