Cervical cancer remains a formidable global health challenge, marked by substantial disparities in awareness, prevention and healthcare access. Against the backdrop of the awe-inspiring landscapes in District Kangra, Himachal Pradesh, this study aims to probe into the intricacies of cervical cancer knowledge levels, encompassing risk factors, early signs, screening methods and preventive measures among the local residents [1,2].

Globally, cervical cancer stands as the fourth most prevalent cancer among women, posing a persistent threat despite advancements in medical science. In India, it ranks as the second most common cancer among women, underscoring the urgent need for tailored interventions and heightened awareness. The advent of human papillomavirus (HPV) vaccines has presented a promising avenue for prevention, but the effectiveness of these measures is intricately linked with community awareness, timely screening and the resilience of healthcare infrastructure [3-5].

The unique socio-cultural fabric of Himachal Pradesh, especially in District Kangra, introduces an added layer of complexity to cervical cancer awareness. Traditional beliefs, geographic remoteness and diverse socioeconomic backgrounds can significantly shape knowledge levels and health-seeking behavior, necessitating an in-depth exploration to inform targeted interventions aligned with community needs [6,7]. This research aligns with the World Health Organization's holistic approach to cervical cancer control, emphasizing vaccination, screening, community education and empowerment. By identifying existing knowledge gaps,

the study aspires to lay the groundwork for focused educational campaigns, facilitating early detection and fostering a proactive attitude toward preventive measures [7-9].

In delving into this exploration amidst the Himalayas, our goal is not only to contribute to local healthcare but also to enrich the broader dialogue on cervical cancer awareness and prevention. Through this research, we aspire to illuminate a path towards a future where every woman, irrespective of geographic location, is equipped with the knowledge to safeguard her health.

Aims & Objectives:

To evaluate the knowledge levels related to cervical cancer, including risk factors, early signs, available screening methods and preventive measures, among the residents of District Kangra, Himachal Pradesh.

Research Methodology

• Research Approach – Descriptive 

• Research Design – Cross-sectional survey design

• Study area:  District Kangra, Himachal Pradesh

• Study duration- between August 2023 to October 2023

Study Population

The study's target population encompassed all adults aged 18 and above who had been residents of District Kangra for a minimum of 12 months.

Sample Size

A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Cervical Cancer, a precise 5% absolute error margin and a conservative 5% non-response rate.

Study Tool

A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding about Cervical Cancer including its risk factors, early warning signs, available screening methods and preventive measures etc. was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents.

Description of Tool

Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more.

Questionnaire

The questionnaire contains 20 structured knowledge related questions regarding about Cervical Cancer including its risk factors, early warning signs, available screening methods and preventive measures etc. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as: 

>80% (16-20)                      =              Very Good

60-79% (12-15)                  =              Good

41-59% (8-11)                    =              Fair

<40% (< 8)                         =              Poor

Validity of tool – by the experts in this field.

Data Collection

Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the residents of District Kangra, Himachal Pradesh for responses using online modes like e-mail and social media platforms like WhatsApp groups, Facebook, Instagram and LinkedIn till the 400 responses were collected. 

Data Analysis

Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

Ethical Considerations

Participants confidentiality and anonymity was maintained.

The goal of the current study was to assess general public knowledge regarding cervical cancer, including risk factors, early signs, available screening methods and preventive measures, through a non-experimental descriptive survey. A total of 400 respondents took part in the study, with 135 (33.75%) coming from urban areas and 265 (66.25%) from rural areas. 

In the present study 24% (96) participants had very good knowledge (16-20 marks) towards Cervical Cancer, 37.75% (151) had good knowledge (12-15 marks), 24.5% (98) had fair knowledge (8-11 marks) and 13.75% (55) having poor knowledge (<8 marks).

The findings of this study provide a comprehensive overview of the knowledge landscape related to cervical cancer among the residents of District Kangra, Himachal Pradesh. The assessment covered various aspects, including risk factors, early signs, screening methods and preventive measures. The results reveal a nuanced understanding within the community, with notable variations across different domains.

Globally, cervical cancer remains a significant public health concern, particularly in low- and middle-income countries. The knowledge levels observed in District Kangra echo the global trend, where awareness about cervical cancer, its risk factors and preventive measures is pivotal but often suboptimal. The prevalence of HPV, a major contributor to cervical cancer, underscores the importance of awareness and vaccination campaigns [10-13]. The study participants exhibited commendable awareness regarding the nature of cervical cancer, its primary risk factors and the role of HPV.

Table-1: Knowledge regarding cervical cancer among study participants

Table 2: Knowledge score towards cervical cancer among study participants

In the Indian context, cervical cancer holds the position of the second most common cancer among women. The study participants' awareness aligns with the broader Indian scenario, where initiatives like VIA screening have been implemented to enhance early detection [4-7]. The relatively lower awareness about HPV's role in cervical cancer development emphasizes the need for targeted educational efforts, especially given the rise of vaccination programs in the country. This resonates with findings from Shastri et al. [6], who emphasized the effectiveness of VIA screening in Mumbai.

The unique socio-cultural fabric of Himachal Pradesh, as evidenced in District Kangra, introduces distinct challenges to cervical cancer awareness. Traditional beliefs and geographic remoteness may contribute to variations in knowledge levels compared to more urbanized regions. A study by Basu et al. [7] highlighted the importance of community-specific interventions, acknowledging the diverse cultural landscape in India. Therefore, initiatives in District Kangra should be tailored to the local context to maximize effectiveness.

Comparisons with other studies globally and within India highlight both commonalities and specific areas requiring attention. Similar to our findings, studies by Sankaranarayanan et al. and Mittal et al. [5,12] have emphasized the need for robust educational campaigns to bridge knowledge gaps. The variations in knowledge about HPV and its link to cervical cancer are consistent with the findings of a study by Sinha et al. [11].

The knowledge scores in this study indicate a moderate level of awareness, with 24% of participants demonstrating very good knowledge. This underscores the potential for improvement in awareness campaigns, especially in areas related to HPV and its vaccination. Initiatives such as the National Cancer Control Programme (NCCP) in India highlight the commitment to combating cervical cancer [14].

Limitations and Future Directions:

While this study contributes valuable insights, certain limitations must be acknowledged. The reliance on self-reported data and the online survey format might introduce biases. Future research should incorporate a more diverse range of respondents and employ mixed-methods approaches for a comprehensive understanding.

In conclusion, our study unveils the intricate knowledge landscapes of cervical cancer in District Kangra, Himachal Pradesh, emphasizing the critical need for targeted interventions to bolster awareness and understanding within the community. While a commendable proportion of participants demonstrated a good grasp of cervical cancer fundamentals, including its nature, risk factors and preventive measures, gaps persist, particularly concerning the role of human papillomavirus (HPV) and vaccination. These findings underscore the imperative for region-specific educational campaigns, acknowledging the unique socio-cultural fabric of Himachal Pradesh. The moderate knowledge scores suggest room for improvement, offering a strategic foundation for collaborative efforts involving healthcare providers, policymakers and community leaders. Bridging these knowledge gaps is pivotal for fostering a proactive attitude toward preventive measures and advancing cervical health in District Kangra towards a future characterized by heightened awareness and resilient healthcare practices.

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