Raj Sneha, Kattepur Abhay K, Shylasree T S, Mishra Gauravi A, Patil Akshay, Pimple Sharmila, Noronha Santosh, Pramesh C S
Department of Gynecological Oncology and Preventive Oncology, Tata Memorial Centre, Dr Ernst Borges Marg, Parel, Mumbai 400012, India.
Department of Surgical Oncology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India.
Gynecol Oncol Rep. 2023 Jul 12;48:101241. doi: 10.1016/j.gore.2023.101241. eCollection 2023 Aug.
Cervical cancer is a public health problem in India due to weak national screening policy compounded by lack of resources including scarcity of trained personnel to carry out community-based screening program. Para medical professionals (PMPs) are closely related to women in local communities. Hence, training PMPs by incorporating novel technology and reduced time duration to achieve adequate competence in screening is an area underutilized and needs to be explored.
A pilot cross sectional analytical study was conducted at a tertiary referral cancer center using a shorter version of educational intervention of 2 weeks duration (EI2W) involving PMPs. Pre- and post-training assessment of knowledge, attitude, and practice (KAP) was done using questionnaires consisting of 5 domains viz. awareness of cervical cancer, awareness of cervical pre-cancer, practical screening methodology (practice oriented), data management and aspects of human papilloma virus (HPV). Wilcoxon signed-rank test was used for comparison and the degree of change was measured using analysis of covariance (ANCOVA). A p value of <0.05 was considered significant.
118 PMPs were included. There was a significant improvement in scores of all domains (except cervical pre-cancer domain), following introduction of EI2W. Knowledge scores, post EI2W was better in Auxiliary Nurse Midwives (ANMs) than other participants. Awareness regarding cervical cancer was higher with more years of experience. The KAP analysis showed excellent interrater reliability in the practice 0.726 (0.649-0.792) followed by knowledge domain 0.711 (0.626-0.783).
EI2W was effective in significantly improving the competence of PMPs, thus reducing human resource constraints in cervical cancer prevention and elimination.
由于国家筛查政策薄弱,加上资源匮乏,包括缺乏开展社区筛查项目的专业人员,宫颈癌在印度是一个公共卫生问题。辅助医疗专业人员(PMPs)与当地社区的女性联系密切。因此,通过引入新技术并缩短培训时长,使PMPs在筛查方面具备足够能力,这一领域尚未得到充分利用,有待探索。
在一家三级转诊癌症中心开展了一项试点横断面分析研究,对PMPs采用了为期2周的简化版教育干预(EI2W)。使用包含5个领域的问卷对知识、态度和实践(KAP)进行培训前和培训后的评估,这5个领域分别是宫颈癌认知、宫颈癌前病变认知、实际筛查方法(以实践为导向)、数据管理以及人乳头瘤病毒(HPV)相关方面。采用Wilcoxon符号秩检验进行比较,并使用协方差分析(ANCOVA)测量变化程度。p值<0.05被认为具有统计学意义。
纳入了118名PMPs。引入EI2W后,所有领域(除宫颈癌前病变领域外)的得分均有显著提高。EI2W后,辅助护士助产士(ANMs)的知识得分高于其他参与者。宫颈癌认知度随工作年限增加而提高。KAP分析显示,实践领域的评分者间信度极佳,为0.726(0.649 - 0.792),其次是知识领域,为0.711(0.626 - 0.783)。
EI2W有效地显著提高了PMPs的能力,从而减少了宫颈癌预防和消除工作中的人力资源限制。