Health insurance is insurance against the risk of
incurring medical expenses among individuals. By estimating the
overall risk of health care and health system expenses, among a
targeted group, an insurer can develop a routine finance
structure, such as a monthly premium or payroll tax, to ensure
that money is available to pay for the health care benefits
specified in the insurance agreement. The benefit is administered
by a central organization such as a government agency, private
business, or not-for-profit entity. According to the Health
Insurance Association of America, health insurance is defined as
"coverage that provides for the payments of benefits as a result
of sickness or injury. Includes insurance for losses from accident,
medical expense, disability, or accidental death and
dismemberment
Awareness is the ability to perceive, to feel, or to be conscious of events, objects,
thoughts, emotions, or sensory patterns.[1] In this level of consciousness, sense data can
be confirmed by an observer without necessarily implying understanding. More broadly,
it is the state or quality of being aware of something. In biological psychology,
awareness is defined as a human's or an animal's perception and cognitive reaction to
a condition or event. Awareness is a relative concept. An animal may be partially aware, may
be subconsciously aware, or may be acutely unaware of an event. Awareness may be focused
on an internal state, such as a visceral feeling, or on external events by way of sensory
perception. Awareness provides the raw material from which animals develop qualia,
or subjective ideas about their experience. Insects have awareness that you are trying to swat
them or chase after them. But insects do not have consciousness in the usual sense, because
they lack the brain capacity for thought and understanding.
bstract
Background
Over the years awareness and uptake of cervical cancer screening services has remained poor in
developing countries. Problems associated with cervical cancer incidence include late reporting,
ignorance and cultural issues relating to cervical cancer screening. This study sought to explore the
awareness, perception and utilization of cervical cancer screening among women in Ibadan as well as
factors that influence utilization.
Method
This is a qualitative study that utilized Eight Focus Group Discussions to collect information from women
in selected health facilities in Ibadan, South West, Nigeria. The 82 participants were purposely recruited
from women attending Antenatal clinics in 4 secondary and 4 primary health care facilities after approval
was received from the Institutional Review Board in charge of the facilities. The focus group discussions
were tape recorded and transcribed verbatim. The transcripts were analyzed into themes.
Findings
The study provided qualitative information on the awareness, perception of the utilization of cervical
cancer screening services among women in Ibadan. Participants were mainly married women (92.7%),
mean age =27.6, SD =4.5, mainly traders (39%) and from Yoruba ethnic backgrounds (87.8%) and had
secondary education (39%). The respondents reported not being aware of cervical cancer and were not
utilizing the services. Though they did not know what cervical cancer screening entailed or the screening
methods, they still believed that it is important since like for other diseases will help in early detection
and treatment. The participants were eager to get more information from nurses on cervical cancer
about cervical cancer screening. The major factors identified by the women that influence screening
utilization were ignorance, Illiteracy, belief in not being at risk, having many contending issues,
nonchalant attitude to their health, financial constraint and fear of having a positive result.
Conclusion
There is an urgent need for more enlightenment about cervical cancer especially by health workers. Also,
cervical cancer services should be made available at very affordable cost so that women can easily
access the services in order to reduce incidence of invasive cancer.
Keywords:
Awareness; Perception; Utilization; Cervical cancer screening; Women
Background
Cancer of the cervix uteri is the second most common cancer among women worldwide [1-3]. with an
estimated 529,409 new cases and 274,883 deaths in 2008. About 86% of the cases occur in developing
countries, representing 13% of female cancers [1]. Each year approximately, 10,000 women develop
cervical cancer, and about 8,000 women die from cervical cancer in Nigeria [4]. Spayne [5] reported in
their study that over half the study population was under 50years of age suggesting this disease is
responsible for a disproportionately greater loss of life-years and social cost. Records from cancer
registry UCH indicate that the incidence is high; it was 353 out of 1942 total malignancies in 2007.
Evidence of decline in incidence has been observed from countries like the United States where there are
established screening protocols [6].
Sporadic screening is being carried out in Nigeria using opportunist method for those who visit certain
clinics. Also, there is no standard policy or protocol for cervical cancer screening in Ibadan is similar to
that of Nigeria which is sporadic or opportunistic;. It is more worrisome as all sexually active women are
at risk for the development of cervical cancer. Where the services are available, many women seem not
to be aware of the services. Services are mainly available in some secondary and tertiary health facilities
at a cost that make it not accessible and affordable to many women.
Over the years awareness and uptake of services has remained poor despite all the studies on cervical
cancer screening. Various studies indicate that cervical cancer screening services is poorly utilized and
the awareness of the need for it is very low but can be treated if detected early [7-10]. Problems
associated with cervical cancer incidence include late reporting, ignorance and cultural issues relating to
cervical cancer screening (reference). . The barriers identified by Mutyaba 3were ignorance about
cervical cancer, cultural constraint/beliefs about illness, economic factors, domestic gender power
relations, alternative authoritative sources of reproductive health knowledge and unfriendly health care
services.
Women in developing countries like Nigeria seem to utilize reproductive health services more during
pregnancy. They also use reproductive health services for post natal check up and family planning or
when faced with various gynaecological problems. It is important to ensure that these women are
screened in order reduce incidence of cervical cancer. Their visit to the clinics provides opportunity to
give them information on the importance of the screening and where to get the services. The researchers
observed that many women attending various health facilities have not been screened. Thus the need to
explore the factors influencing utilization of cervical screening services among women in selected Health
facilities in Ibadan, Oyo State.
Objectives of the study
1. To examine womens awareness of cervical cancer
2. To investigate womens perception of screening programmes
3. To evaluate the womens utilization of screening services
4. To determine factors influencing utilization of services
5. To find ways of overcoming the problems
Theoretical framework
Health belief model
The health belief model is a psychosocial model proposed by Rosenstock (1966) in Stanhope and
Lancaster [11] for studying and promoting the uptake of health services like screening. The model
explains preventive behaviour.
The model assumes that belief and attitudes of people are critical determinants of their health-related
actions. It holds that when cues to actions are present, the variations in uptake behaviour can be
accounted for by beliefs concerning four sets of variables. These include:
The individuals view of own vulnerability to illness. If an individual does not see him or herself as being
at risk of any problem, he or she will not seek care
Belief about severity of the illness. The associated problem could be seen as little, therefore little
attention will be required
The persons perception of the benefits associated with action to reduce the level of threat or
vulnerability
The individuals evaluation of the potential barrier associated with the proposed action, this could be
physical, psychological, financial and social.
Framework of the Three Major Components of Health Belief Model
Figure 1 is used to illustrate the framework of the three major components of Health Belief Model as it
relates to perception and utilization of cervical cancer screening services.
Figure 1. Health belief Model Adapted from Stanhope and Lancaster[11].
The three major components of the health belief model are: individual perception; modifying factors; and
variables affecting likelihood of action:
Individual perception: perception is the process of becoming aware of objects, qualities or relation by
the way of sense organ. The individuals perception of being at risk of cervical cancer will motivate the
person to preventive services.
Modifying factors: these are variables that change or improve likelihood of action. They include
demographic variables, level of education, location of health facility, mass media etc. They affect
perception of threat; increased knowledge will result in correct perception of threat based on scientific
knowledge of cervical cancer.
Likelihood of action: an individual will take action if he or she understands that there is a need and that
the particular action will help in meeting the need. Also if barriers to the utilization of such services are
minimized.
Since cervical cancer is not usually noticed until late stage the call to go for screening seems to be
ignored. Some women may not consider it as important because they have other competing needs.
While others who may perceive screening as needful preventive health behaviour.
Materials and methods
The study was carried out in eight selected health facilities in Ibadan, Oyo state. The choice of the health
facilities was informed by the availability of MCH services and patient turnover. The health facilities
consist of four (4) secondary health facilities and four (4) Primary Health Centres (PHCs). The 82
participants were purposely recruited from women attending the clinics. Antenatal clinic was used since
both the primary and secondry health facility have it available with good attendance. Eighty (82)
participants were purposely recruited for the study after approval was received from the Institutional
Review Board in Oyo State Ministry of Health in charge of the facilities.
Data was collected through FGD; FGD was chosen as the method of Data collection as it provides real life
data while discussing with the women. it gives room for more depth during information gathering. The
group size was between 8 to 11 and eight sessions were conducted within 2months each lasting around
60 minutes The 82 women participated in eight FGDs. The group Size was between 8 to11 each. Eight
focus groups were carried out within two months, each lasting around 60 minutes. The researcher and
three trained assistants were in the group as note taker, recorder and lead moderator.
The discussion was semi-structured using a Focus group discussion guide, and women were asked to talk
freely on questions and issues raised during the discussion on cervical screening. Informed consent was
obtained after study was explained to the participant. A structured questionnaire was used to collect
their demographic data. The focus group discussions were tape recorded and transcribed verbatim. The
transcripts were analyzed into themes. After familiarization with the transcripts, a thematic framework
was developed with themes organized into 11 broad areas.
1. Common topics discussed by nurses in the clinic
2. The things you hear about cervical cancer outside the clinic
3. Perception about cervical cancer as an important topic during health talks
4. Information received about cervical cancer
5. Information received about screening methods
6. Perception about cervical cancer screening
7. Perceived role of cervical cancer screening in preventing death from the disease
8. Perception about early detection through the screening
9. Impression about the utilization of cervical cancer screening services by women
10. Perceived reasons for poor utilization of available cervical cancer screening services
11. Suggestions on ways that screening uptake can be improved
These were further grouped into four to meet the objectives of the study which include
Awareness of cervical cancer screening methods
Womens Perception about Positive result at early stage of the disease
Perceived Utilization of Cervical Cancer Screening Services
Suggestions by the women on ways screening uptake can be improved
The discussion was carried out openly among the women as there was room for expression of views.
Every participant was given a chance to respond to the questions to the best of their undestanding. All
the responses were noted and organized into the themes. Many of the participants became aware of the
disease (cervical cancer) during the course of the discussion.
