Cervical Cancer Prevention Among Rural Women in Gujarat, India: A Mixed Methods Study on Risk Factors and KAP (Knowledge, Attitude and Practice).

Abstract

Cervical cancer causes significant morbidity and mortality among women in India. Despite national screening guidelines, uptake of these tools remains poor, especially in rural areas where complex sociocultural factors are at play. Integrated mixed-methods designs can provide better insights into multilevel barriers influencing screening behaviours. This study aimed to assess the knowledge, attitudes, practices, and sociocultural factors associated with cervical cancer prevention among marginalized rural women. A mixed-method study of 400 women aged older than 18 years was conducted using a pretested questionnaire on cervical cancer knowledge, attitudes, self-reported screening practices, and sociodemographic variables. An exploratory qualitative study also interviewed 30 women to explore perspectives on screening using semi-structured guides. The survey data were analyzed via logistic regression, and thematic analysis was performed for the qualitative data. The results were triangulated to enable nuanced interpretation. Only 27% (108/400) of participants had heard of cervical cancer, and 61% (244/400) were illiterate. Poor knowledge was observed in 83% (332/400) of participants, predicted by early marriage, high parity, low education, and socioeconomic status. Despite 64% (254/400) expressing positive attitudes, only 9% (36/400) reported undergoing cervical cancer screening. None of the participants were vaccinated against humanpapillomaviruses (HPV). Stigma, gender roles, spousal communication gaps, and access barriers emerged as key qualitative themes. The integrated results highlighted the intersections between villagers' worldviews and sociocultural norms and between access issues and prevention. Multifaceted sociocultural challenges underpin the cervical cancer prevention gap among marginalized rural women. Grassroots educational efforts respectfully addressing fears and stigma, along with increased male engagement, community health worker training, and integrated screening services, can promote informed screening decisions among underserved groups.