CHAPTER II

REVIEW OF LITERATURE

Review of literature is a broad, comprehensive in depth, systematic and critical

review of scholarly publications unpublished scholarly print materials, audio visual

materials and personal communications. It is a continuing process in which knowledge

gained from earlier studies is an integral part of research in general. Review of literature

in this study is organized under the following headings.

1. Review of literature related to cervical cancer.

2. Review of literature related to knowledge on cervical cancer.

3. Review of literature related to attitude on cervical cancer.

1. REVIEW OF LITERATURE RELATED TO CERVICAL CANCER:

Jemal et al (2018) there were up to 47,100 new reported cases cervical

cancers and 288000 of these ending up in deaths worldwide. About 80% of these

cases were from developing countries in 2008 there were 529,800 new cases of

cervical cancer that were reported. Accounting for 9% of the world wide cancers and

275,100 deaths making 8% of the cancer deaths. In total 56% for these cases and

64% of the total deaths from developing countries. Differences between the

mortality rates in deneloping countries compared to developed countries is highly

[11]
 notable in the table below, this is due to the response to cervical cancer campaigns

that have been carried out. Women in developed countries are faily expired to much

information, medical facilities and vaccines are available. In developing countries

however the social economic state dose not allow the cervical cancer to be a lead

consideration factor , however some significant decrease in mortality may be redited

to availed cheaper methods of screening.

ACCP(2018) Cervical cancer has continuously been striking hard on the

poorest countries such as central and south America, the Caribean, Sub-Saharan

Africa, some parts of Oceania and Asia with rates as high as 30 per 100000 women ,

compared with North America and Europe that have reports of about 10 per 100,00

cases. approximately 1.4 million women worldwide living with cervical cancer and

India may account for more that one fourth of the total reporting nearly 132,000 new

cases annually. A small population of women from the poor and developed countries

that receive cervical cancer treatments therefore having a window of 7 million

women world wide inclusive of possible precancerous conditions that have not been

identified.

Leyden (2017) cases of invasive cancer were analyzed among members of

seven prepaid omprehensive health plans in the USA diagnosed between 1 January

1995 and 31 December 2000. Medical records were reviewed for the three years

before diagnosis. Demographic charecteristics were independently associated with

the odds of a case being ascribed to failure to screen (patient has no pap test during

[12]
the 4-36 months prior to diagnosis). The study identified these, 24% were age 50-64

and 17% age at diagnosis, older women diagnosis attributed (3.89-10.79).

Bosch&Mounoz(2017) The involvement of HPV in cancers of the vulva, anal

canal, vagina and penis is currently being identified in addition to these, the possible

infectivity of HPV in cutaneous cancer, oral cancers and other cancers of the upper

aero digestive tract is being [Link] humans, specific papilloma virus types

have been associated with over 99% of cervical cancer biopsies (Walboomers et al.,

1999) These are considered the high risk types and include in order of prevalence,

HPV types 16, 18, 31 and 45. HPVs have also been associated with other anogenital

lesions and carcinomas, oral and pharyngeal papillomas and skin lesions in a rare

genetic disorder called epidermodysplasia verruciforms. (EV)

Prussia(2016) Retrospective study in Barbodos to determine the types of

paptest abnormalities and their clinical implications in girls aged 18 and under during

the five year period January 1995 to December 1999. Gynaecological history and

histology reports for these patients were [Link] hudred and sixty-five pap

smears were examined from 236 patients. Of the 236 first – visit samples 94(39.8%)

were abnormal with 58(24.5%) reported as atypical cells of undetermined

significance (ASCUS) 33 (14%) reported as low grade sqamous intra epithelial

lesions (LSIL) and three (1%) reported as high grade squamous intra epithelial

lesions (HSIL) . Twenty two (23.4%) of the 94 patients who had abnormal smears

(either ASCUS or LSIL) were re evaluated within 6-12 months of the initial

[13]
abnormal diagnosis. Eight of these 22 patients (36.4%) had a histological diagnosis of

LSIL, including cervical intra epithelial neoplasia grade 1 (CIN1) ansd ondylomata.

High risk HPV DNA types were detected in two of these eight patients (25%).

Zurhausen(2016) Cancer of the uterine cervix is one of the leading cancer

among women worldwide , with an estimated 520,000 new cases and 274,000 deaths

reported annually (WHO/ ICO) information centre on HPV and cervical cancer–HPV

cervical cancer statistics in India 2010. About 86% of the cervical cancer cases

occur in developing countries, which represents13% of all female cancers

(WHO/ICO) Cervical cncer is subdivided into cervical squamous cell carcinoma and

cervical adenoma carcinoma (Snijders et al., 2006). Majority of the cases of cervical

cancer are squamous cell carcinoma (scc) and adenocarcinomas are rare. Cervical

squamous carcinoma (scc) develops gradually over time from pre- existing non

invasive squamous precursor lesions, also called cervical intraepithelial neoplasia.

(Zurhausen 2016) Papilloma Virus infections in humans are known to cause

a variety of benign proliferations; these includes warts, intraepithelial neoplasia,

anogenital papillomas, oral laryngeal and pharyngeal papillomas.

Lowy et al., (2015) Molecular and epidemiological evidence has now

established that HPV types associated with anogenital neoplasms, including

condylomata, cervical dysplasia and cervical carcinoma, are almost always sexually

transmitted.

[14]
 Bernard et al.,(2015) Papilloma viruses (PVs) are epitheliotrpic viruses and

infect the vertebrates, where they cause neoplasia or exist asymptomatically.

Papilloma virus isolates are identified as ―types‖ when their L1 gene sequence

differs from every other types by atleast 10 percent. the L1 gene is instrumental for

PVs classification , as it is mostly conserved among the PVs , and this is one of the

strong reasons for genom based classification PVs.

(WHO/ICO information centre 2015) In Indian women and about 7.9% of

women in the general population are estimated to harbor persistent HPV infection at

any given time. An estimate suggest number of new cervical cases to increase by the

year 2025 to 2,03,757 and estimated number of deaths in 2025 may be 1,15,171

which is almost 70% increase compared to the existing estimates for persistent HPV

infection.

Bosch et al., Bruchell et al., (2014) After studying cervical cancer patients

from 25 countries reported that HPV types 16 and 18 are detected in more than 70%

of cervical cancer cases. The HPV type 16 prevalance in India is also reported to be

high (70%) ( Das et al ., 2008) where as HPV 18 occurrence differs from 3-20% ,

followed by other high risk type such as HPV 45, 33, 35, 52, 58,59 and 73 (. The

HPV type distribution varies depending on geographical regions and also cultural

variations.

[15]
 Schifman and Castle(2008) Sankaranarayanan et al., (2014) reported that

the cervical cancer and HPV infection prevalence in India indicate that thye

initiations as well as peak of HPV infection occurs at a slightly older age group (26-

35 years ) women , when compared to the global incidence ( peak in 18-25 years ). It

is observed that, while in the developed countries there was significant decrease of

cervical cancer mortality after incorporation effective screening programs, no

reduction in the incidence of cervical cancer was observed during past three decades

in the developing countries.

WHO/ICO (2013) India has a population of 366.58 million women of ages

15 years or older who may be potentially at risk of developing cancer of uterine

cervix. Current estimates indicate that every year approximately 134,000 women are

diagnosed with cervical cancer of which more than half (72, 825) die from the

disease in India. Cervical cancer is the most frequent cancer in India women and

about 7.9% of women in the general population are estimated to harbor persistent

HPV infection at any given time. An estimate suggest number of new cervical cases

to increase by the year 2025 to 2,03, 757 and estimated number of deaths in 2025

may be 1,15,171 which is almost 70% increase compared to the existing estimates

for persistent HPV infection.

[Link] et al (2013) This study provides the first systematic literature review

of cervical cancer incidence and mortality as well as human papilloma virus (HPV)

genotype prevalence among women with cervical cancer in the pacific Island

[16]
countries and territories . the cervical cancer burden in the Pacific region is

substantial , with age standardized mortality rate from 2.7 to 23.9 per 100,000

women per year. The HPV genotype distribution suggest that 70-80% of these

cancers could be preventable by the currently available bi-or quadrivalent HPV

vaccines.

According to Parkin cervical cancer is an important public health problem

for adult women in developing countries. The risk of cervical cancer remains high in

many developing countries mostly due to lack or insufficiency of existing prevention

programmes. This review attempts to give a brief picture about the scenario of

cervical cancer identification and prevention of HPV epidemiology in India.

Shantha (2013) estimated that India has a population of approximately

1.2 billion and accounts for a significant burden of cervical cancer in the Indian

subcontinent. There is an estimated annual global incidence of 5,00,000 cancers , in

that India contributes 100,000 ie., one – fifth of the world burden . A total of 4304

cervical cancer cases were registered during 1982-89 in the Chennai registry, India.

2. REVIEW OF LITERATURE RELATED TO

KNOWLEDGE ON CERVICAL CANCER:

Akshar S et al., (2014) A cross sectional questionnaire based study was

conducted from December 2013 to february 2014 in five primary health clinics

inSharjah, UAE by means of interviews carried out by trained pharmacist with

[17]
proper skills. A total of 212 respondents participated in the study. The sample was

calculated by using the built in STATCAL. The inclusion criteria were married

women with the age between 20 to 60 years old. The exclusion criteria were women

less than 20 years old and not married. All the women who gave informed

consent to participate in the study were included. The response rate was 85%. The

participants score of knowledge and practice. The participants median score on

knowledge was 2.08 on a scale with a maximum of 6 (range 0- 6) . The participants

median score on practice was 3.66 on a scale with a maximum of 9 (range 0-9).

Knowledge level knowledge score range from the lowest score 0 (11.32%) to the

highest score of 6(2.36%) with the normal distribution. Mean (SD)core is

2.23(1.466). Eighty (37.7%) of respondents had a good knowledge score while

132(62.26%) 0f respondents had a poor knowledge score. The correlation between

knowledge and practice was (p=0.038) significant. This finding adds to the growing

body of evidences showing that increased knowledge is automatically translated into

changes in attitude and practices.

[Link] bansal, [Link](2014) Facility-based cross- sectional

study was conducted in an OPD of AIIMS Bhopal during months of March/April

2014. All patients are subjected to anthropometric and blood pressure assessment at

central measurement station before visiting respective departments. Every third

women aged 15-45 reporting to this measurement station was approached for

participation in the study, and verbal informed consent was obtained. Consenting

[18]
women were included in the study and further interview with pretested structured

questionnaire was conducted by one of the investigators. The questionnaire was

comprised of four sections to gather information regarding the sociodemographic

characteristics of the participants, knowledge, attitude, and practice regarding

cervical cancer and its screening. The sociodemographic characteristics included

age, educational status, occupation, marital status, age of marriage, and per capita

family monthly [Link] knowledge was assessed using a 20 points scale

which had ichotomous response, that is, correct and incorrect. Each correct response

was scored as 1 and incorrect as 0. A score 50% (≥10 correct responses) was

considered as optimal. Attitude was assessed by 7 statements regarding cervical

cancer screening and risk factors responses to which were categorized as 3-point

scale Disagree, Neutral, and Agree. Attitude was considered as favorable for

screening if four or more ―Agree‖ responses were obtained. Those who had been

screened for cervical cancer through pap-smear were regarded as having good

[Link] size estimations were based on assumption that 50% women will

have optimal knowledge score (>50%). Therefore, required sample size to estimate

the proportion of women with optimum knowledge score with 95% confidence

interval (CI) of 50% (95% CI 45-55%) 384. Final sample size with 5% nonresponse

rate was [Link] were entered into Epi-info version 7 (CDC, Atlanta). Qualitative

variables were summarized as counts and proportions and numerical variables as

mean and standard deviation. Univariate analysis using Chi-square test and t-test as

[19]
appropriately was done to compare sociodemographic and other factors among

optimal knowledge versus sub- optimal knowledge group, favorable attitude versus

nonfavorable attitude group and takers of the screening test versus nontakers. We

considered P < 0.05 as statistically significant. We performed binary logistic

regression analysis separately to identify predictors of optimal knowledge, favorable

attitude, and good practices. Independent factors for these three models were

statistically significant variables of optimal knowledge, favorable attitude, and good

practices groups on univariate analysis.

Choudhury(2013) Between April 2012 and February 2013, a predesigned,

pretested, self -administered multiple responses questionnaire survey was conducted

among staff nurses’ working in various hospitals of sikkim. Questionnaire contained

information about their demographics, knowledge of cervical cancer, its risk factors,

screening methods, attitudes toward cervical cancer screening and practice of Pap

smear amongst themselves. Overall, 90.4% nurses responded that they were aware

of cancer cervix. Three quarter of the staff nurses were not aware of commonest site

being cancer cervix in women. Of the 320 participants, who had heard of cancer

cervix, 253 (79.1%) were aware of cancer cervix screening. Pap smear screening

should start at 21 years or 3 years after sexual debut was known to only one-third of

the nursing staff. Age was found to be a significant predictor of awareness of Pap

smear screening among nursing staff. Awareness was significantly more prevalent

among older staff (P < 0.007). Married nursing staffs were significantly more likely

[20]
to be aware of screening methods, and nursing staff of Christian and Buddhist

religion were 1.25 times and 2.03 times more likely to aware of screening methods

than Hindu religion respectively. Only 16.6% nurses, who were aware of a Pap

smear (11.9% of the total sample), had ever undergone a Pap smear test. Most

common reason offered for not undergoing Pap smear test were, they felt they were

not at risk (41%), uncomfortable pelvic examination (25%) and fear of a bad result

(16.6%). Knowledge of cancer cervix, screening and practice of Pap smear was low

among Sikkimese nursing staff in India. There is an urgent need for re-orientation

course for working nurses and integration of cervical cancer prevention issues in the

nurses’ existing curriculum in India and other developing countries.

Ali SF et al., (2009) A cross sectional , interview based survey was

conducted in June , 2009 . Sample of 400 was divided betw een the three tertiary

care centres. Convenience sampling was applied as no definitive data was available

regarding the number of registered interns and nurses at each centre. Of all the

interviews conducted, 1.8% did not know cervical cancer as a disease. Only 23.3%

of the respondent were aware that cervical cancer is the most common cause of

gynaecological cancers and 26% knew it is second rank in mortality. Seventy eight

percent were aware that infection is the most common cause of cervical cancer, of

these 62% said that virus is the cause and 61% of the respondent knew that the virus

is human papilloma virus (HPV) . Majority recognized that it is sexually transmitted

but only a minority (41%) knew that it can be detected by PCR. Only 26% of the

[21]
study population was aware of one or more risk factors. Thirty seven percent

recognized Pap smear as a screening test. In total only 37 out of 400 respondents

were aware of the HPV vaccine. This study serves to highlight that ther majority of

working health profeesionals are not adequately equipped with knowledge

concerning cervical cancer. Continuing medical education programme shuld be

started at the hospital level along with conferences to spread knowledge about this

disease.

Sheila,Twin. (2005) conducted a study among chinese women from a total

sample of 467 in order to identify the knowledge about cervical cancer. Evident

suggested that women knowledge about cervical cancer and preventive strategies are

significant their screening practices. The need for further knowledge about the

cervical screening and preventive measure was demonstrated.

[Link], a specialist in gynaecological oncology at Calcutta’s

Chittaranjan National Cancer Institute (CNCI) states that more than 130,000 new

cases roughly one-fourth of the global total are reported in the country every year. In

addition; an estimated 74,000 Indian women die annually from the disease, which

results from the abnormal growth of cells in the cervix. Nationwide, the disease

accounts for an estimated 24 percent of India’s cancer cases among women,

compared with 20 percent for breast cancer.21 India’s National Cancer Control

Program emphasizes the importance of early detection and treatment. But the

country has no organized screening program, and many Indian women lack both

[22]
awareness about the disease and access to prevention and treatment [Link]

factors put poor and rural women at heightened risk for cervical cancer. Evidence

shows that the disease in India is more common among the lower economic strata.

3. REVIEW OF LITERATURE RELATED TO ATTITUDE

ON CERVICAL CANCER:

Matin M, LeBaron S. Our key informants were five Muslim women who

identified pelvic and Pap smear screening exams as major sources of anxiety for

their community, and therefore major barriers to health care. Three focus groups

were then convened, including 15 women ages 18-25, to discuss these issues in more

detail. Many Muslim women from immigrant backgrounds face challenges in

obtaining adequate health care due to some common barriers of language,

transportation, insurance, and family pressures. Additionally, many Muslim women

resist screening practices that are the standard in the US but which threaten

their cultural and religious values. Equally important, many health care professionals

contribute to the women's challenges by making inappropriate recommendations

regarding physical exams and reproductive health. The women were enthusiastic and

candid in discussing these highly sensitive and taboo topics.

Wong LP, Wong YL, (2012) In this qualitative study, in-depth interviews

were conducted with 20 Malaysian women, ages 21 to 56 years, who have never had

a Papanicolaou (Pap) smear. Respondents generally showed a lack of knowledge

[23]
about cervical cancer screening using Pap smear, and the need for early detection for

cervical cancer. Many believed the Pap smear was a diagnostic test for cervical

cancer, and since they had no symptoms, they did not go for Pap screening. Other

main reasons for not doing the screening included lack of awareness of Pap smear

indications and benefits, perceived low susceptibility to cervical cancer, and

embarrassment. Other reasons for not being screened were related to fear of pain,

misconceptions about cervical cancer, fatalistic attitude, and undervaluation of own

health needs versus those of the family. Women need to be educated about the

benefits of cervical cancer screening. Health education, counseling, outreach

programs, and community- based interventions are needed to improve the uptake of

Pap smear in Malaysia.

Zaria (2010) This was a cross-sectional study to evaluate the knowledge,

attitude and practice of cervical cancer screening among market women. A total of

260 women were administered with questionnaires which were both self and

interviewer administered. These were analysed using SPSS version 11. Respondents

exhibited a fair knowledge of cervical cancer and cervical cancer screening (43.5%);

however, their knowledge of risk factors was poor. There was generally good

attitude to cervical cancer screening (80.4%), but their level of practice was low

(15.4%). sThere was a fair knowledge of cervical cancer and cervical cancer

screening among Nigerian market women in this study, their practice of cervical

cancer screening was poor.

[24]
 Anarado AN, Agunwah [Link] al., (2010) The incidence of cervical cancer

has declined in developed nations due to routine use of cervical cancer screening

services. In developing nations opportunistic screening is the practice, and many

women present with late-stage disease. This study was designed to ascertain the

knowledge of the women in Nigeria to cervical cancer, their practice of cervical

cancer screening and factors hindering the use of available screening services. A

cross-sectional study was done with interviewer-administered questionnaire. Only

the consenting women attending an annual Christian religious meeting in 2007 in

three towns in Enugu, South Eastern Nigeria participated. Only 15.5% of the

respondents were aware of availability of cervical cancer screening services. The

awareness significantly varied with the level of educational attainment (P<0.0001).

Only 4.2% had ever done Pap smear test and all were referred for screening. The

most important factors hindering the use of available cervical cancer screening

services were lack of knowledge (49.8%) and the feeling that they had no medical

problems (32.0%). There is very poor knowledge and practice of cervical cancer

screening among Nigerian women. Effective female education and free mass

screening are necessary for any successful cervical cancer screening programme in

Nigeria.

A descriptive cross-sectional study conducted by Mutyaba etal. regarding

knowledge, attitudes and practices on cervical cancer sreening among the medical

workers of Mulago Hospital,Uganda. About 310 medical workers including nurses,

[25]
doctors and final year medical students were interviewed using a self- administered

questionnaire. Response rate was 92%(285).Of these 93 % considered cancer of the

cervix a public health problem and knowledge about Pap smear was 83% among

respondents. Less than 40% knew risk factors for cervical cancer, eligibility for and

screening interval. Of the female respondents 65% did not feel susceptible to

cervical cancer and 81% had never been screened. Of the male respondents only

26% had partners who had ever been screened. Only 14% of the final year medical

students felt skilled enough to use a vaginal speculum and 87% had never

performed pap smear. Medical students and nurses training curricula needs review to

incorporate practical skills on cervical cancer screening.

A descriptive study conducted by Udigwe G O regarding Knowledge,

attitude and practice of cervical cancer screening(pap smear) among female

nurses in Nnewi, South Eastern Nigeria A self administered questionnaire

survey of all the female nurses .Among 140 nurses, 122 (87%) were aware of the

existence of screening services. Although 9.3% had lost relations to cancer of the

cervix, only 5.7% had ever undergone a pap smear. While 52 (37.1%) had no reason

for not screening, 21 (15%) were afraid of the possible outcome and 35 (25%) felt

they were not likely candidates for cancer of the cervix. Knowledge of cervical

cancer screening services among female nurses in Nnewi is high while uptake rate is

poor. There is need to further educate the nurses who will play a major role in

enlightening the public on the availability and need for cervical screening services.

[26]
 A descriptive study conducted by Nganwai P etal. regarding Knowledge,

attitudes and practices on cervical cancer among registered nurses at the Faculty of

Medicine, Khon Kaen University, Thailand. Systematic sampling was used and self-

administered questionnaires were sent. Out of 149 registered nurses 133 (89.3%) of

whom responded. The respondents' averaged 34.6 years of age while 54.6% had

sexual partners and 61.4% had normal deliveries. About 66.2% would like to have

prophylactic HPV vaccines because they thought that it would prevent HPV

infection. Almost all of the registered nurses have a moderate level of knowledge

regarding cervical cancer and HPV but there are still some major misunderstandings.

Thus educational pamphlets, notices and hospital announcements would be useful in

increasing their knowledge.

Raley, JC. (2011) suggested that Human papilloma virus (HPV) is the

causative agent of cervical neoplasia and genital warts. A vaccine has recently been

developed that may prevent infection with HPV. Vaccination for HPV may become

a routine part of office gynecology. Researcher surveyed members of the American

College of Obstetricians and Gynecologists (ACOG) to determine their attitudes to

HPV vaccination. A survey was sent to Fellows of ACOG to evaluate gynecologists'

attitudes. Vaccine acceptability was analyzed by using 13 scenarios with the

following dimensions and respective attributes: age of patient (13, 17 and 22 years);

efficacy of vaccine (50% or 80%); ACOG recommendation (yes or no); and disease

targeted (cervical cancer, warts or both). Each scenario was rated by means of an 11-

[27]
point response format (0 to 100). Responses were evaluated using conjoint analysis.

Results of 1200 surveys that were sent out, 181 were returned and included in our

analysis. ACOG recommendation was considered the most important variable in

vaccine distribution (importance score = 32.2), followed by efficacy (24.5), age

(22.4) and, lastly, disease targeted (20.9). Of these variables, higher efficacy was

favored; preference was given to age 17 years, with a strong disinclination to

vaccinate at age 13 years; and protection against cervical cancer, or genital

warts, or both. Demographic characteristics of the gynecologists (i.e., age of

physician, gender, and practice setting and community size) did not play an

important role in the decision to recommend vaccination. Professional society

recommendation is important for acceptability of a potential HPV vaccine.

Gynecologists are willing to include this vaccine in their practice.

CONCLUSION

 Cervical cancer is caused by HPV infection.

 It can be prevented by HPV vaccination.

 Awareness & health consciousness among people especially women will reduce

to cervical incidence to a greater extent.

[28]
CONCEPTUAL FRAME WORK

The conceptual produces certain frame of reference for clinical

practice research Education.

The conceptual framework selected for the study is based on Orem’s self

care model. This conceptual frame work identified and defines the factor for

phenomenon of work in Nursing situation describes their relationship.

Tommy AM (1994) each individual has an innate ability to care for

oneself. It is a theoretical model. Which values individual responsibility

and believes in health education as a key aspect of nursing intervention –

Dorothea Orem

This study is aimed to assess the knowledge on selected aspects of

Cervical Cancer among women. The study will focus to find the

association if any between knowledge selected demographic variables.

Nursing is concerned with the individuals need for self care action in

order to help the women in situation of life, health recovery form disease

and cope with their effects.

In Orems view nursing can may one offered to individuals who have

self care requisites nursing care assists the women to achieve the health

result that the women desires.

The investigator has applied the self care theory and nursing system

theory designed by Orem.

[29]
 Orems self care concepts were incorporated because of their

emphasis on health and client as the center activity. The concept of orem

self care theory is

 Self care

 Self care capabilities

 Therapeutic self care demand

 Nursing capabilities (nursing Agency)

Self care

It refers to the women going for routine screening Pap smear

modifications of life style activities and regular follow up

Self care capabilities

It refers to adequate knowledge as importance, purpose, recommended

of Cervical Cancer regular screening for cervical cancer.

Therapeutic self care demand

It refers to acquisition of knowledge regarding cervical cancer Pap smear.

Nursing capabilities

It refers to assess the knowledge on Cervical Cancer and evaluating

the effective structure teaching programme.

Nursing system:

Nursing system refers to screening action a nurse takes to met a clients

self care requisites nursing system theory of Orem’s has 3 Nursing Systems.

[30]
  Wholly compensatory system

 Partly compensatory system

 Supportive educative system

This study is aimed to assess the effectiveness of structure Teaching

Programme on cervical cancer among women. Supportive nursing system

appropriate for the study.

Supportive education system is essential in all situations where women

have a need to gain knowledge become effective as self care agent.

According to this model the women role is to participate in the

study and follow preventive measures.

The nurse action includes

1. Assessment of the knowledge of participants related to

Cervical Cancer and Pap smear by administering pre test.

2. Conducting / rendering Teaching Programme to the participants.

3. Administration of post test to evaluate the knowledge

related to Cervical Cancer.3

The women action includes

1. Acquiring knowledge about cervical cancer

2. Routine follow up

Based on Orem’s self care frame works the supportive education

system operates with the clients centered system where health care

teaching materials is considered to be an appropriate teaching

[31]
 strategy.

SELF CARE
Routine screening for pap smear
Modification of life style activities
Regular follow up
R

Self care capabilities Therapeutic self are demand

 Adequate knowledge on cervical cancer
 Adequate knowledge On importance and
Purposes of cancer screening Acquisition of knowledge
 Regular screening for Cervical cancer regarding cervical cancer

R R

Nursing capabilities
Assess knowledge on cervical cancer
Organizing structure teaching programme
Evaluating the effectiveness of structure
Teaching programme
Wholly compensatory
Partially compensatory
Nursing Action
Supportive educative

Acquiring knowledge about cervical

Women’s Action
Routine screening

Assessment of knowledge

Nursing Action
Structure teaching programme
[32]
Conceptual frame work based on term theory Figure -1

[33]