The Effect of Women's Health Literacy Status on their Attitudes and Behaviors Towards the Pap Smear Test: A Series In Turkey

Document Type : Original Article

Author

Yozgat Bozok University, Faculty of Health Sciences, Yozgat, Turkey

Abstract

Background and Objective: Early diagnosis is important for the prevention and treatment of cervical cancer. Pap smear test, which is used for early diagnosis, does not reach about half of women. This low level of use of preventive health services is associated with low health literacy. The aim of this study was to determine the effect of women's knowledge and health literacy status on their attitudes and behaviors towards the Pap smear test. 

Materials and Methods: This descriptive, cross-sectional study was completed with 260 women. The convenience sampling method was used, and the study data were collected with a personal information form and the Health Literacy Scale at Yozgat Bozok University Research and Application Hospital between June and September 2022. 

Results: The average age of the women included in the study was 33.5±10.6 years and the total health literacy score was mean 54.52±13.40. The health literacy levels of women aged ≥41 years, who were married, with a primary school level of education, and not working in an income-generating job were lower than those of the others (p<0.05). It was determined that only 28.1% of the women had previously had a Pap smear test and were considering having it done again. The health literacy level of the women who did not know the test, had not had one previously, and did not plan to have it, was lower than that of the others (p<0.05). 

Conclusion: The study results demonstrated that health literacy affects women's attitudes and behaviors towards the Pap smear test. The attitudes and behaviors of women with a high health literacy level towards the Pap smear test were seen to be positive.

Keywords


Availability of data and materials: Datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request

Consent for publication: Not applicable

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. 

Ethical consideration: Approval for this study was granted by the Ethics Commission of Yozgat Bozok University (20.04.2022/32/08) and permission was obtained from the institution where the data would be collected. Written informed consent was obtained from all the study participants.

Author contributions: Study design, data collection, data analysis and writing manuscript: Funda TOSUN GÜLEROĞLU.

1. World Health Organization (WHO). Global Health Estimates 2020: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2019. WHO; 2020. Available from: who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death Date accessed 24.10.2022.
 
2. World Health Organization. (2021). WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, second edition: use of mRNA tests for human papillomavirus (HPV). Geneva. ISBN 978-92-4-004043-4 Available from: https://www.who.int/publications/i/item/9789240040434 Date accessed 24.10.2022.  
 
3. Bruni L, Albero G, Serrano B, Collado JJ, Gómez D, Muñoz J, et al. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in the World. Summary Report 22 October 2021. Available from: https://hpvcentre.net/statistics/reports/XWX.pdf Date access: 19.10.2022  
 
4. GLOBOCAN. Female Cancer Data 2020. Ranking (Cervix uteri), estimated age-standardized incidence rates (World) in 2020, all ages. Available from: https://gco.iarc.fr/today/online-analysis-map?v=2020&mode=ranking&mode_population=continents&population=900&populations=900&key=asr&sex=2&cancer=23&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&nb_items=10&group_cancer=1&include_nmsc=0&include_nmsc_other=0&projection=natural-earth&color_palette=default&map_scale=quantile&map_nb_colors=5&continent=0&show_ranking=0&rotate=%255B10%252C0%255D Date accessed: 24.10.2022  
 
5. Selçuk AK, Yanıkkerem E. Prevalence of Cervical Cancer and Human Papillomavirus (HPV), and HPV Vaccination Programs. Kadın Sağlığı Hemşireliği Dergisi. 2018;4(2):40-55.  
 
6. World Health Organization (WHO). Questions and answers about HPV vaccination. Information for parents and caregivers. Date Access: 02.03.2023 Available from: https://www.euro.who.int/__data/assets/pdf_file/0009/356841/Q-and-A_HPV_Parents_EN.pdf  
 
7. Öztürk Y. Obstacles Preventing Women from Having Pap Smear Screening Test. STED. 2020;29(1):61-68.  
 
8. Özkan N, Toprak D, Can SG, ve ark. Pap Smear Results of the Patients Applied to Gynecology Policlinics and Their Sociodemographic Features. Smyrna Tıp Dergisi. 2015:19-26.  
 
9. Akyüz A, Güvenç G, Yavan T, ve ark. Evaluation of the Pap smear test status of women and of the factors affecting this status. Gülhane Tıp Dergisi. 2006;48(1):25-9.  
 
10. Kılıç M. Determination of State of Women to Have Pap Smear Test and the Associated Factors. Sakarya Tıp Dergisi. 2018:8(4):830-839.
https://doi.org/10.31832/smj.464648  
 
11. Yılmazel G, Çetinkaya F. The importance of health literacy for community health. TAF Prev Med Bul. 2016;15(1):69-74.
https://doi.org/10.5455/pmb.1-1448870518  
 
12. Taş TA, Akış N. Sağlık okuryazarlığı. STED. 2016;25(3):119-124.  
 
13. Özkan S, Tüzün H, Dikmen AU, ve ark. Community Behavior and Health Literacy in Outbreaks. J Biotechnol and Strategic Health Res. 2020;1(Special issue):105-10.  
 
14. Flores BE, Acton G, Arevalo-Flechas L, Gill S, Mackert M. Health literacy and cervical cancer screening among mexican-American women. HLRP: Health Literacy Research and Practice. 2019;3(1):e1-e8.
https://doi.org/10.3928/24748307-20181127-01
PMid:31294299 PMCid:PMC6608916  
 
15. Oldach BR, Katz ML. Health literacy and cancer screening: A systematic review. Patient Education and Counseling. 2014;94(2):149-157.
https://doi.org/10.1016/j.pec.2013.10.001
PMid:24207115 PMCid:PMC3946869  
 
16. Pagan JA, Brown CJ, Asch DA, Armstrong K, Bastida E, Guerra C. Health literacy and breast cancer screening among Mexican American women in south Texas. J Cancer Educ. 2012;27:132-137.
https://doi.org/10.1007/s13187-011-0239-6
PMid:21573944  
 
17. Suka M, Odajima T, Kasai M, Igarashi A, Ishikawa H, Kusama M, et al. The 14-item Health Literacy Scale for Japanese Adults (HLS-14). Environmental Health and Preventive Medicine. 2013;18(5):407-415.
https://doi.org/10.1007/s12199-013-0340-z
PMid:23689952 PMCid:PMC3773092  
 
18. Türkoğlu N, Kılıç D. Sağlık Okuryazarlığı Ölçeği'nin Türkçeye uyarlanması: geçerlilik ve güvenilirlik çalışması/ Adaptation of Health Literacy Scale to Turkish: Validity and Reliability Study. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 2021;24(1):25-33.  
 
19. T.C. Sağlık Bakanlığı. Türkiye sağlık okuryazarlığı düzeyi ve ilişkili faktörleri araştırması./ Survey of health literacy level and related faktors in Turkey. Ed. Özkan S. Özyurt Matbaacılık, 2018, Ankara, pp:81-87. Yayın no: 1103. ISBN: 978-975-590-689-8 Date Access: 25.10.2022 Available from: https://sggm.saglik.gov.tr/Eklenti/39699/0/soya-rapor-1pdf.pdf  
 
20. Nakai A, Imoto C, Miyai N, Yamada K, Morioka I. Health-promoting lifestyles of Japanese expatriates residing in the Philippines and Thailand. SAGE Open Medicine. 2019;7:1-9.
https://doi.org/10.1177/2050312119880747
PMid:31636905 PMCid:PMC6787877  
 
21. Çelikkanat Ş, Akbaş M, Gökyıldız ŞS. Determination of Adult Women's Health Literacy Levels. International Social Sciences Studies Journal. 2020;6(54):19-27.
https://doi.org/10.26449/sssj.2009  
 
22. Sultan AA, Ozturk FO. Health Literacy Levels of Women and Related Factors in Turkey. Journal of Nursing Research. 2021;29(6):e180.
https://doi.org/10.1097/JNR.0000000000000452
PMid:34380974  
 
23. Vural AG, Özdemir F. Health literacy levels of women in climacteric period. Cukurova Med J. 2020;45(1):352-361.
https://doi.org/10.17826/cumj.641709  
 
24. Ayaz SA, Ozturk FO. Health Literacy Levels of Women and Related Factors in Turkey. Journal of Nursing Research. 2021;29(6):e180.
https://doi.org/10.1097/JNR.0000000000000452
PMid:34380974  
 
25. Ilgaz A. Bir Aile Sağlığı Merkezi'ne Kayıtlı Bireylerde Sağlık Okuryazarlığı Seviyesi ve İlişkili Faktörler. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi. 2021;8(2):151-159.
https://doi.org/10.31125/hunhemsire.966349  
 
26. Bakan AB Yıldız MA. Study on Determining the Health Literacy Levels of Individuals Aged 21-64. Sağlık ve Toplum. 2019;29(3):33-40.  
 
27. Eser N, Çelik N. Association between rational drug use and health literacy among pregnant women: a cross-sectional study. Women & Health. 2022;62(7):612-620.
https://doi.org/10.1080/03630242.2022.2100033
PMid:35861057  
 
28. Moradzadeh R, Nazari J, Orouji A, Zamanian M, Shamsi M, Chezani-Sharahi N. Health literacy among mothers with children under 6 years old, a population-based cross-sectional study in Iran, 2019-20. Health Education and Health Promotion. 2022;10(2):395-401.  
 
29. Moeini B, Rostami-Moez M, Besharati F, Faradmal J, Bashirian S. Adult functional health literacy and its related factors: a cross-sectional study. International Journal of Epidemiologic Research. 2019;6(1):24-29.
https://doi.org/10.15171/ijer.2019.05  
 
30. Toprakcı E, Meşe ÖF. Relationshıp Between Education and Health of Induvaduals in Turkey: An Analysis in The Light of National Data. Mehmet Akif Ersoy Üniversitesi Eğitim Fakültesi Dergisi. 2019;51:118-143.  
 
31. Yılmazel G. Low health literacy, poor knowledge, and practice among Turkish women patients undergoing cervical cancer screening. Journal of Cancer Research and Therapeutics. 2019;15(6):1276-1281.
https://doi.org/10.4103/jcrt.JCRT_1142_16
PMid:31898660  
 
32. World Health Organization. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention. Geneva. 2021. ISBN 978-92-4-003082-4 Available from: https://www.who.int/publications/i/item/9789240030824 Date accessed 24.10.2022.  
 
33. Ersı̇n F, Kissal A, Polat P, ve ark. Kadın sağlık personelinin servikal kansere yönelik algıları ve bunu etkileyen faktörler. Hemşirelikte Araştırma Geliştirme Dergisi. 2016;18(2-3):31-43.  
 
34. Kılıçsokan P, İlhan N. Status of Having Undergone a Pap Smear Test Among Women Admitted to a Family Health Center And Their Health Beliefs About Cervical Cancer and Pap Smear Test. JinekolojiObstetrik ve Neonatoloji Tıp Dergisi. 2020;17(2):323-327.  
 
35. Akın B, Aksoy YE, Karakuş Ö. Women's Pap Smear Test Status, Healthy Lifestyle Behaviors and Attitudes Towards Early Diagnosis of Cervical Cancer. CBU-SBED. 2022;9(2):273-282.
https://doi.org/10.34087/cbusbed.1052929  
 
36. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, et al. Health literacy interventions and outcomes: an updated systematic review. Evidence report/technology assessment. 2011;(199):1-941.  
 
37. Heberer MA, Komenaka IK, Nodora JN, Hsu CH, Gandhi SG, Welch LE, et al. Factors associated with cervical cancer screening in a safety net population. World Journal of Clinical Oncology. 2016;7(5):406-413.
https://doi.org/10.5306/wjco.v7.i5.406
PMid:27777883 PMCid:PMC5056332