Cervical cancer awareness and behaviour among

medical students in Porto

2nd Protocol Proposal14th December ‘09

Introdução à Medicina IClass 16 - 2009/2010

Summary

I. Background

II. Research Question and Aims

III. Participants and Methods

IV. Expected Results

V. References

Cervical cancer has a high incidence and mortality.

A lack of knowledge about the disease is shown in articles previously consulted.

We believe there is potential for better results on prevention of cervical cancer.

Knowledge is a key first step to health education intervention and appropriate decision-making.

Medical students will play a major role in the future public healthcare and education.

BackgroundWhy are we developing this study?

A slow developing malignant cancer that starts in the tissues of the cervix.

Human papillomavirus (HPV) is implicated in more than 99% of these cancers. (Kaplan-Myrth N, 2007, Family Physicians of

Canada)

BackgroundWhat is cervical cancer?

CINInfectedCervix

HPV Infection

HPV Clearance

Normal Cervix

CancerProgression

Regression

HPV infectionmust persist for

more than one year

Invasion

BackgroundHow does cervical cancer develop?

1st grade college students’ knowledge was uncertain about forms of HPV transmission. There were no major differences between genders, except for the knowledge about the link between HPV and genital warts (4,2%-males; 11,6%-females). (Baer H. et

al, 2000, J Community Health)

BackgroundHow aware are people of cervical cancer?

Awareness among young university students is low.

“Health professionals and women had better knowledge about HPV than other participants (…) Overall, the knowledge of the general public about HPV infection is poor.” (Klug SJ et al, 2008, Prev. Med.)

“In a population sample of British women (…) only 2.5% cited HPV as the cause of cervical cancer without prompting (…) Public education is urgently needed.” (Marlow LA et al, 2007, Br J Cancer)

BackgroundHow aware are people of cervical cancer?

Portugal is the country with the greatest incidence of cervical cancer among the Western Europe.

It is also one of the countries with higher mortality rate.

BackgroundHow common is cervical cancer?

Summary

I. Background

II.Research Question and Aims

III. Participants and Methods

IV. Expected Results

V. References

Are medical students well informed about cervical cancer? And how do they behave?

Major aim:

• To assess medical students’ knowledge on cervical cancer...

• Link between cervical cancer and HPV infection

• Methods of prevention and detection

• (...)

Research question and aimsMajor and minor aims

... and their behaviour in regard to this problem.• Number of sexual partners• Age of sexual activity initiation• Vaccine• Others

Secondary aims:

• To compare the results between male and female medical students’.

• To confront differences involving basic and clinical grades.

• To associate the students’ behaviour with the level of knowledge shown.

Research question and aimsMajor and minor aims

Summary

I. Background

II. Research Question and Aims

III. Participants and Methods

IV. Expected Results

V. References

• Observational

• Analytic

• Cross sectional

• Unit of analysis: individual

Participants and methodsStudy design

Inclusion Criteria:• FMUP’s student (available population)

Exclusion criteria:• No questionnaire obtained (no response or no

contact with the subject, after two attempts);

• Classes 16 and 15 of the 1stgrade

Participants and methodsInclusion & exclusion criteria

Target Population:• Medical students;

Sampling Methods:

1. Stratification of the sample, according to the students’ grades

2. Random group sample (to select which classes we’ll select as a sample)

Participants and methodsStudy participants & sampling methods

FMUP’s classes

Average number of students per class in each

grade

Random selection of enough classes to

apply the questionnaire to

about 100 students per grade

Participants and methodsStudy participants & sampling methods

Selection of date and schedule to apply

the questionnaire to each class

All the students are

present?

Application of the questionnaire to the students of the class

yesno

Selection of other date and schedule

to apply the questionnaire to

the missing students

End

Participants and methodsStudy participants & sampling methods

Main objectives in the design (Leung WC, 2001,

StudentBMJ)

• To maximize the response rate

• Simplicity, shortness and clearness

• Close-ended questions only

• Sensitive questions last

• To obtain accurate and relevant information for our survey

• Different types of questions

• Reversed coded questions

• Good question quality

Participants and methodsData collection methods. Questionnaire.

Characteristics of the questionnaire:

• Self-administered, 4-paged; to be applied in groups (classes), during obligatory practical sessions.

• Two sections:

• Section A – Knowledge

• Section B – Personal data and behaviour

• Each question has a “Comments” area.

• Will be piloted for clarity in a random 1st grade class.

• Questions will be coded for an easier analysis.

Participants and methodsData collection methods. Questionnaire.

‘Introduction’

Questionnaire ID

Title and logo

Objective AnonymityConfidentialityInstructions

Participants and methodsData collection methods. Questionnaire.

‘Questions’

Participants and methodsData collection methods. Questionnaire.

• Each question generates one or more variables.

• Analysed variables:

• Global knowledge of cervical cancer (using a scale); degree of preoccupation of being infected; degree of self-evaluated knowledge; frequency of pap smearing ordinal variables; outcomes in scales

• Knowledge of specific subjects – questions 2 to 5 (e.g, of the causal link between HPV and cervical cancer) nominal variables; outcomes: yes/no

• Age of initiation of sexual activity; number of sexual partners in lifetime and in the last 12 months quantitative variables; outcomes will be categorized

• Having started sexual activity; use of condom; being vaccinated; having done a pap smear nominal variables; outcomes = yes/no

• Independent variables: age, gender

Participants and methodsVariables description

• Analysis of each question according to their previously determined codes.

• Treatment of the results will be made in SPSS © (Statistical Package for Social Sciences).

• Descriptive statistics

• Comparative statistics, according to several interest groups: gender, grade, having or not started sexual activity, using or not using condom, etc.

• Results in tables and graphs.

Participants and methodsPlanned statistical analysis

Summary

I. Background

II. Research Question and Aims

III. Participants and Methods

IV. Expected Results

V. References

Knowledge and behaviour of students from the clinical grades (4th, 5th & 6th) will be better than those of students in the basic ones (1st, 2nd & 3rd);

Awareness should increase with the grades.

Expected resultsBasic grades vs clinical grades

Comparing the female subjects with male ones it should be noticed a slight difference in knowledge and alertness on this matter.

However, concerning to genders, the difference between men and women may be more evident in the undergraduate years than in the post-graduate ones.

Expected resultsMales vs females

Summary

I. Background

II. Research Question and Aims

III. Participants and Methods

IV. Expected Results

V. References

References Baer H, Allen S, Braun L. Knowledge of human papillomavirus infection among young adult men

and women: implications for health education and research. J Community Health. 2000

Feb;25(1):67-78.

Gerhardt CA, Pong K, Kollar LM, Hillard PJ, Rosenthal SL. Adolescents’ Knowledge of Human

Papillomavirus and Cervical Dysplasia. J Pediatr Adolesc Gynecol. 2000 Feb;13(1):15-20.

Holcomb B, Bailey JM, Crawford K, Ruffin MT 4th. Adults' knowledge and behaviors related to

human papillomavirus infection. J Am Board Fam Pract. 2004 Jan-Feb;17(1):26-31.

Kaplan-Myrth N, Dollin J. Cervical cancer awareness and HPV prevention in Canada. Can Fam

Physician. 2007 Apr;53(4):693-6, 697.

Klug SJ, Hukelmann M, Blettner M. Knowledge about infection with human papillomavirus: a

systematic review. Prev Med. 2008 Feb;46(2):87-98. Epub 2007 Sep 14.

Lambert EC. College students' knowledge of human papillomavirus and effectiveness of a brief

educational intervention. J Am Board Fam Pract. 2001 May-Jun;14(3):178-83.

Leung WC. How to design a questionnaire. studentBMJ (2001);09:171-216

Marlow LA, Waller J, Wardle J. Public awareness that HPV is a risk factor for cervical

cancer. Br J Cancer. 2007 Sep 3;97(5):691-4. Epub 2007 Aug 7.

Pitts M, Clarke T. Human papillomavirus infections and risks of cervical cancer: what do

women know? Health Educ Res. 2002 Dec;17(6):706-14.

Tiro JA, Meissner HI, Kobrin S, Chollette V. What do women in the U.S. know about human

papillomavirus and cervical cancer? Cancer Epidemiol Biomarkers Prev. 2007

Feb;16(2):288-94.

Yacobi E, Tennant C, Ferrante J, Pal N, Roetzheim R. University students' knowledge and

awareness of HPV. Prev Med. 1999 Jun;28(6):535-41.

References