Awareness, attitude, and practice towards cancer cervix prevention among rural women in southern India: A community-based study

Cervical cancer remains a significant global health problem, particularly in low- and middle-income countries (LMICs). India bears a substantial burden, with high incidence and mortality rates. The long latency period from premalignant to malignant lesions makes cervical cancer preventable through primary and secondary prevention strategies. However, despite national guidelines, screening uptake remains low in India, largely due to insufficient awareness, negative attitudes stemming from stigma, and limited access to healthcare facilities offering cervical cancer screening at the primary care level. The World Health Organization (WHO) aims to eliminate cervical cancer as a public health problem by 2030, targeting 70% screening coverage. This study, conducted in Southern Karnataka, aimed to determine the baseline awareness, attitudes, and practices of rural women regarding cervical cancer, its risk factors, and prevention through screening, filling a data gap in this region.

Existing literature reveals variable levels of awareness and practices regarding cervical cancer prevention and screening across different regions and populations. Studies in India report a wide range of awareness (40.2%-74.6%), with knowledge regarding prevention and early detection methods varying considerably. The sources of information also differ, with mass media frequently cited but also interpersonal sources like friends and relatives. Studies from other LMICs such as Ethiopia, Vietnam and Zimbabwe highlight similar disparities, underscoring the heterogeneous nature of understanding and practice related to cervical cancer prevention.

A cross-sectional survey was conducted from January to December 2017 among 1100 married women aged 20-65 years residing in rural southern Karnataka, India. Ethical approval was obtained. A pre-designed semi-structured questionnaire was used to collect data on socio-demographic characteristics, awareness (assessed using a scoring system based on correct/incorrect responses to questions about risk factors, prevention, and early detection), attitudes (assessed by questions about the importance of screening and willingness to participate), and practices (defined as having undergone at least one cervical screening test). Data analysis was performed using SPSS version 16.0, utilizing frequency and percentage calculations, means, standard deviations, univariate and multivariable logistic regression to assess associations between knowledge adequacy and socio-demographic factors. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

Of the 1100 participants, 737 (67%) knew the term "cervical cancer." Among these, 35.7% had adequate knowledge, with awareness of risk factors ranging from 5.0% (smoking) to 41.4% (poor genital hygiene). Friends/relatives (73.7%) and mass media (71.5%) were primary sources of information. Only 17.2% knew about early detection. Despite this poor knowledge, 99% had a favorable attitude towards screening. However, only 7 (0.9%) participants had ever undergone a Pap smear. Analysis revealed that adequate awareness was significantly associated with age, education level, employment, and socio-economic status (Table 3). Younger women and those with higher education levels demonstrated greater knowledge. Those employed and from a middle socio-economic status also displayed better awareness.

The study's findings reveal a significant disparity between attitudes and practices regarding cervical cancer screening among rural women in Southern India. Despite a largely positive attitude towards screening, awareness and actual practice remain suboptimal. This gap highlights the need for targeted interventions. The strong association between knowledge adequacy and socio-demographic factors such as education and socio-economic status underscores the importance of addressing these disparities through culturally appropriate health education programs tailored to different literacy levels and socio-economic backgrounds. The reliance on interpersonal sources of information suggests the potential for community-based interventions involving influential figures within the community.

This study reveals a favorable attitude towards cervical cancer screening among rural women in Southern India, but this is not reflected in adequate awareness or practices. Targeted interventions, including health awareness programs and improved access to screening services in primary healthcare settings, are crucial for improving screening uptake and reducing the burden of cervical cancer in the region. Future research could focus on evaluating the effectiveness of specific intervention strategies, exploring barriers to screening in more depth, and further investigating the role of cultural factors in influencing health behaviors.

The study's limitations include the potential underrepresentation of working women, information bias due to sensitive questions, and the inability to assess barriers and perceived beliefs about cervical cancer screening due to a lack of organized screening services in the region. The cross-sectional design also limits causal inference.