Ismail, Nor Fatma
(2018)
The effectiveness of health education programme on knowledge and attitude on cervical cancer prevention and human papillomavirus (HPV) vaccination among secondary school girls in Kota Bharu, Kelantan.
Masters thesis, Pusat Pengajian Sains Perubatan.
Abstract
Introduction: Cervical cancer ranks as the third most frequent cancer among women in Asia
and second in Malaysia after breast cancer. Malaysia introduced school-based National HPV
prophylaxis vaccination programme started in 2010 to the girls aged 13 years old. However,
many studies reported that adolescents had poor knowledge about cervical cancer and HPV
vaccination with no standardised education module provided. The aim of our study is to
determine the effectiveness of health education intervention in increasing the knowledge and
attitude on cervical cancer prevention and HPVvaccination among students in Kelantan.
Methodology: This is an open, non-randomised interventional study with control performed
between April and August 2015 using multi-stage cluster sampling among female students
in two secondary schools in Kota Bharu, Kelantan.The intervention group received health
education programme about HPV vaccination and cervical cancer. It was delivered in Malay
language by a trained-personnel consists of health talk with PowerPoint presentation, video
show, flip chart and interactive presentation as well as equipped with related references. The
students from control group received the standard education materials. A self-administered
validated questionnaire was used for evaluation of the effectiveness of intervention on
knowledge and attitude score at the baseline and at 3 months. Data were analyzed using
SPSS version 22.
Results: A total of 198 Malay female students was involved with equal number of subjects.
Of those, 176 of them responded to post-test evaluation with 88.8% response rate. At the
baseline, the mean (SD) of knowledge percentage score in intervention group was 44.9
(18.66) and for control group was 47.2 (15.29). Attitude mean (SD) percentage score in
intervention group was 69.86 (10.43) and 66.37 (9.18) in control group. Mean knowledge
percentage score within each group based on time at baseline and 3 months shows the mean
difference (95% CI) was 12.23 (16.48,7.98) for intervention group and 3.80 (0.77,6.83) for
control group. Post intervention, the estimated marginal mean (EMM) (95% CI) for
knowledge percentage score was 57.6 (49.12,60.71) in the intervention group and 50.63
(47.81,53.47) in the control group. Respectively, the EMM (95% CI) for attitude percentage
score was 70.3 (68.32,72.70) in the intervention group and 66.3 (64.09,68.59) in the control
group. The mean difference between groups at baseline and 3 months was statistically
significant for knowledge (P=0.001) but not for attitude (P=0.870).
Conclusion: The new health education intervention has been shown to increase the
knowledge on cervical cancer and HPV vaccination among the girls. However, it is not
effective in increasing the attitude score when compared to the current standard health
education practice. This new health education intervention could be used as culturallycompetent
intervention and as the standard education module to improve the current
education practice by school health unit. In addition, this could assist the health staff and
paramedics in delivering health education to the students about cervical cancer and HPV
vaccination.
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