By Fatjona Kamberi

1. Cervical Cancer prevention among
women in Vlora city:
the influence of fear-related to
possible positive outcomes
1*Fatjona Kamberi RN, MSN, PhD Candidate,
²Gjergji Theodhosi,²Vjollca Ndreu ,²Enkeleda Sinaj
1Yllka Bilushi, ³Leonard Kamberi
Authors:
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 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)
Cervical Cancer facts

3. Problem statement
 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
 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. 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, randomly selected) 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. 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).
Method and samples

8. 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
Health Belief Model*
*”the most commonly used theory in health education, promotion and
screening”. (National Cancer Institute [NCI], 2005; “Theory at a Glance”,2005).
Variables included in the
questionnaire
•Socio-Demographic characteristics
•Fear and anxiety related to
outcome stratified by socio-
demographics
•Can you speak freely about cancer
stratified by socio-demographics
•I will be very frightened, if I reveal
to have cancer
•Pap test uptake
•Feelings of anxiety & Pap test
uptake

9. Studies based on Health Belief Model
• Fear and financial problems were frequently addressed in
previous studies.(Ersin F et al.,2013)
 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)
 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
14.33%
30.78%
54.78%
77.28%
22.72%
79.55%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
Elementary
school
High school University
degree
Full time Part time Married
Level of Education Employment status Marital status

11. 0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
Elementary
school
High school University
degree
Full time Part time Married
71.11%
67.37%
73.26%
63.72%
27.64%
80.69%
Fig.2. Fear and anxiety related to outcome stratified
by socio-demographic characteristics , p≥0.05

12. Fig.3. Can you speak freely about cancer stratified by demographic
characteristics
0%
10%
20%
30%
40%
50%
60%
70%
80% 60%
68.29%65.07% 65.93% 78.26%
62.90%
80%
* Odds ratio = 2.5; **=1;***=0.39
° Odds ratio = 0.49; °°=0.48
▪ Odds ratio = 0.79; ▪▪=1.22

13. 87.22%
12.78%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Yes No
Yes No
Results
Fig.4. I will be very frightened, if I reveal to have cancer

14. Results
Fig.5. Pap test uptake
40.26%
59.74%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
Yes No

15. Results
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
Fear of the
results*
Can you speak
freely about
cancer *
I will be very
frightened if I
reveal to have
cancer*
33.33% 37.19%
39.94%
66.67% 62.81%
60.66%
Pap test uptake yes Pap test uptake no
Fig.6.Feelings of anxiety & Pap test uptake
*p-value =0.0007

16. Conclusion & Recommendation
 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.
 Analysis of the qualitative data revealed
several psychological barriers to cervical
cancer screening.

17. The results
of the study
suggests that:
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 .

18. Thank you
for your attention!