- Title
- Understanding cervical cancer knowledge, perceptions, and attitudes among female senior high school students in Ghana
- Creator
- Ampofo, Ama Gyamfua
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- In 2018, the World Health Organization (WHO) made a global call to action toward eliminating cervical cancer as a public health problem. Cervical cancer elimination requires all countries to reach and maintain an age-adjusted cervical cancer incidence rate below 4 women per 100,000 women-years. To achieve this goal, a set of evidence-based cervical cancer prevention targets need to be met by each country by 2030. These targets are for increases in the following areas: Human Papillomavirus (HPV) vaccination (i.e., 90% of 15-year-old girls fully vaccinated); cervical cancer screening (i.e., 70% of women screened by age 35 years and again by 45 years of age); and cervical cancer treatment (i.e., 90% of women with cervical cancer received treatment). In addition, the targets include use of risk reduction strategies including sex education, smoking cessation and condom use. The WHO highlighted that implementation of these effective cervical cancer prevention strategies will need to be sensitive and responsive to personal, cultural, social, structural and economic barriers to accessing healthcare across varying settings globally. In 2020, over 80% of the global burden of cervical cancer occurred in Lower-Middle income Countries (LMICs) that are lacking well-coordinated cervical cancer prevention programmes. Ghana is an LMIC in Sub-Saharan Africa, where 27.4 new cases per 100,000 women and 17.8 new deaths per 100,000 women from cervical cancer were reported in 2020, making cervical cancer the leading cause of cancer-related death among women in Ghana. These figures are predicted to increase in the absence of progress toward the WHO cervical cancer prevention targets. To date, research in Ghana has largely focused on understanding individual modifiable behavioural risk factors (e.g., sex, smoking and condom use) for cervical cancer and HPV infection. In anticipation of the rollout of a national HPV vaccination programme for adolescent girls in Ghana by the end of 2023, this thesis is based on two studies’ reports on primary prevention of cervical cancer and HPV (i.e., knowledge, intentions and behaviours), health education preferences, and effectiveness of school-based cervical cancer education among this group. The Integrated Behaviour Model (IBM) informed study development and interpretation of findings. Study 1 was a large cross-sectional study of female students (n=2400) recruited from senior high schools (n=17) in the Ashanti region of Ghana. Findings indicate a high prevalence of multiple cervical cancer and HPV infection risk behaviours, low HPV vaccination uptake, and knowledge-perception-intention-behaviour gaps among students, and highlight the need for culturally appropriate school- and home-based interventions to improve behavioural outcomes. The majority of students preferred the involvement of parents, faith-based leaders and healthcare professionals in cervical cancer prevention interventions. Study 2 was a systematic review and meta-analysis of the effectiveness of school-based education interventions in improving cervical cancer and HPV knowledge and perceptions, attitudes towards HPV, intentions and uptake of HPV vaccination and screening. Findings support evidence that school-based education can improve cervical cancer and HPV knowledge and vaccination intentions, but not attitudes and uptake of vaccination and risk perceptions. Overall, this body of work will help to inform cervical cancer and HPV education interventions for adolescents in Ghana, in advance of population-based rollout of interventions to meet the WHO targets, in a way that is sensitive to personal, cultural, social, structural and economic barriers in Ghanaian school settings.
- Subject
- cervical cancer; Ghana; school; HPV vaccination; adolescents; risk factors; education; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1495832
- Identifier
- uon:54075
- Rights
- Copyright 2023 Ama Gyamfua Ampofo
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
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| View Details Download | ATTACHMENT01 | Thesis | 31 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 306 KB | Adobe Acrobat PDF | View Details Download |