Servicios Personalizados
Revista
Articulo
texto en 
Inglés (pdf)
Articulo en XML
Referencias del artículo
Traducción automática
Enviar articulo por emailIndicadores
-
Citado por SciELO
Links relacionados
-
Similares en
SciELO
Compartir
Permalink
Revista de la Facultad de Medicina Humana
versión impresa ISSN 1814-5469versión On-line ISSN 2308-0531
Rev. Fac. Med. Hum. vol.23 no.2 Lima abr./jun. 2023 Epub 18-Abr-2023
http://dx.doi.org/10.25176/rfmh.v23i2.5645
Original article
Socio-cultural factors that influence 50-year-old users for Papanicolaou screening at a Nasca Hospital
1Universidad Privada San Juan Bautista, Ica, Peru.
2Instituto De Investigación En Ciencias Biomédicas De Universidad Ricardo Palma, Lima, Peru.
Objective:
The objective of this study was to determine the sociocultural factors in 50-year-old users for pap smears at the Ricardo Cruzado Rivarola de Nasca Hospital during the period December 2021 - February 2022.
Material and methods:
Observational, analytical, and prospective study. The study population is made up of 80 50-year-old users who attend the Ricardo Cruzado Rivarola Hospital for PAP tests at the gynecology-obstetrics office and the sample is 67 users, selected by non-probabilistic sampling for convenience.
Results:
For the first analysis, in simple and multiple regression, it was found that women with high levels of knowledge had a 384% and 382% higher frequency of having ever undergone a PAP test compared to those with low levels of knowledge.
Conclusions:
The level of knowledge about the PAP has a relevant influence on having carried out a PAP; but also the women who had a high level were the ones who had the highest frequency of having done it. This added to the number of children; possibly because in the circles of women with children one of the topics to be discussed is about maternal health and within them the PAP.
Keywords: PAP; smear; sociocultural factors; knowledge level.
INTRODUCTION
Cervical cancer is a public health problem worldwide due to its high mortality rate and resulting disability. It is a preventable disease through timely detection of the virus and/or promotion of healthier lifestyles1.
Virus detection is related to early diagnosis, and there are several screening tests such as the Papanicolaou (PAP)1. However, this intervention is not effective if women do not attend places where this service is offered, as there may be sociocultural factors such as educational level, support and interest from partners, misinformation regarding the belief that the Papanicolaou test is only for young women, and the shyness of lacking privacy or trust with the healthcare professional. These factors may influence their decision to undergo the Papanicolaou test1.
Cervical cancer is one of the neoplasms with the highest incidence worldwide, and it is mostly detected at advanced stages. Invasive cervical cancer is found in 78%, stage I in 8%, stage II in 42%, stage III in 43%, and stage IV in 7%. Therefore, we know that the Papanicolaou is one of the tests that helps detect cervical cancer in a timely manner, which is why it is crucial to undergo it annually2. The crude incidence rate of cervical cancer in Peru is 31.3/100.000, and the age-adjusted rate is 34.5/100.0003.
HPV infection is one of the most common sexually transmitted infections (STI) worldwide. It is estimated that there are approximately 440 million HPV infections globally, of which 160 million are clinical infections3. Also, it is estimated that of the 100 types of HPV, at least 20 are oncogenic. Among these, HPV 16 and 18 contribute to more than 70% of all cases of cervical cancer, 41% and 67% of high-grade cervical lesions, and 16% to 32% of low-grade cervical lesions3.
On the other hand, among the factors mentioned by other studies that influence PAP testing are family income, marital status, having children, knowledge of cervical cancer symptoms, prior counseling before the test, and positive attitudes4.
The lack of interest in undergoing Papanicolaou testing at the Hospital Ricardo Cruzado Rivarola in Nasca is quite broad as a result of various factors such as belonging to a rural area, lack of information, or personal beliefs of each individual. Therefore, the objective of this study is to determine the sociocultural factors that influence 50-year-old users in undergoing Papanicolaou testing at the Ricardo Cruzado Rivarola Hospital in Nasca during the period December 2021 to February 2022.
STUDY DESIGN AND AREA
This is an observational, analytical, and prospective study aimed at determining the sociocultural factors that influence 50-year-old users in undergoing Papanicolaou testing at hospital Ricardo Cruzado Rivarola in Nasca during the period may 2022 to july 2022.
Population and sample
The study population consisted of 80 50-year-old users who attended the hospital Ricardo Cruzado Rivarola in Nasca for Papanicolaou screenings at the gynecology-obstetrics office between May 2022 and July 2022. For sample selection, finite population calculation was performed, resulting in a sample size of 67 users. The sample was selected using non-probabilistic convenience sampling.
Variables and instruments
The variables evaluated in this research are: Papanicolaou testing (yes/no) and the sociocultural factors that influence it: level of knowledge about Papanicolaou testing and marital status.
Procedures
Data was collected using a data collection form in google forms, divided into 3 parts: the first part contains data on Papanicolaou taking (yes/no), the second part includes general patient information, and the third part is a survey on the level of knowledge (high, moderate, low) consisting of 10 items. All patients who met the inclusion criteria were selected. To confirm the final version of the instrument, a previously validated survey was used5,6.
Statistical analysis
The collected data will be recorded in a matrix using excel 2016. Statistical analysis was performed using STATA v17.0 software. Descriptive analysis was conducted with qualitative variables summarized as proportions, and quantitative variables presented as means and standard deviations, as they exhibited a normal distribution based on bias, kurtosis, and histogram analysis. In bivariate analysis, the chi-square test was used for categorical variables, and student's t-test was chosen for the numeric variable, provided that the assumptions for each statistical test were met; otherwise, Fisher's or Mann-Whitney tests were used, respectively.
A multivariate generalized linear model from the gaussian family (crude and adjusted) with robust variance was employed. The variables included in the multivariate model were educational level, marital status, and the number of children. These variables were selected based on literature review. The measure of association was the prevalence ratio (PR) with a corresponding 95% confidence interval (CI).
Ethical considerations
The study was approved by the Institutional Research Ethics Committee (IREC) of the Universidad Privada San Juan Bautista (Approval No. 669-2022-IREC-UPSJB). The survey was performed on each participant after providing information about the study's objective and ensuring their anonymity. Informed consent was obtained from voluntary participants, and their privacy was maintained to enhance the trustworthiness of their responses..
RESULTS
A total of 67 women aged 50 were included in the study. It was found that the majority had completed secondary education (46.27%), less than half were in a cohabiting relationship (32.84%), and the majority had fewer than 4 children (67.16%). The proportion of socioeconomic status was approximately 30% for each subtype. The majority had never had a Papanicolaou test (53.73%). Most women had a low level of knowledge (34.33%) (Table 1).
Tabla 1. Sociodemographic characteristics of the women sample (n: 67).
| Characteristics | N% |
| Education level | |
| Incomplete secondary | 17 (25.37) |
| Completed secondary | 31 (46.27) |
| Incomplete higher education | 12 (17.91) |
| Completed higher education | 7 (10.45) |
| Marital status | |
| Single | 18 (26.87) |
| Cohabiting | 22 (32.84) |
| Married | 19 (28.36) |
| Widow | 8 (11.94) |
| Number of children | |
| Less than 4 | 45 (67.16) |
| 4 or more | 22 (32.84) |
| Ever had a *pap test | |
| No | 36 (53.73) |
| Yes | 31 (46.27) |
| Level of knowledge | |
| Low | 23 (34.33) |
| Moderate | 25 (37.31) |
| High | 19 (28.36) |
*PAP: Papanicolaou test.
Women who had fewer than 4 children had a 28.29% higher frequency of having ever had a pap test compared to those who had 4 or more children (55.56% vs 27.27%; p=0.029). Similarly, women with high level of knowledge had a 66.82% higher frequency of having ever had a pap test, and women with regular level of knowledge had a 26.61% higher frequency of having ever had a pap test, compared to those with low level of knowledge (84.21% vs 44% vs 17.39%; p=0.001). Except for education level and marital status, no statistically significant associations were found (Table 2).
Table 2. Bivariate analysis of the associated characteristics on the level of knowledge about Papanicolaou in a sample of women.
| Characteristics | Level of knowledge about PAP | P* | |||
| No (n=17) | Yes (n=13) | ||||
| N (%) | N (%) | ||||
| Education level | |||||
| incomplete secondary | 9 (52.94) | 8 (47.06) | |||
| completed secondary | 17 (54.84) | 14 (45.16) | 0.505* | ||
| incomplete higher education | 8 (66.67) | 4 (33.33) | |||
| completed higher education | 2 (28.57) | 5 (71.43) | |||
| Marital status | 0.202* | ||||
| single | 8 (44.44) | 10 (55.56) | |||
| cohabiting | 11 (50) | 11 (50) | |||
| married | 14 (73.68) | 5 (26.32) | |||
| widow | 3 (37.50) | 5 (62.50) | |||
| Number of children | 0.029** | ||||
| less than 4 | 20 (44.44) | 25 (55.56) | |||
| 4 or more | 16 (72.73) | 6 (27.27) | |||
| Level of knowledge | 0.001** | ||||
| low | 19 (82.61) | 4 (17.39) | |||
| moderate | 14 (56) | 11 (44) | |||
| high | 3 (15.73) | 16 (84.21) | |||
*conducted using Fisher’s test **conducted using chi-square test of independence
For the first analysis, in the simple regression, it was found that women with high knowledge level had a 153% higher frequency of having ever undergone a pap test (PR=2.53; 95% CI: 0.93-6.89), and women with moderate knowledge level had a 384% higher frequency of having ever undergone a pap test compared to those with low knowledge level (PR=4.84; 95% CI: 1.93-12.13). Then, in the multiple regression, the observed association was preserved in terms of direction and magnitude. It was observed that women with high knowledge level had a 382% higher frequency of having ever undergone a pap test compared to those with low knowledge level (PR=4.82; 95% CI: 2.04-11.39). Women with moderate knowledge level had a 183% higher frequency of having ever undergone a pap test compared to those with low knowledge level (PR=2.83; 95% CI: 0.32-7.15). This was adjusted for confusing covariates of education level, marital status, and number of children (table 3).
Table 3. Crude and adjusted Poisson regression model to evaluate the knowledge level on Papanicolaou and having ever undergone a pap test in a sample of women.
| Characteristics | Crude analysis | Adjusted analysis* | |||||
| Rp | Ci 95% | P | Rp | Ci 95% | P | ||
| Level of knowledge | |||||||
| Low | Ref | Ref | |||||
| Moderate | 2.53 | 0.93-6.89 | 0.069 | 2.83 | 0.32-7.15 | 0.027 | |
| High | 4.84 | 1.93-12.13 | 0.001 | 4.82 | 2.04-11.39 | 0.001 | |
* adjusted for education level, marital status, and number of children ** significant p-value <0.05 PR: prevalence ratio. 95% CI: 95% confidence interval source: own elaboration.
DISCUSSION
Main findings
In the present study, the results show that having a high or moderate level of knowledge about pap smear was associated with having undergone a pap smear test at least once, even after adjusting for covariates such as educational level, marital status, and number of children.
Comparison with other studies
According to recent studies, approximately half of Peruvian women have never undergone a PAP smear test. This is reflected in epidemiological data describing coverage rates of less than 50% in Peru, particularly in the highlands, jungle, and rural areas7-11. In our study, the frequency of having ever undergone a PAP smear test was 46.27%, which is similar to the findings of a study by Bendezú et al., whose study reported a prevalence of 52.4% based on the analysis of Demographic and Health Surveys (DHS) data from 2015, 2016, and 2017 in women aged 30 to 49 years11. However, the trend of PAP smear testing in previous years, before 2010, ranged from 7% to 42.9%10, while in 2018, it was reported to be 86.9% (n=6340) based on an analysis of women aged 30 to 49 years who participated in the Demographic and Health Surveys (DHS) 201812. Possible causes for the low PAP smear testing rates include a lack of knowledge about what a PAP smear is and its usefulness9,10,13, low educational level, inadequate history of PAP smear testing, and marital status14-17. In our study, educational level and marital status were not found to be associated with having ever undergone a PAP smear test.
In our study, women who had fewer than 4 children had a 28.29% higher frequency of undergoing a PAP smear test, and this finding was statistically significant. This is similar to a study where women with 1 to 3 children had a 38.3% frequency of undergoing a PAP smear test, compared to mothers with 4 or more children, who had a 15.9% frequency18. Further research is still needed to examine this issue. Possible explanations could be that, although the latest guidelines from the Ministry of Health and EsSalud state that a PAP smear should be done every 3 years or annually starting at 21 and 18 years of age, respectively, a study considering women's opinions revealed that some believe they should start having a PAP smear after having children18. Therefore, it is possible that women who have ever had a PAP smear test did so during prenatal care20,21. Another possible explanation is that women who have children begin to discuss various health-related topics with other mothers. This was reflected in a study that found a strong belief that a PAP smear should be done after having or no longer having children, suggesting that although women knew they should have a PAP smear when sexually active, they might have delayed initiation until after having a child18,22-25.
Women with a high level of knowledge had a 382% higher frequency of having ever undergone a PAP smear test compared to those with inadequate knowledge. This finding is similar to what was reported in other studies, such as Bendezú's, which found a 27% higher frequency among those with adequate knowledge11. The study by Mamani et al also reports that women with no knowledge about PAP smears had a 278% higher likelihood of not having had a PAP smear compared to those with knowledge12. Knowledge about PAP smears leads women to become aware of the risks of not getting tested (such as cervical cancer), learn about risk behaviors associated with this condition, and understand the usefulness of PAP smears at specific times in their lives26; Therefore, greater knowledge implies a greater willingness to undergo a PAP smear27,28.
Recommendations
As this is a cross-sectional study, it is not possible to establish a temporal relationship between the dependent variable and the covariates of the study. Additionally, the study did not consider the attitudes, thoughts, and beliefs regarding the reasons why women may not undergo a PAP smear. However, we believe that the findings of the study are valuable in providing an overview of knowledge about PAP smears and its association with having ever undergone a PAP smear test.
CONCLUSIONS
The level of knowledge about PAP smears significantly influences the likelihood of having undergone a PAP smear test, and women with a high level of knowledge had the highest frequency of having done so. This, combined with the number of children they have, is possibly because discussions about maternal health, including PAP smears, are common among circles of women with children.
REFERENCES
1. Factores socioculturales que influyen en la decisión de las usuarias para la toma de Papanicolaou , puesto de salud metropolitana 2018 [internet]. [cited 2021 sep 22]. Disponible en: http://repositorio.unfv.edu.pe/handle/unfv/3238 [ Links ]
2. González zm. Programa de detección del cáncer cervicouterino: políticas públicas y experiencias de los actores que implementan el programa en el estado de veracruz, méxico. Salud colect. 2017;13(3):521-35. Disponible en: http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=s1851-82652017000300521&lng=es&nrm=iso [ Links ]
3. Plan nacional para la prevención y control de cáncer de cuello uterino 2017- 2021 (r.m. nº 440-2017/minsa) - gobierno del perú disponible en: http://bvs.minsa.gob.pe/local/minsa/4232.pdf [ Links ]
4. Calderón baldera ke. Factores que intervienen en la decisión de la toma de la prueba de Papanicolaou en mujeres de 20 a 69 años del distrito de lambayeque. 16 de marzo de 2018 [citado 9 de mayo de 2023]; disponible en: http://repositorio.unprg.edu.pe/handle/20.500.12893/1840 [ Links ]
5. Serva ortega bl, soto flores m. Nivel de conocimiento y actitudes del tamizaje de Papanicolaou en mujeres que acuden al c.s. de chupaca de enero - marzo del 2016. Universidad peruana del centro [internet]. 2016 [citado el 26 de mayo de 2022]; disponible en: http://repositorio.upecen.edu.pe/handle/upecen/80 [ Links ]
6. Oliva hanke c. Nivel de conocimiento, actitud y práctica en la realización del exámen de Papanicolaou en mujeres mayores de 15 años que asistieron al consultorio externo de ginecología del hospital san josé en los meses de julio y agosto del 2015. Universidad ricardo palma [internet]. 2016 [citado el 26 de mayo de 2022]; disponible en: http://repositorio.urp.edu.pe/handle/urp/569 [ Links ]
7. Cancer (iarc) tia for r on. Global cancer observatory [internet]. [citado el 23 de junio de 2022]. Disponible en: https://gco.iarc.fr/ [ Links ]
8. Ministerio de salud. Plan nacional para la prevención y control de cáncer de cuello uterino 2017- 2021 2017. Disponible en: http://bvs.minsa.gob.pe/local/minsa/4232.pdf [ Links ]
9. Castro m, morfin r, sánchez s, roca j, sánchez e, williams m. Nivel de conocimiento sobre el cáncer cervical y el Papanicolaou en relación al temor, estrés o vergüenza al tamizaje: un estudio transversal en una comunidad pobre de lima. Revista peruana de ginecología y obstetricia. 2005;51(2):94-9. Doi: 10.31403/rpgo.v51i401 [ Links ]
10. Gutiérrez c, romaní f, ramos j, alarcón e. Factores asociados con el conocimiento y tamizaje para cáncer de cuello uterino (examen de Papanicolaou ) en mujeres peruanas en edad fértil. Análisis del periodo 1996-2008. :12. Disponible en: https://pesquisa.bvsalud.org/portal/resource/pt/lil-619934 [ Links ]
11. Bendezu-quispe g, soriano-moreno an, urrunaga-pastor d, venegas-rodríguez g, benites-zapata va. Association between knowledge about cervical cancer and having a Papanicolaou test in peruvian women. Rev peru med exp salud publica. 2020;37:17-24. Doi: 10.17843/rpmesp.2020.371.4730 [ Links ]
12. Mamani s, telma j, de la cruz vargaz. Determinantes socioculturales asociados a la no realización del tamizaje de cáncer de cuello uterino en mujeres de 30 a 49 años de edad según la encuesta demográfica y de salud familiar (endes) del año 2018. Published online 2020 disponible en: https://repositorio.urp.edu.pe/handle/20.500.14138/2963?show=full [ Links ]
13. Luque js, maupin jn, ferris dg, guevara condorhuaman ws. Reaching women in the peruvian andes through cervical cancer screening campaigns: assessing attitudes of stakeholders and patients. Patient prefer adherence. 2016;10:2107-16. Doi: 10.2147/ppa.s119886 [ Links ]
14. Huamaní c, hurtado-ortega a, guardia-ricra m, roca- mendoza j. Conocimientos y actitudes sobre la toma de Papanicolaou en mujeres de lima, perú 2007. Revista peruana de medicina experimental y salud publica. 2008;25(1):44-50. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=s1726-46342008000100007 [ Links ]
15. Hunter jl. Cervical cancer in iquitos, peru: local realities to guide prevention planning. Cad saude publica. 2004;20(1):160-71. Doi: 10.1590/s0102-311x2004000100032 [ Links ]
16. Garcés p ic, rubio l dc, scarinci ic. Factores asociados con el tamizaje de cáncer de cuello uterino en mujeres de nivel socioeconómico medio y bajo en bogotá, colombia. Revista facultad nacional de salud pública. 2012;30(1):7-16. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=5079640 [ Links ]
17. Rodríguez g, caviglia c, alonso r, sica a, segredo s, león i, et al. Conocimientos, actitudes y prácticas sobre el test de Papanicolaou y estadificación del cáncer de cuello uterino. Revista médica del uruguay. 2015;31(4):231-40. Disponible en: http://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=s1688-03902015000400002&lng=es [ Links ]
18. Miles tt, riley-powell ar, lee go, gotlieb ee, barth gc, tran eq, et al. Knowledge, attitudes, and practices of cervical cancer prevention and pap smears in two low-income communities in lima, peru. Bmc womens health. 2021;21:168. Doi: 10.1186/s12905-021-01291-8 [ Links ]
19. Paz-soldán va, nussbaum l, bayer am, cabrera l. Low knowledge of cervical cancer and cervical pap smears among women in peru, and their ideas of how this could be improved. Int q community health educ. 2010;31(3):245-63. Doi: 10.2190/iq.31.3.d [ Links ]
20. Paz-soldán va, bayer am, nussbaum l, cabrera l. Structural barriers to screening for and treatment of cervical cancer in peru. Reprod health matters. 2012;20(40):49-58. Doi: 10.1016/s0968-8080(12)40680-2 [ Links ]
21. Paz soldan va, lee fh, carcamo c, holmes kk, garnett gp, garcia p. Who is getting pap smears in urban peru? Int j epidemiol. 2008;37(4):862-9. Doi: 10.1093/ije/dyn118 [ Links ]
22. Baezconde-garbanati l, agurto i, gravitt pe, luciani s, murphy s, ochoa c, et al. Barriers and innovative interventions for early detection of cervical cancer. Salud publica mex. 2019;61(4):456-60. Doi: 10.21149/10425 [ Links ]
23. Dufour dl, piperata ba. Rural-to-urban migration in latin america: an update and thoughts on the model. Am j hum biol. 2004;16(4):395-404. Doi: 10.1002/ajhb.20043 [ Links ]
24. Lee fh, paz-soldan va, carcamo c, garcia pj. Knowledge and attitudes of adult peruvian women vis-à-vis human papillomavirus (hpv), cervical cancer, and the hpv vaccine. J low genit tract dis. 2010;14(2):113-7. Doi: 10.1097/lgt.0b013e3181c08f5e [ Links ]
25. Baumann lm, robinson cl, combe jm, gomez a, romero k, gilman rh, et al. Effects of distance from a heavily transited avenue on asthma and atopy in a periurban shantytown in lima, peru. J allergy clin immunol. 2011;127(4):875-82. Doi: 10.1016/j.jaci.2010.11.031 [ Links ]
26. Bou-orm ir, sakr re, adib sm. Cervical cancer screening among lebanese women. Rev epidemiol sante publique. 2018;66(1):1-6. Doi: 10.1016/j.respe.2017.10.004 [ Links ]
27. Arevian m, noureddine s, kabakian t. A survey of knowledge, attitude, and practice of cervical screening among lebanese/armenian women. Nurs outlook. 1997;45(1):16-22. Doi: 10.1016/s0029-6554(97)90053-1 [ Links ]
28. Al-meer fm, aseel mt, al-khalaf j, al-kuwari mg, ismail mfs. Knowledge, attitude and practices regarding cervical cancer and screening among women visiting primary health care in qatar. East mediterr health j. 2011;17(11):855-61. Doi: 10.26719/2011.17.11.856 [ Links ]
8Article published by the journal of the faculty of human medicine of the ricardo palma university. It is an open access article, distributed under the terms of the creatvie commons license: creative commons attribution 4.0 international, cc by 4.0(https://creativecommons.org/licenses/by/1.0/), that allows non-commercial use, distribution and reproduction in any medium, provided that the original work is duly cited. For commercial use, please contactrevista.medicina@urp.edu.pe.
Received: March 10, 2023; Accepted: May 07, 2023
Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons
