PERCEPTION OF SEVERITY OF WOMEN AT HIGH RISK OF CERVIC CANCER ABOUT CERVIC CANCER SCREENING METHOD IVA

Hotma Ulina Sagala¹, Lilik Zuhriyah², I Wayan Agung Indrawan³

¹²³ Universitas Brawijaya, Malang, Jawa Timur, Indonesia.

Email: [email protected]¹, [email protected]², [email protected]³

KEYWORDS Cervical Cancer, IVA Method, Severity Perception

ABSTRACT Cervical cancer is the fourth most common cause of cancer in the world in women. The high mortality rate is due to the low awareness of women doing early detection. Behavior can be influenced by threat assessment, one of which is perceived severity. The behavior of early detection of cervical cancer can arise due to the perception of the severity of cervical cancer. Women's concern and desire for early detection of cervical cancer is influenced by women's perceptions of cancer. This study aims to explore the perception of the severity of women at high risk of cervical cancer regarding cervical cancer screening using the IVA method. This type of research is a qualitative research with a descriptive phenomenological approach. The research sample used purposive sampling technique. The study was conducted from April to May 2022 in the working area of the Ujung Batu Health Center, 10 participants were interviewed for 25-35 minutes. The variable in this study is the perception of the severity of cervical cancer screening using the IVA method. The instrument used in this study is an interview guide and analyzed by thematic analysis. The results showed that all participants knew that the severity of cervical cancer can harm women and can cause death. The conclusion is that the awareness of participants in cervical cancer screening is still lacking. All participants understand the severity and seriousness of cervical cancer but have not screened for cervical cancer yet.

INTRODUCTION

Cervical cancer is the fourth most common cause of cancer in the world in women. In 2020 there will be 604,000 new cases and 342,000 deaths (WHO, 2020). The incidence of cervical cancer in 2018 was 32,439 cases and the death rate was 18,234 cases (Kementerian Kesehatan RI, 2019). The incidence of cervical cancer in Riau was 471 people (1.1%) out of 44,248 women who had an examination. Early detection is routinely carried out on women aged 30-50 years in all districts/cities of Riau Province (Profil Kesehatan Provinsi Riau, 2019).

The high mortality rate is due to the low awareness of women doing early detection. Women who do not know about cervical cancer will result in low cervical cancer screening behavior which is the main obstacle to cervical cancer screening. Most cervical cancer patients come to the hospital already in an advanced stage. Treatment of cervical cancer becomes more difficult and the results are unsatisfactory, even tend to accelerate death. Cervical cancer can be prevented by detecting precancerous lesions early, by detecting precancerous lesions as early as possible, it can be treated immediately and cancer can be prevented (Ulfah et al., 2019). The government has implemented an early detection program for cervical cancer in controlling cervical cancer using the Acetic Acid Visual Inspection (IVA) method. (Kementerian Kesehatan RI, 2019).

Research result Nugrahani et al., (2017) stated that the lack of knowledge regarding the importance of cervical cancer screening is the cause of doubts about the importance of VIA examinations. Through high knowledge about cervical cancer and the IVA test will affect one's perception in a positive direction. Study Supini et al., (2020). revealed that perception can influence a person to perform an IVA test. The cause of the emergence of a person's negative perception is due to individual dissatisfaction with the object that is the source of perception, individual ignorance and the absence of individual experience of the perceived object, while the emergence of positive perception is due to satisfaction, knowledge, and experience of the perceived object.

According to the Health Belief Model (HBM) theory, a behavior can be influenced by a threat assessment, one of which is the perception of severity. The behavior of early detection of cervical cancer can arise due to the perception of the severity of cervical cancer. Women's concern and desire for early detection of cervical cancer is influenced by women's perceptions of cancer (Rio & Suci, 2017). Based on this description, it is necessary to conduct a study that analyzes women's perceptions of cervical cancer, so this study aims to explore the perception of the severity of women at high risk of cervical cancer regarding cervical cancer screening using the IVA method.

RESEARCH METHODS

This type of research is a qualitative research with a descriptive phenomenological approach. The research sample used a purposive sampling technique with a sample of 10 participants who met the inclusion and exclusion criteria, namely women who have one or more risk factors, have never done cervical cancer screening, are sexually active and are in the working area of the Ujung Batu Health Center. The study was conducted from April to May 2022 in the working area of the Ujung Batu Health Center, 10 participants were interviewed for 25-35 minutes. The variable in this study is the perception of the severity of cervical cancer screening using the IVA method. The instrument used in this study was an interview guide. Data analysis was carried out by means of thematic analysis.

RESULT AND DISCUSSION

A. Result

This study consisted of 10 participants who were in the working area of the Ujung Batu Health Center. Theme 2 contains the perception of women at high risk of cervical cancer regarding the severity of carrying out an IVA examination. This theme produces 2 sub-themes cervical cancer is dangerous and can cause death, there are signs and symptoms of cervical cancer showing seriousness.

1. Cervical Cancer is Dangerous and Can Cause Death

This sub-theme is the perception of severity, the seriousness of women at high risk of cervical cancer being dangerous and causing death. In this sub-theme, all participants know that the severity of cervical cancer can harm women and can cause death. Participants' statements regarding this sub-theme are:

a. Yes, mother, some died of cervical cancer because they arrived late and the situation was serious. Cervical cancer is almost the same as breast cancer, ma'am, even though the operation ended up dying too, it was terrible (P. 1. 32 years).

b. Yes mother is dangerous. This cervical cancer affects the uterus, can become malignant and cause death the same as breast cancer (P. 2. 41 years).

c. If it is seen from the dangerous news, ma'am, especially if there are symptoms. People say it bleeds and hurts when having sex, they say cervical cancer is hard to cure, yes it's scary when you hear it (F. 4. 34 years old).

The Appearance of Cervical Cancer Symptoms Shows Seriousness

This sub-theme is the perception of severity, the seriousness of women at high risk of cervical cancer with the appearance of signs of cervical cancer showing the seriousness of the disease so that participants must immediately take action. Participants' statements regarding this sub-theme are as follows :

a. Check the IVA before there are symptoms because if there are symptoms you must check, especially if the symptoms are severe. It's better that way, but most people only check if there are symptoms (P. 4. 34 years).

b. If there are symptoms, we should immediately check. Judging from the current age it seems to have to check. He was afraid, thought about it, everything would be messed up, that's all he thought. Maybe because there are no complaints, ma'am, so I haven't checked. Yes, ma'am, if you are not sick, you do not want treatment (P. 6. 44 years).

c. We feel no one is sick, why check. If it hurts, we have to check instead of being sick, ma'am (P. 7. 45 years)

d. Yes, ma'am, but if there are no symptoms, why check. No symptoms yet, no pain yet so don't want to check again (P. 2. 41 years)

e. Because there are no symptoms, ma'am, maybe if there are symptoms such as vaginal discharge or itching that I am constantly interested in checking, Ms. (P. 10. 40 years).

B. DISCUSSION

The sub-theme of cervical cancer is dangerous and can cause death, which aims to answer research questions related to the perception of women at high risk of cervical cancer about the severity of the IVA test method. All participants know that cervical cancer is dangerous and causes death but does not affect the IVA screening method. Participants screened for cervical cancer if they experienced symptoms or complaints, especially if the symptoms were severe then they immediately screened the IVA method but if there were no symptoms they did not do the IVA method screening..

In the sub-theme, the emergence of signs of cervical cancer shows the seriousness that all participants know that cervical cancer is very dangerous and if they experience signs of symptoms, immediately carry out an VIA examination. The results of this study are in line with the research conducted Titisari et al., (2018) that the majority of women are aware of the habit of free sex, the signs and symptoms of cervical cancer such as foul-smelling vaginal discharge and abnormal bleeding are signs and symptoms of cervical cancer (Titisari et al., 2018). This is closely related to a woman's level of knowledge and positive attitude towards the signs and symptoms of cervical cancer and its dangers. The number of positive attitudes in women regarding VIA examinations is due to the positive perception that participants have about cervical cancer and the dangers that accompany it. Attitudes also affect the level of education, WUS who have good knowledge about cervical cancer and early detection of cervical cancer but do not do VIA examinations because they are afraid of the results of the examination. WUS who know about the symptoms and impact of cervical cancer tend to be afraid of the results of the examination (Sahr & Kusumaningrum, 2018).

The severity variable in this study is the perception of the dangers of cervical cancer which can be detected early by VIA examination. This study shows that women who have the perception that cervical cancer can be detected early with an IVA examination will perform an IVA examination and vice versa. The perceived severity determines the presence or absence of screening for a disease. The perception of seriousness is often based on health information, knowledge or a person's belief that he will get into trouble due to an illness that will complicate his life (Pratiwi et al., 2018). This study also explains that women will do early detection of cervical cancer if they have been able to increase the perception of the severity of cervical cancer. This is also in accordance with the HBM theory which describes one thing that can affect behavior is the perception of the severity of something (Monica & Ulfa, 2020; Titisari et al., 2018).

Based on the results of interviews related to the perception of severity, it showed that most of the participants had a low perception of the severity of cervical cancer. This shows that participants are still lacking in describing the severity of cervical cancer. The severity of cervical cancer can begin when signs and symptoms such as abnormal vaginal bleeding, pathological vaginal discharge, low back pain, spots after intercourse and edema in the legs have appeared. These symptoms indicate that the patient has entered an advanced stage of cancer because basically cervical cancer does not appear in the pre-cancerous phase until the cancer is in the early stages. When cervical cancer is at an advanced stage, the patient's life expectancy is below 30%. (Kalia et al., 2020). Therefore, early detection of cervical cancer is one of the prevention of cervical cancer because early detection can identify the presence of HPV at an early stage when signs of cervical cancer are not visible.

Women of childbearing age are still lacking in describing the severity of cervical cancer related to pain due to cervical cancer that will be felt by women, decreased quality of life so that they are no longer able to carry out their roles as wives, mothers or working women. WUS is still lacking in describing that cervical cancer is the second most common killer of women after breast cancer. The HBM theory reveals that one of the factors that influence women's perceptions of cervical cancer is the exposure of women to the environment, one of which is the media. Media exposure is one of the media that can be used to increase one's knowledge and perception of certain behaviors. The transfer of knowledge between media, whether mass, print or electronic, requires an intermediary to explain in detail the message to be conveyed through the media. Therefore, not only the media but also the role of health workers to explain and invite WUS to carry out early detection of cervical cancer (Putri et al., 2022). The results of this study are supported by Grimley et al., (2020) that the purpose of doing the IVA test because of the severity of cervical cancer. The HBM theory states that the perception of the seriousness or severity of a disease causes a person to behave in an attempt to treat it. One will take action to protect themselves if they consider that one's condition is in serious trouble (Kashyap et al., 2019).

The discussion on theme 2 is the perception of women at high risk of severity, the seriousness of cervical cancer regarding the IVA method that all participants understand the severity and seriousness of cervical cancer but have not yet screened for cervical cancer. The author concludes that with the perception of the severity of a disease such as cervical cancer, it makes someone willing to undergo an examination using the IVA method. This is because they do not want to be exposed to a serious disease so they will make efforts to prevent the occurrence of the disease. Another reason is due to deep ignorance so they do not want to do cervical cancer screening with the IVA method because they feel painless and do not have signs and symptoms that lead to cervical cancer, so further socialization is needed for women of childbearing age, especially in the Ujung Batu Health Center area.

CONCLUSION

Awareness of early detection of cervical cancer which is still lacking causes the coverage of early detection of cervical cancer at the Ujung Batu Health Center has not yet reached the national target. This is due to the lack of perception of women of childbearing age in describing the severity of cervical cancer. Women of childbearing age need an intervention to increase their perception of the severity of cervical cancer so that women of childbearing age can do cervical cancer screening regularly. Further research can be carried out by analyzing the perceptions of women of childbearing age and their husbands in order to know more deeply about the reasons for not doing cervical cancer screening with the IVA method. Health workers should conduct health education and counseling programs using the media about the importance of screening for cervical cancer using the VIA method and strengthen perceptions of vulnerability, seriousness, threats, obstacles, benefits and cues for action so that the perception of women of childbearing age is better and coverage of cervical cancer screening is achieved.

REFERENCE

Grimley, C. E., Kato, P. M., & Grunfeld, E. A. (2020). Health and health belief factors associated with screening and help‐seeking behaviours for breast cancer: A systematic review and meta‐analysis of the European evidence. British Journal of Health Psychology, 25(1), 107-128.

Kalia, N., Muhani, N., Tataan, P. G., & Pesawaran, P. G. T. K. (2020). Faktor Health Belief Model (HBM) yang berhubungan dengan self efficacy melakukan tes IVA pada pasangan usia subur usia 30-50 tahun The Health Belief Model (HBM) Factor related to self-efficacy conducted IVA test on couples of reproductive aged 30-50 years. Jurnal Dunia Kesmas, 9(3).

Kashyap, N., Krishnan, N., Kaur, S., & Ghai, S. (2019). Risk factors of cervical cancer: a case-control study. Asia-Pacific journal of oncology nursing, 6(3), 308-314.

Kementerian Kesehatan Republik Indonesia. (2019). Penyakit kanker di Indonesia berada pada urutan 8 di Asia Tenggara dan urutan 23 di Asia. Kemkes.go.id.

Monica, L. P., & Ulfa, M. (2020). The Correlation of the perception of early detection cervical cancer with attitude to do visual inspection with acetic acid. Jurnal Ners dan Kebidanan (Journal of Ners and Midwifery), 7(1), 044-049.

Nugrahani, R. R., Budihastuti, U. R., & Pamungakasari, E. P. (2017). Health belief model on the factors associated with the use of HPV vaccine for the prevention of cervical cancer among women in Kediri, East Java. Journal of Epidemiology and Public Health, 2(1), 70-81.

Pratiwi, K. N., Hernawati, S., & Rohkmah, D. (2018). Perceived susceptibility and perceived benefit as factors affecting VIA tests participation in work area of Kertosari health center. Health Notions, 2(6), 641-643.

Profil Kesehatan Provinsi Riau. (2019). Profil Kesehatan Provinsi Riau. In Journal of Chemical Information and Modeling (Issue 9, p. 19).

Putri, S. I., Fajriah, A. S., Asiyah, S., & Ellina, A. D. (2022). The health belief model and cervical cancer examination behavior of women. KnE Life Sciences, 726-737.

Rio, S., & Suci, E. S. T. (2017). Persepsi tentang kanker serviks dan upaya prevensinya pada perempuan yang memiliki keluarga dengan riwayat kanker. Jurnal Kesehatan Reproduksi, 4(3), 159-169.

Sahr, L. A., & Kusumaningrum, T. A. I. (2018). Persepsi dan perilaku wanita usia subur dalam melakukan tes inspeksi visual asam asetat. Jurnal Promosi Kesehatan Indonesia, 13(2), 114-128.

Supini, R., Duarsa, D. P., & Ani, L. S. (2020). Persepsi WUS dan intensitas pelaksanaan deteksi dini kanker serviks metode IVA di wilayah kerja puskesmas Aikmel Lombok Timur. Jurnal Penelitian dan Kajian Ilmiah Kesehatan Politeknik Medica Farma Husada Mataram, 6(1), 75-84.

Titisari, I. A., Riyanti, E., & Prabamurti, P. N. (2018). Aplikasi Teori health belief model pada partisipasi wanita usia subur (WUS) dalam pemeriksaan IVA di Kelurahan Kalibanteng Kulon. Jurnal Kesehatan Masyarakat (Undip), 6(5), 751-759.

Ulfah, K., Mulyati, S., & Purwaningsih, D. (2019). Association of perceived barriers factor and participation of women in early detection of cervical cancer. In International Conference on Interprofessional Health Collaboration and Community Empowerment (Vol. 1, No. 1, pp. 33-37).

WHO. (2020). Burden of cancer Indonesia. In Cancer Country Profile. https://www.who.int/cancer/country-profiles/IDN_2020.pdf

Copyright holders:

Hotma Ulina Sagala, Lilik Zuhriyah, I Wayan Agung Indrawan (2022)

First publication right:

Devotion - Journal of Research and Community Service

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