Factors Influencing uptake of Cervical Cancer Screening among Women in India: A Hospital based Pilot Study

Abstract

Background: In an effort to decrease the toll of cervical cancer, by its knowledge, prevention and treatment services in the community, we provided a nuanced consideration of the sociological and anthropological insight into the women's knowledge and its association with that of socioeconomic-demographic profile in the course of understanding cervical symptomatology, screening and cancer.

Full text

Volume 2 • Issue 6 • 1000157
J Community Med Health Educ
ISSN: 2161-0711 JCMHE, an open access journal
Community Medicine & Health Education
Singh and Badaya, J Community Med Health Educ 2012, 2:6
http://dx.doi.org/10.4172/2161-0711.1000157
Research Article Open Access
Factors Influencing uptake of Cervical Cancer Screening among Women
in India: A Hospital based Pilot Study
Sandeep Singh* and Sorabh Badaya
G. R. Medical College, Gwalior, India
Abstract
Background: In an effort to decrease the toll of cervical cancer, by its knowledge, prevention and treatment
services in the community, we provided a nuanced consideration of the sociological and anthropological insight
into the women’s knowledge and its association with that of socioeconomic- demographic prole in the course of
understanding cervical symptomatology, screening and cancer.
Methods: Study through an in-depth questionnaire was conducted at JA Groups of Hospital’s Obstetrics and
Gynecology OPD, Gwalior, India on a total of 812 women with a modal average age of 35.51 ± 10.64 years, from
June-August 2010.
Results: We found a large amount of lack in awareness and perception in Indian women. Surprisingly all women
presented were married. Only 9.59% of women had ever heard of cervical cancer, mostly belonging to upper socio-
economic group with only 11.62% underwent at least one cervical screening in their life time. None of them reported
exact purpose of the Pap test. Male partner were the sole decision maker of the family in 47.20% women. 73.65% of
the respondents were using clothes instead of tampons or sanitary pads during menstruation.
Discussion: This study revealed the limited knowledge of Indian women about the susceptibility of cervical
cancer, and the necessity of cervical cancer screening among the women. Inadequate public health education, lack
of patient-friendly health services, socio-cultural health beliefs, and personal difculties were the most salient barriers
to screening.
*Corresponding author: Sandeep Singh, G. R. Medical College, Gwalior,
M.P., 474001, India, Tel: +91-141-2761078; Fax: +91-751-2403403; E-mail:
sandeepkcsingh@gmail.com
Received June 06, 2012; Accepted June 23, 2012; Published June 25, 2012
Citation: Singh S, Badaya S (2012) Factors Inuencing uptake of Cervical Cancer
Screening among Women in India: A Hospital based Pilot Study. J Community Med
Health Educ 2:157. doi:10.4172/2161-0711.1000157
Copyright: © 2012 Singh S, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Keywords: Cervical cancer awareness; Socio-economic status;
Sexually transmitted diseases; Health facilities in India
Introduction
Cervical cancer is the second most common cancer in the women
worldwide and the leading cause of cancer deaths among women in
developing countries [1]. e burden of cervical cancer in India is
enormous accounting for about 20 percent of all cancer related deaths
in women and is the number one cause of death in the middle age Indian
women [2]. It is paradoxical that so many deaths are occurring whilst
being a preventable disease. Organized population based screening
linked to treatment of the detected neoplasias can lead to more than
70 per cent reduction of disease related mortality [3]. Where screening
quality and coverage have been high, invasive cervical cancer has
been reduced by as much as 90 percent. is indicates the usefulness
of screening in the population, but with major barriers towards lower
screening coverage [4]. ere are no eective, organized population-
based high-level opportunistic screening programs for cervical cancer
in any of the states in India contemporary to developed nations [2,5-
7], due to which routine screening of asymptomatic women have been
almost non-existent [8]. For a screening program to be successful, a
good attending rate of women undertaking the test is must in context
to which complete thorough exploration of their socio-economic-
demographic prole is a preliminary requirement [9]. Several factors
inuencing cervical cancer screening have been reported which
includes lack of awareness, inadequate access to healthcare facility with
poor infrastructure in addition to unawareness among the doctors at
rural areas regarding importance of early diagnosis and treatment,
existence of alternative medicinal systems and quacks [10], decient
economic and moral support from husband and family [11-12] and
an inappropriate demand for providing cervical cancer screening from
the potential beneciaries could be enumerated as the chief causes [8].
ere are no such studies existing indulging with cervical cancer
screening and its dynamic relations with various stated factors from
Gwalior (Madhya Pradesh, Central India) where the crude incidence
rate of cervical cancer is 3.12% [13]. erefore a study with qualitative
and quantitative components was undertaken using face-to-face
in depth interviews to investigate cervical cancer screeners and to
explore various factors inuencing screening uptake of these women
emphasizing and comparing majorly with their socio-demographic
prole and a call for improvement.
Method
Study place
Discussions with subjects were undertaken in Obstetrics and
Gynecology OPD of Jayarogya Hospital (JAH). JAH is a teaching
hospital for G.R. Medical College, Gwalior, one among the six medical
college hospitals in Madhya Pradesh.
Study participants
A total of 812 women participated the questionnaire carried out
for the guided women for Pap test when attending the Obstetrics
and Gynecological OPD at JAH, Gwalior held from June-August,
2010. Age of participants ranges from 18-85 years. Verbal Informed
consents were sought from the participants prior to their interview and
no one declined participation. Ethical clearance was sought from the
Institutional Ethical Committee (IEC) prior to advent of the study.

Volume 2 • Issue 6 • 1000157
J Community Med Health Educ
ISSN: 2161-0711 JCMHE, an open access journal
Citation: Singh S, Badaya S (2012) Factors Inuencing uptake of Cervical Cancer Screening among Women in India: A Hospital based Pilot Study.
J Community Med Health Educ 2:157. doi:10.4172/2161-0711.1000157
Page 2 of 6
Study instruments
A questionnaire was carried out by the authors to determine
womens’ socio-demographic and fertility prole and their knowledge
regarding the Pap test. Instrument contained questions regarding
socio-demographic factors, their prior history of Pap smear, knowledge
about cervical cancer, cultural beliefs, male behavior and family
supportiveness towards women health issues.
Process
Before the advent of discussions, participants were made aware
about the purpose of the meeting, condentiality of their personal
information and consent regarding discussion and to note down them.
All discussions were in the local language Hindi and then translated into
English while formulating manuscript. It contained an introduction,
purpose of the meeting, rules during the discussions i.e. condentiality,
encouragement of open all-inclusive discussions and nondisclosure of
their personal information. Discussion usually lasts for 10-15 minutes
and the hand notes were prepared from them. One author conducted
the discussion and another acted as an observer and took hand notes.
Questionnaire was asked to the women by the authors (both
males) in a separate room restricting interference from the others (also
family members) except within the presence of few medical personals
(females). Open ended questions were asked on dierent aspects of
their personal and cultural life with a common set and style to avoid
any interference in the data. Personal particulars which include name,
belonging (husband/father), age, parity, occupation, residential address,
chief complaints for appearing were asked directly. Information on
earning was asked as “Who is the source of earning for the family?
From where you and your family get money? How many members
are there in your family, and how much money you actually get out of
that?” Age at marriage was deduced by asking indirectly “How many
years have passed while you married”. is is subtracted from the age
of the women. History of contraceptive use is directly asked as “Are
you using any method for garbh-nirodh (contraception)? What is that?
ey were also simultaneously counseled towards benets and harms
of various stated factors.
Statistical analyses
Quantitative data was coded and analyzed using SPSS for frequency
distribution, chi square testing and odds ratio. A frame work analysis
regarding qualitative part of the study was conducted from the advent
of the data collection (Ritchie and Spencer). e noted data were gone
through by the authors to get familiarize with the issues. ematic
frame work was developed from the prior and emergent themes. is
was then applied to sort out data according to the themes (these were
titled as presented in the ndings). en the explanations were deduced
from the ndings in Indian context.
Result
Questionnaires were analyzed for all 812 women with mean age of
35.51 ± 10.64 years. Women from rural setting were found to be 54.80%
as compared to 45.19% urbanites. All women were married with 85.96%
under 45 years (reproductive age group) while 14.03% above. Mean
value of pregnancies for an individual woman was found to be 2.70
with nil pregnancy rates to be 9.85%. e socioeconomic characteristics
of participants are shown in Table 1. Participants using sterilization,
oral contraceptive, and intrauterine device (IUD) as contraceptive
methods were 24.09%, 5.58% and 1.42% respectively. 68.91% women
were either using any other method of contraception or not using any
of them. Chance of ever received Pap smear was higher among women
from lower socioeconomic class, parous women, belonging to Hindu
religion and from urban background (Table 2). Comparative analysis
and independent t test of ever received Pap smears among urban and
rural for the studied variables has been presented in table 3 and table 4
respectively. Participants who never undergone screening was 84.97%
with that of one previous Pap smear screening 11.62%, 2.82% with
two and 0.59% with more than two previous Pap smear screening.
74.21 % women had previous Pap smear screening within last 1 year,
20.31% within last 5 years and 5.46% within last 10 years. Findings are
presented according to the themes identied in the analysis
Knowledge on cervical cancer
Participants were asked, had they ever heard of cervical cancer,
human papilloma virus (HPV), whether cigarette smoking could cause
cervical cancer? How they could catch the disease, from whom they
got the knowledge regarding disease, where to rst contact regarding
treatment. Majority of the women had never heard of cervical cancer
and not even a single respondent of HPV and cigarette smoking could
lead to cervical cancer. Only 9.59% of the women had ever heard cancer
as a cancer of “mouth of uterus”. Majority of them, 51.20%, described
having no idea that unhygienicity can cause the disease. Mother in law
was the main source of knowledge for majority of women who had
ever heard of the disease. “My mother in law told me that if u not
maintains hygiene during menstrual period, you could get the disease”.
Unawareness about the cervical cancer could partly be due to poor
communicating health service providers. Most of the women, 44.80%
seek public health services (PHC/CHC level) or hakim and vaidh
Characteristic(s) Distribution Within Sample, n
Age (years)
Mean ± SD 35.51 ± 10.64
Median (range) 35(15-85)
Age at marriage (years) Mean ± SD 16.89 ± 4.29
Parity
0-3 585(45.19%)
≥ 4 228(28.07%)
Education
No schooling 369(45.19%)
Primary school 80(9.85%)
High school 215(26.47%)
> High school 148(18.22%)
Occupation
Professional and semi-professional 30(3.69%)
Clerical and shop owner 12(1.47%)
Skilled worker 15(1.84%)
Semiskilled worker 150(18.47%)
Unskilled worker 597(73.52%)
Unemployed 8(0.98%)
Socio -economic status
Low and low upper 606(74.63%)
Middle and upper middle 200(24.63%)
Upper 6(0.73%)
H/o tobacco exposure 101(12.43%)
H/o ever-use of oral contraception 51(6.28%)
Income
≤ 979 12(1.47%)
980-2935 270(33.25%)
2936-4893 261(32.14%)
4894-7322 117(14.40%)
≥ 7323 152(18.71%)
Table 1: Socio demographic prole of study participants.

Volume 2 • Issue 6 • 1000157
J Community Med Health Educ
ISSN: 2161-0711 JCMHE, an open access journal
Citation: Singh S, Badaya S (2012) Factors Inuencing uptake of Cervical Cancer Screening among Women in India: A Hospital based Pilot Study.
J Community Med Health Educ 2:157. doi:10.4172/2161-0711.1000157
Page 3 of 6
Variables Distribution Within Sample, nReceived Pap Odds Ratio CI 95% P Value
Age
> 45 114 18(15.78)
≤ 45 698 104(14.89) 1.07 0.59-1.90 0.77
Literacy
Illiterate 377 60(15.91) 1.13 0.76-1.70 0.55
Literate 435 62(14.25)
Occupation
House wife 315 51(16.19) 1.15 0.76-1.74 0.48
Working 497 71(14.28)
Parity
Parous 735 116(15.78) 2.21 0.94-5.22 0.06
Nulliparous 77 6(7.79)
Socio-economic
L-LM 612 99(16.17) 1.48 0.89-2.48 0.11
UM- U 200 23(11.50)
Resident
Urban 367 62(16.89) 1.30 0.87-1.95 0.20
Rural 445 60(13.48)
Religion
Hindu 741 115(15.51) 1.68 0.71-4.11 0.22
Non Hindu 71 7(9.85)
Table 2: Socio-demographic variables Associated with Receipt of Pap Smear.
*All the data in parentheses are in percent
Table 3: Variable distribution among urban and rural population.
Variables Distribution Within Sample, nReceived Pap
Rural Urban Rural Odds Ratio CI 95% P Value Urban Odds Ratio CI 95% P Value
Age (years)
≤ 20 9 16 1(11.11) 11(6.25) 1
21-30 138 164 21(15.21) 0.69 0.03-6.04 126(15.85) 0.35 00.01-2.75 0.47
31-40 180 111 25(13.88) 0.77 0.03-6.60 120(18.01) 0.30 0.01-2.42 0.46
41-50 82 51 6(7.31) 1.58 0.06-16.97 0.53 11(21.56) 0.24 0.01-2.12 0.26
> 50 36 25 9(25) 0.37 0.01-3.82 0.65 2(8) 00.76 0.02-12.47 1
Education
No schooling 267 110 37(13.85) 123(20.90) 1
Primary school 53 31 6(11.32) 1.26 0.47-3.53 0.82 5(16.12) 1.37 0.43-4.59 0.79
High school 79 131 13(16.45) 0.87 0.39-1.72 0.58 22(16.79) 1.31 0.65-2.63 0.50
> High school 46 95 6(13.04) 1.07 0.39-3.03 110(10.52) 2.24 0.95-5.4 0.05
Age at marriage (years)
< 18 307 181 42(13.68) 135(19.33) 1
≥ 18 138 186 20(14.49) 0.93 0.50-1.73 0.88 25(13.44) 1.54 0.85-2.80 0.15
Religion
Hindu 415 326 61(14.69) 154(16.56) 1
Non Hindu 30 41 1(3.33) 4.99 0.70-100.44 0.100 6(14.63) 1.15 0.43-3.23 1
Parity
Nulliparous 33 44 2(6.06) 13(6.81) 1
Parous 412 323 60(14.56) 0.37 0.06-1.68 0.29 57(17.64) 0.34 0.08-1.20 0.08
Socio-economic
Upper 0 7 0 2(28.57) 0.55 0.09-4.28 0.61
Middle- upper middle 86 107 9(10.46) 1.48 0.66-3.37 0.38 12(11.21) 1.75 0.85-3.68 0.11
Low-low upper 359 253 53(14.76) 146(18.18) 1
Income
≤ 979 7 5 1(14.28) 12(40) 1
980-2935 143 127 23(16.08) 0.87 0.03-7.95 125(19.68) 2.7 0.29-21.62 0.27
2936-4893 156 105 17(10.89) 1.36 0.05-12.80 0.56 15(14.28) 4 0.42-33.42 0.17
4894-7322 58 59 10(17.24) 0.80 0.03-8.30 110(16.94) 3.26 0.32-29.45 0.23
≥ 7323 81 71 11(13.58) 1.06 0.04-10.71 18(11.26) 5.25 0.51-49.29 0.12

Volume 2 • Issue 6 • 1000157
J Community Med Health Educ
ISSN: 2161-0711 JCMHE, an open access journal
Citation: Singh S, Badaya S (2012) Factors Inuencing uptake of Cervical Cancer Screening among Women in India: A Hospital based Pilot Study.
J Community Med Health Educ 2:157. doi:10.4172/2161-0711.1000157
Page 4 of 6
(Greek and Ayurvedic medicine practioners) and 23.2% reported self
or no treatment prior to the visit to this center. “Usually the health
workers don’t tell us from what we are suering and we cannot read
and understand the prescription due to illegible handwriting and
English language”.
Women knowledge on Pap test
Participants were asked, had they ever heard of pap test, from
whom they got the knowledge regarding the test, purpose of pap test,
their previous pap test result, had they under gone test prior to their
marriage. 15.02% of the participants who received Pap test prior to this
visit reported it as “kaanch ki patti wali test (glass slide test)”. 15.02%
of the participants who once undergone the test knows about the test
from health care providers. 28% and 24% of the participants responded
the purpose of test for knowing cause of excessive vaginal discharge
and infertility, infection respectively and rest of them don’t know the
purpose of the test. None of them reported exact purpose of the Pap
test. Out of 15.02% participants who previously received Pap test,
9.97% reported ‘gaath’ (tumor) in their report and rest of them had
no idea of it. Not a single respondent had under gone Pap test prior to
marriage.
Cultural construct about cervical cancer
Some respondents perceived the illness as a “traditional” disease.
On describing symptoms like excessive vaginal bleeding many
explained it as a normal phenomenon of menstruation with some
bleeding excessive and some less. On inquiring for late reporting to
the hospital some participants argued “illness in females is “traditional”
which every women have to face and elderly women in community says
that it could be get rid by self medications prepared at home so what’s
the need to go to doctor to waste money and time”. Many reported
“due to custom and cultural boundaries we are not allowed to go
outside alone without any male members of the family and it is very
embarrassing if to get examined of the private part by the male doctor”.
Economic factors and male partner inuences
Male partner were sole decision maker of the family in 47.20%
women as compared to 27.20% of cases where both partners were
involved. Male is the sole nancial controller in the family. “Our
partners are the ones who have control over the family pocket. Asking
money from them is very troublesome. Having illness of private part
let him thinks that I cheated him” Money is an imperative factor
inuencing the health seeking behavior, “Hospital is very far from my
home so it takes a very long time and cost a lot for it and undergoing
dierent tests. Meeting daily needs are more crucial; preventive
care and detecting cervical cancer is not the priority”. 73.65% of the
respondents were using clothes instead of tampons or sanitary pads
during menstruation.
Health services factors
ere was a great concern regarding the wastage of time, “Waiting
time is too long in the hospital which spoils whole day for getting
one’s turn”. “It is very problematic to reach the consultancy room to
seek physician and fee counter to pay for the consultancy and testing.
We don’t know where to go in such a big OPD and a lot of time goes
in searching the exact place”. Negative perception is there towards
healthcare providers and health facilities. “Health care provider behaves
rudely. If I am having money they give better response and time to you
otherwise not. We always have doubt especially in cleanliness of the
materials used in the process”.
Discussion
Our study revealed a greater rise towards a particular class of women
among each specic components of socio-economic-demographic
prole viz married, parous, low socioeconomic group, less educated,
early marriage, and residing in urban setting involving the screening
facility users. Social factors of cost incurred, educational background,
and cultural issues of modesty and embarrassment contributed deeply
to the screening attendance [14].
Knowledge was low among the participants regarding cervical
cancer and Pap smear screening. ere are no awareness campaigns and
programs regarding disease prevention similar to eective enthusiastic
campaigns against the HIV/AIDS, malaria and tuberculosis. Older
ladies and family are still being the major reservoir of the health
knowledge in Indian society.
Women from higher socioeconomic class, higher educated and
with high family income were very low during the questionnaire. As
the study depicts, women were not satised with the health services
regarding to time consumed up to consultancy, material used and their
cleanliness in government hospitals, as also raised in other studies [15].
One of the main predictor of satisfaction with the service were the
behavior of the sta and the facilities at the centre [11,16-19] which
being unsupportive may even deter these women from attending
public health facilities demanding approach to private health facilities
where 80% of the India’s annual cervical smear is done [5].
Utilization of screening services was found directly proportional
to parity of the women [20,21] indicating that previous contacts with
reproductive health services in their earlier parity (in the form of
gynecological checkups) may increase awareness among women to
be more responsive towards health workers and facilities and getting
Table 4: Independent t test for ever received Pap test among Rural and Urban groups.
Differences
t(160)
Sig.
(2-tailed)
Variables
Mean
Std.
Deviation
Std. Error
Mean
95% condence interval of differences
Lower Upper
Age (Years) Rural 36.97 10.74 1.47 34.01 40.29 1.54 0.12
Urban 33.82 10.38 1.40 31.60 36.37
Age at marriage (Years) Rural 16.08 4.08 0.56 15.27 17.38 1.93 0.05
Urban 17.66 4.34 0.58 15.84 17.83
Parity Rural 3.28 1.60 0.21 2.82 3.74 1.78 0.07
Urban 2.68 1.87 0.25 2.26 3.05
No of times Pap received previously Rural 1.71 1.13 0.15 1.4 2.02 2.28 0.024
Urban 1.31 0.62 0.08 1.15 1.48
Time of last Pap received Rural 12.79 15.72 2.15 8.54 17.04 1.67 0.096
Urban 19.10 22.63 3.05 12.84 24.88

Volume 2 • Issue 6 • 1000157
J Community Med Health Educ
ISSN: 2161-0711 JCMHE, an open access journal
Citation: Singh S, Badaya S (2012) Factors Inuencing uptake of Cervical Cancer Screening among Women in India: A Hospital based Pilot Study.
J Community Med Health Educ 2:157. doi:10.4172/2161-0711.1000157
Page 5 of 6
screened opportunistically [12]. Strikingly all the participants were
married which is consistent with the ndings from others in India and
other low resource settings [12,17,21-23]. It is explainable with the fact
that unmarried women may not be feeling themselves to be at the right
stage for reproductive health facilities [18] or relatively raised need for
frequent obstetrics and gynecology care and increased recommended
tests for reproductive symptoms only for married had overshadowed
the data [12,24]. Also, associated stigma due to the prevailing cultural
disbelief especially in rural India as these tests are meant for sexually
active women forces them to retreat screening [12,23,25].
India is still a patriarchal society where males are the sole decision
maker in the external, economic and social aairs of the family
signicantly in rural areas. Here females are not freely allowed to go
outside alone without male members, thus being as gate keepers for
women to access health services [11,19]. Study from India suggest,
despite the social stigma attached to the screening for unmarried
women they approached to the screening centers, by encouraging
males to promote female participation through community leaders,
irrespective of their marital status [12]. us an eective program needs
to target both genders. Women with less education were found more
likely to be screened, a nding that is inconsistent with the previous
studies [12,20]. Previous studies on relation between socioeconomic
factors and use of health services had shown educational inuences on
screening behavior through its eect on income [26-27].
Education and socioeconomic status decides the living standard of
a person and chances of getting the disease through use of cloths rather
than sanitary napkins which may prone them for genital infections
[28,29]. Women who ever had an STI requires a gynecological
examination so a smear may have been taken as part of the consultation
regarding STI [21,30]. Although rural women were less educated,
underserved but nancially stronger, frequency of getting ever
screened was higher among urban women as compared to rural [31-
33]. is strengthens the hypothesis which advocates being farer away
from hospital may decline access to the health facilities, proved in
other studies too [31-36], since some level of opportunistic cytology
screening are mainly available in tertiary care centers of urban areas
[5] leading to accessibility being easier for urban women despite of low
family income [8]. is nearness may be a major predictor diluting the
disparity of income between urban and rural being [21] as travelling to
hospital kills a lot of time and wages in our and previous studies [24].
Study reveals that early marriage was associated with higher
frequency of being screened with majority (58.99%) of the women
married earlier than 18 years the legal age of marriage in India. Early
marriage prone to have early rst coitus [37] and have young age of
rst pregnancy leading to have more years to become pregnant and
for multiple times [27] which may lead to frequent visit of this women
to reproductive health facilities and greater chance to get screened for
cervical cancer in an opportunistic setting [23].
Cultural beliefs and custom barriers faced by women let her shy to
discuss their problems and getting examined by the male doctors which
could have lead to decreased ever received of pap in women especially
muslims [17,18]. Training of village health nurses could be done, as
being trained nurses are able to identify a cervical abnormality and to
take an adequate pap smear [38] to overcome the cultural barrier of
being get screened by males [19] as patient feels better to get screened
by female [17,18,39].
Economic constraints prioritizes women towards nancial and
social responsibilities and self neglect [15,10] towards their health issues
by curtailing their expenses in the form of time and money in visiting
far to the screening health facilities [40] mainly available in tertiary
care centers [8]. As the most untouched population is being rural and
availability of facility in their society would increase the compliance to
get screened [18,39,41]. Self remedies and self medication, inuence
of local Gods [42], disbelief in healing power of modern medicine
and inuence of medical quacks on the socio-cultural aspects of the
society [18] and their life poses a drastic ill eect in the course of cancer
diagnosis and treatment. Sacricing attitude of the Indian women
are their hall mark worth of the image in the world but render them
susceptible to malnutrition, infection and thus can lead to cervical
cancer.
us our study contributed towards the much needed lag in the
knowledge of cervical cancer, its screening with the socio-demographic
prole of the women participated and their belief towards the disease
and the health care system which had been decient in our literature
specially from developing countries. us, this pilot study can be
instrumental for a larger future studies to be undertaken to target much
implementative and cost eective measures to make a change in their
beliefs and knowledge.
Limitations
As this is a single hospital based study, with its some part memory
based, so a recall biased could be anticipated.
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Volume 2 • Issue 6 • 1000157
J Community Med Health Educ
ISSN: 2161-0711 JCMHE, an open access journal
Citation: Singh S, Badaya S (2012) Factors Inuencing uptake of Cervical Cancer Screening among Women in India: A Hospital based Pilot Study.
J Community Med Health Educ 2:157. doi:10.4172/2161-0711.1000157
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