Socio-demographic characteristics of the participants
Thirty five (35) participants constituting five (5) Focus Group Discussions (FGD) were interacted with to obtain necessary data for the study. Each FGD consisted of seven (7) participants. The group consisted of only women from Oyibi Community within the Kpone-Katamanso District in the Greater Accra Region of Ghana.
The findings of the study revealed that majority of the participants (68.6%) were singles whilst few of them constituting 11 (31.4%) were married for 5years and above. Concerning the age of participants, the results revealed that majority of the participants were within the age of 19 -29years with few above 40 years. Thus, the least age recorded was 19 and 60 years was the highest age was recorded as the highest age. The study again revealed that majority ,that is, 15 participants of the respondents had Secondary education (57.1%) and Tertiary education 13 (37.1%) with 7 making the least participants having basic education background(20%). Majority of the participants 33 (94.3%) were Christians whilst a few of them (5.7%) were Muslims with diverse cultural backgrounds from the Volta region, Ashanti region, Eastern region, Greater Accra region, Northern region, and West region. Regarding their occupational status , majority of the participants were students(28.6%) government workers making up 25.7% of the employed participants interviewed and just a few(8.6%) were unemployed. Less than half of the participants(42.9) were nulliparous , with only one gravida 1 para 1 and the rest were multiparous; para 2, para 3 and para 5.
Two themes emerged from this study which were; Cervical cancer screening and vaccination knowledge and Cervical cancer vaccination effectiveness and cost.
Cervical Cancer Screening and Vaccination Knowledge
From the analysis of data by the researcher, 5 sub-themes emerged under knowledge on cervical cancer vaccination and screening; Cervical cancer screening and vaccination knowledge and Cervical cancer vaccination effectiveness and cost knowledge on cervical cancer screening types, knowledge about cervical cancer screening and vaccination centers, knowledge about how cancer screening is done, knowledge about cervical cancer vaccination, cervical cancer screening and vaccination sources of information
Knowledge about cervical cancer screening types
This study revealed that the study participants had little knowledge with regards to cervical cancer screening and the types of the screening as reported in the quotes below
“I have not heard anything on cervical cancer screening types. Yeah I have a child but during my visits to the hospital when I was pregnant, they never said anything about the cervical cancer screening. Mostly the only thing they talked at the antenatal is how to examine the breast for breast cancer, that one dear they say it a lot but not this screening types you are talking about right now”.P19
“No please I have no ideas about what you are asking of. I don’t know of any effective and efficient screening that is done. The only thing I know of is the blood they take doing antenatal services’’.P35
“For where I am, I don’t know much about other screening that is done; it is only pap-smear that I heard of but that one too I don’t know much about it and I have not done it myself, my friends told me about it.”P9
Nevertheless few participants who happened to be health professionals demonstrated adequate knowledge on cervical cancer screening and types;
“ I am a nurse, so I have knowledge about cervical cancer screening types which is used to detect cervical cancer in women. The common types of screening we do in the hospital are the vaginal swap and the pap smearto investigate if there are papilloma virus at the cervix. These type of screening is better than the rest because you will get the screening results fast.The pap- smear is the most effective. I am a nurse and that what we mostly use to test people who visit our facility and I can tell you it is very effective so far”.(P4).
“I remember my friend who is a nurse said pap-smear is good to detect if you have the disease or not. My friend told me that it is not painful when screening for cervical cancer”.P22’
Knowledge about cervical cancer screening and vaccination centers
The study reported that knowing where cervical cancer screening services is done is key, since it can positively impact the willingness to patronize the screening services. Majority of the participants were of the view that such services could be done in some government and private hospitals in the country.
“Some private hospitals like our place Health Net offer those services, I think Nyaaho does it too and for the public hospitals, Korle bu, Ridge, and others also should be doing this screening since they are big hospitals”(P8).
“It is said that government hospitals offer those services like Ridge and Korlebu. However, they don’t screen you for free. It is not part of the free vaccination so they said it goes for a price and it’s important to take anyways’’.P30
“I am sure it will be done at the various hospitals but I don’t know which one does the screening and the administration of the vaccine”.P13
However, few of the participants were totally ignorant about the various centers that offers cervical cancer screening
‘’My daughter as I was saying I don’t go to the hospital, I have never being to the hospital for all my life. So I do not know about any vaccine and the hospitals that does them. I have not even heard of the disease and the screening you were talking of’’ P32
‘’ Please I do not know about any screening and vaccination center , however, there are many hospitals in the country but I do not know where in particular it is done.I don’t know about any hospital where those tests could be done.’’P29“
Knowledge about how cervical cancer screening is done
Some participants who happened to be nurse and few who have done it recounted that during the procedure a sample is taken from the cervix for analysis at the laboratory. The following quotes relates to the above results:
“Cervical cancer screening is about investigations and screening of the reproductive system specifically the cervix of the woman to see if there is any disease that is if the human papilloma virus is there and it is done by taking a swab from the cervix by putting a speculum into the vagina in other to see the tip of the cervix.The nurse or doctor will educate you before a speculum is inserted to visualize the cervix’’. (P4).
Some participants had misconceptions that the screening cannot be done for virgins since it will cause them to loose their virginity and cause pain since their hymen is intact;
‘’Moreover, the screening cannot be done for women who are virgins because it can devirginize a woman and cause pains. It would cause pain to them when the examiner tries to insert the instrument into the vagina since the hymen is still there and they will no more be virgins because there have been a penetration”. (P14)
‘’This screening cannot be done for virgins because they have not had any sexual intercourse with any man, so it will be of no use to screen for virgins since those that are at risk are women who have multiple sexual partners’’ P22
Majority of the participants also reputed total ignorant about how the cervical cancer screening is done;
“I don’t know how the screening is done like the step by step process because I have not done it before and I am not aware of it’’ P3
‘’I know about the condition and it is a cancer that affects women and we need to screen but I don’t know how the screening is done because I was not paying attention when the program was going on. I know that once a while you need to screen to know your status and if it is discovered that you have then they would treat you, so that you get better”.P20
Knowledge about cervical cancer vaccination
Majority of the women were ignorant about the existence of the cervical cancer vaccine whereas some even doubted if a vaccine could prevent the occurrence of the disease. Some women also assume that cancer prevention vaccines were part of the childhood vaccinations.
“I didn’t know there are vaccines available for preventing cervical cancer. I don’t have any idea about the vaccine but I think maybe it is part of the vaccination we were given when we were young like polio and the rest’’ P24
‘’I have heard of it but I don’t know if it is injection or poured into the mouth like the vitamin A vaccine given”.P3
In addition, the findings brought to the light that a few of participants who knew about the vaccine believed that the cervical cancer vaccines fight against cervical cancer.
“The vaccine is given to women that have gone through the test and have tested negative and treatment is given to those who tested negative. The vaccine is an injection given twice to prevent the disease. I was taught in school, and the clinic where I work does the screening and vaccination”. (P4).
“Yes, I know about the vaccine but I don’t remember the name though. I know that when the person is screened and the person is negative then the vaccine is given . And it protects you for life which is very good. The vaccine is not given to people who have tested positive even though I do not know why they do that. I think the good thing about this vaccine too is that when you are given it protects you for long’’.(P8)
Cervical cancer screening and vaccination sources of information
Evidence gathered from the field data revealed that majority of the participants got to know about the cervical cancer screening and vaccination from various sources. The sources revealed in this study includes schools and relatives
“As I said earlier that I am a Nurse and during my nursing training period we were thought about it and I remember one time some health workers came to our school during my nursing training to screen us but I didn’t do it because I wasn’t having money then" (P4).
I got to know about the cervical cancer screening and vaccination from a relative during a family meeting. My cousin is a doctor and I remember during a family gathering he spoke to us about it. However, I watched it on television too and read more about it on the internet. He told us that he works at Ridge Hospital and his facility provides those services.(P24)
Few of the participants reported that they have not heard from any of the sources their colleagues were mentioning;
“I do not know anything on cervical cancer screening and vaccination, not even during school time. I have not heard or seen it on television or Facebook or from friends. Yeah I have a child but during my visits to the hospital when I was pregnant, they never said anything about the cervical cancer disease or the screening and vaccination. Mostly the only thing they talked at the antenatal is how to examine the breast for breast cancer, that one dear they say it a lot but not this disease you are talking about right now”.(P19)
Cervical cancer vaccination effectiveness and cost awareness
The two subthemes that emerged are; knowledge about the effectiveness of cervical cancer vaccination and awareness about cervical cancer screening cost and vaccination cost
Knowledge about the effectiveness of cervical cancer vaccination
Exploration on the effectiveness of cervical cancer vaccination ascertained that majority were of the view that the vaccine were not effective and hence prevented them from patronizing it. The subsequent paragraphs give comprehensive findings on the subject matter:
“Hmm, even though I heard about cervical cancer vaccination, I have not gone for the screening to receive vaccine for this disease, so I don’t know if it is effective”. (P1).
“In my view, I will say the vaccination will not be effective because they have been given vaccines since but people keep getting sick so I think it will not be different in the case of cervical cancer vaccines”.(P8)
Awareness about cervical cancer screening cost and vaccination cost
The results show that a few of the participants knew about the cervical cancer screening and vaccination cost while majority of the participants were ignorant about the cost involved in the screening and the vaccination. The findings revealed that the cervical cancer screening and vaccination cost depends on the facility visited. The following statements relates to the above findings:
“Actually, the vaccine is an injection. The client takes two shots and one cost about 500 Ghana cedis but even with the cost, I think it depends one the hospital you visit. The private hospitals might take a bit more than that though. The screening is like 50 or 100 Ghana cedis but that one too, it is sometimes free when it’s the cervical cancer month celebration”. (P12).
“I think the vaccine is about 600 Ghana cedis at my work place so if you are taken it for two then its 1200 Ghana cedis. As for the screening, it’s free sometimes and sometimes too we charge 50 Ghana cedis. It is 50 Ghana cedis because we have this thing that we do example during breast cancer month we do it for free so same goes for the screening of cervical cancer”(P35)
However, majority of the participants were ignorant about the cost of screening and vaccination;
‘’I don’t know of the cost of the vaccine because I don’t even know about the vaccine. Moreover, the screening too, I don’t know the amount they take when you go to the hospital to screen. I also don’t know how the screening is done and how the vaccine is given…. yeah .No, no, no, I don’t know about the cost of the screening even though I have heard about it. For the vaccine, I don’t know the cost because I have not heard about it. I don’t know what is really done when you go to the hospital to get screened because my friends didn’t talk about it and Ihave not screened and vaccinated too”.(P23)
Cervical cancer screening and vaccination knowledge
Cervical cancer screening types
The findings of the present study revealed that, participants knowledge on cervical cancer help influence them to assess cervical cancer screening services. Majority of the participants in this present study reported to have little knowledge on the cervical cancer screening types. Among the few participants who demonstrated adequate knowledge on cervical cancer screening types, majority were health professionals (nurse and pharmacist) of which they mentioned vaginal swap, pap smear, scans as the key diagnostic test for cervical cancer. Among the three diagnostic test mentioned above, pap-smear was mostly known to participants in this present study. The findings in this present study is in sync with a similar study conducted by Aniebue and Aniebue (2010) among nursing university students in Nigeria which revealed that,few of the participants about 23.1% identified pap-smear as a screening test which reflected in the poor utilization of cervical cancer screening among the students.
Knowledge about cervical cancer screening and vaccination centers
Cervical cancer screening and vaccination centers was another sub-theme that emerged from the present study. The study reported that, knowing where cervical cancer screening and vaccination services is done is key, since it can positively impact the willingness to patronize the screening and vaccinations services but that was not the case in this present study. Majority of the participants in this present study were of the view that, such services could be done in some government hospitals like Korle-bu and Ridge hospital and private facilities like Nyaho hospitals in the country. However, among these participants, it was deduced that some were just guessing since they knew that screening are done in hospitals. Similarly, the findings in this present study is in similitude to a study conducted by Pegu, Dhiman, Chaturvedi and Sharma (2016) in India among females who reported cervical cancer screening and vaccination were conducted in hospitals since they are health associated. However, they did not specify if it was government or private hospitals as shown in this present study.
Knowledge about how cervical cancer screening is done
Findings of the current study also suggest that, few participants in this study who have undergone cervical cancer screening acknowledged that, they were educated on cervical cancer screening prior to the screening. Others narrated that, they received information on how cervical cancer screening is done from friends and on TV programs. These participants recounted that, during the procedure, a sample is taken from the cervix for analysis at the laboratory with the help of an instrument which was inserted into the vagina. A study done in Ghana revealed that, majority of the participants were well informed on were the screening is done in this country and added that, pap-smear was done with the use of a speculum then taken to the laboratory for further pathological investigations. (Williams, Kenu, Dzubey, Dennis-Antwi, & Fontaine, 2018).
Cervical cancer screening and vaccination sources of information
Participants who have done cervical cancer screening cited nurses and doctors as their source of information. This was followed by social media platforms such as whatsup, facebook, instagram and least was reproductive health education in girls club in secondary school and women fellowship meetings. In correlation to the present study findings, Adejuyigbe et al (2015) also found in their study that, among young adults in Nigeria, the common sources of information on cervical cancer screening and vaccination were from television/radio, followed by print media, health campaigns, family or friends and health care providers. This findings had media topping the list of sources of information because the population used for the study were young, hence, were social media inclined.
Knowledge about cervical cancer vaccination
Concerning knowledge about cervical cancer vaccination, the study found that, majority of the women were ignorant about the existence of the cervical cancer vaccine, whereas, some few participant that knew about it were not sure whether the vaccine was give by mouth of injection.. Whereas, some women also assumed that, cancer prevention vaccines were part of the childhood vaccinations. In respect to the above findings, a study conducted in South Africa by Francis et al (2011) revealed that, cervical cancer cannot be prevented; this is even with vaccine and other participants did not know that, it is preventable by early screening and the use of the vaccine because they did not have adequate knowledge concerning the HPV vaccine. In relation to this current study, it not surprising that, the participants that took part in the study did not believe that, cervical cancer could be prevent with the use of the HPV vaccine, hence, imparted negatively on HPV vaccine utilization. In contrast, majority of participants (69.5%) knew the HPV vaccine was available and can help prevent cervical cancer compared to 38.2% who stated condoms as a preventative measure instead of vaccine (Ferrer, Trotter, Hickman, and Audrey, 2014).
Awareness about cervical cancer screening cost and vaccination cost
The awareness of the cost of the screening and vaccination is very key in enabling one to make a decision to or not to utilize those services. Concerning the cervical cancer screening cost and vaccination costs, the results show that, few of the participants knew about the cervical cancer screening and vaccination cost. Participants who knew about the cost recounted that, the vaccine is an injection and with each shot costing GH¢500(86USD) - GH600(103USD),hence, two shots of the HPV vaccine was equivalent to GH¢1000 (172USD) - GH¢1200 (207 USD). The participants also reinstated that, the screening cost varies from GH¢50 - GH¢100. However, they also added that, the cost of the screening also differs from facility to facility and during cervical cancer month celebration which is usually in January, it is done for free. In correlation, a cross-sectional study conducted by Ihudiebube-Splendeor, et al, (2017) among female students in a Nigerian Tertiary Institution, revealed that, only 38 (13.0%) were aware of the HPV vaccine cost and perceived it as expensive. In contrast to this studies findings, a study done in Australia proved that, the cost of vaccine was effective and inexpensive and was assumed at a price of 115USD (GH¢ 669) per vaccine dose making 230USD (GH¢1338) for two shots (Kotaniemi-Talonen, Nieminen, Anttila, & Hakama, 2005). Participants saw the cost of HPV vaccine as effective in Australia because the government had funds in place to help sustain and motivate women financially to screen and vaccinate, hence , increasing the number of women who utilizes those services. This implies that, the high cost of cervical cancer screening and vaccination in private hospitals in comparison to the government hospitals could be attributed to the fact that, government hospitals receive funds to help reduce the cost whiles private hospitals do not.
Knowledge about the effectiveness of cervical cancer vaccination
Exploration on the effectiveness of cervical cancer vaccination ascertained that, majority were of the view that, they do not know whether the vaccine is effective because they have not gone for the screening to receive HPV vaccine for against cervical cancer. This implies that, effectiveness of HPV vaccine could better be determined by individuals who have undergone cervical cancer vaccination. Series of studies have also shown the effectiveness of cervical cancer vaccine in the quest of preventing cervical cancer occurrence. A study conducted by Adejuyigbe et al (2015) among medical students of the University of Lagos, Nigeria, revealed that, most of the respondents supported vaccination of adolescent girls and were willing to recommend vaccination to colleagues/friends (82.1%) due to the fact that, they knew the effectiveness of the HPV vaccine against cervical cancer.