RESEARCH – April 2013

Women’s knowledge of perceived personal need for cervical cancer prevention measures in Estonia

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Abstract

Background.  The incidence and mortalityrate of cervical cancer in Estonia are higher than in most other European countries. The purpose of this study was to evaluate women`s awareness of the prevention measures of cervical cancer and to investigate the relationship between socio-demographic and health behavioural factors in Estonia.

Methods.  The study is based on the data from a stratified (gender) probability sample survey of the prevalence of genital warts among the young general population in Estonia. Estonian Population Registry records were used as the sampling frame: the sample included 7607 subjects (3804 men and 3802 women) aged 18–45 years.  e postal survey was conducted in the period from March to July 2011. The study group consisted of 3,224 persons who filled in and returned a questionnaire sent to them.  The overall response rate was 45.2% and the women`s response rate was 51.7%.  e data for 1965 women was included in the study. For the awareness of preventive measures, the answers “yes”, “no” or “I do not know” were given on the basis of the women`s self-evaluation. Correlates of awareness were explored using the chi-square test for proportions, Fisher’s exact test for small cell expected values (< 5), the t-test for normally distributed continuous variables and multiple logistic regression analysis for assessing confounding and interaction between variables. Factors with p < 0.05 in univariate analysis were included in multivariate comparison.

Results. The results of the study showed that 42.2% of the women were aware of both prevention measures – cervical cancer screening and vaccination against the HPV virus. Of the women 68.2% considered themselves aware of cervical cancer screening and 56.4% considered themselves aware of vaccination.  The awareness of the preventive measures is related to ethnicity and utilization of reproductive health services: it is higher among Estonian-speaking women (screening: AOR 2.13 95% CI 1.59 to 2.86; vaccine: AOR 2.44 95% CI 1.75 to 3.33) and among those who use health services because of pregnancy (screening: AOR 1.52 95% CI 1.02 to 2.27), have a Pap smear test (screening: AOR 1.45 95% CI 1.11 to 1.92) or have had an abnormal Pap smear (vaccine: AOR 2.62 95% CI 1.70 to 4.04). Also the awareness is positively associated with increasing age (< 29 vs 40+: AOR 1.49 95% CI 1.02 to 2.22) in the case of screening, and with income (I-II vs III+: AOR 1.46 95% CI 1.07 to 1.98) in the case of vaccination.  The knowledge of preventive measures relates signifi cantly to women`s awareness of the preventive measures: for screening, AOR 2.08 (95% CI 1.04 to 4.16), and for vaccine, AOR 2.77 (95% CI 1.96 to 3.85). However, there was an important difference between the understanding of the need for the two measures: 80.0% of the women considered screening important while only 23.7% considered vaccination important.

Conclusions.  The Estonian women`s knowledge of cervical cancer prevention measures is modest and there is a need for continuing improvement of awareness. More attention should be paid to the Russian-speaking population and to younger women. It is also essential to consider the possible need for implementing awareness-increasing intervention outside the context of medical services, so that relevant information could reach the women who do not use (reproductive) health services. Cooperation between educators, general practitioners and gynaecologists, as well as informing of women about protection measures against cervical cancer are important in improving the situation.