Download cancer of cervix among women residing at

6.
BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION
“While there are several chronic diseases more destructive to life than cancer none is more feared.”
Charles
Few years ago a diagnosis of cancer was usually a death sentence. To make matters even worse
having a case of cancer in the family often lead to ostracism, whispers about the possibility of infecting
others with the disease and an accompanying need for secrecy.
As per WHO, it was only in the developing country that cancer was a relatively serious disease
in terms of morbidity and mortality. However with the increasing control of infectious and nutritional
diseases it is rapidly becoming a major cause of morbidity and mortality and has been a heavy burden
on health care system throughout the world1.
As per Nemcek, the morbidity and mortality of cervical cancer could be nearly eliminated if
women participated in regular screening and evaluation. Cervical cancer is a public health cancer that
challenges health care recruit underserved women for screening and early detection2.
The aim of health education is to create awareness regarding “prevention of cancer of cervix”
among women and motivate them to maintain their health status imperative. Health information in
various ways such as poster, pamphlets and mass media can create awareness2.
Esther reported that, “teaching for health, the nurse may help to identify and solve health related
problems by informing, advising, helping with the process of clarifying beliefs, feeling and values.”3
The aim of self education is to create awareness among women and motivate them to monitor
their health status. Imparting health information can create awareness. Health information can be
imparted in various ways such as, poster, pamphlets and mass education.
6.1
NEED FOR STUDY:
As per WHO cancer is a major universal problem. Globally cervical cancer ranks as a second
most common cancer in women and is one of the leading causes cancer related deaths for women in
developing countries. The highest incidence of invasive cervical cancer is reported in southern and
eastern Africa Central America and Southern Asia. A disproportionate share of cervical cancer deaths
occurs in those nations that lack the necessary resources and treatments of pre invasive and invasive
lesion. India, which accounts for one sixth of the world’s population, also bears one fifth of the
world’s burden of cervical cancer1.
WHO states that invasive cervical carcinoma is a major cancer of women in the developing
world. Nearly one fifth of the new cervical cancer cases worldwide are estimated to occur in India,
where a large majority is identified in an advanced and inoperable stage of disease. This is a public
health tragedy, since among all major human cancers; cervical cancer is potentially the most
preventable. It can be easily diagnosed in its pre-invasive stage, because the cervix is readily
accessible for inspection and sampling and pre-invasive cervical abnormalities persist for many years
and can be effectively treated1.
As per Christine cancer cervix occupies either the top rank or second among cancers in
women in the developing countries, whereas in the affluent countries cancer of cervix does not even
find a place in the top 5 leading cancers in women. The cervical cancer burden in India alone is
estimated as 100,000 in incidence in 2001 AD. The differential pattern of cervical cancer and the wide
variation in incidence are possibly related to environmental differences. Etiology association and
possible risk factors for cervical carcinoma have been extensively studied. The factors are: Sexual and
reproductive factors, socio-economic factors (education and income), viruses e.g., human papilloma
virus (HPV) ,in cervical carcinogenesis while other factors are like smoking, diet, oral contraceptives ,
hormones, etc. The accumulated evidence suggests that cervical cancer is preventable and is highly
suitable for primary prevention. Sexual hygiene, use of barrier contraceptives can undoubtedly reduce
cervical cancer incidence. Education, cervical cancer screening of high-risk groups and improvement
in socio-economic status can reduce cervical cancer morbidity and mortality significantly4.
Today we live in a society characterized by the dizzying pace of advances in electronic
communication. Increase in knowledge is needed to explain the causes of cancer risk, incidence,
progression, morbidity and mortality. Hence the investigator felt the need to prepare planned teaching
on prevention aspects of cancer of cervix.
6.2
REVIEW OF LITERATURE
The reviewed literature for the present study is organized under the following headings:
1.
Literature related to incidence, predisposing factors
2.
Literature related to knowledge of women about pre disposing
factors, early signs and symptoms pap smear test and prevention of
cancer of cervix.
3.
Literature related to effect of planned teaching regarding cancer of
cervix.
1.Literature related to incidence, predisposing factors
WHO states that, “recently it was only in the developing country that cancer was a relatively
serious disease in terms of morbidity and mortality. However with the increasing control of infectious
and nutritional diseases it is rapidly becoming a major cause of morbidity and mortality and has been a
heavy burden on health care system throughout the world.” The American Cancer Society estimates
that in 2008, about 11,070 cases of invasive cervical cancer will be diagnosed in the United States.
Some researchers estimate that non-invasive cervical cancer (carcinoma in situ) is about 4 times more
common than invasive cervical cancer. About 3,870 women will die from cervical cancer in the
United States during 2008. Cervical cancer was once one of the most common causes of cancer death
for American women. The cervical cancer death rate declined by 74% between 1955 and 1992. The
main reason for this change is the increased use of the Pap test. This screening procedure can find
changes in the cervix before cancer develops. It can also find early cervical cancer in its most curable
stage. The death rate from cervical cancer continues to decline by nearly 4% a year5.
A case control study done by Biswas on sexual risk factors for cervical cancer among rural
Indian women suggest that the association between sexual behaviour and cervical cancer is well
established6.
WHO states that, recently it was only in the developing country that cancer was a relatively
serious disease in terms of morbidity and mortality. However with the increasing control of infectious
and nutritional diseases it is rapidly becoming a major cause of morbidity and mortality and has been a
heavy burden on health care system throughout the world. The American Cancer Society estimates
that in 2008, about 11,070 cases of invasive cervical cancer will be diagnosed in the United States.
Some researchers estimate that non-invasive cervical cancer (carcinoma in situ) is about 4 times more
common than invasive cervical cancer. About 3,870 women will die from cervical cancer in the
United States during 2008. Cervical cancer was once one of the most common causes of cancer death
for American women. The cervical cancer death rate declined by 74% between 1955 and 1992. The
main reason for this change is the increased use of the Pap test. This screening procedure can find
changes in the cervix before cancer develops. It can also find early cervical cancer in its most curable
stage. The death rate from cervical cancer continues to decline by nearly 4% a year7.
2. Literature related to knowledge of women about pre disposing factors,early signs and
symptoms Pap smear test and prevention of cancer of cervix.
Heather had done a study on Knowledge of Human Papillomavirus infection among young
adult women implications for health education and found Human papillomavirus (HPV) infection of
the genital tract is one of the most common sexually transmitted diseases (STDs). The prevalence of
HPV infection is highest among adolescents and young adults. An anonymous survey was distributed
to all first year students at a private university. The results were analyzed and concluded that health
education should be reconceptualized to incorporate a better understanding of STDs, including HPV
infection, by engaging adolescents and young adults in exploring the biological and social context of
STDs, their public health importance, strategies for prevention8.
Amarin (2005) conducted a study on attitudes and beliefs about cervical smear testing in evermarried 760 Jordanian women. A questionnaire was introduced for assessing the knowledge of
cervical cancer and the Pap smear test. Result says the knowledge was inadequate in less-educated and
older patients. Around 95% of the sample had never had the test. Major barriers to Pap smear
screening included inadequate knowledge about the test, not being referred by a health professional
and fear of having a bad result9.
Hoque (2006) conducted a study on Evaluation of cervical cancer screening program at a
rural community of South Africa. A cross-sectional population based descriptive study was
undertaken at a rural community of South Africa targeting women 30 years and over. The assessment
was performed by means of a questionnaire survey. Outcome measures were percentage of women
with the knowledge on risk factors for cervical cancer and use of Pap smear test and had undertaken
Pap smear test. A total of 611 women (random samples) were recruited from the selected households.
This study showed low uptake of Pap smear test and low level of knowledge on prevention of cervical
cancer and risk factors thus warrants urgent extensive health education program for this rural
communities 10.
3.Literature related to planned health teaching regarding preventive aspect of cancer of
cervix
A study was done by Rengaswamy Sankaranarayanan, on effective screening programmes
for cervical cancer in low and middle-income developing countries states that cervical cancer is an
important public health problem among adult women in developing countries in South and Central
America, sub-Saharan Africa, and south and south East Asia. Person-to-person and group health
education on cervical cancer was provided to 97000 women in Madha Tehsil, Solapur district,
Maharashtra State and found that awareness regarding cervical cancer was generated among the
women and they were responding to the pap smear campaign11.
Krouse H J conducted the study on Video modelling to educate patients. Changes in health
care delivery in the United States of America due to economic pressures have required nurses to
develop innovative instructional materials for educating patients and families. Educational materials
such as videotapes, specifically designed to provide information and promote active participation in
treatment decisions, can be effective tools for empowering patients. The use of video modelling has
potential benefits for clinical practice in facilitating knowledge acquisition, reducing preparatory
anxiety, and improving self-care. Nurses must become more actively involved in evaluating various
teaching approaches used with patients to enhance practice and outcomes and should develop the
power point presentation for the community for enhancement of knowledge12.
As per National Cancer Institute (2008) Health education programmes and screening
methods, such as clinical breast examination and examination of the cervix may help reduce the
number of women who develop breast cancer and cervical cancer13.
6.3
PROBLEM STATEMENT
“A study to assess the effectiveness of planned health teaching regarding preventive aspect of cancer
of cervix among women residing at Hegganahalli in Bangalore.”
6.4
OBJECTIVES OF STUDY
1. To assess the pre-test knowledge score regarding preventive aspect of cancer of cervix among
women residing at Hegganahalli in Bangalore.
2. To assess the post test knowledge score regarding preventive aspects of cancer of cervix among
women residing at Hegganahalli in Bangalore.
3. To compare pre-test & post-test knowledge score regarding preventive aspect of
cancer of cervix among women residing at Hegganahalli in Bangalore.
4. To assess the effectiveness of planned health teaching on preventive aspects of cancer of cervix
among women residing at Hegganahalli in Bangalore.
5. To analyze the relationship between selected demographic variables such as age, education,
occupation, religion, age of menarche, age of marriage, number of children.
6.5
OPERATIONAL DEFINITIONS
Effectiveness
Effectiveness means “to check the change in the score between pre-test and post test whether
positive or neutral.”
Planned health teaching
Planned health teaching refers to a set of information and meaningful interaction on preventive
aspect of cancer of cervix by showing the power point presentation.
Women
Women mean all the women of reproductive age group above 35years to 50 years residing at
Hegganahalli in Bangalore.
6.6
HYPOTHESIS
H1 – There will be significant difference in the knowledge score between pre-test and post test.
H2 – There will be significant association between knowledge and demographic variables.
6.7
ASSUMPTION
1. A women have limited knowledge regarding cancer of cervix.
2. Planned health teaching is useful strategy for learning to enhance knowledge
regarding preventive aspect of cancer of cervix.
6.8
DELIMITATION
The study is delimited to women above 35 years, residing at Hegganahalli, Bangalore.
6.9
PROJECTED OUTCOME
The study will provide knowledge to women regarding cancer of cervix.
7.
MATERIALS AND METHODS
7.1
SOURCE OF DATA
7.2
METHOD OF DATA COLLECTION
7.2.1
SAMPLING CRITERIA
INCLUSION CRITERIA
EXCLUSION CRITERIA
7.2.2
RESEARCH DESIGN
Women residing at Hegganahalli in Bangalore.

Women above 35 yrs of age.

Those willing to participate.

Those who are already diagnosed as cancer of cervix.

Those who are already treated for cancer of cervix.

Health workers dealing with cancer.
One-group Pre-test post-test experimental design.
7.2.3
VARIABLES UNDER STUDY:
INDEPENDENT VARIABLE
In this study the independent variable is the planned teaching
programme on preventive aspect of cancer of cervix.
DEPENDENT VARIABLE
The dependent variable in the study is knowledge score.
7.2.4
SETTING
The study will be conducted at Hegganahalli in Bangalore.
7.2.5
POPULATION
Women residing at Hegganahalli in Bangalore.
7.2.6
SAMPLE
Women above 35 years, residing at Hegganahalli in Bangalore.
7.2.7
SAMPLE SIZE
The sample will consist of 100 women residing at Hegganahalli
in Bangalore.
7.2.8
7.2.9
SAMPLING TECHNIQUE
The convenient sampling technique will be used in this study.
TOOL OF RESEARCH
Appropriate structured questionnaire for checking knowledge
regarding prevention of cancer of cervix will be constructed and
validated by experts and it will be used to collect the needed
data.
SECTION A :
Deals with the demographic variables of the women
SECTION B:
Includes the structured questionnaire regarding cervical cancer
women.
7.2.10 COLLECTION OF DATA
1. A prior formal permission will be obtained from the
municipal corporation authority, at Hegganahalli,
Bangalore for collecting the required data.
2. Informed consent will be obtained from the women
residing at Hegganahalli in Bangalore.
3. Structured questionnaire will be administered to collect
the data regarding knowledge of women regarding
preventive aspects of cancer of cervix.
4. Duration of data collection is 4 weeks.
7.2.11 METHODS OF DATA
ANALYSIS AND
PRESENTATION
1. Descriptive and Inferential statistics will be used.
2. Mean, median and mode will be used to explain demographic
variables.
3. Paired “t” test will be used to find out the effectiveness of
planned teaching programme.
4. Chi square test will be used to find the association between the
perceived knowledge level of women and selected demographic
variables.
7.3
DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE
CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE
DESCRIBE BRIEFLY.
Yes. The study requires implementation of planned teaching programme to be conducted on women at
Hegganahalli in Bangalore.
7.4
HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE
OF 7.3?
1. Ethical clearance will be obtained from the research committee of Anuradha College of
Nursing.
2. Permission will be obtained from the Municipal corporation authority of Hegganahalli,
Bangalore.
3. Consent will be obtained from the women who are willing to participate in the study.
8.
LIST OF REFERENCES:
1. G:\review\Increase of cancer in India–causes and prevention.html.
2. Nemcek.F.(1990).,Maternity And Gynecological Nursing,(5th edi), Mosby, St.Louis,
Philidalphia,148-149.
3. Esther.M. (2002), Advanced Practice In Oncology Nursing (2nd edi ),Saunders:Pp no 334-345.
4. Christine. M. (2000)., Oncology Nursing Assessment And Clinical Care,(3rd edi),Mosby,223230.
5. Susan V.(2000),A Cancer Source Book of Nurses,(8th edi),American Cancer Society, 29-39.
6. Biswas .L. (1997), sexual risk factors for cervical cancer among rural Indian women,
International Journal of Epidemiology,26,(3),491-495.
7. www G:\review 1\Cancer Statistics, 2006 - Jemal et al_ 56 (2) 106 - CA A Cancer Journal for
Clinicians.html
8. Heather .B.(2000),Knowledge of Human Papillomavirus Infection Among Young Adult Men
and Women: Implications for Health Education and Research ,Journal of Community Health ,
25,(4), 20-23.
9. Amarin .O. (2005), Attitudes and beliefs about cervical smear testing in ever-married 760
Jordanian women, American Journal of Obstetrics & Gynecology, 128 (4), 809-810.
10. Hoque M.(2006).,Evaluation of cervical cancer screening program at a rural community of
South Africa,Journal of Community Health , 20, (5) ,20-25.
11.Rengaswamy .S.(2002).,effective screening programmes for cervical cancer in low and middleincome developing countries, Journal of Community Health , 20,(6),20-24.
12. Krouse.J. (1994). Video modelling to educate patients, International journal of gynecological
cancer, 11, (2), 651-660.
13. G:\review 2\Cervical Cancer Home Page - National Cancer Institute.html.
9.
SIGNATURE OF THE CANDIDATE
10.
REMARKS OF THE GUIDE
11.
NAME AND DESIGNATION
11.1
GUIDE
11.2
SIGNATURE
11.3
CO-GUIDE
11.4
SIGNATURE
11.5
HEAD OF THE DEPARTMENT
11.6
SIGNATURE
12
REMARKS OF THE PRINCIPAL
12.1
SIGNATURE
Rajiv Gandhi University of Health Sciences, Karnataka
Curriculum Development Cell
CONFIRMATION FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
Registration No.
Name of the Candidate
: Mrs. NIRMALA SHRINIVAS BHARATI
Address
: Anuradha College of Nursing,
Sreegandhadakawalu, Bangalore.
Name of the Institution
: Anuradha College of Nursing,
Sreegandhadakawalu, Bangalore.
Date of Admission to Course
: 15/5/2009
Title of the Topic
: “A study to assess the Effectiveness of Planned
Health
Teaching regarding preventive aspect of
cancer of cervix among women residing at
Hegganahalli in Bangalore.”
Brief Resume of the work
: Attached
Signature of the Student
:
Guide Name
: Mrs. Radhika K.
Remark of the Guide
:
Signature of the Guide
:
Co-Guide Name
:
Signature of the Co-Guide
:
HOD Name
: Mrs. Radhika K.
Signature of the HOD
:
Principal Name
: Mrs. Radhika K.
Principal Mobile No.
: 9945621112
Principal E-mail ID
: [email protected]
Remark of the Principal
:
Principal Signature
: