Background:
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.
Aim:
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.
Methods:
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.
Results:
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).
Conclusions:
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.