Cancer is a word used to illustrate diseases in

Cancer is a word used to illustrate diseases
in which abnormal cells grow uncontrollably and as a result attack other
tissues. It is conveyed to other body parts via the blood and lymph system
(National Cancer Institute, 2013). There exist over a hundred different types
of cancer, and their names are mostly determined by the tissues or cells they
infected (Cancer Trends Progress Report, 2011/2012). Cervical cancer takes
place when abnormal cells on the cervix split without control.

cancer is a commonly reported genital tract disease among females, next to
breast cancer in the developing nations (Ezem, 2007). Globally, cervical cancer
is regarded as a major but avoidable public health challenge among females
(Arulogun and Maxwell, 2012). According to WHO (2015), the cause of cervical
cancer is attributed to sexually-transmitted human papilloma virus (HPV). There
are over 120 types of HPV out of which only 2 types (16 and 18) are identified
as dangerous and causes of over 70% of all cervical cancer incidence (Poljak,
2012). About 500,000 estimated cases cervical cancer are diagnosed annually,
with over 50% of such cases resulting in death especially among the developing

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(2006) reported that the Papanicolaou (Pap) smear is an indispensable screening
tool for early detection of cervical cancer and is found to be highly efficient
in preventing the disease. Özgül (2007) asserted that the essence of Pap smear
screening in alleviating the probability of cervical cancer and mortality
cannot be undermined. Regular screening reduces the possibility of developing
cervical cancer by 80%. The utilization of Pap smear screening helps to
discover the malignancy in early stages; and the propagation of the screening
exercise has led to significant declining rate in the incidence of cervical
cancer in developed nations such as the United States and some European nations
over the last thirty years (Jemal, Center, DeSantis, and Ward, 2010). Similarly,
Wong et al., (2009) found that both the availability and utilization of Pap
smear have significantly reduced mortality within the range of 60-90% in some
developed nations. Therefore, this study evaluates the impact of cervical
cancer education on knowledge of cervical cancer and uptake of Pap-smear among secondary school


the American Cancer Society (2012) advocates that cervical screening should
commence at age 21; for females within the ages of 21 -29, a 3 year interval is
recommended, while women who have received HPV vaccine should stick to the
screening regimen for their age bracket. In Namibia, the Ministry of Health and
Social Services (2010) suggests that Papanicolou (Pap) smear should be
conducted for the followings: sexually active women; ages 15-25 years are to be
screened 3 years after their initial sexual intercourse; a yearly interval
screening for women infected with HIV regardless of age; a 3 year interval
screening for women within ages 25-49 years; and five year interval screening
for age 50 and above.


despite measures taken to reduce the incidence of cervical cancer, the burden
of its morbidity and mortality cannot be overemphasized especially, in
developing countries. Okunnu (2010) found that about 80% of cervical cancer
death occurs in developing countries; also cervical cancer kills one woman in
every two minutes universally. Gakidou, Nordhagen, and Obermayer (2008) in a
study on coverage of cervical cancer screening in 57 countries, found that only
19% had been screened in developing countries within the space of three years
as against 63% in developed countries.


study by Forouzanfar, Foreman, Delossantos et al. (2011) on cervical cancer,
the researchers reported an increase in mortality rate from 174,000 in 1980 to
200,000 in 2010. According to their findings, the percentage of deaths
attributed to cervical cancer is lower in Western Europe, Australia, and North
American when compared to Southeast Asian nations. For instance, as at 2010 in
Malaysia, the probability of women dying as a result of cervical cancer was
0.7% of the world population. Also, the rate of cervical cancer patients having
stage 3 and stage 4 diagnoses was 26% and 19% (Malaysia: National Cancer
Registry Report, 2011). Another study conducted by National Health and Morbidity
Survey (2006) found out that about 47.3% women in Malaysia ever participated in
Pap Smear screening. The Ministry of Health, Jamaica, reported that 17% of
mortality recorded in year 2000 was attributed to cancer alone (Ministry of
Health Annual Report, 2001). When compared to the United States, the cervical
cancer incidence in Jamaica is 4 times greater (Lewis, 2004). Okore (2011)
reported that the Southern African region has a prevalence rate of 15.5%, and
in Botswana, cervical cancer is known as the most prominent cancer.


Nigeria, according to WHO/ICO (2014) about 47.72 million women stand the risk
of developing cervical cancer. The researchers also predicted that in 2025,
Nigeria will be recording about 19,440 new cases of cervical cancer, and 10,991
deaths. The age standardized rate is 33/100,000 cases yearly. Ferlay,
Soerjomataram, Ervik et al., (2012) estimated that about 14,089 women have
cervical cancer diagnosis and 8,240 deaths recorded annually in Nigeria. Ferlay
et al., also reported that not as much as 10% of Nigerian women have undergone
cervical screening, unlike about 40-50% screened in developed nations. The
findings of Ferlay et al., still emphasize that the level of cervical cancer
education is still very low.


instance, in a WHO study carried out in Nigeria and five other African
countries on effectiveness and acceptability of VIA (Visual Inspection of the
Acetic Acid painted cervix) and Cryotherapy, in Nigeria, 49 health facilities
participated in Ogun State with about 100 healthcare workers who were tutored
and equipped to conduct VIA in their local areas. From September 2007 to May
2010, about 5,529 women were screened for cervical cancer. The researchers
noticed significant variations in the execution of screening programmes in some
facilities in the Local Government Areas (LGA). Averagely, more than 50% of the
facilities screened about two women monthly. Over the space of 33 months,
Odogbolu LGA screened 118 women, and one of the three VIA centres designated in
the LGA did not screen anyone. The findings show that in spite of the huge
amount of money spent on the screening exercise, the turnout of the women was
very poor due to low level of awareness. Considering the present low level of
cervical cancer awareness in Nigeria, there is a need for a robust health


The goal of health education is to discourage
individuals, groups, or larger populations from engaging in behaviours/lifestyles
that are detrimental to health, and on the other encouraging them to engage in
positive health-related behavioural changes that are beneficial to both present
and future health (Simonds, 1976). According to WHO (2014), health education is
any organization of learning experiences aimed at improving the health of
individuals and communities by enhancing their knowledge or influencing a
positive change in their attitudes. One of the prominent health models used in
promoting health knowledge or influencing health behavioural changes is The
Health Belief Model (HBM).

HBM is regarded as an
important psychosocial model of health seeking behaviour (actions a person
considered to be healthy takes to prevent disease) or illness behaviour
(actions a person considered to be ill takes to gain relief). HBM is frequently
used in health promotion and health education. HBM can be used to predict
health behaviours. HBM focuses on the attitudes and beliefs of a person in
order to explain, predict, and influence health behaviour of such person. HBM highlights an individual’s intentions
and decisions to engage in preventive actions, depending on the perceived
susceptibility to the disease, severity of the disease, benefits of preventive
actions and barriers to taking preventive actions (Nejard, Wertheim &
Greenwood 2005). Counselling is very vital in realizing the goal of screening,
providing the community with vital information on cervical cancer and health
services is fundamental to raising awareness and alleviating both morbidity and
mortality. Delivering information through counselling from health care provider
will grant the woman access to the right information and also help to correct
misconceptions (Ndikom and Ofi, 2011).

In addition, technology is playing vital
roles in ensuring that health education becomes more efficient. In a bid to
promote health-behavioural changes, the use of technology enhances the
provision of periodic health messages at a low-cost compared to frequent visits
to health care facilities or even counselling sessions. Regular messages are
usually sent through mobile phones (Leon, Fuentes, and Cohen, 2014). An example
of such is mHealth, which is the usage of wireless technologies such as mobile
phones, notebooks, ipads etc to promote health care services (U.S. Department
of Health and Human Services, Health Resources and Services Administration,
2014). Globally, mHealth interventions are adopted to reinforce health care
systems in areas like enhancing emergency referrals for obstetric care,
reaching out to community health workers and midwives in rural areas in form of
support, enhancing the collection of data in remote areas by community health
workers, and providing health promotion/education services to patients (Tamrat
and Kachnowski 2012).


The ever increasing rate of mobile phone
users in Nigeria might provide an effective communication channel to fortify
the health information systems. The pocket-friendly nature of mobile phones and
network providers’ flexible charges have proliferate its usage in the country.
The recent pervasive nature of mobile phones provides a good platform to
promote health care services by adopting services such as mHealth to improve
health related behaviour, health seeking behaviour, personal wellness etc. Hence,
the study aims at evaluating the impact of cervical cancer education on
knowledge of cervical cancer and uptake
of Pap-smear among secondary schools female teachers in Ibadan.



Problem Statement

women have died as a result of cervical cancer in Nigeria. Women, rich or poor,
urban or rural dwellers, educated or uneducated, regardless of professions or
vocations, within the ages of 30s to 50s are more susceptible to the menace of
cervical cancer. This shows that the most productive proportion of the women
population is threatened with untimely death. It is most sorrowful that
cervical cancer that kills averagely one woman every sixty minutes in Nigeria (Committee
Encouraging Corporate Philanthropy, 2015) can actually be prevented if detected
at early stage.


though, efforts are being made to reduce the incidence, studies still show low
level of awareness of the preventive measures in Nigeria. For example, Balogun, Odukoya, Oyediran, and Ujomu (2012) in their study
among female urban slum dwellers in Lagos, found that none of the women that
participated in their study was aware of cervical screening test. Not one woman
had ever attended cervical cancer screening exercise. Adefuye (2006)
conducted a study at Remo District, Ogun State, the findings revealed that
about 9% of the participants had ever undertaken cervical cancer screening.
Study by Anorlu (2008) among women who had appointment in the General Out
Patient department at Ibadan, substantiated poor knowledge of cervical cancer
and prevention. Wright, Faseru, Kuyinu,
and Faduyile (2014) in their study among market women in Lagos, reported that
less than 15% of participants ever heard about using Pap smear for cervical
cancer screening. Prior to their study, about 5% of their respondents had used
Pap smear test. A study among women in Ibadan showed that the women
don’t have education about cervical cancer, vulnerability to the disease,
consequently, were not encouraged to go for cervical cancer screening (Ndikom
and Ofi, 2012).


on aforementioned studies, one can deduce that poor health education on
cervical cancer among women is significantly influencing the increasing rate of
the incidence. As a result, Maree, Lu, and Wright (2012) opined that national
cancer screening programme will be unproductive if the women are not properly
educated about the causal factors, health seeking behaviours, and preventive
measures about the disease. In other words, cervical cancer screening programme
must not only depend on making cervical screening facilities available, it also
requires mass health education that will engender substantial mobilization among
women to undertake the screening test. Therefore, the study aims at
investigating the impact of cervical cancer education on knowledge of cervical
cancer and uptake of Pap-smear among
secondary schools female teachers in Ibadan.


Justification of the study

considered the number of deaths that has been attributed to cervical cancer, the
present rate of cervical cancer patients, and the susceptibility of sexually
active women to the disease, it is imperative for a study like this to be
conducted. The study is essential because the findings would show the impact of
cervical cancer education on knowledge of cervical cancer and uptake of Pap
smear which could help in reducing or preventing the current situation where
most cervical cancer cases are diagnosed at later stages. In other words, the
results of the study would boost the uptake of Pap smear among women which may
enhance early diagnosis of precancerous changes in the cervix when appropriate
action can be taken. Consequently, alleviating morbidity and mortality related
to cervical cancer. It is expected that the findings of the study will enhance knowledge
of susceptibility to cervical cancer among sexually active women and the
benefits of undertaking Pap smear test.


addition, the findings of the study would also have impact on the younger
generations. Since the population of study are secondary school teachers who
are saddled with the responsibilities of imparting knowledge to the younger
generations, the findings of the study would not only have positive impact on
the teachers, it would also enhance the teachers to equip the younger
generations (their students) with adequate knowledge on how to prevent cervical
cancer when they become sexually active.


the findings of the study would equip various governmental and non-governmental
organizations on effective approaches that might be engaged in conducting
community-based cervical screening services. The recommendations of the study
would help subsequent researchers (with interest in cervical cancer) to identify
more areas to explore in their studies.


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