Study design and setting
The design and setting for this study have been published in our paper titled Socio-demographic determinants of cervical cancer screening uptake among women of child-bearing age in Mangochi, Malawi [12].
Study Participants
The study participants have been published elsewhere [12].
Sample And Procedures
Sample size and procedures used for sampling study participants are published elsewhere [12].
Questionnaire, Independent And Dependent Variables
In this study, the dependent variable was uptake of CCS. Respondents were asked if they had ever been screened for CC and the response was binary (yes − 1 or no − 0). For independent variables, we assessed both categorical and continuous data. Variables with continuous data were categorized accordingly. The respondents were asked questions pertaining to the health system factors; willingness to be screened for CC by male health workers, distance travelled from their respective villages to the facilities offering CCS and recommendation given by health workers for CCS as well as individual need factors; HIV status, history of multiple sex partners, had participants ever heard of CC, source of CC information, knowledge of signs and symptoms of CC, knowledge of CC risk factors and beliefs towards CCS.
Key variables and measurements
I. Individual need factors
The following were the variables that were examined under individual need factors; HIV status, life time sex partners, participants ever heard of CC, source of CC information, level of knowledge of CC signs and symptoms, level of knowledge of risk factors, level of beliefs towards CCS.
Hiv Status
HIV status was categorized and coded as below;
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HIV negative (HIV-) – Refers to respondents who did not have HIV as confirmed by HIV testing.
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HIV positive (HIV+) – Refers to respondents who had HIV as confirmed by HIV testing.
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Unknown – Refers to respondents who were unaware of their HIV status.
Life Time Sex Partners
Life time sex partners was categorized and coded as below;
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With 2 or more sex partners
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Without or with 1 life time sex partner
Had Participants Ever Heard Of Cc?
This was categorized and coded as below;
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Yes
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No
Source Of Cc Information
Source of CC information was categorized and coded as below;
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Health facility
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Radio
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Friends/family
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Other (television, newspapers/magazines, school/learning institution, & mobile public address system)
Level Of Knowledge Of Cc Signs And Symptoms
Level of knowledge was categorized as low-level – 1 and high-level – 2. A scoring method was developed. Knowledge about signs and symptoms of CC was measured by using a question with five knowledge answers. A total of 5 points were given to respondents who upon probing had given all the correct answers. Respondents were asked to mention CC signs and symptoms. The correct answers were; post coital bleeding (1 point), foul vaginal discharge (1 point), painful sex (1 point), lower abdominal pain (1 point) and abdominal mass as a sign of CC (1 point). A mean score of 0.64 was calculated. Respondents with scores above the mean score were deemed as having high knowledge of CC signs and symptoms whereas those with scores below it were deemed as having low knowledge [17]. Thus, even respondents with one correct answer were deemed as having high-level knowledge of CC signs and symptoms. We, therefore, considered a score of mean value or above (≥ 3) to this question as a high-level of knowledge, otherwise lower scores were deemed as low-level of knowledge of CC signs and symptoms [18].
Level Of Beliefs Towards Ccs
Level of belief was categorized as positive belief – 1 and negative belief – 2. A scoring method was developed. A total of 4 points were given to respondents who had given all the correct answers. Four statements were read to the respondents to gauge their beliefs towards CCS, namely;
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I am at risk of getting cervical cancer hence I need to go for screening (respondents were awarded 1 point if they gave either of the two responses – strongly agree or agree and 0 point if they gave strongly disagree and disagree as responses).
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Cervical cancer screening is important (respondents were awarded 1 point if they gave either of the two responses – strongly agree or agree and 0 point if they gave strongly disagree and disagree as responses).
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Cervical cancer is curable if diagnosed early (respondents were awarded 1 point if they gave either of the two responses – strongly agree or agree and 0 point if they gave strongly disagree, disagree and “not sure” responses).
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I am afraid the screening procedure might be painful that is why I have not gone for screening (respondents were awarded 1 point if they gave either of the two responses – strongly disagree or disagree and 0 point if they gave strongly agree, agree and “not sure” as responses).
A mean score of 2.64 was calculated. Respondents with scores above the mean score were deemed as having positive beliefs towards CCS whereas those with scores below it were deemed as negative beliefs towards CCS [17].
Level Of Knowledge Of Risk Factors
Level of knowledge was categorized as high-level – 1 and low-level – 0. A scoring method was developed. Knowledge about risk factors of CC was measured by using a question with seven knowledge answers. A list of CC risk factors was read out loud to the respondents and they were asked if they knew them. The respondents had to indicate yes, no or do not know. Answering yes was assigned 1 point. A total of 7 points were given to respondents who had given all the correct answers. The CC risk factors were; having multiple sexual partners (1 point), STIs history (1 point), being HIV+ (1 point), early onset of sexual activity (1 point), family history of CC (1 point), having uncircumcised male partner (1 point) and high parity (1 point). A mean score of 5.62 was calculated. Respondents with scores above the mean score were deemed as having high knowledge of risk factors of CC whereas those with scores below it were deemed as having low knowledge [17].
II. Health system factors
Three variables were assessed under health factors, namely; recommendations for CCS given by health workers, willingness to be screened for CC by male health workers and distance travelled to the health facility.
Recommendations For Ccs Given By Health Workers
Recommendations for CCS given by health workers was categorized and coded as below;
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Yes
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No
Willingness To Be Screened For Cc By Male Health Workers
Willingness to be screened by male health workers was categorized and coded as below;
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Yes
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No
Distance To The Health Facility
Data in terms of distance travelled by respondents from their respective villages to health facilities were collected by asking them to name the village where they came from. The Research Assistant (data collector) had estimated distances for all villages to the health facilities where the study was conducted. The estimated distances from health facilities to all villages were collected from the Environmental Health Department of Mangochi District Hospital. Data on distance were collected as a continuous variable and were later categorized and coded into the following;
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≤ 10 km meant distance travelled by equal to or less than 10 km
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11–20 km meant distance travelled ranging from 11 km to 20km
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21–35 km meant distance travelled by a respondent ranging from 21 km to 35 km
Statistical analysis
Data were entered and analyzed using SPSS Inc. PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc. Chi-squared or Fisher’s exact tests were used to compare the distribution of CCS uptake according to different independent groups, and statistical significance was considered at p < 0.05.