Knowledge, attitudes, and practices regarding cervical cancer and screening among Ethiopian health care workers

Figures & data

Table 1 Demographics of participants

	Medical doctorsa (n=84)	Medical students (n=52)	Nurses and midwivesb (n=197)	Total (n=333)
Age (years)
<25	13 (15)	46 (88)	45 (23)	104 (31)
26–35	59 (70)	6 (12)	79 (40)	144 (44)
36–45	8 (10)	0 (0)	54 (27)	62 (19)
≥46	4 (5)	0 (0)	17 (9)	21 (6)
Missing/unknown	0 (0)	0 (0)	2 (1)	2 (1)
Sex
Male	59 (70)	27 (52)	30 (15)	116 (35)
Female	25 (30)	25 (48)	167 (85)	217 (65)
Setting
Hospital	81 (96)	52 (100)	174 (88)	307 (92)
FGA clinic	3 (4)	0 (0)	23 (12)	26 (8)
Primary language
Amharic	65 (77)	42 (81)	152 (77)	259 (78)
Oromia	6 (7)	6 (12)	22 (11)	34 (10)
Somali	6 (7)	2 (4)	13 (7)	21 (6)
Tigringa	1 (1)	0 (0)	1 (1)	2 (1)
Other	4 (5)	2 (4)	3 (2)	9 (3)
Missing/unknown	2 (2)	0 (0)	6 (3)	8 (2)
Religion
Ethiopian Orthodox	59 (70)	38 (71)	132 (66)	227 (69)
Muslim	9 (11)	6 (12)	25 (13)	40 (12)
Protestant	11 (13)	6 (12)	37 (19)	54 (16)
Other	4 (5)	3 (6)	1 (1)	8 (2)
Missing/unknown	1 (1)	1 (2)	2 (1)	4 (1)
Number of years on the job
<1	23 (27)	2 (4)	13 (7)	38 (11)
1–5	46 (55)	26 (50)	58 (29)	130 (39)
6–10	6 (7)	24 (46)	65 (33)	95 (29)
>10	7 (8)	0 (0)	61 (31)	68 (20)
Missing/unknown	2 (2)	0 (0)	0 (0)	2 (1)

Notes:

Values are given as number (percentage);

a physician’s specialty: obstetrics and gynecology =7 (2%); primary care physician (GP, internal medicine, pediatrics) =29 (9%); residents =48 (14%);

b nurses =159 (48%) and midwives =38 (11%).

Abbreviation: FGA, Family Guidance Association.

Table 2 Knowledge of cervical cancer etiology and prevention

Question	Medical doctors (n=84)	Medical students (n=52)	Nurses and midwives (n=197)	Total (n=333)	P-valuea
	Correct answera
Cervical cancer is one of the leading causes of death in women worldwide – True	73 (87)	45 (87)	153 (78)	271 (81)	0.038
Cervical cancer is preventable – True	82 (98)	50 (96)	151 (77)	283 (85)	<0.001
It is possible to detect pre-cancerous cervical cells – True	77 (92)	50 (96)	162 (82)	289 (87)	0.019
The purpose of screening for cervical cancer is to detect pre-cancerous changes – True	83 (99)	50 (96)	171 (87)	304 (91)	0.012
If untreated cervical cancer is fatal – True	78 (93)	47 (90)	152 (77)	277 (83)	0.016
Cervical cancer is caused by a virus that is spread sexually – True	78 (93)	46 (88)	63 (32)	187 (56)	<0.001
There is a vaccine that can prevent cervical cancer – True	64 (76)	23 (44)	36 (18)	123 (37)	<0.001
Cervical cancer is not curable – False	56 (87)	28 (54)	88 (45)	172 (52)	0.013
Cervical cancer is most common among women in their 20s – False	78 (93)	40 (77)	133 (68)	251 (75)	<0.001
For cervical cancer, the progression of pre-cancerous cells to cancer can take 10–20 years – True	78 (93)	41 (79)	70 (36)	189 (57)	<0.001
Cervical cancer can usually be found at an early stage because of the obvious symptoms – False	66 (79)	30 (58)	85 (43)	181 (54)	<0.001

Notes:

Values are given as number (percentage);

a difference in knowledge between group.

Table 3 Knowledge of risk factors for cervical cancer

Question	Medical doctors (n=84)	Medical students (n=52)	Nurses and midwives (n=197)	Total (n=333)	P-valueb
	Correct answera
Correctly identified all four risk factors	59 (70)	25 (48)	70 (36)	156 (47)	<0.001
Infection with the human immunodeficiency virus (HIV)	78 (93)	39 (75)	123 (62)	240 (72)	<0.001
Infection with human papilloma virus (HPV)	81 (96)	48 (92)	147 (75)	276 (83)	<0.001
Having multiple sex partners	80 (95)	47 (90)	135 (69)	262 (79)	<0.001
Smoking cigarettes	64 (76)	34 (65)	118 (60)	216 (65)	0.032
Misidentified at least one non-risk factor	23 (27)	35 (67)	120 (61)	179 (54)	<0.001
Poor personal hygiene	19 (23)	29 (56)	102 (52)	150 (45)	<0.001
Use of intrauterine devices (IUDs)	6 (7)	19 (37)	32 (16)	57 (17)	<0.001
Use of herbal remedies	5 (6)	7 (13)	59 (30)	71 (21)	<0.001
Use of tampons	5 (6)	9 (17)	26 (13)	40 (12)	0.102

Notes:

a Values are given as number (percentage);

b difference in knowledge between groups.

Table 4 Attitudes, awareness, and experiences related to cervical cancer screening

Question	Medical doctors (n=84)	Medical students (n=52)	Nurses and midwives (n=197)	Total (n=333)	P-valueb
	Strongly agree/agreea
Cervical cancer screening is an essential part of women’s health carec	84 (100)	50 (96)	184 (95)	329 (97)	0.136
Cervical cancer is a very serious diseased	84 (100)	52 (100)	184 (96)	320 (98)	0.055
A cervical cancer screening program should be started in my communitye	84 (100)	49 (94)	158 (83)	291 (89)	<0.001
	Yesa
Female respondentsf
Have you ever received a pap smear	8 (32)	0 (0)	29 (18)	37 (17)	0.035
Have you ever heard of the following tests
Pap smear	80 (95)	51 (98)	175 (89)	306 (92)	0.041
Human papilloma virus DNA testing	72 (86)	40 (77)	69 (35)	181 (54)	<0.001
Liquid-based cytology	55 (65)	19 (37)	41 (21)	115 (35)	<0.001
Visual inspection with acetic acid	69 (82)	31 (60)	62 (31)	163 (49)	<0.001
Visual inspection with Lugol’s solution	68 (81)	37 (71)	51 (26)	156 (47)	<0.001
Have you ever diagnosed a patient with cervical cancerg	33 (42)	7 (14)	29 (15)	69 (22)	<0.001
Have you ever diagnosed pre-cancerous cervical lesions in a patienth	56 (67)	10 (19)	52 (27)	118 (36)	<0.001
Have you ever treated pre-cancerous cervical lesions in a patienti	26 (31)	5 (10)	26 (14)	57 (18)	<0.001

Notes:

a The 5-point scale eliciting the answers “strongly agree”, “agree”, “no opinion”, “disagree” and “strongly disagree” was dichotomized to “strongly agree” or “agree” versus “no opinion”, “disagree” or “strongly disagree”; values are given as number (percentage);

b difference between groups;

c four missing values for nurses/midwives;

d five missing values for nurses and midwives;

e seven missing values for nurses/midwives;

f 216 female respondents, one missing value for nurses and midwives;

g four missing values for nurses and midwives;

h three missing values for nurses and midwives;

i one missing value for medical doctors and six missing values for midwives.

Table 5 Perceived barriers to providing cervical cancer screening

Question	Medical doctors (n=84)	Medical students (n=52)	Nurses and midwives (n=197)	Total (n=333)	P-valueb	No answer
	“Quite a bit” or “a lot” of barrier(s)a
My patients dislike/refuse screening	8 (10)	11 (30)	22 (13)	41 (15)	0.016	52 (16)c
My patients have more pressing health problems	32 (41)	15 (43)	54 (34)	101 (37)	0.390	59 (18)d
I have not had the necessary training in order to screen	37 (47)	21 (49)	80 (55)	148 (52)	0.491	46 (14)e
The screening tests are too expensive for patients	31 (39)	14 (37)	75 (44)	120 (42)	0.590	47 (14)f
I do not have enough time/I am too busy to screen	9 (12)	7 (19)	27 (16.4)	43 (15)	0.532	53 (16)g
I do not have the necessary equipment/supplies	45 (57)	20 (56)	79 (50)	144 (53)	0.593	61 (18)h
The screening procedures are too difficult	9 (12)	5 (14)	37 (24)	51 (19)	0.066	65 (20)i
I do not have the necessary laboratory resources to screen	36 (47)	15 (41)	60 (39)	111 (41)	0.452	65 (20)j
I do not have the capacity to follow-up patients after screening	27 (35)	16 (45)	56 (36)	99 (37)	0.605	66 (20)k

Notes:

a The 4-point scale eliciting the answers “not at all”, “somewhat”, “quite a bit” and “a lot” was dichotomized to “not at all” or “somewhat” versus “quite a bit” or “a lot” where values are given as number (percentage);

b difference between groups;

c missing values for five doctors, 15 medical students, and 32 nurses and midwives;

d missing values for six doctors, 17 medical students, and 36 nurses and midwives;

e missing values for five doctors, nine medical students, and 32 nurses and midwives;

f missing values for five doctors, 14 medical students and 28 nurses and midwives;

g missing values for seven doctors, 15 medical students, and 31 nurses and midwives;

h missing values for five doctors, 16 medical students and 40 nurses and midwives;

i missing values for seven doctors, 17 medical students and 41 nurses and midwives;

j missing values for eight doctors, 15 medical students and 42 nurses and midwives;

k missing values for ten doctors, 16 medical students and 43 nurses and midwives.

Figure 1 Number of cervical cancer screening procedures performed by provider type.

Note: Proportion of medical doctors, medical students and nurses and midwives having performed pap smear, visual inspection with acetic acid (VIA) or visual inspection with Lugol’s iodine (VILI).