Knowledge, attitude, practice of Pap smear and their associated factors among female staff of Universiti Sains Islam Malaysia, Nilai

Introduction: The poor practice of Pap smear especially in the developing countries has been a longstanding issue and causes high number of cervical cancer cases detected at late stages with poor prognosis. Global Cancer Statistics 2012 estimated a number of 527,600 cervical cancer cases and 265,700 deaths worldwide in 2012; majority were in the developing countries. Inadequate knowledge, awareness, and poor attitude towards Pap smear lead to the low uptake. In Malaysia, the National Health and Morbidity Survey IV reported that Pap smear uptake in Malaysia was only 12.8% in 2011. Objectives: The aim of this study is to determine the level of knowledge, attitude and practice of Pap smear among Universiti Sains Islam Malaysia (USIM) female staff and their associated factors, which include socio-demographic, socio-economic, lifestyle practice, health, and family factors. Methodology: A cross sectional study was conducted among married or ever married female staff from seven faculties and the main library of USIM, in Nilai. All eligible staff aged 20 – 65 years old was included in this study. A total of 232 self-administered questionnaires were distributed. Chi-square Test, Fischer Exact Test, and Simple Logistic Regression were used to identify the factors associated with knowledge, attitude and practice of Pap smear among the participants. Binary Logistic Regression was used to determine the predictors of knowledge, attitude and Pap smear practice. All hypothesis tests were two-sided and level of significance was set at 0.05. Results: The total number of respondents included was 187 and the response rate was 80.95%. The median age of the participants was 36.0 ± IQR 8.0. Half (50.8%) of the participants were academician while another half was management staff. The lowest educational background was SPM level, while the highest was PhD. Adequate knowledge on cervical cancer and Pap smear was identified among 48.1% of the study participants. A total of 51.9% participants had positive attitude towards Pap smear, and 65.2% have done Pap smear at least once, of which, 65.6% participants had it done within the past three years. Factors associated with the level of knowledge were some of the variables in lifestyle practices and family factors. Factors associated with level of attitude and practice of Pap smear includes variables in socio-demographic, socio-economic, lifestyle practice, health, and family factors. The predictors of having adequate knowledge were Diploma/Degree educational level (AOR=4.51, 95%CI=1.09-18.62), use of contraceptive method (AOR=4.75, 95%CI=1.60-14.10), and positive attitude towards Pap smear (AOR=2.02, 95%CI=1.02-4.00). Predictors of positive attitude towards the test includes receiving husband’s support (AOR=2.36, 95%CI=1.09–5.08), having adequate level of knowledge (AOR=2.29, 95%CI=1.12–4.67), and have done Pap smear (AOR=4.34, 95%CI=1.95–9.67). Lastly, the predictors of Pap smear practice were higher number of children (AOR=5.83, 95%C =1.73-19.61), attending annual medical check-up (AOR=3.07, 95%CI=1.33-7.09), receiving husband support (AOR=2.51, 95%CI=1.14-5.53), and having positive attitude (AOR=4.89, 95%CI=2.22-10.79). Conclusion: Higher percentage of respondents who have ever did Pap smear were found as compared to many other studies in Malaysia, however the level of knowledge and attitude were still not satisfying. There was still low level of knowledge with misconception on cervical cancer and perceived barrier on Pap smear. Therefore, effective health education, and new recruitment strategies on Pap smear among women should be planned and implemented to promote early detection of cervical cancer and better prognosis.

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