Barriers to Cervical Cancer Screening in India: A Knowledge Attitude Gap Analysis of Nurses in a Tertiary Hospital in Northern India

Background: Cervical cancer is potentially one of the most preventable and treatable cancers. Despite the known efficacy of cervical screening, a significant number of women in developing countries like India do not avail themselves of the procedure due to lack of awareness and sociocultural misconceptions. Objectives: This study was conducted to elicit information on the Knowledge, Attitude and Practice (KAP) regarding cervical screening (Pap test) and to assess barriers to acceptance of the Pap test among nurses in a tertiary care hospital in Northern India. Awareness and acceptance for vaccination for Human Papilloma Virus (HPV) was also assessed. Materials and Methods: A cross-sectional, descriptive study was conducted with semi-structured, self-administered questionnaire among female nurses. The study subjects were interviewed for KAP regarding risk factors for cancer cervix, Pap test and HPV vaccination for protection against carcinoma cervix. Descriptive statistics were used to characterize the study participants. Association between socio-demographic factors and awareness and practices were assessed using the chi square test. p-value <0.05 was considered significant. Results: A large no of nurses had good knowledge about the risk factors and the importance of PAP test screening (95.9%). Many of the study subjects had a favourable attitude towards Pap test 92 (93.9%) and vaccination 82 (88.2%), but despite being in a centre with direct access to screening 68 (69.4%) of the study subjects never had a Pap test themselves and the most common reason cited was not finding the need to screen as they felt it was not applicable to them (45.6 %) not finding the need to screen as they felt it was not applicable to them. Acceptance for HPV vaccination was more 58 (59.2%) than Paps test 30 (31.4%). Conclusion: In spite of good knowledge and attitudes towards prevention of cancer cervix, Pap test and HPV vaccination, practice remained low among the nurses. Acceptance of HPV vaccination was more than Pap test reflecting the lower acceptance of intimately invasive procedures.