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Current Women`s Health Reviews

Editor-in-Chief

ISSN (Print): 1573-4048
ISSN (Online): 1875-6581

Research Article

Levels and Correlates of Functional Cervical Cancer Literacy among Lebanese Women: A Cross-sectional Study

Author(s): Carmel Bouclaous*, Obey Albaini, Melissa Bou Malham, Marie-Josée Salem, Mary Deeb and Faten Al Ghadban

Volume 20, Issue 3, 2024

Published on: 15 June, 2023

Article ID: e040523216508 Pages: 8

DOI: 10.2174/1573404820666230504103521

Price: $65

Abstract

Introduction: Cervical cancer can be prevented through vaccination against HPV and routine screening through HPV DNA testing or Pap smear. This cross-sectional study aimed to assess functional cervical cancer literacy (FCCL) levels and correlates among women of reproductive age in Lebanon.

Methods: The Arabic self-administered questionnaire consisted of the Cervical Cancer Literacy Assessment Tool, socio-demographic characteristics (age, education, employment status, religiosity, ability to pay), and health-related factors (smoking, parity, chronic diseases, self-perceived health, history of uterine or cervix surgeries, health insurance, visits to physician in the past three months, and regular Pap smear and HPV DNA testing).

Results: Of 619 women mean age of 33.9 years (±12.0), 51.7% had insufficient FCCL. Lower educational level, difficulty in covering medical expenses, lack of health insurance and poor self-perceived health were significantly associated with insufficient FCCL. Multiple logistic regression analysis showed that monthly income (OR: 1.74 [95% CI: 1.12 – 2.72]), ability to pay for medical expenses (OR: 1.81 [1.05 – 3.14]), and visits to the doctor in the last three months (OR: 1.51 [1.07 – 2.12]) were predictive of FCCL level.

Conclusion: In addition to a national vaccination program against HPV combined with cervical cancer screening, we recommend the inclusion of cervical cancer as a topic within sexuality education programs. Special attention should be given to women with limited FCCL and uninsured women of low socioeconomic status. To enhance cervical cancer literacy, and promote vaccination and screening, efforts should extend beyond health care settings and leverage various media channels, including social media.

Graphical Abstract

[1]
Global strategy to accelerate the elimination of cervical cancer as a public health problem. Geneva: World Health Organization. 2020. Available from; https://www.who.int/publications/i/item/9789240014107
[2]
Sawaya GF, Kulasingam S, Denberg TD, Qaseem A. Cervical cancer screening in average-risk women: Best practice advice from the clinical guidelines committee of the American college of physicians. Ann Intern Med 2015; 162(12): 851-9.
[http://dx.doi.org/10.7326/M14-2426] [PMID: 25928075]
[3]
Bou-Orm IR, Sakr RE, Adib SM. Cervical cancer screening among Lebanese women. Rev Epidemiol Sante Publique 2018; 66(1): 1-6.
[http://dx.doi.org/10.1016/j.respe.2017.10.004] [PMID: 29249573]
[4]
Kim JJ, Sharma M, O’Shea M, et al. Model-based impact and cost-effectiveness of cervical cancer prevention in the Extended Middle East and North Africa (EMENA). Vaccine 2013; 31 (Suppl. 6): G65-77.
[http://dx.doi.org/10.1016/j.vaccine.2012.06.096] [PMID: 24331822]
[5]
Flores BE, Acton G, Arevalo-Flechas L, Gill S, Mackert M. Health literacy and cervical cancer screening among Mexican-American women. Health Lit Res Pract 2019; 3(1): e1-8.
[http://dx.doi.org/10.3928/24748307-20181127-01] [PMID: 31294299]
[6]
Williams KP, Reiter P, Mabiso A, Maurer J, Paskett E. Family history of cancer predicts Papanicolaou screening behavior for African American and white women. Cancer 2009; 115(1): 179-89.
[http://dx.doi.org/10.1002/cncr.23994] [PMID: 19025974]
[7]
Bazaz M, Shahry P, Latifi SM, Araban M. Cervical cancer literacy in women of reproductive age and its related factors. J Cancer Educ 2019; 34(1): 82-9.
[http://dx.doi.org/10.1007/s13187-017-1270-z] [PMID: 28799072]
[8]
Choi YJ, Lee HY, An S, Yoon YJ, Oh J. Predictors of cervical cancer screening awareness and literacy among Korean-American Women. J Racial Ethn Health Disparities 2020; 7(1): 1-9.
[http://dx.doi.org/10.1007/s40615-019-00628-2] [PMID: 31410785]
[9]
Talley CH, Williams KP. Impact of age and comorbidity on cervical and breast cancer literacy of African Americans, Latina, and Arab Women. Nurs Clin North Am 2015; 50(3): 545-63.
[http://dx.doi.org/10.1016/j.cnur.2015.05.008] [PMID: 26333609]
[10]
Thompson EL, Wheldon CW, Vamos CA, Griner SB, Daley EM. How is health literacy related to pap testing among US women? J Cancer Educ 2019; 34(4): 789-95.
[http://dx.doi.org/10.1007/s13187-018-1375-z] [PMID: 29931455]
[11]
Buja A, Lago L, Lago S, Vinelli A, Zanardo C, Baldo V. Marital status and stage of cancer at diagnosis: A systematic review. Eur J Cancer Care 2018; 27(1): e12755.
[http://dx.doi.org/10.1111/ecc.12755] [PMID: 28850741]
[12]
Drapkina O, da Graça Freitas M, Mikkelsen B, Breda J, Salakhov E. The WHO european action network on health literacy for prevention and control of noncommunicable diseases. Public Health Panorama 2019; 5(2-3): 197-200.
[13]
Bouclaous CH, Salem S, Ghanem A, et al. Health literacy levels and predictors among Lebanese adults visiting outpatient clinics in Beirut. Health Lit Res Pract 2021; 5(4): e295-309.
[http://dx.doi.org/10.3928/24748307-20211012-02] [PMID: 34756119]
[14]
Nutbeam D. Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int 2000; 15(3): 259-67.
[http://dx.doi.org/10.1093/heapro/15.3.259]
[15]
Wagner C, Knight K, Steptoe A, Wardle J. Functional health literacy and health-promoting behaviour in a national sample of British adults. J Epidemiol Community Health 2007; 61(12): 1086-90.
[http://dx.doi.org/10.1136/jech.2006.053967] [PMID: 18000132]
[16]
Adams RJ, Piantadosi C, Ettridge K, et al. Functional health literacy mediates the relationship between socio-economic status, perceptions and lifestyle behaviors related to cancer risk in an Australian population. Patient Educ Couns 2013; 91(2): 206-12.
[http://dx.doi.org/10.1016/j.pec.2012.12.001] [PMID: 23276386]
[17]
Yilmazel G. Low health literacy, poor knowledge, and practice among Turkish women patients undergoing cervical cancer screening. J Cancer Res Ther 2019; 15(6): 1276-81.
[http://dx.doi.org/10.4103/jcrt.JCRT_1142_16] [PMID: 31898660]
[18]
Health literacy development for the prevention and control of noncommunicable diseases. Geneva: World Health Organization. 2022. Available from: https://www.who.int/publications/i/item/9789240055391
[19]
Cochran WG. Sampling techniques. (3rd ed.), New York: John Wiley & Sons 1977.
[20]
Williams KP, Templin TN. Bringing the real world to psychometric evaluation of cervical cancer literacy assessments with Black, Latina, and Arab women in real-world settings. J Cancer Educ 2013; 28(4): 738-43.
[http://dx.doi.org/10.1007/s13187-013-0549-y] [PMID: 24072456]
[21]
Jacobs B, Ir P, Bigdeli M, Annear PL, Van Damme W. Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low-income Asian countries. Health Policy Plan 2012; 27(4): 288-300.
[http://dx.doi.org/10.1093/heapol/czr038] [PMID: 21565939]
[22]
Huot S, Ho H, Ko A, et al. Identifying barriers to healthcare delivery and access in the Circumpolar North: Important insights for health professionals. Int J Circumpolar Health 2019; 78(1): 1571385.
[http://dx.doi.org/10.1080/22423982.2019.1571385] [PMID: 30696379]
[23]
Lebanese Ministry of Public Health. Available from: http://www.moph.gov.lb
[24]
Lebanon National Health Strategy: Vision 2030. Out of the crisis and towards better health for all. Republic of Lebanon: Ministry of Health. 2023. Available from: https://moph.gov.lb/en/Pages/9/67044/lebanon-national-health-strategy-vision-2030
[25]
Han HR, Song Y, Kim M, et al. Breast and cervical cancer screening literacy among Korean American Women: A community health worker–led intervention. Am J Public Health 2017; 107(1): 159-65.
[http://dx.doi.org/10.2105/AJPH.2016.303522] [PMID: 27854539]
[26]
Bouclaous CH, Alrazim A, Chababi J, et al. Association between sources of sexuality education, sexual beliefs and behaviours in Lebanese young adults: A university-based cross-sectional study. Sex Educ 2021; 21(1): 1-12.
[http://dx.doi.org/10.1080/14681811.2020.1722624]
[27]
Valdez A, Napoles AM, Stewart SL, Garza A. A randomized controlled trial of a cervical cancer education intervention for Latinas delivered through interactive, multimedia kiosks. J Cancer Educ 2018; 33(1): 222-30.
[http://dx.doi.org/10.1007/s13187-016-1102-6] [PMID: 27573420]
[28]
Musa J, Achenbach CJ, O’Dwyer LC, et al. Effect of cervical cancer education and provider recommendation for screening on screening rates: A systematic review and meta-analysis. PLoS One 2017; 12(9): e0183924.
[http://dx.doi.org/10.1371/journal.pone.0183924] [PMID: 28873092]
[29]
Allen CG, Todem D, Williams KP. Adherence to mammography and pap screening guidelines among medically underserved women: The role of family structures and network-level behaviors. J Cancer Educ 2021; 36(6): 1155-62.
[http://dx.doi.org/10.1007/s13187-020-01879-y] [PMID: 33107009]
[30]
Nolan TS, Tan A, Williams KP. The ties that bind: Cancer history, communication, and screening intention associations among diverse families. J Med Screen 2021; 28(2): 108-13.
[http://dx.doi.org/10.1177/0969141320920900]
[31]
Tiraki Z, Yılmaz M. Cervical cancer knowledge, self-efficacy, and health literacy levels of married women. J Cancer Educ 2018; 33(6): 1270-8.
[http://dx.doi.org/10.1007/s13187-017-1242-3] [PMID: 28668992]

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