CHAPTER-I

INTRODUCTION

“A man too busy to take care of the health is like a mechanic

to busy to take care of the tool”.

BACKGROUND OF THE STUDY

Reproductive problem is mainly pelvic inflammatory diseases and
vulvar dystrophies, disorder of the cervix, disorder of the uterine body, uterine
tube and ovaries female infertility the mainly affected the reproductive
problem.
(Rose and Wilson)

Cervical cancer develops in the lining of the cervix, the lower part of the
uterus that enters the vagina. The condition usually develops over time. Normal
cervical cells may gradually undergo changes to become precancerous and then
cancerous.
(Neelamkumari, 2010)

Cervical cancer occurs when abnormal cells on the cervix grow out of
control the cervix is the lower part of the uterus that opens in to the vagina
cervical cancer can often be successfully treated when its found early.
(T.Krishna Kanth, 2010)

Carcinoma of the cervix is the most frequently diagnosed cancer in

pregnancy. It is area table condition if detected early and 80% of cases detected
in pregnancy are diagnosed in the first or second trimester. The cervical
carcinoma in women world wide and a major contributor to mortality in
women in developing countries.
(Myles, 2004)

1
 Carcinoma of the cervix is predominantly squamous cell cancer cervical
cancer is less common then it once was be cause of early detection of cell
cancer by pap smear. Common females reproductive cancer and is estimated to
affect more than 11, 300 women in the United States, every year risk factors
are presented sexual activity.
(Brunner & Suddarth, 2012)

NEED FOR THE STUDY

In most of the developing countries carcinoma of the breast and cervix
are the leading sites of malignancies in female and are major public health
problems.

In India twelve population based cancer registries (PBCRs) the most

common followed by cancer of the cervix (ICMR-2004) whereas that of cancer
cervix was between 14 and 24% mainly affected by pregnancy approximately
one in 2, 500.
(D.C.Dutta, 2009)

In incidents of cancer in pregnancy are 6,000 live births in south east

Asia highest rate.
(Lewis & Drife, 2001)

Cancer of the cervix is the second most common cancer in women world
wide and is a ending causes of cancer related death in women in under
developed countries worldwide approximately 5,00,000 causes of cervix cancer
are diagnosed each year.

Invasive cancer in the United States, where approximately 13,000 causes

of invasive cervix cancer and 5,000 of cervical carcinoma a situ are diagnosed
yearly.
(Neelamkumari, 2008)
2
 This is the second most common cancer among women worldwide with
and estimated 5,24,000 new cases in 1995 developing countries where it is
often the most common cancer among women account for 80% of cases.

Wide variation is incidence and moralities from the disease exist

between countries North America, Western Europe, Africa and South East Asia
have the highest rate.

Cancer cervix affected relating young women with incidents increasing

rapidly from the age of 25-45 years then leveling off and finally falling again.
(K.Park, 2011)

STATEMENT OF THE PROBLEM

A study to evaluate the effectiveness of structured teaching programme
on prevention of cervical cancer in terms of knowledge among female in
selected community area.

OBJECTIVES
1. To assess the demographic variables among females.
2. To assess the pre-test knowledge scores regarding prevention of cervical
cancers among females.
3. To assess the post-test knowledge scores regarding prevention of
cervical cancers among females.
4. To compare the pre-test and post-test knowledge scores regarding
prevention of cervical cancers among females.
5. To find the association between post-test knowledge scores with their
selected demographic variables.

HYPOTHESES
H1: The mean post-test knowledge score is significantly higher than the pre-
test knowledge score regarding prevention of cervical cancer among
female.

3
H2: There will be significant association between the post-test knowledge
score regarding prevention of cervical cancer with their selected
demographic variables among with females.

OPERATIONAL DEFINITIONS
EFFECTIVENESS:
In their study it refers to gained level of knowledge as determined by
significant difference between pre and post-test knowledge scored among
female regarding cervical cancer which is measured in terms of statistical
measurement.

STRUCTURED TEACHING PROGRAMME

It refers to a planned series of information to the group of people so on
to help their to learn to something in this study, it refers to a structured set of
information for 45 min by using flash cards to create awareness and spread
knowledge to the female regarding cervical cancer. It includes definition,
etiology, risk factors, stages, signs and symptoms, management and prevention
cervical cancer.

KNOWLEDGE
It means level of understanding in this study it refers to the verbal
response of the female and their level of understanding about cervical cancer,
which is measured by structured interview schedule and its scores.

CERVICAL CANCER
Cervical cancer abnormal cells on the cervix the lower part of the uterus
that enters the vagina.
(T.Krishna Kanth, 2010)

ASSUMPTIONS
1. Female with may have less knowledge about cervical cancer.
2. Structured teaching programme may helps the females to improve their
knowledge and develop desirable attitude regarding cervical cancer.
4
LIMITATION
The study is delimited to,
1. data collection period was 7 days.
2. 30 samples.

PROJECT OUTCOME
The study would provide a data of knowledge and attitude regarding
cervical cancer. The structured teaching programme will help to create
awareness and develop favorable attitude among female regarding cervical
cancer. It will help their practice through gained knowledge and way spread to
outer people in the community thus it will help to reduce the incidence of
cervical cancer.

5
 CHAPTER II

REVIEW OF LITERATURE
The literature review involves the systematic identification, location,
scrutiny and summary of written materials that contain information of a
research problem.
Polit and Hungler., (2004)
The literature gathered from exclusive view is depicted under the
following headings.
PART -I
Overview of Cervical Cancer
PART -II
 Studies related to knowledge
 Studies related to effectiveness of teaching programme on cervical
cancer
 Studies related to knowledge regarding cervical cancer screening
tests

PART –I: Overview of Content of cervical cancer

INTRODUCTION
Cervical Cancer occurs when abnormal cells or the cervix grew out of
control squamous cell carcinoma. The carcinoma is the second worst common
malignancy in worldwide and it remains a leading cause of cancer related death
for women in developing countries.

DEFINITION
Cervical cancer is abnormal cells outside the cervix. The lower part of
the uterus that enters the vagina. This condition usually develops overtime.
Normal cervical cells may gradually undergo changes to become
precancerous. The most 80-90% invasive cervical cause approximately 10-
15% of cases developing in glandular surface cells. Cervical cancer is the

6
second most common worldwide and it remains a leading cause of cancer
related to death for women in developing countries.
D.C. Dutta (2007)
INCIDENCE
Cancer of the cervix is the second most common cancer in women.
Approximately 5,00,000 cases of cervical cancer are diagnosed each year.

The invasive cervical cancer in the United States, approximately 13,000

affected by cervical cancer and 1000 cases of cervical carcinoma.

It mainly affected the women middle aged and older in women of poor
socioeconomic states and higher rate of invasive among African, American and
Native American women.

Lu Ludia twelve population based cancer registries (PBCRS) showed

cancer of cervical 14 & 24%
D. C. Dutta (2007)
CAUSES
 Human Papilloma Virus (HPV)
 Sexual Contact
 Genital warts
 Multiple Sexual Partners
 Cigarette Smoking
 Oral Contraceptives
 Lack of Regular Pap test
 Weak immune System
 Using birth Control Pill for Long time.
 Dietary
 Genetic Factors
 Over use of Drugs. D.C.Dutta (2007)

7
STAGES
Stage 0:
Cancer cells are confined to the lining of the cervix. “0” stage should not
be included in any therapeutic statistics.

Stage I:
Cancer cells are confined to the cervix.

Stage IA:
Cancer can only be detected using a microscope and amount of cancer is
small.

Stage IA1:
Cancer measures less than 7mm in diameter and less than 3 mm deep.

Stage IA2:
Cancer measures less than7mm in diameter and in between 3 mm and 5
mm deep.

Stage IB:
Cancer can be seen without using a microscope or cancer has spread
deeper than 5 mm or is larger than 7mm in diameter.

Lesions of great dimensions of stage IA2 whether seen clinically or not.

Stage IB1:
Cancer can be seen without a microscope and is not larger than 4 cm in
diameter.

Stage IB2:
Cancer can be seen without using a microscope and is larger than 4 cm
in diameter.

8
Stage II:
Cancer has not spread to the pelvis or the lower vagina but has grown
beyond the cervix.

Stage IIA:
Cancer has not spread into the tissues, surrounding the cervix but may
have spread into the upper vagina.
To obvious parametrical involvement.

Stage IIB:
Cancer has spread into the tissue surrounding the cervix.
To obvious parametrical involvement.

Stage IIIA:
Cancer has spread to the lower vagina but not to the pelvic wall.

Stage IIIB:
Cancer has spread to the walls of the pelvis to the lymph nodes in the
pelvis or blocking the ureter.
Cancer has spread to ureter to other organs or areas of the body.

Stage IVA:
Cancer has spread to the bladder or uterus.

Stage IVB:
Cancer has spread to organs outside of the pelvis such as the liver or
outer abdominal organs or the lungs.
Myles (2004)
TYPES
 Squamous cell carcinoma.
 Adenocarcinoma

9
i) Squamous Cell Carcinoma:
Squamous cell is most common accurating for around 90% of all cancer
of the cervix. They arise from squamous cell in the cervix and screening test
detects abnormalities in the squamous cells.

ii) Adeno carcinoma

They mainly in cancer 10- 15% develop from the endometrial canal
either from the lining epithelium or from glands.
D.C. Dutta (2007)
CLINICAL FEATURES
 Abdominal vaginal bleeding
 Pain
 Irregular menstrual Periods
 Bleeding after Sexual Intercourse
 Douching
 Vaginal Discharge
 Pelvic & low back Pain
 Painful Sexual Intercourse
 Painful Urination
 Edema of Lower extremities
 Post Coital Bleedings
 Weight Loss
 Anemia
 Foul Smelling
D. C. Dutta (2007)
DIAGNOSIS FINDING
 History Collection
 Physical Examination
 Pelvic Examination
 Pap Swear
 Colonoscopy

10
  Biopsy
i) Punch Biopsy
ii) Endo cervical Curettage
iii) Conization
 Blood Test
 Chest X-Ray (to detect lung metastasis)
 CT Scan
 Proctoscopy
 Intravenous Pyelogram
 Lymph node Palpation
 Barium edema
D.C. Dutta (2007)

MANAGEMENT
 Preventive
 Curative

i) Preventive:
Primary Prevention:
It involves identifying the causal factors and eliminating or preventing
those from exerting their effects.
These are easy to enumerate but difficult to implement in practice.

Identifying High Risk Female:

 Early Sexual Intercourse
 Early age of first Pregnancy
 Low Socioeconomic States.
 Poor Maintenance of Local Hygiene.
 Sexually transmitted orcegeis.

11
Identifying High Risk Male:
 Multiple Sexual Partners
 Previous wife died of cervical carcinoma
Proper health education of the population especially among the poor
socioeconomic group could be important steps in prevention.

Secondary Prevention:
This is done by screening.

Collection of Material:
The cervix in exposed with a vaginal speculum without lubricant and
prior to bimanual examination. Lubricants tend to distort Cell morphology.

Cervical Scraping:
The material from the cervix is best collected using Hyren’s Spatula
made of wood or plastic whole of the squamo columnar junction has to be
scrapped to obtain good material.

Vaginal Pool Aspiration:

The exfoliated cell accumulated in the vaginal pool in the posterior
forenix in collected either using a glass pipette about 15 cm and 0.5 cm in
diameter with rubber bulb at one end or by a swab stick. This is not much
reliable.

Down staging Screening WHO 1986:

Detection of the disease at an earlier stage when it still curable detection
is done by nurses and other paramedical health workers using a simple
speculum for visual inspection of the cervix.

ii) CURATIVE
 Ideally, the management of the patient with cervical cancer is a team
approach. Both the gynecologist and radio oncologist should review the

12
 patient along with the biopsy report and the plaueutomy be
individualized.
 General condition of the patient.
 Stage of the disease facilities available - surgical and radiometry.
 Which of the patient to be judicially compiled with history of the patient
D.C. Dutta (2007)
SURGERY
 Primary Surgery
 Primary Radiotherapy
 Chemotherapy
 Combination therapy

Primary Radiotherapy
Cancer of the cervix was the first cancer of an internal organ to be
treated with ionizing radiation using radium by Margret cleves in 1903.

Neoadjuvant Chemotherapy
 The lymphadeuectemy has improved the respectability of the bulky
4cm disease. The drugs used are in combination of cisplatin for
Ifosfamide, paclitaxel or viuorelbine.

Combination therapy
 Perforation of the uterus may result during introduction of uterine
tandem.
 This is indicated in cases with positive lymph nodes detected following
surgery.
 Accidental discovery of invasive carcinoma cervix of a uterus removed
by simple Nysterectomy.
Myles (2004)

13
COMPLICATION
 Haemorrhage
 Ureteric Pain
 Pyelone Puritin
 Hydronepurosis
 Vesicovaginal Fistula
 Rectovaginal Fistula
 Pyometra
D.C.Dutta (2007)
PART - II
STUDIES RELATED TO KNOWLEDGE
Zur Hausen, (2002) A study was conducted to examine knowledge
regarding cervical cancer among 400 female workforces in U.K by using
knowledge questionnaire on cervical screening treatment for abnormalities and
HPV. Four Hundred women returned completed knowledge questionnaires of
cervical cancer were good but risk factors for cervical cancer were not well
known. Awareness and knowledge of HPV was very limited. It is essential to
improve women’s knowledge of cervical cancer and risk factors.

An exploratory study was conducted in Australia among 140 females

from Sydney University regarding social and psychological impact of HPV in
cervical screening among females aged 18-45 years (mean 19yrs, SD 3.3yrs)
using purposive sampling. The results were revealed as 25.7% of students
reported “having ever heard of HPV”, compared to the 89.3% who reported
“having ever heard of genital warts”. When asked whether HPV infection is
the main cause of cervical cancer, 11.6% said yes, 5.8% said no, and 82.6%
said they didn’t know. The study was concluded with saying that there is low
awareness of HPV perse and low awareness of the link between HPV and
cervical cancer.

14
 A survey was conducted in Queen Victoria hospital in Australia to
understand women’s current knowledge, attitudes and behaviors related to
HPV, the HPV vaccine, cervical screening and cervical cancer. A sample of
1000 women was surveyed via telephone plus five focus groups (young, older,
Iraqi, TAFE, nurses). the results concluded with a view that all participants
were having positive attitude about cervical screening and the vaccine.

An exploratory research design was adopted to assess the knowledge

and practice regarding cervical cancer among 100 married women between the
ages 20 -60 years at Indore (M.P) using purposive sampling. The investigator
used a structured questionnaire of 9 items to assess the knowledge regarding
early diagnosis and prevention of cervical cancer. Reliability was calculated
using split half method and the 'r' value was 0.8. The findings revealed that all
of the subjects 100(100%) had no knowledge regarding early diagnosis and
prevention of cervical cancer, 86(86%) of the subjects were at low risk for
cervical cancer, 14(14%) of them are at moderate risk for developing cervical
cancer. Hence the conclusion was made by saying that there is a need to create
public awareness regarding the benefits provided by the government through
various health schemes and all government hospitals must make these schemes
available to the population. Nurses should also be trained through in-service
education to spread the health awareness to the individuals and families.

STUDIES RELATED TO EFFECTIVENESS OF TEACHING

PROGRAMME ON CERVICAL CANCER
Boshart, et.al., (1984) An evaluative study was conducted to determine
effectiveness of a teaching programme on knowledge about cancer prevention
and early detection of cancer among 99 teacher trainees in College of
Education, Udupi Taluk, Karnataka State. The instruments used for the study
were demographic questionnaire and knowledge questionnaire. The results
found that the pretest score was 43.75% and posttest score was 79.15%. . This
clearly indicated the effectiveness of structured teaching programme.

15
 The study was conducted to assess the effectiveness of structured
teaching programme on knowledge of women regarding early detection and
prevention of cervical cancer in Periyar Maniammai Family welfare Centre and
hospital through experimental design, among women between the age group of
35to55 years. The pre-test results showed that out of 60 women in overall
knowledge on cancer cervix 41(68%) had inadequate knowledge 19(32%)
moderate, and no one of them had adequate knowledge. The post-test result
showed that, the knowledge of the women had increased through structured
teaching programme, compared with the pre-test knowledge. In post-test
51(55%) had adequate knowledge and 9(15%) moderate adequate knowledge
regarding cancer cervix this data proved that the knowledge of the women had
been markedly improved after structured teaching programme.

A study was conducted among 300 women in urban area, concluded that
in the pre teaching phase, a majority of woman lacked knowledge regarding
prevention of cervical cancer. in the post teaching phase the woman have
gained knowledge and basic skills in performing prevention of cervical cancer.
The study was conducted in South Korean woman with cervical cancer to
explore the prevention of cervical cancer. This was multicenter descriptive
study comprising 968 cervical cancer patients who had been treated from 1983
through 2004 at any of six South Korean hospitals. The study data were
obtained through a mail-in self-responses questionnaire that asked about
patients on prevention of cervical cancer. The result found that out of 968
cervical cancer patients, 404 (41.7%) had sought cancer information. When
patients felt a need for information, their information-seeking behavior
increased (overall risk = 4.053,95% confidence interval =2.139-7.680) .

An improvement in the knowledge level of women on cervical cancer

will lead to healthy practices, early identification of signs and symptoms,
participation in screening programs and compliance to appropriate treatment.
Screening has helped in early identification of precancerous lesions and other
cervical characteristics. Early identification and referral for prompt treatment,
16
undoubtedly inhibits the occurrence of cervical cancer. Hence, structure
teaching program and screening respectively had an impact on the health status
of the women.

STUDIES RELATED TO KNOWLEDGE AND ATTITUDE

REGARDING CERVICAL CANCER SCREENING TESTS
Sankaranaryanan, et.al, (2009) A study was conducted to assess the
knowledge attitude and practice regarding cervical cancer screening test among
Kuwaiti women in Hawalli Health district, Kuwait. Out of 300 women who
were randomly selected, complete information was obtained from 281(93.7%)
women using a structured questionnaire which covered socio-demographic
characteristics, knowledge, attitude and practice related to cervical cancer
screening. Results revealed that knowledge was adequate in 147(52.3%)
women while 86(30.6%) had adequate attitude and 67(23.8%) had adequate
practice. The only significant factor independently associated with inadequate
knowledge and attitude towards pap smear is the level of education. The study
recommended a well-designed health education program on cervical cancer and
benefits of screening to increase the awareness among Kuwaiti women.

A descriptive study was conducted to assess the beliefs and predictors of

cervical cancer screening test among women, who were attending a women’s
health clinic in Kolkota. The sample size was 299 women. Randomized
sampling technique was used. Questionnaire method was used for data
collection. The results revealed that only 10% of women had received Pap
smear at least once in lifetime. 84% of women had inadequate knowledge of
cervical cancer and 95% of women had inadequate knowledge of pap smear.
The study concluded that there is a need to increase the cervical cancer
awareness in the community and to develop a community based programme.

A qualitative study was conducted to assess the attitude of Malaysian

women towards cervical cancer and participation in early detection and
screening services. The sample size was 20 Malaysian women (21 to 56 years).

17
The study tool was in depth interviews. The study revealed that there is a lack
of knowledge regarding cervical cancer screening test, and the need for the
early detection for cervical cancer. Other reason for not undergoing pap smear
are lack of awareness of pap smear indications and benefits, perceived low
susceptibility to cervical cancer, embarrassment, fear of pain, fatalistic attitude
and under evaluation of own health verses those of family. The study suggested
that women need to be educated about the benefits of cervical cancer screening.
The study concluded that health education, counseling, outreach programs and
community based interventions are needed to improve the uptake of pap smear.

A research study to assess the attitude of women and social barriers to

cervical cancer screening in India revealed that most of the women were
reluctant to go to doctor in the absence of any symptoms. Lack of approval
from the husbands was another reason. The study suggested that modification
of health behavior through health education and social empowerment of
women are essential for a population based cervical screening programme to
success in India.

A study was conducted in New Delhi to assess the knowledge, attitude

and behavior of urban slum dwellers regarding common cancers. It revealed
that only 13% of subjects were aware of pap smear. Thus suggested an urgent
need for effective information, education and communication regarding cancer.

A study conducted to evaluate the knowledge, attitude and practice

regarding Paponicalous test in Argentinean Community, reveals that the
knowledge and practice were adequate in 49.5% and 30.5% of subjects,
respectively although the attitude towards the test was considered adequate in
80.5% of subjects. The lack of request from physicians or health care
professionals was the main reason for not undergoing test. The study suggested
that there is a need for increasing the information provided to the public by
health care services and professionals.

18
 CHAPTER - III

METHODOLOGY

This chapter explains the methodology adapted by the researched to

assess the knowledge regarding cervical cancer among females. methodology
deals with research design, settings, samples, sampling technique, tool for data
collection and data analysis.

RESEARCH APPROACH
The evaluative approach was used to conduct the present study to assess
the effectiveness of structured teaching programme regarding cervical cancer in
terms of knowledge and attitude among female.
RESEARCH DESIGN
The research design of the study was one group pretest and posttest pre
experimental design.

GROUP PRE TEST INTERVENTION POST TEST

I O1 X O2

The symbol used were explained as follows

Group-1: Females
O1: Collection of demographic data, pretest assessment of knowledge
and attitude regarding cervical cancer by using structured
interview schedule.
X: Implementing structured teaching programme regarding cervical
cancer by using flash card.
O2 : Posttest-Assessment of knowledge and attitude regarding cervical
cancer by using same structured interview schedule.

19
RESEARCH SETTINGS
The study was conducted in rural village Kuppuchipalayam, Tirupur
district. It consist of lost streets the total population is 4728 out of those 174
families are going for agricultural work and private companies.

POPULATION
The target population of the study was female who are residing in
Kuppuchipalayam in Tirupur.

SAMPLE
The sample of the study is female who are having with 25-45 years of
age residing Kuppuchipalayam in Tirupur.

CRITERIA FOR SAMPLE SELECTION

Inclusion Criteria
 Female who are available during data collection period.
 Female who know Tamil to read and writing.
Exclusion Criteria
 Female who have got sick the female who are not willing to
participate in the study.

SAMPLE SIZE
The sample size consists of 30 females who are having with 25-45 years
of age group.

SAMPLING TECHNIQUE
The sample were selected by using purposive sample technique was
used to pretest and posttest selected the sample for the study.

INSTRUMENT OF SCORING PROCEDURE

DESCRIPTION OF TOOL
The tool was developed based on the objectives of the study

20
Part-I
The demographic data consist of the items related to female such as age,
education, occupation, family monthly income, religion, and types of family

Part-II
It consist of structured interview schedule to assess the knowledge
regarding cervical cancer which consists of 30 multiple choice question which
four options among which one is correct answer

Scoring procedure
Part-I
It consist of demographic variables

Part-II
Structured interview schedule to assess knowledge regarding cervical
cancer consist of 30 multiple choice questions. The correct answer scored ‘1’ is
given and three wrong answer is ‘0’ total score was 30 and the score and
interpreted as below.

SCORING PROCEDURE
Level of knowledge Score Percentage
Inadequate 0-8 0-33%
Moderate adequate 9-16 34-67%
Adequate 17-25 68-100%

VALIDITY
The tool was validated by 4 experts in the field of obstetrics and
gynecological nursing and obstetrician. No modification were done.

DATA COLLECTION PROCEDURE

The study conducted at Kuppuchipalayam in Tirupur district. The data
was collected for a period of 7days in the month of January before conducting
the study written permission was obtained from municipal commissioner
21
Dharapuram. The oral consent was obtained from each participant. A total
number of 30 samples those who met inclusion criteria were selected by using
purpose and rapport was established with them.
The first day demographic variables were collected and per-test was
conducted by using structured interview schedule to assess knowledge. The
interview was conducted for about 45 mints on the same day .The structured
teaching programme was given in the group teaching for 45 mints by using
flash cord in a common place of the street at 11am on the 7th day post-test was
done by using the same structured interview schedule. The time period for data
collection was 9.00 am to 1.00 pm. The same procedure was continued to
obtained data from 30 samples.
PLAN FOR DATA ANALYSIS
SL. Data Method Remark
NO analysis
1 Descriptive Frequent To assess the demographic variables
analysis percentage among females
Mean standard To assess to knowledge scores
deviation regarding cervical cancer among
females
2 Inferential ‘T’ test To assess the effectiveness of
analysis structured teaching programme
regarding cervical cancer among
females
Chi-square test To find out the association between
pre test and post test knowledge,
scores regarding cervical cancer
among females
PROTECTIVE HUMAN RIGHTS
The purpose study was conducted after the approval of dissertation
committee prior to conduct the study. Verbal consent was obtained from each
participated before data collection confidentiality was maintained the
throughout study.

22
 CHAPTER-IV

DATA ANALYSIS AND INTERPRETATION

This chapter deals with analysis and interpretation of the collected data
to assess the effective use of the structured programme on knowledge and
attitude of female with cervical cancer. Data was collected from 30 females
using structured interview. The data was obtained analyzed and presented
under the following headings.

ORGANIZATION OF DATA
The data has been tabulated and organized as follows,
Section A: Distribution of demographic variable .
Section B: Comparison between pre and post- test knowledge’s scores
regarding prevention of cervical cancer
Section C: Comparison of mean standard deviation pretest and post-test
knowledge scores and regarding prevention of cervical cancer
among females.
Section D: Association between knowledge score of regarding prevention of
cervical cancer among females.

23
SECTION A: DISTRIBUTION OF DEMOGRAPHIC VARIABLE
Table-1: Distribution of demographic variable of prevention of cervical
cancer. Frequency and percentage of demographic variables.

Sl. No Demographic variables Frequency (f) Percentage %

AGE
1.1 25-30 years - -
1.2 31-35 years 4 13
1.3 36-40 years 15 50
1.4 41-45 years 11 36

EDUCATION
2.1 No formal education 13 43
2.2 Primary education 11 36
2.3 Secondary education 6 16
2.4 Higher Secondary - -

OCCUPATION
3.1 Coolie worker 11 36
3.2 Business 13 43
3.3 Private employee 6 20
3.4 Government employee - -

FAMILY MONTHLY
INCOME
4.1 Less than Rs.3000 13 43
4.2 Rs.3001-6000 12 40
4.3 Rs.6001-10,000 5 16
4.4 Rs.10001-15000 - -

5.1 RELIGION 17 57
5.2 Hindhu 9 30
5.3 Chiristian 4 13
Muslim

TYPE OF FAMILY
6.1 Nuclear family 13 43
6.2 Joint 17 57

24
Table 1 should that distribution of demographic variable of prevention of
cervical cancer.
The female with belonged to the age group of 23-30years was only
0%.31-35 years of female with were 4(13 %). 36-40 years majority of the
people with were 15(50 %). 41-45 years of females cervical cancer were
11(36%).

There were 13 (43%) female with were in no formal education 11(36%)

of the female with cervical cancer were studied primary education 6(16%) of
female with cervical cancer were studied secondary education.

Regarding occupation 11(36%) of females with prevention of cervical

cancer were coolie worker 13(43%) of female with prevention of cervical
cancer were business 6(20%) of female with were private employee.

Regarding family monthly income 13(43%) of female with had income

less then Rs.3,000 and 13(43%) of the female with between Rs.3001-Rs.6000.
12(40%) of female prevention of cervical cancer had income between Rs.6001-
Rs.10000 and 5(16%) of females with had income Rs.10001-Rs.15000.

The highest number 17(56%) 0f females with prevention of cervical

cancer where Hindus. 9(30%) of females with prevention of cervical cancer
were Christians. 4(13%) of females with prevention of cervical cancer were
Muslims.

Majority of 17(57%) of females with prevention of cervical cancer

belonged to joint family where as 13(43%) of females with prevention of
cervical cancer belonged to the Nuclear family.

25
 50%
50

45

40
36%
35
PERCENTAGE

30

25

20

15 13%

10

5
0%
0
25-30 31-35 36-40 41-45
AGE

Figure:1Distribution of Demographic Variables According to the Age of Female knowledge regarding cervical cancer

26
 45
43%

40
36%
35

30
PERCENTAGE

25

20
16%
15

10

5
0%
0
NO FORMAL EDUCATION PRIMARY EDUAION SECONDARY EDUCATION HIGHER SECONDARY
EDUCATION

Figure:2 Distribution of Demographic Variables According to the education of Female knowledge regarding cervical cancer

27
 45
43%

40
36%
35

30
PERCENTAGE

25

20%
20

15

10

5
0%
0
COOLIE WORKER BUSINESS PRIVATE EMPLOYEE GOVERNMENT EMPLOYEE
OCCUPATION

Figure: 3 Distribution of Demographic Variables According to the occupation of Female knowledge regarding cervical cancer

28
 45 43%
40%
40

35

30
PERCENTAGE

25

20
16%

15

10

5
0%
0
LESS THAN 3000 3001-6000 6001-10000 10,001-15,000
FAMILY MONTHLY INCOME

Figure:4 Distribution of Demographic Variables According to family monthly income regarding cervical cancer

29
Figure:5 Distribution of Demographic Variables According to Religion regarding cervical cancer

30
Figure:6 Distribution of Demographic Variables According to Type of family regarding cervical cancer

31
 SECTION B
COMPARISON BETWEEN PRE AND POST-TEST KNOWLEDGE
REGARDING PREVENTION OF CERVICAL CANCER
Table-2: Comparison between pre and post-test knowledge score
regarding prevention of cervical cancer
Pretest Post test
Level of knowledge Percentage Percentage
Female Females
(%) (%)
Adequate -- -- 23 76%

Moderate adequate 22 73% 7 23.5%

Inadequate 8 26.5% - -

Total 30 100% 30 100%

Table 2 showed that knowledge scores among 30 mothers with

prevention of cervical cancer in pretest majority 22(73%) of females with
prevention of cancer moderately adequate knowledge and inadequate
knowledge and 8(26%) of females and no females for adequate knowledge and
In post-test majority 23(76%) adequate knowledge 7(23.5%) of females had
moderately adequate knowledge and no mothers had inadequate knowledge.
100 Pretest
90 Post Test Post test
80 76% Pre Test
70 73%
60
50 Pre Test
40 Post Test 26.5%
30 23.5%
20
10 0% 0%
Adequate Moderate Adequate Inadequate
32
 SECTION-C
Table 3: Comparison of standard deviation pre and post test knowledge
score regarding prevention of cervical cancer.

S. No Variable Score Standard deviation

1. Pretest 14.9 9.12
2. Post test 20.5 3.85

Table 3 showed the score of pre& post-test knowledge score regarding

prevention of cervical cancer 14.9(standard deviation9.12) and 20.5 standard
deviation (less than5.74).

The mean post-test score were higher than mean pre-test scores.

33
Table-4: Association between knowledge score regarding prevention of
cervical cancer.
level of knowledge
Table Infer
Demographic variables Adequate Moderate Inadequate
2 value ence
F % F % F %
1. AGE
1.1 25-30 - - - -
1.2 31-65 2 6% - - -
1.3 36-40 10 33% 5 16% - - 0.837 12.59 NS
1.4 41-45 8 26% 5 16% - -

2. EDUCATION
2.1 No formal education 8 26% 7 23% - -
2.2 Primary education 8 26% 3 10% - - 0.54 9.49 NS
2.3 Secondary education 2 6% 2 16% - -

3.OCCUPATION
3.1 coolie worker 8 26% 3 10% - -
3.2 Business 9 30% 4 13% - - 0.25 9.49 NS
3.3 private employee 3 10% 3 10% - -
3.4 government - - - - - -

4.FAMILY MONTHLY
INCOME
4.1 Less then Rs.3000 9 3% 4 13% - -
4.2 Rs.6000 7 23% 5 16% - - 0.325 9.49 NS
4.3 Rs.6000-10,000 4 13% 1 3% - -
4.4 More than Rs.10,000 - - - - - -

5. RELIGION
5.1 Hindu 11 36% 6 20% - -
5.2 Christian 7 23% 2 6% - - 0.334 9.49 NS
5.3 Muslim 2 6% 2 6% - -

6. TYPE OF FAMILY
6.1 Nuclear 9 30% 5 16% - -
6.2 Joint 9 30% 5 16% - - 0.305 9.49 NS

NS-Non significant ; S-Significant

34
 Chi-square value were calculated to find-out the association of table
knowledge among females with demographic variable like age ,area of
residence education ,occupation and income regarding prevention of cervical
cancer

Chi-square value were calculated to find the association between score

of female with their demographic variables regarding prevention of cervical
cancer reveals that there no significant association between knowledge score
with the selected demographic variable like age, area of residence education
occupation income type of family religion .

35
 CHAPTER -V

DISCUSSION

This discussion chapter deals with sample characteristic and objective of

this study. The aim of this present study was to assess the knowledge regarding
preventive of cervical cancer of community area Kuppuchipalayam in Tirupur.

DESCRIPTION OF DEMOGRAPHIC VARIABLES

 The female with belonged to the age group of 25-30yrs were only
0(0%). 31-35yrs of female with were 14(13%). 41-45 years majority of
the females with were 11(36%).
 There were 13(43%) female with no formal education 11(36%) of
female were studied primary education. 5(16%) of female with cervical
cancer were study secondary education.
 Regarding occupation 11(36%) of females with coolie worker 13(13%)
of females with business 6(20%) of female were private employee.
 Regarding family monthly income 13(43%) of females had income less
than Rs.3000 and 12(40%) of the female with between Rs.3000-6000.
5(16%) of females with Rs.6001-10000.
 The highest number of 17(56%) of females with prevention of cervical
cancer were Hindu. 9(30%) of females with prevention of cervical
cancer were Christians. 4(13%) of females with Muslims.
 Majority of 15(53%) of females belonged to joint family and 13(43%) of
females belonged to nuclear family.

SECOND OBJECTIVE
The data analysis showed that the assessment of knowledge regarding
prevention of cervical cancer among 30 females rivaled pretest majority
22(73%) of females had moderately adequate and 8(26.5%) had adequate and
post test 23(76%) had adequate knowledge and 7(23.5%) moderately adequate.

36
THIRD OBJECTIVE: To find the association between the knowledge
regarding prevention of cervical cancer.
The study that there is no significant association between knowledge
score with selected demographic variables like age, education, occupation and
income, religion, type of family. The chi square value was calculated to find
the association between scores of female with their demographic variable
regarding prevention of cervical cancer reveals that there is no significant
association between knowledge score with the selected demographic variable
like age, education, Occupation ,income, family type and religion.

37
 CHAPTER VI

SUMMARY, CONCLUSION, IMPLICATION,

RECOMMENTION AND LIMITATION

SUMMARY OF THE STUDY

The focus of the study in the assess the knowledge regarding prevention
of cervical cancer among female in community area Kuppuchipalayam in
Dharapuram.

The design used for the pre-test and post-test study was descriptive
design. The sample was selected by simple random sampling techniques and
the level of knowledge was assessed by structured questionnaires. The data was
analyzed using descriptive statistics and inferential statistics the study findings
reveals that there was adequate and moderate adequate knowledge regarding
prevention cervical cancer.

Major Finding Of The Study

 Out of 30 samples 14(50%) of female age group 36-40years.
 Majority 13(43%) of female had completed there no formal education.
 Most of them 13(43%) were business.
 Most of them 13(43%) had low income people Rs.3000/-month.
 Majority 17(56%) of female had Hindu.
 Most of them 15(50%) of female were the joint family.
 Most of them 22(73%) had moderate adequate in pretest and 8(26.5%)
had inadequate knowledge post test 23(76%) majority of females had
adequate knowledge 7(23.5%) had moderate adequate.
 There was no significant association between knowledge scores when
compared to age, education, number of pregnancy & number of child.

38
CONCLUSION
The pretest and post test study was conducted to structural teaching
programmed to assess the knowledge regarding prevention of cervical cancer
among females the result showed that 22(73%) had moderate adequate in
pretest and 8(26.5%) had inadequate post test 23(76%) majority of females had
adequate knowledge, 7(23.5%) had moderate adequate. The mean and standard
deviation for knowledge scores 14. Pre-test 14.9(9.12) then post test 20.5(5.74)
regarding prevention of cervical cancer.

IMPLICATION FOR NURSING

The findings of the study have certain important implications for the
nursing service education administration and nursing research.

NURSING SERVICE
 The findings of the study clearly enlighten the knowledge level among
the families regarding prevention of cervical cancer
 Nursing personnel are having the responsibilities to impact the
knowledge regarding prevention of cervical cancer

NURSING EDUCATION
 The study finding signify the importance of formulating and
implementing the education level regarding prevention of cervical
cancer by the nursing personnel working in hospital and community
setting.
 Nurses to prepare the chart to teach the females in community setting.

NURSING ADMINISTRATION
Nurse administration should organize inservice education program for
nurse regarding prevention of cervical cancer the nurse administrating should
arrangement to see the sufficient man power, money and material are available
disseminating health information.

39
NURSING RESEARCH
 Nursing research should be done to find out the effectiveness of
teaching programme in team of improved or healthy behaviour.
 This study can be baseline for future studies to build upon.

RECOMMENDATIONS
 A Similar study can be replicated on a large scale sample.
 An experimental study can be conducted to determine effect structured
teaching program of prevention of cervical cancer.

LIMITATIONS
 Data collection period was limited.
 It was consuming for the investigate assist look on user for interview for
an each sample.

40
 REFERENCES

1. K. Park, “Text book of preventive and social medicine”, 19th edition,

Banarasidas Bhanot publisher, Jabalpur, 2003, 291.
2. Anandhi R.J. “Changing trends, cancer epidemiology in India” ICMA
1998, 6-7
3. Usha B Saraiya, Kamini A Rao,Alokendu Chatterjee “Principles and
practice of obstetrics& gynaecology for post graduates”,5th edn ,
Jaypee publishers, Mumbai,2001,487
4. Varghese.C, Amma M.B, Chithrathara.K, “Cancer epidemiology and
clinical research division, Bull World Health Organisation.1999, 77[3]
281-283.
5. Jacques Milliez, “Cervical cancer prevention & the millennium
development goals”; Bull World Health Organ vol.86 no.6 June 2008.
6. Ruth Mccorkle, Marilyn Frank-Stromberg, Marcia Grant, “Cancer
Nursing a comprehensive text book”;2 edn, W.B. Saunders company,
Philadelphia, 2002, 2538,265-298.
7. B.T Basavanthappa, “Projects for the control of cervical cancer”,
Community Health Nursing, 2nd edn, Jaypee publishers, Delhi, 2004,809
8. Vidya Ratnam, “Handbook of preventive and social medicine”,
Community Medicine, 9th edn Jaypee publishers, Delhi, 2000,283.
9. R.K.Manelkar, “Text book for health workers”, 1st edn, Vora medical
publishers, Mumbai, 2002, 203
10. Vidya Bhusan, D.R Sachdeva, “An introduction to sociology” 39th edn
Jaypee publishers Mumbai, 291.
11. Vivekushal “Chemotherapy for carcinoma with what & when”
obstetrics &gynaecology, vol no.3, 2005
12. Rinku sen Gupta “Changing face of cervical cancer review of
literature and our experience”, obstetrics and gynaecology, vol no 9,
2002.
13. Polit & Hungler, “Nursing Research: principles and methods”, 6th
ednLippincott publishers, Philadelphia 1999,144

41
14. Casamitjana M, Sala M, Ochoa D , “Results of a cervical cancer
screeningprogramme from an area of Barcelona with a large
immigrant population”,Eur JPublic Health.2009 May 12.7.
15. Schnatz PF, Markelova NV, Holmes D, “The prevalence of cervical
HPV andcytological abnormalities in association with reproductive
factors of rural Nigerianwomen”, J Womens Health (Larchmt).2008
Mar; 17(2):279-85.
16. Ahmed T, Ashrafunnessa, Rahman J, “Development of a visual
inspectionprogramme for cervical cancer prevention in Bangladesh”,
Reproductive HealthMatters.2008 Nov; 16(32):78-85.
17. Amarin ZO, Badria LF, Obeidat BR, “Attitudes and beliefs about
cervical smear testing in ever married Jordanian women”. East
Mediterr Health J.2008 Mar-Apr;14[2]:389-97
18. Rengaswamy Sankaranarayanan,M.D,Bhagwan M.Nene M.D,Surendra S
Shasthri M.D, “HPV Screening for cervical cancer in rural India”, The
new England Journal of Medicine 2009;361:304-06.

JOURNALS
19. Mrs.Vijayalakshmi. S, (2008). The effect of social support on labour
among primigravida mothers. Nightingale Nursing Times 53-55.
20. Mrs.Vijayalakshmi.S, (2008). Non Pharmacological methods helpful to
both laboring women and caregivers.
21. Latha Venkatesan, (2009) Effect of position during labour on maternal
and neonatal nursing, The official Journal of Trained Nurses Association
of India. 420-26.
22. Senju, (2002) Labour and delivery pain. Nightingale Nursing times. 23:
43-48.

42
WEBSITES
23. http://informahealthcare.com
24. http://www.health.am/socialandprofessionalsupportinchildbirt/
25. http://stti.confex.com
26. http://www.faqs.org/abstract
27. www.interscience.wiley.com/journal
28. http://www.babyworld.co.uk/information

43
 APPENDIX - A
TOOL-I
Part I:
Demographic Variables
1. Age in Years
a.23 - 30 yrs
b. 31 -35 yrs
c.35 - 40 yrs
d.41 - 45 yrs
2. Educational Status
a. No formal Education
b. Primary Education
c. Secondary Education
3. Occupation
a. Coolie worker
b. Business
c. Private employee
d. Government Employee
4. Monthly income
a. Below Rs.3000
b. Rs. 6000
c. Rs.6000 - 10,000
d. More than 10,000
5. Religion
a. Hindu
b. Muslim
c. Christian
6. Type of Family
a. Nuclear Family
b. Joint Family

44
 TOOL-II
STRUCTURED INTERVIEW SCHEDULE KNOWLEDGE
QUESTIONNAIRE REGARDING CERVICAL CANCER
1. What is means by cervical cancer?
a) Abnormal cell in the liver
b) Abnormal cell in the kidney
c) Abnormal cell in the cervix
d) Abnormal cell in the bladder
2. What is the cositive organism of cervical cancer?
a) Stephtochachai
b) Stephylochocus
c) E-coli
d) Human bapyloma virus
3. What is the main causes of cervical cancer?
a) Multiple suscual
b) Dietary deficiency
c) Increasing sodium intake
d) Excessive CHO intake
4. Which age group of women mostly affected cervical cancer?
a) More than 60 years
b) 25 to 45 years
c) Below 20 years
d) More than 18 years
5. What are the main clinical features of cervical cancer?
a) Vaginal bleeding
b) Fever
c) Polyurea
d) Headache
6. What are all the major symptoms of cervical cancer?
a) Back pain
b) Vomiting
c) Fever
d) Vaginal pain
7. How long the women can take treatment?

45
 a) First 2 days
b) 4 to 6 days
c) First one day
d) Upto 10 days
8. What is the main complication of cervical cancer?
a) Haemorrage
b) Postpartum haemorrage
c) Kidney failure
d) Liver failure
9. Which one is the controlling measure of cervical cancer?
a) Pelvic examination
b) Intake more water
c) Intake of more iron rich diet
d) Proper environment hygienic
10. What is preventive management cervical cancer?
a) Safe sexual partner
b) Maintain the good environment
c) Maintain the balanced diet
d) Maintain the proper hygienic
11. Which are the dietary factors may caucusing the cervical cancer?
a) Folate beata, carotein and vitamin K
b) CHO deficiency
c) Vitamin D deficiency
d) Vitamin B deficiency
12. What are the organs are get assicidated?
a) Liver and kidney
b) Lympth nodes
c) Cervix
d) Shoulder

13. Which is the main part should affected in the cervical cancer?
a) Cervix

46
 b) Uterus
c) Ovary
d) Pelvic bone
14. How to look like cervical cancer patient?
a) Excessive weight
b) Low weight
c) Excessive taking of food
d) Shortness of leanth
15. When the HPV should give to the women?
a) 4 to 5 years
b) 5 – 6 years
c) At birt
d) 9 – 26 years
16. When the cervical cancer should identify to the women?
a) 21 years
b) 18 years
c) 35 years
d) 55 years
17. Howmany years occur the pacemaker test should take to reduce the cervical
cancer?
a) 1 year
b) 6 months
c) 3 to 5 years
d) 7 years
18. Which one I she cervical cancer treatment?
a) Fewer medication
b) Radiation therapy
c) Headache medication
d) Surgery cervix
19. Which is the preventive measure of cervical cancer?
a) Ptn rich diet
b) Proper testing

47
 c) Excessive intake of water
d) Iron rich the food
20. What is the preventive measures of cervical cancer?
a) Intake of more fruits
b) Proper test
c) Take low oral pills
d) Proper life style changes
21. What is the complication of cervical cancer?
a) Excessive bleeding
b) Headache
c) Bachale
d) Excessive white discharge
22. Which type of surgical treatment that the cervical cancer?
a) Removal of cervix
b) Removal of uterus
c) Removal of cervix and uterus
d) Removal of cervix and ovarian fallopian tube
23. The main complication of cervical cancer?
a) Fever
b) Backache
c) Arm pain
d) Excessive small with white discharge
24. What is the main complication of cervical cancer?
a) Sexual contact with pain
b) Headache
c) Bleeding in the cervix
d) Fever

25. What is the most commonly found cancer among women in rural India?
a) Cervix
b) Mouth
c) Breast

48
 d) Lungs
26. Where is cervix situated?
a) Part of uterus
b) Part of stomach
c) Part of mouth
d) I don’t know
27. What are all the predisposing factors of cervical cancer?
a) Poor hygiene
b) Two many abortion
c) Infection for reproductive tract
d) Early menarche
28. What is the treatment for cervical cancer patient should undergo?
a) Surgery
b) Radiation therapy
c) Chemotherapy
d) All the above
29. What are all the measures you follow the prevent cervical cancer?
a) Use condoms while having sex
b) Adopt family planning methods
c) Get treated the reproductive tract infection
d) Have only one sex partner
30. What is PAP smear test
a) In the procedure cervix secretions or the cells from the cervix are
collected.
b) In the procedure the tissues from the cervix collected
c) In this procedure the muscles from the cervix is collected
d) I don’t know

49