The study was conducted at the University of Gondar, College of Medicine, and Health Sciences in Gondar town, northwest Ethiopia. Gondar town is located in northwestern Ethiopia at a latitude of 12"36'North, and longitude of 37"28'East. The University of Gondar is located in the west of the Central Gondar Administrative Zone, which is, 747 kilometers far from Addis Ababa in the Northwest direction(11).
Study design and period
An institution-based cross-sectional study was conducted at the University of Gondar, College of Medicine, and Health Sciences on April 2018.
Measurements of variables
Measurement of knowledge: Participants who have scored greater than or equal mean value from 11 knowledge questions were considered to have good knowledge, and those who had scored less than the mean value was considered to have poor knowledge.
Measurement of attitude: Participants who have scored greater than or equal mean value from 9 attitude questions were considered to have a positive attitude and those who had scored less than the mean value were considered to have a negative attitude.
Measurement of practice: Participants used at least one alternative method of cervical cancer screening/ prevention/control of cervical cancer was considered as good practice with a score of 1, otherwise poor practice as a score of 0.
Sample size determination
The required sample size was determined by using the single population proportion formula based on the following assumptions. The proportion of knowledge/attitude was taken from the results of a study done in Mizan Tepi University, Ethiopia, 61% (12), with 95% CI, α-level 5%, and considered the margin of error 5%. The minimum sample size was calculated based on the following formula:
n= (Za/2)2 P (1-P)/d2 ; n= (1.96)2*0.61(1-0.61)/(0.05)2=367
Where: n = sample size
Z α /2= normal distribution value at 95% CI (Z=1.96)
P= the successful proportion of knowledge/attitude (0.61)
d= margin of error (5%)
Therefore, the final sample size after adding 10% non-response rate was 403female students.
A stratified sampling technique was used to select the participants of the study. The study population was stratified based on the department. Participants were selected from twelve departments of the University of Gondar, College of Medicine and Health Sciences by using simple random sampling methods. The sample size was proportionally allocated for each selected department based on their class size by using the formula: ni =n𝑥𝑁𝑖/N
Where n= the total sample size (403); ni= sample size in each stratum, Ni= Number of female students in each department; N= Total number of female students in the study area (1746).
Using the students' lists obtained from the office of the registrar as a sampling frame, the respondents were selected by a simple random sampling method. The sample size was proportionally allocated by using the above formula for each department.
The data was collected by using a self-administrated questionnaire that contains different items like socio-demographics, knowledge, attitude, practice, and control of cervical cancer screening, prevention, and control. Questionnaires were adapted from different pieces of literature from previous studies. These questions explored the respondent’s knowledge, attitude, and practices about cervical cancer, screening, prevention, and control. The questionnaires were translated from English to Amharic for data collection and vice-versa for data entry for ensuring its consistency.
Data quality management
A pre-test was done on 5% of the questionnaire to make sure the questionnaire was appropriately structured and to ensure its consistency. Two days of training were given to data collection facilitators and supervisors for improving the data collection process. Close supervision was followed for ensuring the completeness of questionnaires at the time of data collection. Finally, data editing and clearance were done for the proper management of data.
Data management and analysis
Data were entered after encoded the completed questionnaires and analyzed using SPSS version 20 statistical packages. Descriptive data analysis was used to describe the knowledge, attitude, and practice for cervical cancer screening, prevention, and control. The results were presented in mean/ median, standard deviation, texts, and tables.