1. Cervical Cancer prevention among women in Vlora city: the influence of fear-related to possible positive outcomes
Authors:
1*Fatjona Kamberi RN, MSN, PhD Candidate,
²Gjergji Theodhosi,²Vjollca Ndreu ,²Enkeleda Sinaj
1Yllka Bilushi, ³Leonard Kamberi
1*Department of Public Health, Faculty of Public Health,
University ‘Ismail Qemali’ Vlora, Albania
2Faculty of Technical Medical Sciences, Tirana, Albania
3Vlora Regional Hospital

2. Cervical Cancer facts
Cervical cancer is a largely preventable disease, but worldwide it is one of the leading causes of cancer death in women.
New cases: Cervical cancer ; the fourth most commonly diagnosed cancer in women with an estimated of 527,600 new cases worldwide.
Deaths: Cervical cancer ; the fourth leading cause of cancer death in women worldwide in 2012, with an estimated 265,700 deaths.
Nearly 90% of cervical cancer deaths occurred in developing parts of the world.
Global trends: The large geographic variation in cervical cancer rates reflects differences in both the availability of screening, which can detect and allow for the removal of precancerous lesions, and HPV infection prevalence.
In several Western countries, where screening programs have long been established, cervical cancer rates have decreased by as much as 65%. ( ACS, 2015)

3. Problem statement are an increasing problem.
Cervical cancer, in Albania ranks as the 3rd
most frequent cancer
among women between 15 and 44 years old.
Refer to International Association Cancer Research
the incidence and mortality from cervical cancer
in Albania, there were
respectively 2.7% and 1.7%. (IARC, 2012)
Cancer diseases in general in Albania
are an increasing problem.

4. Problem statement cervical cancer is diagnosed in the last stage,
The current cervical cancer screening programs
and practices in Albania are,
however casual or nonexistence. (Poljak at al., 2013)
Even if well-prepared plans and strategies
have been established for switching to organized
screening in the near future. (Maver at al., 2013)
In the absence of the National Cervical Screening Program
cervical cancer is diagnosed in the last stage,
therefore incurable with high prevalence in deaths,
although the fact that it may detect early. (NCCP 2011, p. 30)

5. “ To analyze the influence outcome and Pap test uptake”
The study
The objective of this study is :
“ To analyze the influence
of fear and anxiety
related to
outcome and Pap test uptake”

6. Method and samples Type of study: Cross–sectional
The sample study: 313 healthy (without a presents of illness) women, with different socio-economic and educational background, who worked to several institutions and private enterprises in Vlora city between January-July in 2015.
The inclusion criteria :Women in the target age group (25-65 years) old without history of hysterectomy.
The exclusion criteria :Women outside the target age group (25-65) years old.

7. Method and samples
Data collection instrument:self-administered questionnaire adopted in base of theoretical,conceptual framework Health Belief Model,reference to survey instrument,the Cervical CAM of Cancer Research UK (2011).
Perceived barriers
Socio-Demographic characteristics
Fear and anxiety related to outcome stratified by demographic characteristics
Can you speak freely about cancer stratified by demographic characteristics
I will be very frightened, if I reveal to have cancer

8. Perceived susceptibility or personal risk
Health Belief Model* 1
Perceived susceptibility or personal risk 2
Perceived severity 3
Perceived benefits 4
Perceived barriers
(represent beliefs about the material and psychological costs of taking action) 5
Cues to action and self-efficacy
*”the most commonly used theory in health education, promotion and screening”. (National Cancer Institute [NCI], 2005; “Theory at a Glance”,2005).

9. Studies based on Health Belief Model
Anxiety and fear were associated with decreased likelihood of having participated in cervical screening and positively associated with screening barriers. ( Hill EM ,Gick ML 2013)
Fear and financial problems were frequently addressed in previous studies.(Ersin F et al.,2013)
Screening barriers were elevated among individuals with insecure attachment styles
preoccupied, fearful;
and insecure participants were less likely to have engaged in screening compared to secure participants.( Hill EM ,Gick ML 2013)
Single/divorced/widowed status and women with no children are more vulnerable to cancer screening adherence.(Visanuyothin S et al.,2015)

10. Results Fig.1 .Socio-Demographic characteristics, n=313
Age (years) : Mean= 39.17, SD±10.33

11. Fig.2. Fear and anxiety related to outcome stratified by demographic characteristics , p≥0.05

12. Fig.3. Can you speak freely about cancer stratified by demographic characteristics
*  Odds ratio = 2.5; **=1;***=0.39
° Odds ratio = 0.49; °°=0.48
▪  Odds ratio = 0.79; ▪▪=1.22

13. Results
Fig.4. I will be very frightened, if I reveal to have cancer

14. Results
Fig.5. Pap test uptake

15. Results *p-value ≥0.05 *p-value =0.0007
Fig.6.Feelings of anxiety & Pap test uptake
*p-value ≥0.05
*p-value =0.0007

16. Conclusion & Recommendation
 Analysis of the qualitative data revealed several psychological barriers to cervical cancer screening.
The barrier of fear- related to possible positive outcomes was present in all women. Part of the perceived barriers identified were statistically significant.
These perceived barriers (as cited in previously studied using the Health Belief Model) influenced attendance rates at cervical cancer screenings globally.

17. The Recognition of general and individual barriers of fear factors and anxiety to cervical screening by health professionals in clinical practice will increase women’s access to, and acceptance of cervical screening among women in Vlora city .
The results
of the study
suggests that:

18. Thank you for your attention!