Prevention of Cervical

Cancer through health

behaviour change

Group members:
Prithi Singh
Tandeka Barton
Fauzia Khan
Melissa Ramdeen

University of Guyana
Health Behaviour
MPH 6104
Lecturer: Dr. Paloma Mohamed
3 April 2016

Outline of Presentation

Definition

Global and local context

Health Belief Model

Social Cognitive Theory

Diffusion of Innovations

Persuasion of Communication Theory

Actions to date

Conclusion

What is cervical cancer?

a malignant neoplastic disease which tends to

begin slowly whenever there is disruption of the
cervical epithelium found near the
squamocolumnar junction of the uterine cervix.

abnormal cells usually multiply rapidly in tissue

thereby usually exhibiting no signs and
symptoms of cervical cancer but can be
detected through early screening

Cervical cancer
instances when there are signs and
symptoms it is usually in the form of vaginal
bleeding and pelvic pain
detection and diagnosis
- examination of the cervix through various
tests
Screening:
Visual Inspection using Acetic Acid (VIA)
Pap smears

Risk Factors

cervical cancers are virtually associated

with the human papilloma viruses (HPV);
however, the majority of women with HPV
do not develop cervical cancer.

HPV is the major risk factor for cervical

cancer

Risk Factors
There are multiple factors involved in cervical
cancer etiology:
low socio-economic level
early age at first intercourse
multiple sex partners
early age at first pregnancy
use of hormonal contraceptives
smoking

Why a Public Health problem

WHO estimated that without intervention 84 million people

will die of cancer between 2005 and 2015

Low-income and medium-income countries are harder hit by

cancer than the high-resource countries

Majority (around 85%) of the global burden occurs in the less

developed regions, cervical cancer accounts for almost 12%
of all female cancers

Number of cancer deaths in the Americas is projected to

increase from 1.3M to 2.M between 2012 and 2030

WHO estimates

Guyana

Cancer was the third leading cause of death

between the periods 2008 to 2012
Cumulative incidence rate for females were 1,054.4
while for males it was 681
Two thirds of all cases were in women below 60
years with incidence peaking in 15-39 years age
group
Nearly 1/5 (1,268) of cancers were in persons older
than 75 years of age and the second most affected
age group were persons aged 15 39 years with
597 (11%) of cancers

Source: WHO 2014: Guyana Cancer Mortality profile

Out of 300 female deaths, 20.9% were from

cervical cancer as shown below

Source: WHO 2014: Guyana Cancer Mortality profile

Public Health Approach

Primary prevention - avoiding exposure to the
agents that directly cause cervical (HPV)
Vaccine against HPV has shown to be effective for
the prevention of cervical cancer but it is
controversial because of the fact that it must be
given to young girls before they become sexually
active

primary prevention early detection

screening
Treatment

Health Belief Model

Constructs:
perceived susceptibility
perceived seriousness
perceived benefits
perceived barriers to behaviour
cues to action
most recently factor of perceived self-efficacy
To mitigate against cervical cancer or promote
the adaptation of prevention of cervical cancer

Application of HBM
Construct
Application
Define population(s) at risk and levels of risk
Perceived
Susceptibilit Modify risk information based on individual
y
characteristics or behaviours

Perceived
Severity

Support individuals to develop accurate

perceptions of own risk
Identify consequences of risks and conditions
and recommended action

Perceived
Benefits

Define action and explain how, where, and

when to take action
Clarify potential positive results

Application of HBM
Construct
Perceived
Barriers
Cues
Action
SelfEfficacy

Application
Offer reassurance, incentives, and assistance

Correct misinformation
to Make available how-to information
Promote awareness
Use appropriate reminder systems
Provide training and guidance in performing
action
Use progressive goal setting
Give verbal reinforcement
Demonstrate desired behaviours
Reduce anxiety

HBM

states that individuals are more likely to adopt

cancer screening behaviours when they believe that
they are at-risk for those cancers and the cancer is
severe enough to warrant preventive action

individuals with more self-efficacy are more likely to

get a Pap smear or be vaccinated with HPV vaccine
because they believe that it will prevent the
adverse outcome of cervical cancer

HBM

SCT

Focuses on cervical cancer prevention activities at the

interpersonal level which contains formal (and informal)
social networks and social support systems that can
influence individual behaviours, including family, friends,
peers, co-workers, religious networks, customs or traditions
Individual behavior change is facilitated by affecting social
and cultural norms and overcoming individual-level barriers
Friends, family, health care providers, community health
workers, and patient navigators represent potential sources
of interpersonal messages and support

SCT constructs
Application
Behaviour serving as a social prompt is the
Behavioral
health care worker demonstrating vaccination
Capability
will prevent illness
Media campaigns to promote screening and
vaccination
Reciprocal
Determinis Skits enacting real life situations of being
m
screened and vaccinated against cervical
cancer
Willingness of community members to
intervene in order to help others is useful in
bringing people together and mobilizing them
Emotional
into action.
Coping
Responses Development of group activities that allow
individuals to get to know each other better
increases confidence to get screened or
vaccinated
Construct

SCT constructs
Application
Huge goal of administering HPV vaccines to all
population at risk is broken down into smaller
Self-Efficacy
measurable steps. Allows recognition and
celebration of small successes along the path
to larger behavior change.
HCW making screening recommendations to
their patients, patients receiving reminders
Collective
about the need for screening/vaccination,
Efficacy
community leaders and others helping to
remove logistical and other barriers to
screening
Role models who are cervical cancer survivors
and willing to share their experiences, offer
Observationa
messages of empowerment, optimism and
l Learning
success as the result of early diagnosis and
screening and serve as a local resource. They
can advocate for use of HPV vaccines.
Construct

SCT constructs
Construct
Incentive
Motivation
Facilitation
SelfRegulation
(Self-Control)

Application
Reducing costs of Pap smears, making tests
equitable
Screening and vaccination conducted in
outreach campaigns
Self-monitoring, goal-setting, feedback, selfreward, self-instruction, and enlistment of
social support
Screened or vaccinated in a large group

Moral
Disengageme
nt

Emphasize on right of being healthy by using

prevention techniques (screening,
vaccination)

SCT

DOI

Takes

a radically different approach to most

other theories of change

Sees

change as being primarily about the

evolution or reinvention of products and

behaviours so they become better fits for
the needs of individuals and groups

DOI constructs
Construct

Application

Diffusion

Disseminate messages for getting vaccinated

through schools, churches

Disseminatio Disseminate information about screening

n

practices and benefits, evidence about its

effectiveness to affect adoption decisions

Innovation

Decisions about innovations often are made

partly on the basis of desirable status of being
healthy and prevention of HPV

Communicati Messages that differentiates among the

on Channels

individuals within communities such as

hinterland areas

DOI constructs

Construct
Social
System

Application
Early involvement of partners who will
distribute, provide access to, and refer potential
adopters to cancer screening programs
Small group of influential persons are looked to
by large numbers of others for cues to action
and inaction

Innovation

Confirming the prior positive adoption decisions

Developmen

by individuals during the subsequent stages of

innovation implementation and routinization

positively impacts slows the rate of innovation
for screening programs

DOI constructs

Construct Application
Adoption Most individuals are highly attuned to social
norms concerning the use of screening
techniques; when they perceive that the norms
of their immediate reference group--both real
and mediated social modelssupport adoption,
they adopt, especially in hinterland communities
Grassroots outreach programs that promote
early detection of cervical cancer. Health
workers, who may or may not be cancer
survivors, serve as educational and health
service resources

DOI constructs
Construct
Application
Implementati Establishing a decentralized support system
on

for health workers to share tacit solutions to

implementation problems improves
implementation, especially in remote areas

Maintenance Recruit and train community members

Maintain relationships with regular
feedback
Sustainabilit Emphasise the risks of being exposed to
y

cervical cancer
Maximise their familiarity with screening
techniques

DOI constructs
Construct
Application
Institutionalizati Advocate for cost-effective interventions
on

for cervical cancer prevention.

Develop and apply new evidence-based
policies to scale up cervical cancer
screening and treatment, in order to
have an impact on chronic disease
prevention and control

DOI factors
Factors that influence adoption of an innovation

Relative Advantage (degree to which an innovation is seen

as better than the idea, program, or product it replaces)

Compatibility (how consistent the innovation is with the

values, experiences, and needs of the potential adopters)

Complexity (how difficult the innovation is to understand

and/or use)

Triability (extent to which the innovation can be tested or

experimented with before a commitment to adopt is made)

Observability (extent to which the innovation provides

tangible results)

Communication for Persuasion

Theory

Developed by social psychologist William McGuire and

basically focuses on how people process information

McGuire (1984) highlighted twelve interdependable steps in

the process of persuasive communications

*Persuasion of people by mass media messages

Communication for Persuasion

Theory

concepts to this theory involves how people

process information.

There are five inputs which are the different

aspects of the persuasion/communication
attempt.
-Source i.e. credibility, attraction,

trustworthiness of the sender

-Message i.e. type, strength, repetition of the
argument

Communication for Persuasion

Theory
Channel i.e., the type of media and way in which
the message is broadcast
Receiver i.e., attitude, beliefs, prior knowledge etc
of the person receiving the message
Context i.e., environmental factors, noise, clutter
etc influencing the message

Communication for Persuasion

Theory

Assimilation and Performance of a new

behaviour

(McGuire, 1984; National Cancer Institute and National

Institutes of Health,2002)

Constructs

Application

Exposure

Tuning into the message

screening methods
Risk factors
treatment

Attention

Capture interest

Interest

Personally relevant by
capturing all areas of
interest

Communication for Persuasion

Theory
Construct

Application

Comprehension

Understanding the message

(making it simple to capture all
intellectual levels

Acquisition

Gaining skills on how to act on

the message being delivered and
willing to accept change being
proposed

Agreeing(yielding)

Agreeing with the

message/accepting the change
being proposed (to be screened
early, change risky behaviour

Memorizing

Storing the message /validating

message for later use e.g. where
to go for screening

Communication for Persuasion

Theory
Construct

Application

Retrieving

Retrieving the message from

memory and being able to think
of the message in relevant
contexts or situations

Deciding

Act according to the

message/make decisions on
retrieved information

Acting

Performing the Actions/behave in

line with that decision

Reinforcement

Receiving appropriate
rewards/positive reinforcement
for that behaviour

Consolidation

Integrating the message/new

behaviour into their life

Communication for Persuasion

Theory

Aforementioned twelve steps are interdependent

Achieving any of them is strictly contingent on

success at all prior steps

Message

design,

messenger

credibility,

communication channels, and characteristics of

both the target audience and the recommended
behaviour which should be intended to fit easily in
peoples lives, all influence behavioural outcomes

Communication for Persuasion

Theory

Due to the fact that an audiences

characteristics and needs may change
over
time,
communicators
should
incorporate these changes in message
design and delivery as well as redefine
recommended behaviours in function of
peoples lifestyles and needs.

Conclusion

HPV vaccines are safe and effective, and have achieved

90% of efficacy in preventing cervical pre-cancers in young
women nave to the targeted HPV types
WHO recommends routine HPV vaccination for girls aged 913 years when feasible and sustainable, and where
prevention of cervical cancer on other HPV-related diseases
constitute a public health priority
GAVI Alliance is supporting HPV vaccine in Guyana from
2012 to present
Due to limited awareness of cervical cancer, its relationship
to HPV, and concerns about safe practices, the ideal
strategies for vaccination, screening and increasing
awareness are required that can help us to identify
important steps for awareness, implementation and
availability of HPV vaccination