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KNOWLEDGE, ATTITUDE AND
PRACTICE REGARDING ORAL CANCER
AND SCREENING PROCEDURES
AMONG PRIMARY HEALTH CARE AND
COMMUNITY HEALTHCARE WORKERS
OF WAGHODIA, GUJARAT
BAFNA HARSHAL P *, AJITHKRISHNAN CG**, KALANTHARAKATH THANVEER***, RICKY PAL SING*, HEMAL PATEL****
ABSTRACT
Background: India has the highest rate of oral cancer in world and there is a 60% rise in past three decades. Mortality
rate for oral cancer is higher in population with poor access to oral health care. With 72% of Indians residing in rural
areas they have a better access to community health care providers (CCPs) and primary health care providers (PCPs)
who, could play a major role in oral cancer prevention and reduce death rate.
Objectives: The study aimed at evaluating knowledge, attitude and practice regarding oral cancer and screening
practices among CCP's and PCP's by using pretested questionnaire.
Material and Methods: A cross sectional questionnaire study was conducted among all CCP's and PCP's of Waghodia,
Vadodara. A self designed, modified close ended and pre-piloted questionnaire was used for recording data. Mean and
percentage were used for statistical analysis.
Results: 78.24% believed that prevention and early detection was important, while 53% had actually referred cases in
past one year. All believed tobacco to be a risk factor for oral cancer but only 49% answered for other factors. 91.37%
were ready to be a part of continuing education (CE).
Conclusion: The participants had deficient knowledge about the risk factors for oral cancer and were ready to
participate in CE.
Key-words: Oral Cancer, Health Care Workers, Gujarat
Received: 12-11-2013; Review Completed: 22-01-2014; Accepted: 13-02-2014
ADDRESS FOR AUTHOR CORROSPONDENCE : DR. , PHONE: 8469048732BAFNA HARSHAL P
20
Original Article
*P.G. STUDENT, **PROF. & HEAD, ***PROFFESOR, ****SR.LEC, DEPT.
DEPT. OF PUBLIC HEALTH DENTISTRY, K.M. SHAH DENTAL COLLEGE
INTRODUCTION:
The World Health Organization reports a
worldwide death toll from tobacco use to be four
million per year. The death toll is expected to rise to
[1]
ten million per year by 2020's or early 2030's.
Tobacco is thought to be one of the most important
etiological factors in development of oral cancer.
India has the highest rate of oral cancer in the world
with a 60% increase in past three decades and no
improvement in the mortality rate has been seen
[2]
during this period.
Oral cancer is a disease with known high risk factors
and an asymptomatic phase with identifiable
clinical features. The mortality rate for oral cancer
is higher in population who traditionally experience
[3]
poor access to the oral health care system. Also
unfortunately, for a large segment of high-risk
individuals, access to dental care is limited where
dental surgeons can help to identify these
individuals and provide necessary treatment. About
those residing in rural areas, they have a better
access to non dental CCPs and PCPs. Therefore,
CCPs and PCPs could play a major role in
prevention of oral cancer and reducing death toll
owing to oral cancer. One way to achieve these
goals is to develop a network of dental and other
healthcare providers to promote the early screening
The Journal of Ahmedabad Dental College and Hospital; 5 (1), March 2014 - August 2014
of oral soft tissue lesions that may be pre-cancerous
[4]
or cancerous.
India has a population of 1.21billion and with 72%
[5] [6]
of the Indian population residing in rural areas, ,
the government has implemented various rural
health strategies and national programmes through
Primary and community health care centres,
National Cancer Control Programme (NCCP) being
one of them. Lack of such a network with regards to
oral health care practices in India and unavailability
of oral health professionals to provide on site basic
oral health services discourages further the
[7]
integration of oral health services in these centres.
Thus it becomes necessary for these health care
workers to play a role in oral cancer prevention and
therefore the present study was proposed to assess
the knowledge of oral cancer, attitude towards it
prevention and screening practice of oral cancer
among CCPs and PCPs Waghodia Taluka,
Vadodara, Gujarat.
MATERIAL AND METHODS:
Ethical approval was obtained from the Institutional
Ehics committee. Permissions were obtained from
the Chief District Health Officer (CDHO) of
Vadodara district and the Block Health Officer of
Waghodia Taluka to conduct the survey at the
primary and community health care centres of
Waghodia taluka. The purpose and procedure of the
study was informed to each participant and
participant information sheet was provided to them.
Also informed consent was obtained from each
participant who was willing to participate in the
study.
A pilot study was conducted in the beginning for
testing of validity and reliability of the developed
questionnaire among four Experts and four
respondents. The medical officers were considered
as experts while the other staff members were
BAFNA HARSHAL KAP regarding Oral Cancer among PCP's and CCP's et. al. :
21
considered as respondents and four from each were
chosen randomly by lottery method as participants
for pilot study. The validity of questionnaire using
Concurrent Validity method was 90.3. The
reliability results obtained by test – retest was
89.92% which showed a high agreement.
The sampling frame included all Medical officers,
staff nurses, health workers, health educator, and
health assistants working at these centre's during the
study period i.e. from June 2012 to August 2012
which constituted a total of 85 subjects. The
individuals who were not willing to participate in
the study or were absent at the centre during three
consecutive visits were excluded from the study.
For each health care centre the questionnaire was
administered on first day of visit and recollected on
the second day by the principal investigator himself.
The participants who were absent on the first day of
visit were contacted over the phone and a later date
was fixed with them for the questionnaire fill up. All
the absent individuals responded in the first call.
Data was collected with the help of a self designed,
modified close ended & pre-tested questionnaire
used in English and Gujarati language. The Gujarati
version was validated by back translation method.
The questionnaire consisted of six, four and five
questions pertaining to knowledge of Oral cancer,
screening practice of Oral cancer and attitude
towards Oral cancer prevention respectively.
The data was analyzed using Descriptive statistical
analysis i.e. percentage in Microsoft Excel 2007
spreadsheet.
The Journal of Ahmedabad Dental College and Hospital; 5 (1), March 2014 - August 2014
RESULTS:
As seen in Table 1 participants had a good level of
knowledge regarding oral cancer prevalence, its
ability to metastasize and its life threatening
potential.
Table 1: Table showing knowledge of participants
regarding oral cancer
Table 2 shows that participants had good level of
knowledge about different methods for detection of
oral cancer but only less than half had actually
referred patients for suspicious oral cancer cases in
past 12 months. A larger no agreed that health care
providers needed more education about oral cancer
screening.
Table 2: Table representing knowledge of oral
cancer screening among the participants
The participants had a positive attitude towards
prevention of oral cancer development, while a
larger number believed that its early detection could
help in successful treatment of the patient (Table 3).
As seen in Fig.1 and Fig.3 participants had good
knowledge about different types of oral cancer and
the signs and symptoms of oral cancer but a fewer
participants (Fig.2) were aware of different
causative agents responsible for oral cancer
development.
Figure 1: Distribution of subjects according to their
knowledge regarding different types of oral cancer
Figure 2: Distribution of subjects according to
knowledge regarding different causes of oral cancer
Sr.no Question Yes No Total
1. Occurrence of oral cancer
is common in India 90.59%
(N=77)
9.41%
(N=8)
100%
(N=85)
2.
Oral cancer can metastasize
87.05%
(N=74)
12.95%
(N=11)
100%
(N=85)
3 Oral cancer is life
threatening disease. 85.88%
(N=73)
14.22 %
(N=12)
100%
(N=85)
Sr.no Question Yes No Total
1. Awareness regarding different methods for
detection of oral cancer
65.88%
(N=56)
34.22%
(N=29) 100%
(N=85)
2. Referral of patients to dental specialist for
suspicious oral cancer cases in last 12 months
41.17%
(N=35)
58.83%
(N=50) 100%
(N=85)
3. Ability to detect oral cancer
78.82%
(N=67)
21.18%
(N=18) 100%
(N=85)
4. Health care providers needed more education
about oral cancer screening. 78.82%
(N=67) 21.18%
(N=18) 100%
(N=85)
Sr.no Question Yes No Total
1. Early detection can lead to
successful treatment of oral cancers 98.82%
(N=84)
1.18%
(N=1)
100%
(N=85)
2.
Oral cancer develops by chance and
nobody can do anything to prevent it. 41.17%
(N=35) 58.83%
(N=50) 100%
(N=85)
BAFNA HARSHAL KAP regarding Oral Cancer among PCP's and CCP's et. al. :
22The Journal of Ahmedabad Dental College and Hospital; 5 (1), March 2014 - August 2014
Figure 3: Distribution of subjects according to
knowledge regarding sign and symptoms of oral
cancer
Figure 4: Attitude of participants towards
prevention of oral cancer
The subjects (Fig.4) were willing to participate in
educational courses related to screening of oral
cancer, and become a part of organized networks
promoting oral cancer screening. Also they believed
that strict laws should be introduced against the sale
of to bacco.
DISCUSSION:
Oral cancer is on the increase with incidence rates
[7]
having doubled over the last ten to 15 years. The
death toll is expected to rise to ten million per year
[1]
by 2020's or early 2030's. Prevention of oral
cancer, and reducing cancer-related burden and
deaths could be achieved by an integrated program
that involves health care providers, health care
organizations, the government at various levels, and
the public.
The present study was conducted to assess the
knowledge of oral cancer, attitude towards it
prevention and screening practice of oral cancer
among CCPs and PCPs of Waghodia, Gujarat. This
study, concerning oral cancer, was the first of its
kind among the health care workers of Waghodia
who comprised of a total of 85 in number.
Out of 85 workers, 77 (90.59 %) answered that oral
cancer was commonly occurring among the Indian
population which is consistent with oral cancer
prevalence data provided by IDA (Indian Dental
[2]
Association), suggestive of good awareness
among the PCP's and CCP's.
A high percentage of workers i.e. 73 (85.88 %),
agreed to the statement that “oral cancer is a life
threatening disease” and a similar number of 74
(87.05%) agreed that oral cancer could spread to
other parts of the body. A total of 84(98.82 %)
workers believed that early detection of oral cancer
could help in successful treatment of such cases,
this could be the reason that all the 85 subjects were
willing to participate in educational courses related
to screening of oral cancer and similar number of
individuals 81(95.29%) were ready to participate in
established or organized networks to promote
screening of oral cancer. These findings are in
agreement with those of Kumar M and Macpherson
[3], [7]
LMD et al.
Of the 85 workers 78 (91.77 %) answered correctly
that oral cancer included cancer of lips, cancer of
tongue and cancer of other parts of mouth and
oropharynx. While a similar no. of subjects 63
(74.11%), answered correctly that oral cancer
BAFNA HARSHAL KAP regarding Oral Cancer among PCP's and CCP's et. al. :
23The Journal of Ahmedabad Dental College and Hospital; 5 (1), March 2014 - August 2014
presented with swelling, redness and ulceration of
the overlying tissue which could also be associated
with pain. But the lack of clinical skills relating to
oral cancer screening practices was evident from
the fact that out of 85 workers, only 56 (65.88 %)
agreed that they were aware of different methods for
detection of oral cancer while a similar no. of
subjects answered that they could identify oral
cancer clinically if they would come across the
same. This could also be the reason that only
35(41.17 %) subjects had referred patients to a
dental specialist for suspicious oral cancer cases in
past 12 months. These results are in agreement with
those of Kumar M. These findings justify the
agreement of high percentage 67 (78.82 %) of
subjects for the provision of education about oral
cancer screening to health care providers.
All of the 85 subjects believed that tobacco use was
the one of the major cause for development of oral
cancer while 81(95.29%) agreed that strict laws
should be introduced against the sale of tobacco.
This response, if reflected onto the other health
workers of Gujarat state government, can justify the
recent efforts of Gujarat government to bring about
a ban on sale of Gutkha in September 2012 to
become a “Tobacco Free State”.
These findings suggest that interventions such as
clinical training for oral cancer screening must be
provided to these health workers. It is also
recommended that they be provided with detailed
information of aetiology and precipitating factors of
oral cancer. These goals could be achieved by
introducing professional regulations, interactive
[9]
workshops and educational outreach visits.
Furthermore it is also suggested that a centralized
network of health workers and Dentists should also
be established at both, state and national level to
reduce the burden of oral diseases, especially oral
cancer and thus increase the efficiency of
programmes such as NCCP undertaken by the
government.
CONCLUSION:
A high percentage of participants had good
knowledge related to oral cancer types, sign &
symptoms of oral cancer and oral cancer prevalence
but a lesser percentage was correct about oral cancer
screening, highlighting the deficient clinical
experience of the participants. Also the participants
had good attitude towards oral cancer prevention
and were ready to be a part of Continuing Education
programme.
REFERENCES:
1. The Oral Cancer Foundation available at
http://www.oralcancerfoundation.com
accessed on 16th Jun, 2011.
2. Oral Cancer available at http://www.ida.org.in,
accessed on 16th Jun,2011
3. Kumar M, Prashant GM, Chandu GN.
Knowledge of oral cancer and screening
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Davangere district, Karnataka. Journal of
Indian Association of Public Health Dentistry.
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4. Sohn W, Ismail A, Kolker. Knowledge of Oral
Cancer and Screening Practices of Primary
Care Providers at Federally Qualified Health
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5. Bulletin on Rural Health Statistics in India
March-2003. Issued by infrastructure division,
Dept. of Family Welfare, MOH & FW, Nirman
Bhavan, New Delhi.
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6. Sequeira P, Anup N, Srinivas P. A KAP Study on
Dental Health in Anganwadi Workers. Indian J
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in primary care nursing centres: opportunities
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8. Macpherson LMD, McCann MF, Gibson J,
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Binnie VI and Stephen KW. The role of primary
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9. Sohn W, Ismail A, Tellez M. Efficacy of
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25The Journal of Ahmedabad Dental College and Hospital; 5 (1), March 2014 - August 2014
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