Gandhi Rohankumar, Patel Abhishek, Patel Monika, Sojitra Sakshi A, Kundal Tanmay S, Murugan Yogesh
Community and Family Medicine, Shri Meghaji Pethraj (MP) Shah Medical College, Jamnagar, IND.
Internal Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College, Valsad, IND.
Cureus. 2024 Sep 11;16(9):e69169. doi: 10.7759/cureus.69169. eCollection 2024 Sep.
Cervical cancer causes significant morbidity and mortality among women in India. Despite national screening guidelines, uptake of these tools remains poor, especially in rural areas where complex sociocultural factors are at play. Integrated mixed-methods designs can provide better insights into multilevel barriers influencing screening behaviours. This study aimed to assess the knowledge, attitudes, practices, and sociocultural factors associated with cervical cancer prevention among marginalized rural women.
A mixed-method study of 400 women aged older than 18 years was conducted using a pretested questionnaire on cervical cancer knowledge, attitudes, self-reported screening practices, and sociodemographic variables. An exploratory qualitative study also interviewed 30 women to explore perspectives on screening using semi-structured guides. The survey data were analyzed via logistic regression, and thematic analysis was performed for the qualitative data. The results were triangulated to enable nuanced interpretation.
Only 27% (108/400) of participants had heard of cervical cancer, and 61% (244/400) were illiterate. Poor knowledge was observed in 83% (332/400) of participants, predicted by early marriage, high parity, low education, and socioeconomic status. Despite 64% (254/400) expressing positive attitudes, only 9% (36/400) reported undergoing cervical cancer screening. None of the participants were vaccinated against human papillomaviruses (HPV). Stigma, gender roles, spousal communication gaps, and access barriers emerged as key qualitative themes. The integrated results highlighted the intersections between villagers' worldviews and sociocultural norms and between access issues and prevention.
Multifaceted sociocultural challenges underpin the cervical cancer prevention gap among marginalized rural women. Grassroots educational efforts respectfully addressing fears and stigma, along with increased male engagement, community health worker training, and integrated screening services, can promote informed screening decisions among underserved groups.
宫颈癌在印度女性中导致了严重的发病和死亡情况。尽管有国家筛查指南，但这些筛查工具的使用率仍然很低，尤其是在存在复杂社会文化因素的农村地区。综合混合方法设计能够更好地洞察影响筛查行为的多层次障碍。本研究旨在评估边缘化农村女性中与宫颈癌预防相关的知识、态度、行为及社会文化因素。
对400名18岁以上女性进行了一项混合方法研究，使用了一份经过预测试的关于宫颈癌知识、态度、自我报告的筛查行为及社会人口统计学变量的问卷。一项探索性定性研究还采访了30名女性，以使用半结构化指南探索她们对筛查的看法。通过逻辑回归分析调查数据，并对定性数据进行主题分析。对结果进行三角验证以实现细致入微的解读。
只有27%（108/400）的参与者听说过宫颈癌，61%（244/400）为文盲。83%（332/400）的参与者知识水平较差，早婚、多产、低教育程度和社会经济地位是其预测因素。尽管64%（254/400）的人表达了积极态度，但只有9%（36/400）的人报告接受过宫颈癌筛查。没有参与者接种过人乳头瘤病毒（HPV）疫苗。耻辱感、性别角色、配偶沟通差距和获取障碍成为关键的定性主题。综合结果突出了村民世界观与社会文化规范之间以及获取问题与预防之间的交叉点。
多方面的社会文化挑战是边缘化农村女性宫颈癌预防差距的根本原因。基层教育工作应尊重地解决恐惧和耻辱问题，同时增加男性参与、社区卫生工作者培训和综合筛查服务，这可以促进服务不足群体做出明智的筛查决策。
