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This dissertation thesis touches very current and among public and experts often discussed topic. It concerns particularly matter of papillomaviral infections and vaccination against them. The research proved vaccination-coverage level of respondents and also their knowledge level. The vaccination-coverage level of girls is very high (almost 80%). A lot of girls also used possibility of full vaccination in the age of 13. This dissertation thesis should serve as a source and summary information about HPV viruses, diseases caused by them, about ways of transmission and epidemiological measures. Furthermore it also informs about cervical cancer, risk factors, diagnostical possibilities, therapy and at last but not lest about prevention of cervical carcinoma.

Aim: The aim of this thesis was to investigate experiences of receiving notification of an abnormal Pap smear result and its impact on women’s health-related quality of life as well as to investigate women’s awareness of human papillomavirus.   Methods: In total, 176 women and 20 healthcare professionals participated. Data were collected through individual interviews (I, II) and a questionnaire (IV) including the instrument Functional Assessment of Chronic Illness Therapy – Cervical Dysplasia (FACIT-CD) and Hospital Anxiety and Depression Scale (HADS). For the translation and cross-cultural adaptation of the FACIT-CD, and for evaluation of its linguistic validity and reliability, cognitive debriefing interviews and a questionnaire consisting of the Swedish instrument FACIT-CD was used. Data were analysed by content analysis (I, II) and by using statistical analysis (III, IV), while one part (III) was analysed according to FACIT translation methodology.     Results: Women receiving notification of an abnormal Pap smear result have good overall HRQoL; they become anxious but not depressed. Reasons for anxiety were mainly that women misinterpreted the result as cancer, which could lead to lower attendance for further investigation, treatment and follow-up. To cope with the anxiety, women sought emotional support and information. They primarily used the Internet for information but also turned to healthcare professionals for information needs. Moreover, women had low awareness of HPV, its sexually transmitted nature, and its relationship to abnormal Pap smear results and cervical cancer. An awareness of HPV as a sexually transmitted infection did not lead to higher level of anxiety or more depression symptoms or worse HRQoL, compared to not being aware. Finally, the Swedish FACIT-CD is equivalent to the English version and linguistically valid and exhibited good internal consistency reliability.   Conclusion: Women have low awareness of HPV and abnormal Pap smear results, whereupon they misinterpret their test result as cancer. It is of importance that women understand their test result, in order to minimise anxiety as well as to maintain high attendance for investigation, treatment and follow-up of abnormalities.

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Text in English / Cervical cancer remains the leading cause of cancer mortality among women worldwide, a burden in the developing countries and commonly detected through symptoms at later invasive stages. The study aimed at establishing knowledge and awareness of the importance of cervical cancer screening in the Makhuduthamaga Sub-district by exploring the perceptions of women and professional nurses and through the review of the National Cervical Cancer Screening Policy (2013). Recommendations to address the gap in knowledge and to inform the National Cervical Cancer Screening Policy were developed based on the study findings. A mixed-method approach was used in this study through a sequential explanatory design, which is quantitatively driven was used. Quantitative data were obtained by using a researcher developed checklist. The checklist was developed from variables stated in the National Cervical Cancer Screening Policy and was used to review its implementation. Qualitative data was obtained through in-depth interviews with individual women and focus group discussions with professional nurses. The study was conducted in ten randomly selected clinics of Makhuduthamaga Sub-district. Purposive sampling was done to obtain qualitative data. An average score of 9.7 was obtained for all ten clinics that participated in the study with regard to the evaluation of the implementation of the National Cervical Cancer Screening Policy. Only 6 (60%) clinics implemented the policy whereas 4 (40%) clinics did not implement the policy. Women and professional nurses perceived cervical cancer screening as important. Lack of knowledge among women regarding cervical cancer screening contributed to the majority of women not screening for cervical cancer. Lack of resources, the 10 year interval of normal cervical cancer screening, the use of disposable vaginal speculums and brushes, lack of standardized cervical cancer screening training, centralization of cytology laboratories came out as factors that negatively influence the uptake of cervical cancer screening. Cervical cancer screening awareness campaigns, availability of resources and standardized in-service trainings on cervical cancer screening were recommended to enhance the cervical cancer screening uptake. Key concepts: / Health Studies / D. Litt. et Phil. (Health Studies)

Cervical cancer is an emerging public health problem in developing countries. Globally, it is the 3rd most common malignancy in women after breast and colorectal cancers and 4th most frequent cancer in women, with an estimated 570,000 new cases and 311,000 deaths in 2018. Cervical cancer screening in the developed countries is credited with the reductions in cervical cancer morbidity and mortality during the last 50 years. However, nearly 90% of cervical cancer deaths occur in less developed countries. Ghana has a cervical cancer rate of 26.4%. Further, it is the highest cancer incidence faced among women 25 to 44 years and has a mortality rate of 17.4% in this age group. Knowledge, culture, attitude, and beliefs are known to limit women's participation in Pap test screening programs. Guided by the health belief model, the purpose of this quantitative study was to examine how knowledge, attitude, culture, and religious beliefs affected intent to seek Pap test screening among adolescent girls in Accra, Ghana. A total of 155 participants ages 16 to 20 years completed a 30-item questionnaire. Descriptive frequencies were calculated. Correlation and Chi-square tests were also performed to assess associations with intent to screen with Pap test. Most girls (92%) had never heard about Pap test screening. There were statistically significant correlations between cervical cancer knowledge (p=0.032) and attitude (p=0.001) with intent to participate in Pap test screening. However, culture (p=0.049) and religious beliefs (p=0.529) were not significantly associated with screening intent. The implications for social change include informing practice and research on how cervical cancer prevention programs can be tailored to girls living in countries where different cultural and religious values are practiced.

Text in English / The purpose of the study was to explore perceptions, knowledge and attitudes of women undergoing cervical cancer screening in Omaheke, Namibia. A qualitative exploratory study was conducted. Data were collected from a purposive sample of eight participants using a self-developed interview guide. Data were analysed using Tesch’s descriptive method of open coding. Three themes were identified namely; cervical cancer as a disease, perception of cervical cancer and service delivery at the facility. The findings also revealed some suggestions for the facility that could improve screening uptake. The study proposes a community education programme on cervical cancer and related topics to be covered during health education sessions. In addition the study recommends the Omaheke directorate to look into operational issues in order to facilitate access to cervical cancer screening. / Health Studies / M.P.H.

The purpose of this study was to describe the factors that determine the utilisation of VIA, and to investigate the socio-economic status of women who undergone VIA. A retrospective document analysis of 323 clinical records was conducted at a specific rural hospital in Zimbabwe. A retrospective, cross-sectional, non-experimental, descriptive, analysis of clinical records was conducted using a checklist to extract data from the records of women who have undergone VIA for cervical screening at the specific rural hospital. The results revealed that 70% (N=225) were from outside the catchment area, 73% (N=234) were poor, 54% (N=173) were of high parity, 85% (N=275) were ill with conditions that included lower back and abdominal pains, excessive vaginal discharge and vaginal bleeding after intercourse. The study further revealed that 72% (N=226) had no prior cervical cancer screening and 87% (N=277) were screened by chance. The conclusion drawn was that socio-economic and logistical constraints hinder cervical cancer screening among rural women. It is recommended that VIA screening and health education on cervical cancer be offered to all women visiting healthcare facilities. Furthermore, the government should consider funding in order to prioritise women’s health issues. / Health Studies / M.A. (Nursing Science)

MCur / Department of Advanced Nursing Science / Cervical cancer remains one of the major public health problems globally, despite the fact that it is preventable and curable if identified at an early stage. Currently, cervical cancer is the leading cause of death among women in Sub-Saharan Africa where the knowledge about the disease is scarce among the affected population. Methods A quantitative cross-sectional survey was conducted in Thulamela Municipality of Limpopo Province. The purpose of the study was to assess the knowledge of cervical cancer prevention among women in four villages in Thulamela Municipality. The population of the study was composed of all women aged above 30 in the villages Malamulele, Mhinga, Muledane and Phiphidi. A sample of one thousand five hundred and forty-six (1546) was drawn using random sampling. Quantitative data were collected using a twenty-six-item questionnaire. The data were coded and then processed using the Statistical Package for Social Sciences to produce frequency tables and descriptive statistics such as chi-square and correlation. Results A number of findings were made in this study. The majority of the women in this study had little or no knowledge about cervical cancer, human papilloma virus and vaccines. The majority of the women had little or no knowledge on cervical cancer risk factors and how the disease is spread. These findings were confirmed by chi-squared values at p<0.05 and showed significant association between variables: that young women were likely to be aware of cervical cancer compared to elderly women, educated women were more likely to be knowledgeable about cervical cancer than those with low education attainment, elderly women were more likely to be not worried about cervical cancer compared to young women. Correlation, Pearson rho scores at p<0.05 showed significant correlations knowledge of cervical cancer and age (negative), knowledge and education (positive). The findings signified the need for cervical cancer prevention education in Vhembe District, and the need for primary health care nurses to promote access to such services through robust health education. vi Recommendations The study made a number of practical recommendations likely to educate women about cervical cancer, human papilloma virus and its prevention. These include: The possibility of large hospitals having their own small broadcasting stations that will frequently disseminate information throughout the local municipalities, road shows and use of informal sector like politicians and traditional healers in disseminating information.