Knowledge, Attitudes and Behavior of Bangkok Metropolitan Women Regarding Cervical Cancer Screening

  • Chaowawanit, Woraphot ;
  • Tangjitgamol, Siriwan ;
  • Kantathavorn, Nuttavut ;
  • Phoolcharoen, Natacha ;
  • Kittisiam, Thannaporn ;
  • Khunnarong, Jakkapan ;
  • Supawattanabodee, Busaba ;
  • Srijaipracharoen, Sunamchok ;
  • Thavaramara, Thaovalai ;
  • Pataradool, Kamol
  • Published : 2016.04.11


Purpose: To assess knowledge, attitudes and cervical cancer screening behavior of Bangkok Metropolitan women. Materials and Methods: Thai women, aged 25-to-65 years old, having lived in Bangkok for 5 years or more were invited to participate in the study. After signing informed consent, all women were asked to complete a self-questionnaire (Thai language) with literate assistance if needed. The questionnaire was divided into 3 parts: (I) demographic data; (II) knowledge about cervical cancer screening; and (III) behavior and attitudes, towards cervical cancer screening. Adequate screening was defined as women who had ${\geq}$two cervical cancer screening tests except women aged 25-30 years who may have only one screening, and the last screen was within 5 year or had had regular screening. Results: Of 4,339 women, there were 1,857 (42.8%) with adequate screening and 2,482 (57.2%) with inadequate screening. Significant factors associated with inadequate screening included age < 45 years, pre-menopausal status, family monthly income <625 USD, no reported sexual intercourse, nulliparous, no knowledge, lack of awareness and poor attitudes. Three major reasons provided by women for inadequate screening were no symptoms (54.4%), fear of pain (33.2%), and embarrassment (34.6%). Conclusions: Personal features, knowledge, and attitudes influence screening behavior of Bangkok Metropolitan women. The three most common reasons of women for not undergoinging screening are no symptoms, fear of pain, and embarrassment. These factors should be the focus of attention to improve coverage of cervical cancer screening in Bangkok.


Knowledge;attitudes;behavior;cervical cancer screening;Bangkok Metropolitan


  1. Al Sairafi M, Mohamed FA (2009). Knowledge, attitudes, and practice related to cervical cancer screening among Kuwaiti women. Med Princ Pract, 18, 35-42.
  2. Annual Population Statistics (2014). Report, The Bureau of Registration Administration, Thailand.
  3. Arbyn M, Bergeron C, Klinkhamer P, et al (2008). Liquid compared with conventional cervical cytology: a systematic review and meta-analysis. Obstet Gynecol, 111, 167-77.
  4. Baskaran P, Subramanian P, Rahman RA, et al (2013). Perceived susceptibility, and cervical cancer screening benefits and barriers in Malaysian women visiting outpatient clinics. Asian Pac J Cancer Prev, 14, 7693-9.
  5. Bradford L, Goodman A (2013). Cervical cancer screening and prevention in low-resourcesettings. Clin Obstet Gynecol, 56, 76-87.
  6. Budkaew J, Chumworathayi B (2014). Factors associated with decisions to attend cervical cancer screening among women aged 30-60 years in Chatapadung Contracting Medical Unit, Thailand. Asian Pac J Cancer Prev, 15, 4903-7.
  7. Charakorn C, Rattanasiri S, Lertkhachonsuk AA, et al (2011). Knowledge of Pap smear, HPV and the HPV vaccine and the acceptability of the HPV vaccine by Thai women. Asia Pac J Clin Oncol, 7, 160-7.
  8. Claeys P, Gonzalez C, Gonzalez M, et al (2002). Determinants of cervical cancer screening in a poor area: results of a population-based survey in Rivas, Nicaragua. Trop Med Int Health, 7, 935-41.
  9. Cunningham MS, Skrastins E, Fitzpatrick R, et al (2015). Cervical cancer screening and HPV vaccine acceptability among rural and urban women in Kilimanjaro Region, Tanzania. BMJ Open, 5.
  10. International Agency for Research on Cancer (2012). Population fact sheets [Internet].
  11. Ferlay J, Soerjomataram I, Ervik M, et al (2015). Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 136, 359-86.
  12. Gaffikin L, Blumenthal PD, Emerson M, Limpaphayom K; Royal Thai College of Obstetricians and Gynaecologists (RTCOG)/JHPIEGO Corporation Cervical Cancer Prevention Group (2003). Safety, acceptability, and feasibility of a single-visit approach to cervical-cancer prevention in rural Thailand: a demonstration project. Lancet, 361, 814-20.
  13. Khuhaprema T, Attasara P, Srivatanakul P, et al (2012). Organization and evolution of organized cervical cytology screening in Thailand. Int J Gynaecol Obstet, 118, 107-11.
  14. Kritpetcharat O, Suwanrungruang K, Sriamporn S et al (2003). The coverage of cervical cancer screening inKhonKaen, Northeast Thailand. Asian Pac J Cancer Prev, 4, 103-5.
  15. Massad LS, Einstein MH, Huh WK, et al (2013). 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis, 17, 1-27.
  16. Moore MA, Attasara P, Khuhaprema T, et al (2010). Cancer epidemiology in mainland South-East Asia - past, present and future. Asian Pac J Cancer Prev, 11, 67-80.
  17. National Cancer Institute, Department of medical services, Ministry of Public Health, Thailand (2013). Guideline for cervical cancer screening [Internet].
  18. National Health Service (2013). Cervical Screening Programme [Internet].
  19. Nunez-Troconis J, Tulliani E, Gabriela Martinez M, Fernandez N (2013). Knowledge and attitudes as predictors of cervical cancer screening among women in a Venezuelan urban area. Invest Clin, 54, 20-33.
  20. Papanicolaou GN, Traut HF (1941). The diagnostic value of vaginal smears in carcinoma of the uterus. Am J Obstet Gynecol, 42, 193-205.
  21. Paul P, Winkler JL, Bartolini RM, et al (2013). Screen-andtreat approach to cervical cancer prevention using visual inspection with acetic acid and cryotherapy: experiences, perceptions, and beliefs from demonstration projects in Peru, Uganda, and Vietnam. Oncologist, 18, 6-12.
  22. Sanghvi H, Limpaphayom KK, Plotkin M, et al (2008). Cervical cancer screening using visual inspection with acetic acid: operational experiences from Ghana and Thailand. Reprod Health Matters, 16, 67-77.
  23. Sankaranarayanan R, Wesley R, Thara S, et al (2003). Test characteristics of visual inspection with 4% acetic acid (VIA) and Lugol's iodine (VILI) in cervical cancer screening in Kerala, India. Int J Cancer, 106, 404-8.
  24. Saslow D, Solomon D, Lawson HW, et al (2012). American cancer society, american society for colposcopy and cervical pathology, and american society for clinical pathology screening guidelines for the prevention and early detection of cervical cancer. Am J ClinPathol, 137, 516-42.
  25. Thanapprapasr D, Deesamer S, Sujintawong S, et al (2012). Cervical cancer screening behaviours among Thai women: results from a cross-sectional survey of 2112 healthcare providers at Ramathibodi Hospital, Thailand. Eur J Cancer Care, 21, 542-7.
  26. The Royal Thai College of Obstetrics and Gynaecology (2012). RTCOG guideline for cervical cancer screening [Internet].
  27. Tran NT, Choe SI, Taylor R, et al (2011). Knowledge, attitude and practice (KAP) concerning cervical cancer and screening among rural and urban women in six provinces of the democratic people's republic of Korea. Asian Pac J Cancer Prev, 2, 3029-33.
  28. Wongwatcharanukul L, Promthet S, Bradshaw P, et al (2014). Factors affecting cervical cancer screening uptake by Hmong hilltribe women in Thailand. Asian Pac J Cancer Prev, 15, 3753-6.
  29. zur Hausen H (1977). Human papillomaviruses and their possible role in squamous cell carcinomas. Curr Top Microbiol Immunol, 78, 1-30.

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