Knowledge of cervical cancer screening and its determinants among 30–49 years old rural reproductive age women in Sadi Chanka district,West Oromia,Ethiopia,2022: A mixed method study

Abstract

Background:

Cervical cancer is one of the cancers affecting the female organs connecting the uterus and vagina. It is the second most common form of cancer among reproductive-age women living in Ethiopia. It is one of the preventable cancers; through effective interventions with timely screening and treatment can reduce the risk of deaths associated with the disease. The study aimed to assess the knowledge of cervical cancer screening and its determinants among rural reproductive-age women in Sadi Chanka district, Western Ethiopia.

Methods:

A community-based cross-sectional study supplemented with qualitative findings was conducted from February 1 to 28, 2022, with a total sample size of 867. Data collection was done by using a structured interviewer-administered questionnaire using simple random sampling techniques to select representative rural women aged between 30–49 years from selected kebeles. Bivariable logistic regression analysis was performed, and the variables with a p-value less than 0.25 were recruited to the multivariable analysis. Finally, an adjusted odds ratio with a 95% CI and a p-value less than 0.05 was used to declare the statistically significant determinants of knowledge of cervical cancer screening. For qualitative findings, a key informant interview guide was used to collect the qualitative data through in-depth interviews. A total of nine Key Informants Interviews were selected by a purposive sampling technique. Participants’ interviews were translated, transcribed, coded, categorized, and triangulated with quantitative data.

Results:

In this study, the prevalence of knowledge of cervical cancer screening among reproductive-age women was 51.3% with a 95% CI of (95% CI: 47.7–54.6). The mean age of the participants was 38.50 (±4.4 SD) years, and their ages ranged from 30 to 49 years. Of all assessed factors: modern contraceptive methods use (AOR = 1.79, (95% CI: 1.21–2.63)), history of sexually transmitted diseases (AOR = 1.97, (95% CI: 1.15–3.38)), family history of cervical cancer (AOR = 2.02, (95% CI: 1.06–3.87)), and knowing women who had cervical cancer (AOR = 2.72, (95% CI: 1.96–3.79)) were significantly associated with knowledge of cervical cancer screening.

Conclusion:

The study revealed that, the knowledge of cervical cancer screening is found to be low, which is only 51.3% of reproductive-age women knew about cervical cancer screening. The study identified that modern contraceptive methods use, history of sexually transmitted disease, family history with cervical cancer, and knowing those women who had cervical cancer were found to be the determinants of knowledge of cervical cancer screening among reproductive-age women. Thus, the district health office and concerned stakeholders should work on interventions aimed at improving the awareness of cervical cancer screening among reproductive-age women through providing appropriate health communication activities about cervical cancer screening at the community level using health extension workers.

Keywords

Cervical cancer screening cervix cancer determinant knowledge Ethiopia

Introduction

Cervical cancer is a developing cancer that occurs in the lining of the lower cervix, where the vagina and uterus join. It is the fourth most common form of cancer among women in the world.¹ Sexually transmitted diseases (STDs), chlamydia infection, human immunodeficiency virus (HIV), human papillomavirus (HPV), early age of onset of sexual intercourse, multiparity, prolonged use of oral contraceptives method, low socio-economic status, and low immune status are associated with cervical cancer disease.^2–4 Timely screening and treatment of cervical dysplasia can decrease morbidity and mortality associated with this disease by 80%.⁵ The World Health Organization (WHO) recommends reproductive age women between 30 and 49 years old are the target population for cervical cancer screening every 5 years intervals.^5,6

According to the global statistics report in 2020, worldwide, there were 604,000 newly diagnosed reproductive-age women with this cases, and about 342,000 women died due to cervical cancer-related problems.^1,7 Africa is one of the most rigorously affected regions by cervical cancer, with 117,316 new incidences and 76,745 deaths annually in 2020.^1,8 In Ethiopia, about 29.4 million reproductive-age women are at risk of acquiring cervical cancer, which is the second most frequent female cancer among women aged between 15 and 44 years old. In 2020, about 7445 women were newly identified, and 5338 deaths occurred due to cervical cancer annually.^1,5 An absence of cervical cancer screening services, limited awareness about cervical cancer screening, and an attitude toward cervical cancer screening are the key obstacles to early detection of cancer of the cervix and control in developing countries, including Ethiopia.^9,10

Previous studies showed that the knowledge of cervical cancer affects the utilization of cervical cancer screening services. Those women who had adequate knowledge of cervical cancer screening were utilizing the service more than their counterparts.^11–13 Despite the increasing number of cervical cancer cases and deaths due to this cancer in Ethiopia, there is still inadequate knowledge of cervical cancer screening, particularly in the study area. Therefore, there had been no previous study conducted about cervical cancer screening in the Sadi Chanka district of west Ethiopia. The findings from this study may provide some important information on the knowledge of cervical cancer screening. Moreover, the result of the finding would be helpful as a baseline guide to all the stakeholders involved in the interventions aimed at cervical cancer prevention and control of the existing service screening programs through improving the knowledge of women. The purpose of the study was to assess the knowledge of cervical cancer screening and its determinants among rural women aged 30–49 years old in West Oromia, Ethiopia.

Methods and materials

Study design, setting, and period

A community-based cross-sectional study was supplemented with qualitative phenomenological findings and carried out in the Sadi Chanka district, West Ethiopia from February 1 to 28, 2022, GC. The district is located 588 km from Addis Ababa and 66 km from Dambi Dollo, the capital city of Kellem Wollaga zone. Sadi Chanka district has 15 administrative kebeles, 13 rural kebeles, and 2 urban kebeles. According to the Sadi Chanka district health office, in 2022, there were about 11,969 women aged 30–49 years old in the Sadi Chanka district. In the district, there are two health centers, and 15 health posts that provide primary health care services to the community, including cervical cancer screening service (Source: Sadi Chanka District Health Office).

Population

Source population

All rural women aged 30–49 years old living in the Sadi Chanka district.

Study population

Women aged 30–49 years old living in eligible households from randomly selected kebeles.

For qualitative study, purposively selected healthcare providers working in maternal and child health services, screened women for cervical cancer, and health extension workers were considered as the study population.

Eligibility criteria

Inclusion criteria: All rural reproductive-age women between 30 and 49 years old in selected kebeles of the Sadi Chanka district and those living in the district for at least 6 months were included in this study.

Exclusion criteria: Rural reproductive-age women between 30 and 49 years old and those who are unable to respond due to hearing and speaking problems during the data collection period were excluded.

Sample size determination

The sample size was calculated by using a single population proportion formula while considering the following assumptions: 3.0% (0.03) margin of error (d),¹³ 46.8% prevalence (p) of knowledge of cervical cancer screening,¹⁴ and 10% of non-response rate. The final sample size considered for this study was 867.

For qualitative findings, in-depth interviews (IDIs), twelve participants were selected purposively, and nine individuals were included in the study (three health-care providers, two health extension workers, and four screened women for cervical cancer). Moreover, the sample size for the qualitative study was determined based on the idea saturation of study participants.

Sampling procedures: Sadi Chanka district has 15 administrative kebeles. A simple random sampling technique was used to select reproductive-age women between 30 and 49 years from selected kebeles. Five kebeles were randomly selected by using lottery method from the total of 15 kebeles found in the Sadi Chanka district. Of the selected kebeles, the households with eligible women were identified, and listed from the family folder as the sampling frame. A family folder is a registry book containing all family members’ profiles in the kebele/village.

Finally, about 867 study participants were selected using simple random sampling techniques based on the principles of subsequent nearest eligible households after proportional allocation to the number of all eligible women in each village. For qualitative findings, nine study participants were included in the study (two health extension workers, four screened women for cervical cancer, and three health professionals working on the maternal and child health program as focal persons at health facilities). The study participants for qualitative study were selected by using heterogeneous purposive sampling technique. The participants for IDIs of the qualitative study were selected using a purposive sampling technique by considering their working experiences with the cervical cancer program, knowledge about cervical cancer diseases, service-related responsibilities, and reproductive-age women who experienced a history of cervical cancer diseases. Moreover, the number of key informants for IDIs of the qualitative study was determined based on their idea saturation during data collection.

Data collection tools and procedures

Data were collected using structured interviewer-administered questionnaires that have been validated and adapted from different reviews of the literature.^1,5 It consists of socio-demographic characters, reproductive and behavioral related factors, and knowledge of cervical cancer screening-related questions (Supplemental file). Data were collected by five trained female health professionals.

The qualitative data were collected by using pretested semi-structured interview guide with flexible probing related to cervical cancer service screening (IDIs guide-Supplemental file). Interview guides were developed and used for data collection through face-to-face interviews, and the average interview time for respondents ranged from 30 to 60 min. The IDIs were conducted at the participant’s workplace and home by the principal investigator with the Masters of Public Health holder in collaboration with the assistance of a note-taker and audio tape recorder. The principal investigator was chosen to collect qualitative data based on previous experience and participation in qualitative study findings. The transcription and translation of the data were done from audio tape recorder for each participants word by word according to their verbatim responses.

Study variables

Dependent variable

Knowledge of cervical cancer screening.

Independent variables

Socio-demographic characteristics: (Age of respondents, occupation, income, education, marital status), Reproductive and behavioral factors (Age at first pregnancy, age at first marriage, abortion history, age at first sexual intercourse, and gravidity), and knowledge about cervical cancer screening-related questions were used.

Measurements and operational definitions

Knowledge: women were asked ten knowledge questions. After computing the sum score for each respondent, the mean score was calculated, and those who scored the mean and above had “Adequate knowledge,” and those who scored below the mean were considered having “Inadequate knowledge” of cervical cancer screening.¹⁴

History of STDs: Those women who had one or more of the following syndromes: genital ulcer, vaginal discharge, lower abdominal pain, and burning in the vagina.⁶

History of gynecological examination: when women exposed their reproductive organs to health professionals during delivery, breast examination, STDs examination, and abortion.¹⁵

Data quality control

The questionnaire was prepared in English language and translated into Afan Oromo (Local language), and then -translated back into English to check consistency by language experts to prevent possible misunderstanding and misinterpretation. The 2 days training were given to the data collectors and supervisors on the objective of the study, the data collection methods, and ethical considerations. The pretest was conducted on 5% of the total sample size. Possible modification concerning clarification of content and simplification of wording were done after pretesting the questionnaires. The principal investigator and supervisor gave feedback and corrections on daily activities for the data collectors before they were deployed to the field. The completeness, accuracy, and clarity of the collected data were checked carefully. Any errors, ambiguity, or incompleteness encountered were corrected on a daily basis before starting the next day’s activities.

For qualitative findings, the interview guides were evaluated by experts in qualitative research and cross-checked by other independent health professionals to compare the consistency and accuracy of the data through peer debriefing the collected data. During data collection, probing techniques were used to encourage the participants to elaborate their ideas in detail. The data collectors used a tape recorder and written field notes to record the interviews. The principal investigator is fluent in the local language. Interviews were conducted during a convenient time for the participants. All the recorded audiotapes of the key informant interviews were transcribed into the local language (Afan Oromo) and later translated into English. The transcription and coding of the data were done as per the verbatim of the participants using word-by-word note writing.

Statistical analysis

EpiData manager version 4.6 was used for data entry and then exported to the statistical package for social science (SPSS) software version 26 for analysis. Descriptive statistics such as proportions and percentages were done for different variables as necessary. Variables that have an association in bivariable logistic regression analysis with a p-value less than 0.25 were entered into the multivariable logistic regression model. Finally, multivariable logistic regression was performed to control for the possible confounding effect of the selected variables. The variables with a p-value of less than 0.05 were considered statistically significant determinants of knowledge of cervical cancer screening. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to show the degree of association between the independent and the outcome variables. Multicollinearity was checked by using standard error (SE) and there was no multicollinearity detected.¹⁶ Model fitness was checked by the Hosmer and Lemeshow goodness-of-fit¹⁷, and its p-value = 0.074. Qualitative data were first transcribed verbatim in the Afan Oromo language, by which the interviews were conducted. Next, the data was translated and transcribed into English by language experts. Four data coders were coded the qualitative data, the final edition of the code was developed, and the categories and themes were constructed. Data were transcribed, coded, categorized, and analyzed using thematic analysis manually (Inductive thematic approach) and triangulated with the quantitative finding.

Results

Socio-demographic characteristics of the participants

A total of 852 respondents were included in this study with a response rate of 98.2%. The age of participants ranged from 30 to 49 years with a mean of 38.5 (±4.4 SD). Concerning the religion of the respondents, about 373 (43.8%) participants were protestant. More than two-thirds of the respondents, 525 (61.5%) were not formally educated and about 485 (57.8%) of parents had no formal education.

Regarding the occupational status of the participants, two-thirds of the study participants, 534 (62.7%) were farmers. Of the participants’ ethnicity and marital status, about 689 (80.9%) and 764 (89.7%) of the participants were Oromo and married respectively. Concerning household’s average monthly income, the majority of participants, 548 (64.3%) were in the average monthly income category of greater than or equal to 2701 ETB. About 734 (86.2%) of participants had ever used electronic media as a source of information (Table 1).

Table 1.

Socio-demographic characteristics of women in west Ethiopia, 2022.

Variables	Categories	Frequency	Percentage
Age of the participants	30–39 years	473	55.5
Age of the participants	40–49 years	379	44.5
Religion of respondents	Protestant	373	43.8
	Orthodox	263	30.9
	Muslim	216	25.3
The education level of respondents	No formal education	525	61.6
	Primary education	248	29.1
	Secondary education	53	6.2
	College and above	26	3.1
Education level of partners	No formal education	485	57.8
	Primary education	209	24.9
	Secondary education	114	13.6
	College and above	31	3.7
Ethnicity	Oromo	689	80.9
	Amhara	102	12.0
	Tigre	38	4.5
	Gurage	23	2.6
Marital status	Single	13	1.5
	Married	764	89.7
	Divorced/separated	19	2.2
	Widowed	56	6.6
Occupation of respondents	Housewife	118	13.9
	Merchant	36	4.2
	Daily laborer	145	17.0
	Student	19	2.2
	Farmer	534	62.7
Average monthly income	⩾2701 ETB	548	64.3
	1601–2700 ETB	114	13.4
	901–1600 ETB	149	17.5
	⩽900 ETB	41	4.8
Ever used electronic media	Yes	734	86.2
	No	118	13.8

Reproductive and behavioral-related factors

Three-fourths (75.7%) of respondents got married at the age of ⩾18 years old. The majority, 75.2% of respondents, had started sexual intercourse for the first time at the age of ⩾16 years. Of the respondents, 6.1% had a history of abortion, and 6.6% had a family history of cervical cancer disease. The majority (79.5%) of respondents had a history of modern contraceptive methods use (Table 2).

Table 2.

Reproductive characteristics of women aged 30–49 years old in Sadi Chanka District, Ethiopia, 2022.

Variables	Categories	Frequency	Percentage
Age at first got married	<18 years	204	24.3
Age at first got married	⩾18 years	635	75.7
Pregnant status	Yes	817	95.9
Pregnant status	No	35	4.1
Total pregnancies	<5	363	44.4
Total pregnancies	⩾5	454	55.6
Age of first becoming pregnant	<18 years	105	12.9
Age of first becoming pregnant	⩾18 years	712	87.1
History of abortion	Yes	50	6.1
History of abortion	No	767	93.9
History of modern contraceptive methods use	Yes	677	79.5
History of modern contraceptive methods use	No	175	20.5
Duration of contraceptive used	<5 years	528	78.0
Duration of contraceptive used	⩾5 years	149	22.0
History of STDs	Yes	74	8.7
History of STDs	No	778	91.3
History of HIV test	Yes	299	35.1
History of HIV test	No	553	64.9
Smoking status of respondents	Yes	3	0.4
Smoking status of respondents	No	849	99.6
Family history of cervical cancer	Yes	56	6.6
Family history of cervical cancer	No	796	93.4
Age at started first sexual intercourse	<16 years	208	24.8
Age at started first sexual intercourse	⩾16 years	631	75.2
Lifetime number of sexual partners	Single	794	93.2
Lifetime number of sexual partners	Multiple	58	6.8
History of gynecological examination	Yes	395	46.4
	No	457	53.6

Knowledge of cervical cancer screening

Of the participants, about 461 (54.1%) of the respondents had heard about cervical cancer screening. The majority (60.6%) of participants heard information about cervical cancer disease from different mass media. The mean score (±SD) of participants’ knowledge of cervical cancer screening was 19.11(±4.33). The result of study showed that about 51.3% of respondents had adequate knowledge of cervical cancer screening (Table 3). The qualitative findings coding and sub-categories have been integrated within each thematic area and presented as a whole in the manuscript. A total of nine participants were involved in the qualitative study (two health extension workers, four women with history of cervical cancer screening and three health professionals working on maternal and health). The ages of the participants ranged from 24 to 45 years. Concerning their educational status, out of nine participants (two of them attended primary education, two participants attended secondary education, and five participants attended college and above education). Out of nine participants interviewed for qualitative findings, seven participants were females.

Table 3.

Knowledge of cervical cancer screening among women in Ethiopia, 2022.

Variables	Categories	Frequency	Percentage
Ever heard about cervical cancer screening	Yes	461	54.1
Ever heard about cervical cancer screening	No	391	45.9
Source of information	Media	279	60.6
	Health workers	142	30.9
	Family	24	5.2
	School	16	3.3
Multiple sexual partners risk for cervical cancer?	Yes	595	69.8
	No	125	14.7
	I do not know	132	15.5
Screening can prevent cervical cancer	Yes	104	12.2
	No	188	22.1
	I do not know	560	65.7
Cervical cancer is severe and fatal	Yes	527	61.9
	No	76	8.9
	I do not know	249	29.2
Early detection is good for treatment outcome	Yes	523	61.4
	No	99	11.6
	I do not know	230	27.0
Know health institutions that provide cervical cancer screening	Yes	228	26.7
	No	38	4.5
	I do not know	586	68.8
Cervical cancer damages reproductive organ	Yes	479	56.2
	No	144	16.9
	I do not know	229	26.9
Cervical cancer can happen without symptoms	Yes	55	6.5
	No	217	25.5
	I do not know	580	68.0
Women aged 30–49 years recommended to cervical cancer screening	Yes	238	27.9
	No	49	5.8
	I do not know	565	66.3
Cervical cancer is a communicable disease	Yes	91	10.7
	No	340	39.9
	I do not know	421	49.4
Cervical cancer can be preventable	Yes	215	25.2
	No	376	44.1
	I do not know	261	30.7

The findings from a qualitative study have emerged the following four themes as follows; theme 1: Knowledge and awareness-related factors, theme 2: Healthcare care providers’ related factors, theme 3: Health facility-related factors, theme 4: Previous health-seeking behaviors related factors were the identified themes from qualitative findings. From each of the identified themes, the quotes were emerged and triangulated with quantitative findings as mentioned in the manuscript.

The findings from the qualitative study indicated that not having adequate information and knowledge about cervical cancer are the factors for not undergoing cervical cancer screening. “Most women in our community don’t have adequate information about cervical cancer screening and disease, however, if they knew about the disease and screening service, they would have undergone screening.” (25 years old, female, health extension worker).

Determinants of the knowledge of cervical cancer screening

A binary logistic regression analysis was performed to assess the association of each independent variable with knowledge of cervical cancer screening. Of all assessed determinants, nine variables showed association with knowledge of cervical cancer screening; age of respondents, education status of respondents, educational status of partners, gravidity, modern contraceptive method use, history of STDs, family history with cervical cancer disease, received gynecological service, and knowing women who have cervical cancer disease. The variables with a p-value less than 0.25 were recruited for the multivariable logistic regression model after controlling for confounders. The result of the multivariable logistic regression model revealed that, those women who had used modern contraceptive methods had a history of STDs, family history with cervical cancer disease, and knew women who have cervical cancer disease were found to be significantly associated with the knowledge of cervical cancer screening at p-value ⩽ 0.05 together with 95% confidence intervals (Table 4). The findings from the qualitative study indicated that many barriers were identified from the evidence ideas of study participants. The findings by sub-categories have been integrated within each thematic area and presented as a whole. In addition, any specific ideas of the participants were identified among these sub-categories and highlighted in each theme as appropriate and supplemented to the quantitative finding to support the evidence and enrich the significantly associated factors.

Table 4.

Determinants of knowledge of cervical cancer screening among women in west Ethiopia, 2022.

Variables (n = 852)	Knowledge status		COR (95% CI)	AOR (95% CI)
Variables (n = 852)	Adequate n (%)	Inadequate n (%)	COR (95% CI)	AOR (95% CI)
Age of respondents
40–49 years	180 (47.5)	199 (52.5)	0.76 (0.58, 1.00)	1.25 (0.89, 1.74)
30–39 years	257 (54.3)	216 (45.7)	1.0	1.0
Education of respondents
College and above	17 (65.4)	9 (34.6)	2.08 (0.91, 4.75)	0.96 (0.36, 2.60)
Secondary education	36 (67.9)	17 (32.1)	2.33 (1.28, 4.25)	1.38 (0.66, 2.86)
Primary education	134 (54.0)	114 (46.0)	1.30 (0.96, 1.75)	0.85 (0.57, 1.27)
No formal education	250 (47.6)	275 (52.4)	1.0	1.0
Education of partners
College and above	28 (82.4)	6 (17.6)	5.49 (2.23, 13.49)	2.60 (0.94, 7.24)
Secondary education	63 (55.8)	50 (44.2)	1.48 (0.98, 2.24)	1.32 (0.80, 2.20)
Primary education	116 (55.5)	93 (44.5)	1.47 (1.06, 2.03)	1.20 (0.80, 1.82)
No formal education	222 (46.0)	261 (54.0)	1.0	1.0
Gravidity
⩾5 children’s	200 (44.1)	254 (55.1)	0.56 (0.42, 0.74)	0.64 (0.46, 0.89)
⩽5 children’s	212 (58.4)	151 (41.6)	1.0	1.0
History of modern contraceptive methods use
Yes	373 (55.1)	304 (44.9)	2.13 (1.51, 3.00)	1.79 (1.21, 2.63)*
No	64 (36.6)	111 (63.4)	1.0	1.0
History of STDs
Yes	49 (66.2)	25 (33.8)	1.97 (1.19, 3.25)	1.97 (1.15, 3.38)*
No	388 (49.9)	390 (50.1)	1.0	1.0
Family history of cervical cancer disease
Yes	40 (71.4)	16 (28.6)	2.51 (1.38, 4.56)	2.02 (1.06, 3.87)*
No	397 (49.9)	399 (50.1)	1.0	1.0
History of gynecological service
Yes	217 (54.9)	178 (45.1)	1.31 (1.00, 1.72)	1.30 (0.97, 1.77)
No	220 (48.1)	237 (51.9)	1.0	1.0
Know women who have cervical cancer disease
Yes	174 (68.5)	80 (31.5)	2.77 (2.03, 3.78)	2.72 (1.96, 3.79)*
No	263 (44.0)	335 (56.0)	1.0	1.0

Bold entries to show the significant category of the variables.

NB: statistically significant at p-value < 0.05; COR = Crude odds ratio; AOR = adjusted odds ratio; 1 = reference group.

Those respondents who had a history of modern contraceptive methods use were 1.79 times more likely to have adequate knowledge of cervical cancer screening as compared to those who did not have history of modern contraceptive methods use (AOR = 1.79, 95% CI: 1.21–2.63). Those women who had a history of STDs were 1.97 times more likely to have adequate knowledge of cervical cancer screening as compared to those who did not have a history of STDs (AOR = 1.97, 95% CI: 1.15–3.38).

The result of the qualitative finding revealed that having adequate counseling and awareness of cervical cancer is the key factor to receive cervical cancer screening among reproductive-age women. “I think 2 years, I was treated for pelvic pain and vaginal itching at the hospital, then I was wanted to screen for cancer of the cervix after counseling by Doctors.” (38 years-old women, IDIs participants).

Women who had a family history of cervical cancer disease were 2.02 times more likely to have adequate knowledge of cervical cancer screening as compared to those who did not have a family history of cervical cancer disease (AOR = 2.02, 95% CI: 1.06–3.87). The findings of the qualitative study revealed that having an understanding and information on cervical cancer is the key reason to receive cervical cancer screening among reproductive-age women. “I was also heard about the disease when my mother sick with cancer and treated at a hospital; then I decided to do the screening early before the occurrence of the disease.” (41-year-old, screened woman).

Participants who know women who have cervical cancer disease were 2.72 times more likely to have adequate knowledge of cervical cancer screening than their counterparts (AOR = 2.72, 95% CI: 1.96–3.79). The qualitative finding indicated that the integration of the services in health facilities during the women’s visits to the health institutions to receive other services is the key factor for cervical cancer screening among reproductive-age women. “If one mother comes for family planning service, especially for an intrauterine contraceptive device (IUCD), before service takes she informed about cervical cancer and screening then. . .” (28 years old, female, maternal and child health care provider). Another participant reported that “Those women come for treatment of any STD sign and symptoms at a health facility are more screening for cancer of the cervix, because of women who had sign and symptoms of STDs are counseled about the disease at health facility” (33 years old, Male, Maternal, and child health care provider).

Discussion

The study aimed to assess the knowledge of cervical cancer screening among women aged 30 49 years in Sadi Chanka District, west Ethiopia. The study showed that those women who had a history of modern contraceptive methods use, had a history of STDs, had a family history of cervical cancer disease, and women who knew about cervical cancer disease were the identified determinants of knowledge of cervical cancer screening.

This study found that only 51.3% (95% CI: 47.7–54.6) of women had adequate knowledge of cervical cancer screening. This finding is in line with studies done among women aged 15–49 years in Bishoftu town (51.2%)¹⁸ and Durame town (51.5%).¹⁹ In contrast, this finding is higher than studies conducted in Aira Hospital, West Wollega (46.8%),¹⁴ Gurage district (26.6%),²⁰ and Wolaita zone (43.1%).²¹ The variation might be due to differences in the study period, study setting, and sample size among the studies. However, our finding is lower than studies conducted in Eastern Ethiopia (55.7%) and Butajira town.^22,23 The reason for this variation may be that the study was conducted in an area with less awareness of the disease, as the majority of rural women have limited access to social media to get appropriate information about cervical cancer service screening. It is important to develop health communication activities through the use of awareness-creation campaigns to raise awareness among women.

The result of the study showed that those women who had a history of modern contraceptive use were associated with knowledge of cervical cancer screening. Those who had a history of modern contraceptive methods used were among the factors that affected the knowledge of cervical cancer screening. Women who had a history of modern contraceptive use were more likely to have adequate knowledge of cervical cancer screening as compared to those who did not have history of modern contraceptive methods used. The finding is in line with the study conducted in Butajira and Burkina Faso.^21,22 This might be due to an increased chance of communicating with family planning service providers to obtain information about screening and the availability of the service. The finding from the qualitative study supports this statement, which shows that during the visits to health facilities for family planning services, especially of the intrauterine contraceptive device (IUCD), they were informed about cervical cancer screening issues for their understanding of cervical cancer.

Those women who had a history of STDs were also associated with knowledge of cervical cancer screening. Those women who had a history of STDs were more likely to have adequate knowledge of cervical cancer screening as compared to those who did not have a history of STDs.

This finding is also consistent with the study done in Shashemene town.²⁵ This association can be explained by those women diagnosed and treated for STDs who had the chance to get information and counseling from the health professions on cervical cancer screening and the method of preventing themselves from cervical cancer. The qualitative study also supports this finding: those women who come from the treatment of STDs with signs and symptoms at health facilities are more utilizing cervical cancer screening due to they had been counseled on STD diseases at health facilities.

Another result of the study revealed that those women who had a family history of cervical cancer disease were statistically significant determinants of knowledge of cervical cancer screening. Those women who had a family history of cervical cancer disease were more likely to have adequate knowledge of cervical cancer screening as compared to those who had no family history of cervical cancer disease. This finding is supported by the study conducted in Gurage district and Dire Dewa city.^11,20 This may be because those families who have a history of cervical cancer disease can easily understand and inform their family members concerning any clinical signs and symptoms related to cancer by sharing previous experiences.

According to this study, women who knew about cervical cancer screening were found to be the other determinant that showed a significant association with knowledge of cervical cancer screening. Those women who knew about cervical cancer disease were more likely to have knowledge of cervical cancer screening than their counterparts.

The finding is consistent with previous studies conducted in Gurage district, Jimma town, Shashemene town, and Adigrat town.^18,24-26 This may be due to those women who had known about cervical cancer disease, maybe because they could be more focused on their health issues and seek information about cervical cancer screening and its means of prevention since they have a previous understanding of cervical disease.

Strengths and limitations of the study

As a strength, being a community-based study using both quantitative and qualitative methods of data collection gives the strength for this study.

However, this study encountered some limitations; due to the nature of the study design (cross-sectional), it could be difficult to find whether knowledge of cervical cancer screening or factors variables come first. Since this finding is a cross-sectional study, it is difficult to establish a cause-and-effect relationship between dependent and independent variables. In addition, it used the self-reporting from the women participants (interview response), which might have a social desirability bias.

Conclusion

In conclusion, the knowledge of cervical cancer screening is low in the study area. Those women who had a history of modern contraceptive methods use had a history of STDs, had a family history of cervical cancer disease, and women who had known about cervical cancer disease were statistically significant determinants of knowledge of cervical cancer screening. Hence, to improve knowledge of women about cervical cancer screening, health professionals should work on health communication activities that enhance women’s awareness and work on women’s education using health extension workers and health professionals both at the community and health institution levels.

Supplemental Material

sj-docx-1-smo-10.1177_20503121241241218 – Supplemental material for Knowledge of cervical cancer screening and its determinants among 30–49 years old rural reproductive age women in Sadi Chanka district, West Oromia, Ethiopia, 2022: A mixed method study

Supplemental material, sj-docx-1-smo-10.1177_20503121241241218 for Knowledge of cervical cancer screening and its determinants among 30–49 years old rural reproductive age women in Sadi Chanka district, West Oromia, Ethiopia, 2022: A mixed method study by Ararso Hordofa Guye, Dame Banti Shambi, Tadesse Nigussie and Tolosa Desisa Wayesa in SAGE Open Medicine

Supplemental Material

sj-pdf-2-smo-10.1177_20503121241241218 – Supplemental material for Knowledge of cervical cancer screening and its determinants among 30–49 years old rural reproductive age women in Sadi Chanka district, West Oromia, Ethiopia, 2022: A mixed method study

Supplemental material, sj-pdf-2-smo-10.1177_20503121241241218 for Knowledge of cervical cancer screening and its determinants among 30–49 years old rural reproductive age women in Sadi Chanka district, West Oromia, Ethiopia, 2022: A mixed method study by Ararso Hordofa Guye, Dame Banti Shambi, Tadesse Nigussie and Tolosa Desisa Wayesa in SAGE Open Medicine

Supplemental Material

sj-pdf-3-smo-10.1177_20503121241241218 – Supplemental material for Knowledge of cervical cancer screening and its determinants among 30–49 years old rural reproductive age women in Sadi Chanka district, West Oromia, Ethiopia, 2022: A mixed method study

Supplemental material, sj-pdf-3-smo-10.1177_20503121241241218 for Knowledge of cervical cancer screening and its determinants among 30–49 years old rural reproductive age women in Sadi Chanka district, West Oromia, Ethiopia, 2022: A mixed method study by Ararso Hordofa Guye, Dame Banti Shambi, Tadesse Nigussie and Tolosa Desisa Wayesa in SAGE Open Medicine

Footnotes

Acknowledgements

We would like to extend our deep gratitude to the data collectors, supervisors, study participants, and Sadi Chanka District Health Office for providing us with the necessary information and their kind support during conducting this research work.

Authors’ contributions

All authors (AHG, DBS, and TN) participated in conceptualization, data curation, formal analysis, investigation, methodology, resources, software, supervision, validation, visualization, writing-original draft, writing-review, and editing of the revised manuscript.

Data availability and materials

The original contributions presented in the study are included in the article/supplementary material; further inquiries can be directed to the corresponding author.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Contribution to the field

“The finding from the study can provide some relevant information on the knowledge of cervical cancer screening among reproductive-age women. In addition, this finding can be helpful for program coordinators at primary health care units to strengthen the interventions aimed at preventing cervical cancer disease and can be used as a guide for all the stakeholders and health professionals involved in cervical cancer screening for reproductive-age women to improve the existing screening programs. Furthermore, the study can be used as a source of baseline information for future researchers who are interested in related research topics.”

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated.

Ethical approval and consent to participation

Ethical approval was obtained from the Ethical Review Committee of Salale University, College of Health Science. Before conducting the interviews, written informed consent was obtained from all study participants after a thorough explanation of the purpose and procedures of the study, assured confidentiality, and the right to refuse. For those participants who had no formal education (illiterate) informed written consent was obtained by using their fingertip signature. No name or other personal identifying information was included in the data collection tool. The ethical approval number was Ref. No. H/S/C. 878/2022 with the approved date of 25/01/2022.

Consent for publication

Not applicable.

Informed consent

Written informed consent was obtained from all subjects before the study. For those participants who had no formal education (illiterate) informed written consent was obtained by using their fingertip signature.

Trial registration

Not applicable.

ORCID iD

Ararso Hordofa Guye

Supplemental material

Supplemental material for this article is available online.

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Supplementary Material

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