The socio-economic characteristic of participants:
The study participants consisted of 716 females. The minimum age among the participants was 18, and the maximum was 74; the mean was 27.58 years (STD 8.74 years). Age was grouped into six different age groups of ten years intervals. The most frequent age group was 20 to 30 years; 440 (61.5%), followed by 31 to 40 years; 121 (16.9%). The remaining age groups constituted 94 (13.1%), 41 (5.7%), 14 (2.0%), and 6 (0.8%), for the age groups less than 20 years, 41 to 50 years, 51 to 60 years, and more than 60 years, respectively. Among the participants, 35.1% were students, while 22.1% were unemployed. The remaining occupations were 10.6% medical doctors, 6.0% laboratory technologists, 5.7% were teachers, and 5.4% were managers. The remaining 15.1% consisted of other occupations that were insignificantly frequent.
Levels of education among the participants were mostly for those who finished university; 506 (70.7%). For those who continued their higher education (postgraduate) were 165 (23.0%). Participants with pre-university education levels were 45 (6.2%) (Table 1). Participants were generating family income in range of middle (7,001 – 15,000 SDG) and high-income (> 15,000); 356 (49.7%) and 299 (41.8%), respectively. Whereas low-income participants constituted 8.5% of the study participants (61/716). According to the marital status, 448 (62.6%) participants were single, 245 (34.2%) were married, and 23 (3.2%) were divorced. One child was more frequent; 68 (9.5%) among distribution those who have children. About 70.3% of the study participants did not have children (503/716).
When we asked about the family history of cervical cancer, 148 (20.7%) of the participants didn’t know about their family history. In comparison, 523 (75.0%) have confirmed no family history of cervical cancer; the remaining participants, 31 (4.3%), reported a family history of cervical cancer.
The history of sexually transmitted diseases (STDs) was not significant among most of the respondents, as 548 (76.5%) did not know whether they were previously infected with STDs or not. While those who confirmed no previous or current infection were 163 (22.8%), only 5 (0.7%) participants indicated previous STDs infection.
Respondents who reported avoiding contraceptives were 440 (61.5%), while 149 (20.8%) stated they were using contraceptives for family planning. Around 127 (17.7%) did not know what contraceptives were or their use. Not smoking was reported by 658 (91.9%), whereas current smokers and former smokers were 37 (5.2%) and 21 (2.9%), respectively. Only 21 (2.9%) drink alcohol on certain occasions, while 695 (97.1%) do not drink alcohol.
The number of lifetime sexual partners mainly was within one or two partners; 184 (25.7%), while those with more than two partners were only 11 (1.5%). Participants with no sexual life partners were 521 (72.8%) (Table 1).
A total of 580 (81.0%) heard about cervical cancer, while 136 (19.0%) did not hear about it. However, a total of 229 (32.0%) have heard about the Pap test, while 487 (68.0%) did not hear about the Pap test. The knowledge about cervical cancer concerning early detection by screening was known among 421 (58.8%) participants, whereas 285 (39.8%) did not know about cervical cancer screening. When we investigated the risk factors for cervical cancer perceived by the participants, 109 (15.2%) assumed it to be related to alcohol drinking. In comparison, 51 (7.1%) considered it is related to giving birth to many children, 118 (16.5%) to age, 335 (46.8%) to having many sexual partners, 300 (41.9%) to having HPV infection, 256 (35.6%) to the prolonged use of birth control pills, and 162 (22.6%) related to smoking.
The knowledge concerning the transmission of HPV through sexual contact was stated by 335 (46.8%) respondents. In contrast, 318 (44.4%) did not know about it. Regarding the best time to be vaccinated against HPV, participants who did not know were 381 (53.2%); however, 110 (15.4%) pointed the best time for vaccination is to be after marriage, 17 (2.4%) after first sexual contact, or childbirth, and 208 (29.1%) considered the best time for vaccination is before the first sexual contact. When we checked the knowledge of the participants about whether cervical cancer is preventable via vaccination, 163 (22.8%) answered yes, while 167 (23.3%) answered no, and 386 (53.9%) did not know about cervical cancer prevention. Accordingly, the overall knowledge about HPV and cervical cancer and their associated risk factors was significantly related to the participant’s age group; specifically, the age group between 20 and 30 years old had the highest knowledge score among all other age groups. (P value 0.000) (Table 2). Additionally, the knowledge about cervical cancer and HPV was positively associated with the highest education levels; university and post-university groups. (P value 0.000) (Supplementary Table S1).
We asked the participants if they were offered a free cervical cancer screening would they do it or not. A total of 112 (15.6%) did not respond, while 521 (72.8%) agreed to be screened and 83 (11.6%) refused to be screened. Also, those confirmed to be screened for cervical cancer within the next three years were 256 (35.8%). Respondents’ attitudes and practices towards cervical cancer screening were also significant among different age groups. The willingness to get cancer screening was highest among the age group of 20 – 30 years old. (p-value .001). Again, cancer screening willingness was also highest among the university and post-university group 109 (96%). (Supplementary Table S2). Nevertheless, 112 (15.6%) of study participants have expressed that their reason for refusing the cervical cancer screening was mainly because of their psychological fear of finding out that they have it already.
Those who had HPV vaccination were 29 (4.1%), while those who did not get the vaccine were 687 (95.9%), the percentage of vaccine recipients was insignificantly associated with the age group (P-value 0.74). The question about willingness to receive the HPV vaccine for free was yes for 473 (66.1%), the frequency had slightly decreased to 52.9% (379/716) when they were asked whether they are willing to be vaccinated even if they have to pay for it. Regarding vaccine refusal reasons, 83 (11.6%) responded that they do not trust the vaccine safety, 75 (10.5%) considered there is no need to have the vaccine as they are not sexually active, 43 (6.0%) were due to the cost of vaccine might be very high. (Table 3). The correlation of the educational levels with the respondent practices related to HPV and cervical cancer is shown in Supplementary Table S3.
The regression models to predict the effectors on participants’ knowledge, attitude, and practice were showing a low standard deviation of the estimate with higher values of the adjusted R square; [R: 0.041, 0.017, and 0.006; STD: 1.527, 0.417, and 0.426] indicates that the participant’s knowledge, attitude, and practice levels are more influenced by the combination of occupation, educational level, family income, and marital status all together than affected by each affecter separately (Table 4).