Cervical cancer is preventable through screening and eradication of pre-malignant neoplasia. The gap between knowledge and behavior of screening seriously undermines optimal participation rate of screening and compromises the success rate of screening programs.
This study investigated knowledge and self-perceived risk of cervical cancer, and factors that influenced cervical cancer screening participation rate among women of similar middle-class socio-economic status.
All female nurses in Singapore General Hospital were studied by an anonymous questionnaire survey. The influence of age, knowledge score and perceived-risk of cervical cancer on cervical cancer screening was analyzed using SPSS version- 22 statistics package and X2-statistics. Reasons for their decision on screening behavior were also determined.
Of 2000 nurses surveyed, 1622 (81.1%) responded. Out of a maximum score of 10, the mean knowledge score was 4.70 (SD 1.76). Self-perceived risk of cervical cancer was high in 97/1622 (6.0%), low in 675(41.6%) and uncertain in 821 (50.6%) cases.
Of 834 nurses eligible for screening, 351 (42.1%) had regular screening, 110 (13.2%) had irregular screening and 373 (44.7%) were never-screened. Respondents with high knowledge score and self-perceived risk of cervical cancer did not show a higher screening rate compared to the rest of responders. Doctor’s recommendation (34%), husband’s encouragement (20%), “people talked about it” (24%) and “people close to me have done it” (4.9%) were common reasons for regular screening. “People I know do not do it” were cited in 20% of responders doing screening irregularly and in 5.9% of those never screened. Compared to those in the irregular-screening and never-screened groups, more responders in the regular screening group had visited specialists (p<0.001) and gynecologists (p<0.001).
Knowledge-behavior gap in cervical screening existed among women of similar socio-economic status. Physician advocacy and herd signaling played an important role in women’s decision in participating screening.