Association between knowledge, attitude and quality of working life with Papanicolaou Smear uptake among Primary Care Healthcare Workers on Gombak / Zaitul Akmal Abdullah Zawawi

Background: Carcinoma of the cervix is the third commonest cancer among women in Malaysia. Unfortunately, the uptake of Papanicolaou (Pap) smear screening by Malaysian women has been low. The primary care healthcare workers (PCHCW) are in the best position to advocate and offer this screening to the public population. Despite this, the uptake of Pap smear screening among PCHCW themselves has not been reported in Malaysia. Studies in countries such as India and Nigeria have reported a mismatch in knowledge, attitude and practice on Pap smear screening which translates into poor uptake despite having good knowledge. One of the factors that were found to contribute to low uptake among nurses in Taiwan and Egypt is job stress. This study aims to assess the uptake of Pap smear screening; its association with knowledge, attitude towards Pap smear screening and quality of working life which includes the elements of job stress among PCHCW in Gombak.
Methodology: This was a cross-sectional study conducted from January to March 2018. PCHCW with these criteria: being sexually active, age 20 to 65 years old, not on long leave and no history of cervical cancer; were selected using simple random sampling method from 14 government health clinics in the district of Gombak, Malaysia. Ethical approval was obtained from the NMRR. Data was collected using self-administered questionnaires that include demographic details and questionnaire on knowledge, attitude on Pap smear screening and quality of working life (QOWL). Statistical analysis was done using SPSS version 23. The statistical tests performed were independent t-test, chi-square test and logistic regression to determine any significant association between the studied factors and uptake of Pap smear. A p-value of less than 0.05 is considered to be statistically significant.
Results: The respondents comprised of 52 doctors and 154 nurses (n=206). Out of the 206 participants, 132 (64%) had Pap smear at least once in the past year and 83 (40%) have undergone Pap smears in the last 3 years. Demographic analysis revealed the mean age of those who went for Pap smear to be 36.52 (SD 7.62) and it is significantly associated with Pap smear uptake (p=0.040). The factors found to be not statistically significant are ethnicity iii (p = 0.394), training on Pap smear (p = 0.155) and type of job (p = 0.335). Mean knowledge score of those who had Pap smear in the last 3 years was 3.86 (0.46) but this is also not statistically significant (p= 0.280). There were significant association between uptake of Pap smear in the last 3 years with attitude towards Pap smear screening (p<0.001) and quality of working life (p=0.001). Mean attitude score and mean overall QOWL score of those going for Pap smear in the last 3 years were 3.59 (0.56) and 3.82 (0.56) respectively.
Conclusion: The uptake of Pap smear screening was higher among the PCHCW as compared to the general population. Three factors that were found to be significantly associated with Pap smear uptake are age, attitude and quality of working life. Policies could be implemented with the aim to improve attitude and quality of working life thus increasing the percentage of Pap smear uptake further. This would be beneficial for the health of PCHCW who functions as the primary health guardians of the Malaysian public.