“A PRE- EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME REGARDING CERVICAL

CANCER SCREENING AND HPV VACCINE IN TERMS OF KNOWLEDGE
AND PERCEPTION AMONG STUDENTS OF SELECTED NURSING
COLLEGES OF DELHI, NCR”

BY

GROUP C

CHARU GERA
CHARU PANDEY
DIKSHA SHEEL
DISHA SHARMA
DIYA SAMARTH
VINITA MEHRA
Dissertation submitted to the
Chaudhary Charan Singh University Meerut (U.P.)
In Partial Fulfillment of the Requirement For The
Bachelor of Science in Nursing (4th Year)
Under The Guidance of
MS. SIBI SAMUEL

ASSOCIATE PROFESSOR

DEPARTMENT OF MEDICAL SURGICAL NURSING

NIGHTINGALE INSTITUTE OF NURSING

NOIDA

1
 2023-2024

DECLARATION BY THE CANDIDTE

I here declare that this dissertation/thesis entitled “A pre-experimental study to assess the
effectiveness of structured teaching programme regarding cervical cancer screening and
HPV vaccine in terms of knowledge and perception among students of selected nursing
colleges of Delhi, NCR ” is a bonafide and genuine research work carried out by GROUP C
under the guidance of

MS. SIBI SAMUEL

[ ASSOCIATE PROFESSOR]
MASTERS OF SCIENCE IN NURSING
DEPARTMENT OF MEDICAL SURGICAL NURSING
Nightingale Institute of Nursing, Noida

DATE: SIGNATURE OF GROUP C CANDIDATES:

PLACE: NOIDA
CHARU GERA
CHARU PANDEY
DIKSHA SHEEL
DISHA SHARMA
DIYA SAMARTH
VINITA MEHRA

2
 CERTIFICATE BY THE GUIDE

This is to certity that the dissertation/thesis entitled “A pre-experimental study to assess the
effectiveness of structured teaching programme regarding cervical cancer screening and HPV
vaccine in terms of knowledge and perception among students of selected nursing colleges of
Delhi, NCR” a bonafide and genuine research work done by Group C in partial fulfilment of the
requirement for the degree of Bachelor of Science in Nursing from Chaudhary Charan Singh
University, Meerut (U.P.)

DATE: SIGNATURE OF GUIDE:

PLACE: NOIDA
Ms. SIBI SAMUEL
[ ASSOCIATE PROFESSOR]
DEPARTMENT OF MEDICAL
SURGICAL NURSING
NIGHTINGALE INSTITUTE OF
NURSING

3
 ENDORSEMENT BY THE HOD, DIRECTOR/PRINCIPAL/ HEAD OF
THE INSTITUTION

This is to certity that the dissertation/thesis entitled “A pre-experimental study to assess the
effectiveness of structured teaching programme regarding cervical cancer screening and HPV
vaccine in terms of knowledge and perception among students of selected nursing colleges of
Delhi, NCR” is a bonafide and genuine research work done by Group C in partial fulfilment of
the requirement for the degree of Bachelors of Science in Nursing from Chaudhary Charan Singh
University, Meerut (UP.)

DATE: SIGNATURE OF THE

DIRECTOR/PRINCIPAL:

PLACE : NOIDA PROF. LAVANYA NANDAN

[DIRECTOR AND PRINCIPAL]

NIGHTINGALE INSTITUTE
OF
NURSING

4
 ACKNOWLEDGEMENT

“I do not know anyone who has gotten to the top without hard work. That is the recipe. It will not
always get you to the top, but it will get you pretty near (Margaret Thatcher)
The aim of education should be to teach us rather how to think than what to think- rather to
improve our minds, so as to enable us to think for ourselves, than to load the memory with
thoughts of other men. To succeed.. you need to find something to hold on to, something to
motivate you, something to inspire you. All the efforts to carry out this study would not have
been successful or the goal is unattainable without the constructive and purposeful support,
guidance and encouragement offered by number of people . We would like to recognize through
this acknowledgement.
First and foremost we would like to express our heartfelt gratitude to Mr. Ashok Jain,
Chairman, Nightingale Institute Of Nursing, Noida for allowing us to be part of this
prestigious institute.
We would like to thank Prof. Lavanya Nandan, Director/ Principal, Nightingale Institute of
Nursing for being the epitome of motivation, who corrected mistakes and made sure that we
never experience a setback.
We would like to express our deepest sense of gratitude to Ms. Sushama Sharma, HOD and
HR of Administration Department, Nightingale Institute of Nursing for providing the
administrative support and facilities for successful completion of this research study.
We are highly obliged to Ms. Sibi Samuel , Associate Professor , Department of Medical
surgical nursing, Nightingale Institute of Nursing for providing her great support and
guidance throughout our research project and made sure we learn at each step we take towards
the completion of study.
We are highly obliged to Ms. Rupali Arora, Nursing Lecturer, Nightingale Institute Of
Nursing for providing guidance till the end of our research project and made sure we don’t do
any mistake and learn from the research project.

5
We are thankful to entire Master Nursing Faculty of Nightingale Institute of Nursing, for
their constructive and healthy criticism at various stages of this study.
We are extremely grateful to whole Library Staff of Nightingale Institute of Nursing, for
providing me with all the necessary library facilities.
We also take this opportunity to acknowledge the contribution of experts for validating the
research tool irrespective of their busy schedule, contributing suggestions and modification
required.
We are also grateful to Ms. J. Sobiya for granting permission to conduct the final study.
We are extremely thankful to all the subjects who enthusiastically showed interest and
participated in the study. Without their cooperation, it would have been impossible for us to
complete the study.
Finally, heartful thanks to all our friends and classmates of Bachelors of Nursing Batch 2020-
2024 for all the benefits which we have derived from their interaction and goodwill.
We humbly acknowledge our sincere gratitude for all those who had contributed in this research
project.
Above all, we express our deep sense gratitude to God almighty for his abiding grace and
blessing, which gave us strength for success of this research project.

Date: Signature of the Group C Candidates:

Place : Noida Charu Gera

Charu Pandey
Diksha sheel
Disha Sharma
Diya Samarth
Vinita Mehra

6
 LIST OF ABBREVIATIONS

S.NO. ABBRIVIATIONS EXPANDED FORM

1 Df Degree of freedom

2 F Frequency

3 H1 Hypothesis 1

4 H2 Hypothesis 2

5 H3 Hypothesis 3

6 H4 Hypothesis 4

7 MD Mean Difference

8 N Number of samples

9 NS Not significant

10 S Significant

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 ABSTRACT

A pre-experimental study to assess the effectiveness of structured teaching programme regarding

cervical cancer screening and HPV vaccine in terms of knowledge and perception among
students of selected nursing colleges of Delhi, NCR conducted by Group C for partial fulfilment
of the requirement of degree of Bachelors in Science in Nightingale Institute of Nursing Noida
(UP) The objectives of the study is to assess the level of knowledge regarding cervical cancer
screening and HPV vaccine among nursing students, To assess the level of perception regarding
cervical cancer screening and HPV vaccine among nursing students, To assess the effectiveness
of STP on level of knowledge and perception regarding cervical cancer screening and HPV
vaccine among student in selected groups, To determine the association between post-test level
of knowledge score regarding cervical cancer and HPV vaccine among students in selected
groups, To determine the association between the post level of perception score regarding
cervical cancer and HPV vaccine among students in selected groups. A pre- experimental with
pre -test post test research design was adopted and non probability purposive sampling technique
was used for selecting the samples for study. The samples consists of 60 nursing students at
Sumitra Institute of Nursing and Paramedical Science ,Greater Noida. Took the pre-test to check
the previous knowledge based on our problem statement then applied structured teaching
programme for 2 hours before the post-test to check the effectiveness of the interventions given.
Compared the scores among pre-test post-test design. The researcher found that intervention is
effective in increasing the knowledge and perception regarding cervical cancer screening and the
importance of having HPV vaccine among students of nursing college. The data was analysed
and interpreted as per objectives and the research Hypothesis stated. Descriptive and inferential
statistics were used for the data analysis. The results shows the mean score of pre test of
knowledge towards cervical cancer screening and HPV vaccine is 4.7 and perception is 43.05
and the mean score of post test of knowledge towards cervical cancer screening and HPV
vaccine is 18.3 and perception is 97.07.This indicates that mean score of pre test is lower than
the mean score of post test. The obtained mean difference was found to be statistically
significant. The calculated “t” value of knowledge questions is 24.03 and perception questions is
46.68 which is greater than the table value at 0.05 level of significance at df (59). The Chi square
value showed that there is no association between post test knowledge, post test perception
scores regarding cervical cancer screening and HPV vaccine among nursing students with the
selected demographic variables at the 0.05 level of significance. The conclusion of the study
revealed that intervention is effective hence the knowledge and perception improved among
selected nursing students.

8
 TABLE OF CONTENTS

CHAPTER CONTENT PAGE NO.

I INTRODUCTION
Background study 19-21

Need of the study 21

Statement of the problem 21

Objectives of the study 22

Hypothesis 22

Operational definitions 23

Assumptions 23

Delimitations 23

Conceptual framework 24-25

Summary 26

Organization of the study 26

II REVIEW OF
LITERATURE

SECTION A- Literature related

to cervical cancer among nursing
students 28-29

SECTION B- Literature related to

cervical cancer screening
SECTION C- Literature related to

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 HPV Vaccine 30-31
SECTION D- Literature related
to cervical cancer screening and
32-33
HPV Vaccine
Summary
34-35

35

III RESEARCH
METHODOLOGY
Research Approach 37
Research Design 38-39
Variables under study 40
Setting of the study 41
Population 41
Sample 41
Sample size 42
Sampling technique 42
Inclusion criteria 42
Exclusion criteria 42
Data collection tools and
techniques
43
Selection of tools
Description and development of
tools 43

Description of the data 43

collection tool
Content validity of the tool
44
Reliability of tool
Development and
10
 description of structured
teaching programme 45
Ethical consideration
45
Procedure of data collection
46
Final data collection
procedure
Plan for data analysis
Summary 46
47

47

47-48
48

IV ANALYSIS AND
INTERPRETATION OF
DATA
Objectives of study
50
Hypothesis
50-51
Organization and interpretation of
data
51
SECTION 1: Findings related to
frequency and percentage
distribution of nursing college
51-57
students in terms of demographic
variables.
SECTION 2: Findings related to
level of knowledge and
perception regarding cervical
cancer screening and HPV
vaccine before and after the
structured teaching program

11
 given to nursing students. 58-59
SECTION 3: Findings related to
association between post-test
knowledge score of nursing
college students with selected
demographic variables
SECTION 4: Findings related to
association between post-test
perception score of nursing
college students with selected
demographic variables
59- 62
Summary

63-67

68

V RESULTS
Major findings of the study 70-75

Summary 75

VI DISCUSSION,
SUMMARY AND
CONCLUSION
Discussion
77
Summary
78

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 Problem study 78
Objectives of the study 78-79
Hypothesis 79
Conclusion 79-80
Nursing implication 80-81
Delimitation 81-82
Recommendations 82
Summary 82

VII REFERENCES 84-85

VIII APPENDICES 87-147

LIST OF TABLES

S.NO. TABLES PAGE NO.

13
1 Symbolic representation of pre- 39
experimental research design

2 Frequency and percentage 53-54

distribution of nursing college
students in terms of demographic
variables

3 59
Frequency and percentage
distribution of pre test and
post test knowledge scores
regarding cervical cancer
screening and HPV vaccine
among nursing students

4 Mean, mean difference

standard deviation, t-value
of knowledge score 61
regarding cervical cancer
screening and HPVvaccine
among nursing students

5 Frequency and percentage 62

distribution of pre test and post test
perception scores regarding cervical
cancer screening and hpv vaccibe
among nursing students

6 Mean, mean difference, 63

standard deviation, t-value
of perception score
regarding cervical cancer
screening and hpv vaccine

14
 among nusing students

7 Chi square test showing 65-66

association b/w post test
knowledge score and selected
demographic variables

8 Chi square test showing 68-69

association b/w post test
perception score and
selected demographic
variables.

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 LIST OF FIGURES

S.NO. FIGURES PAGE NO.

1 Conceptual framework 25

2 Pie chart shows the 54

frequency percentage
distribution of nursing
college students by age

3 Bar graph shows the frequency 54

percentage distribution of nursing
students by gender

4 Bar graph shows the 55

frequency percentage
distribution of nursing
students by religion

5 Bar graph shows the 55

frequency percentage
distribution of nursing
students by marital status

6 Bar graph shows frequency 56

percentage distribution of

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 nursing students by type of
family

7 Line graph shows the 56

frequency %age distribution
of nursing students by
family income

8 Line graph shows the 57

frequency %age
distribution of nursing
students by education

9 Line graph shows the 57

frequency %age distribution
on the basis of knowledge
about topic

10 Bar graph depicting the frequency 59

and percentage distribution of pre
test and post test knowledge score
of nursing students regarding
cervical cancer and hpv vaccine

11 Bar graph depicting the frequency 62

and percentage distribution of pre
test and post test perception score
of nursing students regarding
cervical cancer and HPV vaccine

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 LIST OF APPENDICES

S.NO. APPENDICES PAGE NO.

1 Letter seeking permission for 86
research study

2 Letter seeking expert opinion and 87-88

suggestions for content validity of
research tools

3 A criteria rating scale for expert 89-90

opinion regarding content validity
of research tools

4 Content validity certificate 91

5 Informed consent 92

6 Demographic performa 93

7 Criteria checklist for validation of 94

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 the tool

8 List of validators 95

9 Tool 1: Demographic Variables 96-97

10 Tool 2: Knowledge Questionnaire 98-103

11 Tool 3: Perception questionnaires 104-107

12 Interpretation of knowledge 108

scores

13 Knowledge questionnaire answer 109

key

14 Interpretation of perception score 110

15 Perception questionnaire answer 111

key

16 Lesson plan 112-129

17 Mastersheets 131-144

18 Photographs 146-147

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 CHAPTER 1

CHAPTER-I
INTRODUCTION
Learn. Prevent. Screening., (WHO, 2024).
In step with the GLOBOCAN 2020 report, cervical cancer is the fourth maximum commonplace
most cancers amongst women worldwide. There are approximately 604,000 new cases and

20
342,000 cancer deaths worldwide each yr. maximum new cases and deaths (approximately 85%
and ninety% respectively) occur in low- and middle-earnings countries (LMICs).

According to 2019 estimates, 45, 300 humans died of breast cancer in India. In India, the
occurrence of breast most cancers in keeping with one hundred,000 girls in 2020 is 18, and the
danger of cervical most cancers in 2020 is 2%. Recurrent contamination of the genital area with
one of the 15 forms of human papillomavirus (HPV) is a common motive of cervical most
cancers. the global human papillomavirus (HPV) contamination price amongst healthful ladies
over the age of 30 is approximately eleven.7%. The age-unique occurrence of HPV
contamination is maximum among girls below 25 years of age at 28%; This indicates that HPV
infection is regularly first transmitted through sexual sex.

In 2018, the WHO Director-well known known as for international movement to eliminate breast
most cancers in as a minimum 4 in a hundred,000 girls international. The effect of 3 protection
degrees is planned. The sector fitness enterprise recommends getting rid of cervical cancer by
vaccinating ninety% of women earlier than the age of 15, whilst tablets have to test and come
across at the least ninety% of girls earlier than age 35 and then at age 45. pre-cancerous cells are
destroyed by using screening and 90% of sufferers have an invasive disease.
In August 2020, the arena fitness agency adopted this worldwide strategy to eliminate most
cancers. the arena fitness corporation has given the framework for tracking the strategy to cast
off cervical most cancers by may additionally 2023, with the aim of increasing the removal of
cervical cancer, a public fitness trouble. This framework identifies particular measures on key
factors and identifies the maximum essential measures for every degree of protection to assist
screen development and make improvements, corrections and modifications. Cervical most
cancers screening, pre-cervical most cancers lesions, value-powerful screening, countrywide
most cancers screening packages. Availability of HPV trying out in primary care (percent) and
referral (linkage to treatment) for women who take a look at wonderful is one in every of
numerous measures to assess techniques.

BACKGROUND OF THE STUDY

In India, in spite of the alarming numbers, the government did no longer fund a nationwide audit.
This take a look at targets to evaluate the weight of cervical most cancers in India and look at the
overall performance characteristics of current cervical cancer screening gear to provide proof
based on suggestions for the simplest use of screening in low-resource settings. Cervical cancer
could be the second maximum commonplace most cancers among ladies in the global by means
of 2021, killing ninety% of ladies in low- and center-profits international locations, in line with

21
the centers for disease manage and Prevention. Approximately 96,922 new cases of cancer are
identified each year in India. Magazine of Racial and Ethnic fitness Disparities, 2021 notes that
cervical most cancers stays the main most cancers among ladies in India. Despite diverse
screening measures, most Indian ladies remain undiagnosed with breast cancer. The extended
occurrence can be due to lack of know-how approximately cervical most cancers screening and
shortage of screening facilities inside the country. This observe assessed expertise, attitudes and
practices (KAP) closer to breast cancer screening among coastal ladies in Karnataka, South
India. Easy steps to attain the WHO goal of getting rid of cervical most cancers as a public
fitness trouble (for instance, decreasing the occurrence of the sickness to much less than 4 cases
according to 1 million women-years). We intention to quantify global disparities in cervical most
cancers prevalence and mortality, along with geographic and socioeconomic popularity and over
time, based totally on the 2020 estimate of the worldwide Survey of cancer (GLOBOCAN).
WHO : Screening the use of the HPV mrna (messenger ribonucleic acid) test is recommended
to detect precancerous cervical lesions and prevent cervical cancer. The yankee magazine of
Radiology notes that maximum cervical cancers start inside the transition quarter, which is the
junction among the outer squamous cellular layer of the cervix and the internal columnar mobile
layer. Dysplasia can occur in squamous cells or columnar cells, ensuing in numerous subtypes.

Global health corporation : Output become these days published in the WHO tenet for
screening and remedy of cervical pre-most cancers lesions for cervical cancer prevention, 2d
version (2021), This modern-day tenet can provide the initial output of the second phase of the
rule update: recommendations for the usage of HPV mrna (messenger ribonucleic acid) checks
for screening to come across cervical pre-cancer and prevent cervical most cancers. American
magazine of Roentgenology states most cervical cancers arise from the transition quarter, which
is the junction between the outer squamous cellular layer and internal columnar mobile lining of
the cervix. Dysplasia can arise in both the squamous or the columnar cells giving upward thrust
to the unique subtypes. The arena health corporation divides cervical cancer into 10 principal
histopathologic subtypes: squamous cellular carcinoma, adenocarcinoma, clean mobile
adenocarcinoma, adeno-squamous carcinoma, serous carcinoma, glassy cell carcinoma, adenoid
basal carcinoma, adenoid cystic carcinoma, undifferentiated carcinoma, and small cellular
carcinoma. Consistent with BMC cancer, 2022 Cervical cancer is the fourth maximum common
most cancers that takes place to girls international. This examine goals to evaluate developments
in incidence and mortality of cervical cancer in India and its states over beyond 3 a long time for
tracking the progress of strategies for the prevention and manipulate of cervical cancer. Cancer
Epidemiology, 2021. Trend evaluation in cancer quantifies the occurrence charge and explains
the fashion and pattern. Breast and cervical cancers are the 2 most common cancers among
Indian women which contributed 39.4 % to the total cancer in India for the year 2020. This study
aimed to document the time developments in cancer prevalence of breast and cervical cancer the
usage of Age–period–Cohort (APC) model from five population based cancer Registries (pbcrs)
in India for the duration of 1985–201. In line with Medknow guides, 2023: Cervical most
cancers is the fourth most not unusual cancer in girls with an expected 6, 04,000 new cases in
2020 representing sixty six% of all female cancers. It's miles the main reason of most cancers-
associated loss of life among women . Consistent with BMC Public fitness, 2023: while cervical
cancer deaths have declined steeply in high-profits international locations because of the
tremendous use of the Papanicolaou take a look at (Pap test), the same fashion has not emerged
in low or center-profits countries (lmics). Get admission to to screening in lmics like India is

22
limited because of barriers such as confined healthcare infrastructures, loss of sexual health
schooling, and stigma demarcating sexually transmitted infections (stis). HPV self-sampling
(HPV-SS), a woman–focused and at-domestic method for screening, can be utilized as a
completely unique screening device to overcome a number of these limitations. Our take a look
at tested the effectiveness of HPV-SS, supported by using family- targeted arts-based sexual
fitness literacy on the uptake of cervical cancer screening amongst difficult-to-reach ladies in
rural and remote areas in India. Indian journal of Gynecologic Oncology, 2024: India bills for
one-fourth of world’s overall cervical cancer deaths. In keeping with the currently released
country wide most cancers Registry software 2020 document, age-adjusted prevalence charge
(AAR) of cervical cancer was highest inside the North jap vicinity accompanied by way of
Bengaluru 17.7 and then Barshi (Rural) 15.3. Papumpare district in Arunachal Pradesh (North-
East India) had the highest AAR of 27.7. The high purpose of the look at is to compare
traditional PAP smear with liquid-primarily based cytology, on the premise of parameters like
slide exceptional, detection of dysplasia in cervical most cancers, and the scope for ordinary
usage of liquid-primarily based cytology in government healthcare centers in India. The Lancet
Oncology , 2023 to meet worldwide cervical cancer removal efforts, a much broader variety of
inexpensive and available vaccines towards human papillomavirus (HPV) are wished. We aimed
to evaluate the immunogenicity and safety of a quadrivalent HPV vaccine (concentrated on HPV
kinds 6, eleven, sixteen, and 18), evolved and synthetic through the Serum Institute of India
(SIIPL). Right here we report outcomes inside the 9–14 years cohort. Magazine of Epidemiology
and worldwide fitness, 2024 Cervical most cancers is a main worldwide fitness concern,
disproportionately affecting ladies in growing international locations. Cervical most cancers has
number one subtypes, squamous cellular carcinoma (SCC) and adenocarcinoma (AC), every
with awesome traits and screening effectiveness. In this take a look at, we aimed to estimate the
worldwide occurrence of cervical cancer consistent with histological subtype to inform
prevention strategies.

NEED FOR STUDY

According to Journal of oncology, Viral infections contribute as a cause of 15–20% of all

human cancers. Infection by oncogenic viruses can promote different stages of carcinogenesis.
Among many types of HPV, around 15 are linked to cancer. In spite of effective screening
methods, cervical cancer continues to be a major public health problem. There are wide
differences in cervical cancer incidence and mortality by geographic region. In addition, the age-
specific HPV prevalence varies widely across different populations and showed two peaks of
HPV positivity in younger and older women. There have been many studies worldwide on the
epidemiology of HPV infection and oncogenic properties due to different HPV genotypes.
However, there are still many countries where the population-based prevalence has not yet been
identified. Moreover, cervical cancer screening strategies are different between countries.
Organized cervical screening programs are potentially more effective than opportunistic
screening programs. Nevertheless, screening programs have consistently been associated with a
reduction in cervical cancer incidence and mortality. Developed countries have achieved such

23
reduced incidence and mortality from cervical cancer over the past 40 years. This is largely due
to the implementation of organized cytological screening and vaccination programs. HPV
vaccines are very effective at preventing infection and diseases related to the vaccine-specific
genotypes in women with no evidence of past or current HPV infection. In spite of the successful
implementation of the HPV vaccination program in many countries all over the world, problems
related to HPV prevention and treatment of the related diseases will continue to persist in
developing and underdeveloped countries
Chinese Journal of Cancer Research 32 (6), 720, 2020 conducted a research that shows
Cervical cancer is one of the leading causes of cancer death among females worldwide and its
behavior epidemiologically likes a venereal disease of low infectiousness. Early age at first
intercourse and multiple sexual partners have been shown to exert strong effects on risk. The
wide differences in the incidence among different countries also influenced by the introduction
of screening. Although the general picture remains one of decreasing incidence and mortality,
there are signs of an increasing cervical cancer risk probably due to changes in sexual behavior.
Smoking and human papillomavirus (HPV) 16/18 are currently important issues in a concept of
multifactorial, stepwise carcinogenesis at the cervix uteri. Therefore, society-based preventive
and control measures, screening activities and HPV vaccination are recommended. Cervical
cancer screening methods have evolved from cell morphology observation to molecular testing.
High-risk HPV genotyping and liquid-based cytology are common methods which have been
widely recommended and used worldwide. In future, accurate, cheap, fast and easy-to-use
methods would be more popular. Artificial intelligence also shows to be promising in cervical
cancer screening by integrating image recognition with big data technology. Meanwhile, China
has achieved numerous breakthroughs in cervical cancer prevention and control which could be a
great demonstration for other developing and resource-limited areas. In conclusion, although
cervical cancer threatens female health, it could be the first cancer that would be eliminated by
human beings with comprehensive preventive and control strategy
Studies shows that in developed countries effective cervical screening system have largely
prevented cervical cancer, (80% of the squamous cell carcinoma) and has led to reduction in
death associated with cervical cancer. India has the highest number of cervical cancer cases
There is a relative lack of awareness among women about various health issues especially in the
rural areas. The women are hence, susceptible to unhealthy risk behavior like unsafe sex, which
as pointed out is one of the risk factor for cervical cancer. There are socio-cultural barriers, lack
of awareness and non-availability of health care facilities in rural areas. There is a general
cancer-phobia' in which a woman with sign and symptoms of cancer does not wish to be
diagnosed with cancer and hence, does not report to a doctor early. Doubt about the possibility of
being cured and a fear of painful death also adds to the reason for this cancer-phobia.While
Human Papilloma Virus is a necessary cause of cervical cancer, it is not a sufficient cause. Other
cofactors which have been established as necessary for progression from cervical HPV infection
to cancer are tobacco smoking, high parity. long-term hormonal contraceptive use and co-

24
infection with HIV. It is also established that well-organized cervical screening programs or
widespread good quality cytology can reduce cervical cancer incidence and mortality. It is
increasingly evident that information about sexual and reproductive health behaviors is essential
to the design of effective preventive strategies against cancer cervix.
As researchers continue to study about cervical cancer screening and HPV vaccine, new
information is being generated daily regarding the theoretical information. Therefore, it is
motivated to conduct study among nursing college students regarding knowledge and perception
of cervical cancer screening and HPV vaccine.

STATEMENT OF THE PROBLEM

A PRE-EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME REGARDING CERVICAL CANCER
SCREENING AND HPV VACCINE IN TERMS OF KNOWLEDGE AND PERCEPTION
AMONG STUDENTS OF SELECTED NURSING COLLEGES OF DELHI, NCR

OBJECTIVES
● To assess the level of knowledge regarding cervical cancer screening and HPV vaccine
among nursing students.
● To assess the level of perception regarding cervical cancer screening and HPV vaccine
among nursing students.
● To evaluate the effectiveness of STP on level of knowledge and perception regarding
cervical cancer screening and HPV vaccine among student in selected groups.

● To find out the association between post-test knowledge and Perception score regarding
cervical cancer and HPV vaccine among students in selected groups.

HYPOTHESES

● H1 -There will be significant difference between the mean pre-test knowledge score and
mean post-test knowledge score of the nursing students regarding cervical cancer
screening and HPV vaccine

25
 ● H2- There will be significant difference between the mean pre-test perception score and
mean post-test perception score of the nursing students regarding cervical cancer
screening and HPV vaccine.
● H3-There will be significant association between post-test knowledge scores regarding
cervical cancer screening and HPV vaccine among nursing students with the selected
demographic variables at the 0.05 level of significance.

● H4-There will be significant association between post -test perception scores

regarding cervical cancer screening and HPV vaccine among nursing students with
the selected demographic variables at the 0.05 level of significance.

OPERATIONAL DEFINITION

Assess- It refers to evaluate the knowledge of structural teaching program

Knowledge - In this study it refers to extent to which structured teaching program will bring
change in knowledge of nursing students regarding cervical cancer screening and HPV vaccine
in terms of significant gain in knowledge score
Structured teaching program - In this study, it refers to information material intended to
enhance the knowledge of nursing students regarding cervical cancer screening and HPV
vaccine.
Perception- It is a subjective process where subjects perceive the structured teaching programme
according to their understanding and through effective teaching there will be change in
perception score.

ASSUMPTIONS OF THE STUDY

The study assumes that:
● Nursing students have some knowledge and perception regarding cervical cancer
screening and HPV vaccine.
● Nursing students will be able to retain some knowledge regarding cervical cancer
screening and HPV vaccine after the administration of structured teaching programme.
● Nursing students may give free and Frank responses regarding knowledge and perception
towards cervical cancer screening and HPV vaccine.

26
 ● Knowledge and perception of nursing students regarding cervical cancer screening and
HPV vaccine will be improved after administration of structured teaching program

DELIMITATIONS
The study is limited to:
● Assessment of knowledge limited to a written response only through a structure teaching
knowledge questionnaire.
● The students who are willing to participate in the study
● The nursing students who are available at the time of data collection

CONCEPTUAL FRAMEWORK OF THE STUDY

A Framework for a research study facilitates to organize the have a look at to provide a context
for the translation of the take a look at locating. Conceptual framework is an analytical tool with
several versions and context. it's far used to make conceptual distinctions and organize thoughts.
A study conceptual framework captures some thing real and does this in a manner that is easy to
don't forget and apply. It frames studies for relevant questions and answers to specific problem
because the take a look at is intended. A study to assess the knowledge and perception of cervical
cancer screening and HPV vaccine among nursing students at selected nursing colleges of Delhi,
NCR. In keeping with their idea a system is a group of factors that interact with each other which
will achieve the intention. A man or woman is an open machine due to the fact he/she receives
enter from the surroundings. The enter is processed and gives an output. All residing systems are
open. there's persistent alternate of count number, energy and data. The machine is cyclic in
nature and remains so long as the four elements input, technique, output and comments-preserve
interacting with every other. If there are adjustments in any elements, there will be alteration in
all other parts. remarks from within the system or from the surroundings gives data which allows
the gadget to determine its effectiveness.

27
 AGENT
RESEARCH
CENTRAL PURPOSE ER
RECEPIENT

A pre-experimental study to assess the 60 NURSING COLLEGE STUDENTS

effectiveness of structured teaching
programme regarding cervical cancer GOAL
screening and HPV vaccine in terms of
USE OF STRUCTURED TEACHING PROGRAMME ON THE
knowledge and perception among R LEVEL OF KNOWLEDGE REGARDING CERVICAL CANCER
students of selected nursing colleges of SCREENING AND HPV VACCINE
MEANS
Delhi, NCR E
STRUCTERED TEACHING PROGRAMME
A

L FRAMEWORK
I SUMITRA INSTITUTE OF NURSING AND
PARAMEDICAL SCIENCES
T
PRESCRIPTION

STRUCTURED TEACHING PROGRAMME

Y

IDENTIFICA
TION DATA INTERVENTI
VALIDATION
ON
AGE, DETERMINING
GENDER, GIVING THE
STRUCTURED EFFECTIVENESS
RLIGION, ,MA
TEACHING OF STRUCTURED
RITAL PROGRAMME TEACHING
STATUS, LECTURE PROGRAMME
FAMILY TEACHING IS AMONG NURSING
INCOME, GIVEN TO COLLEGE
EDUCATION, STUDENTS TO STUDENTS
HAVE YOU INCRESE THE
KNOWLEDGE OF
EVER HEARD
STUDENTS
ABOUT PAP
SMEAR

OUTCOME OF THE STUDY

FEEDBACK

OUTOME NOT
OUTCOME ACHIEVED
ACHIEVED

28
FIGURE: 1 CONCEPTUAL FRAMEWORK BASED ON MODIFIED WIEDENBACH
PRESCRIPTIVE THEORY
 SUMMARY
This chapter dealt with the background of the day, need for the study, statement of the problem,
objectives of study, hypothesis, operational definition, assumptions, delimitation and conceptual
framework.

ORGANIZATION OF THE STUDY

CHAPTER-1- This chapter deals with the background of the study, need for study, statement of
the problem, objectives of study, hypothesis, operational definition, assumptions, delimitation
and conceptual framework.

CHAPTER-2- This chapter deals with the review of literature with research studies and non
research studies relevant to the present study.

CHAPTER-3- Present the methodology adopted for the present study which includes thw
research approaches, research design and setting, sample and sampling techniques, development
and description of the data collection tools, data collection procedures and plan for data analysis

CHAPTER-4- Would deal with the analysis and interpretation of the data.

CHAPTER-5- This chapter deals with the statement of the problem, objectives of study and its
major findings of the study.

CHAPTER-6- Offers the brief study of the discussion of the findings of the study, summary of
the study, conclusion drawn by the researcher, limitations of the study as well as implications
and recommendation of the study.

29
CHAPTER 2

CHAPTER-II

30
 REVIEW OF LITERATURE

Review of literature enlist the systematic identification, reflection, critical analysis and reporting
of existing information in relation to the problem of interest. The purpose of review of literature
is to obtain comprehensive knowledge and depth of information about effectiveness of structured
teaching programme regarding cervical cancer screening and HPV vaccine among nursing
college students of DELHI, NCR.
Review of literature is an essential task in the research process, it brings clarity and focus to the
research problem, improves the Methodology and broadens the knowledge base in the research
area. Review of literature is a broad, comprehensive, deep, systematic and critical review of
scholarly print material, audio visual material and personnel communication.
This chapter deals with the selected studies, which are related to the present study. A review of
literature relevant to the study was undertaken, which help the invigilator to develop deeper
insight into the problem and gain information on what has been done in the past.
Literature gathered form extensive review was depicted the following headings :-

Section-A - Literature related to knowledge and perception towards cervical cancer

Section-B- Literature related to knowledge and perception towards cervical cancer
screening

Section- C- Literature related to knowledge and perception towards HPV vaccine.

Section-A

31
Literature related to knowledge and perception towards cervical cancer

1. Kalayu Birhane Mruts and tesfay Birhane Gebremariam (June 8th, 2018)
conducted a study aimed to determine the level of knowledge and perception closer to
cervical cancer amongst female ordinary undergraduate Debre Berhan university
students.80-four (14. five%) of the take a look at individuals were sexually lively. Of the
contributors, 232(40. five%) had heard of cervical cancer however best 195 (35.6%) had
good know-how in the direction of cervical most cancers and of the take a look at
individuals, handiest 185 (33.2%) perceived as they’re prone for cervical most cancers.
The usage of radio and television as supply of facts [AOR= 1.918 (95% CI: 1.223,
3.010)], having statistics about sexually transmitted infections (STI) [AOR =3.030 (95%
CI: 1.665, 5.514)] have been notably and independently associated with exact expertise
on cervical most cancers.

2. Neha Taneja, Bhavika Chawla et al (April 30,2021) conducted a study giving

information on Cervical most cancers among ladies become 40.22%. expertise of hazard
factors and symptoms and signs and symptoms changed into fairly adequate a few of the
women. 32.68 % of women knew that early age of marriage became a threat element for
Cervical most cancers observed via 23.01% women who cited that early age of initiation
of sexual hobby turned into a commonplace risk component for Cervical most cancers.
Inter menstrual bleeding and foul smelling discharge become the most common signal
and symptom suggested in 30.75 % and 28.86% ladies respectively. Understanding,
attitude and practice concerning Cervical cancer screening become seen in 20.31%,
43.64% and 13.22% of women.

3. Lee Mun Seng, Aina Najwa Rosman et al (August 12, 20 ) conducted a study to assess
and ascertain the current know-how, perception, stage of focus, and attitudes toward
cervical most cancers (CC) among girls in Malaysia. In assessment with other studies,
there’s nevertheless missing of awareness on CC and those caused casual cluelessness
and terrible attitudes toward it. In terms of danger elements, there are elements with a few
diploma of consciousness among girls in Malaysia, i.e., more than one sexual partners
and sexually transmitted illnesses. Ladies in Malaysia have less attention on the causes
and clinical manifestations of the disorder (P < zero.05). they’re conscious that normal
Pap smear might display CC and surgical procedure may be a treatment of desire. In
addition, girls in Malaysia additionally have slight consciousness about Pap smear as
prevention to discover and prevent CC at the early degree.

4. Sothy contact and Jin Kyoung Oh (15 march 2018) conducted a study to examine the
cervical cancer knowledge, attitudes, and practices as well as cervical most cancers

32
 prevention techniques amongst Cambodian ladies. Many of the 440 respondents, 74 and
34% of women had heard approximately cervical most cancers and the Papanicolaou
(Pap) Smear test, respectively, and 7% of ladies had ever been screened by a Pap check.
The participants showed high willingness to go through a Pap check (74%). Moreover,
35% of women were aware that cervical cancer is preventable by using vaccination and
62% of women were inclined to get the HPV vaccine, however most effective 1% of
women have been vaccinated towards HPV. Girls of a younger age (odds ratio: 76.7;
95% self assurance c language: 19.2–306.5 among ladies elderly 20–29 years compared
to 60–69 years, P-for-fashion< zero.0001) and those who have been married (odds ratio:
2.8; 95% self assurance c program language period: 1.3–6.3) have been more likely to be
inclined to receive the vaccination.

5. Zelalem Tilahun Tesfaye, Henok Getachew Tegegn (6 November 2019) has done a
study aimed to assess the information and attention of cervical cancer and HPV in
university of Gondar (UOG) remedy and fitness technology lady college students. A
move-sectional study become completed.a total of 267 female students participated inside
the examine (mean age 20.58 ± 1.22). more than ½ of the participants (59.6%) did no
longer understand the principle cause of cervical most cancers, while pretty much a 5th of
them (19.5%) recognized HPV as the principle reason of cervical cancer. As excessive as
83.9% of the individuals did no longer know different causes of cervical cancer. Binary
logistic evaluation revealed that scholars from midwifery (adjusted odds ratios [AOR] =
14.14, P < zero.05), anesthesiology (AOR = 960,6, P < 0.05) and medication (AOR =
5.84, P < 0.05) departments had been associated with information of the primary reason
of cervical cancer.

6. Shazia Rashid, Satyanarayana Labani et al (11 November,2016) conducted a study

to determine information, recognition and mindset of university students on HPV, HPV
vaccine and cervical cancer. Out of a complete of 1580 college students, ladies had extra
information about cervical most cancers (82.45 %, p<zero.001), HPV (45.61 %,
p<zero.001) and HPV vaccines (44%, p<0.001) whilst compared to the ones in boys. But,
understanding about the types of HPV and vaccines became poor. Curiously, students
from biology-predominant had more knowledge and awareness about cervical most
cancers (81.89%, p<zero.001) and HPV (46.58 %, <zero.001) while compared to non-
biology college students. Ladies from each biology and non-biology organization had
higher recognition compared to boys. Analysis of odds ratio (ORs) in conjunction with
95% CI confirmed older women with 1.2 to 3 fold (p<0.05) better knowledge than boys.
All college students agreed that girls ought to get vaccinated in opposition to HPV
(p<0.001)

Section-B
33
Literature related to knowledge and perception towards cervical cancer
screening

1. Diana Mendes, Iren Bains, Tazio Vanni & Mark Jit.(1 May 2015). Conducted a
study to optimising population-based cervical screening policies is becoming more
complex due to the expanding range of screening technologies available and the
interplay with vaccine-induced changes in epidemiology. Mathematical models are
increasingly being applied to assess the impact of cervical cancer screening
strategies.We found 153 articles meeting our eligibility criteria published up to May
2013. Most studies (72/153) evaluated the introduction of a new screening
technology, with particular focus on the comparison of HPV DNA testing and
cytology (n = 58). Twenty-eight in forty of these analyses supported HPV DNA
primary screening implementation. A few studies analysed more recent technologies
– rapid HPV DNA testing (n = 3), HPV DNA self-sampling (n = 4), and genotyping
(n = 1) – and were also supportive of their introduction. However, no study was found
on emerging molecular markers and their potential utility in future screening
programmes. Most evaluations (113/153) were based on models simulating aggregate
groups of women at risk of cervical cancer over time without accounting for HPV
infection transmission. Calibration to country-specific outcome data is becoming
more common, but has not yet become standard practice.

2. N.B Yimer, M.A Mohammed et al (June 2021) conducted a study to estimate the
pooled uptake of cervical cancer screening and identify its predictors in Sub-Saharan
Africa.We initially screened 3537 citations and subsequently 29 studies were selected
for this review, which included a total of 36,374 women. The uptake of cervical
cancer screening in Sub-Saharan Africa was 12.87% (95% CI: 10.20, 15.54; I2 =
98.5%). A meta-analysis of seven studies showed that knowledge about cervical
cancer increased screening uptake by nearly five times (OR: 4.81; 95% CI: 3.06,
7.54). Other predictors of cervical screening uptake include educational level, age,
Human Immune deficiency Virus (HIV) status, contraceptive use, perceived
susceptibility and awareness about screening locations.

3. S. Aswathy,Mariya Amin Quereshi, et al ( August 2012). Conducted a study were

to find the knowledge of women regarding cervical cancer, to determine screening
practices and determinants, and to identify factors for non-screening. Mean age of the
study population was 34.5 + 9.23 yr. Three fourths of the population (74.2%) knew
that cervical cancer could be detected early by a screening test. Majority of
respondents (89.2%) did not know any risk factor for cervical cancer. Of the 809
women studied, only 6.9 per cent had undergone screening. One third of the
34
 population were desirous of undergoing screening test but had not done it due to
various factors. These factors related to knowledge (51.4%) such as no symptoms, not
being aware of Pap test, not necessary, etc. This was followed by resource factors
(15.1%) like no time, no money, etc. and psychosocial factors (10.2%) included lack
of Interest, fear of procedure, etc. Independent predictors for doing Pap test included
age >35, having knowledge of screening for cervical cancer and Pap check (P<0.05).

4. Butho Ncube,Amita Bey, Jeremy Knight, Patricia Bessler, Pauline E.Jolly.( 7

March 2015) did a research study to carried out to identify factors associated with
Jamaican women’s decisions to screen for cervical cancer. Of the 403 women
interviewed, 66% had a Papanicolaou (Pap) smear and only 16% had a Pap test
within the past year. Significant predicators of uptake of screening were being
married, age, parity, discussing cancer with health provider, perception of
consequences of not having a Pap smear, and knowing a person with cervical cancer.
Women who did not know where to go for a Pap smear were 85% less likely to have
been screened (prevalence odds ratio (POR): 0.15, 95% confidence interval (CI):
0.04, 0.52).

5. Lea Vimpere, Jana Sami et al (29 September 2023) conducted a study to

summarizes findings on CC screening programs for FSWs that have been
implemented worldwide, and assesses their effectiveness and sustainability. The
search identified 13 articles published from 1989 to 2021. All implemented programs
successfully reached FSWs and provided them with CC screening during the study
period. The most effective and sustainable strategies were the Screen and Treat
approach, introducing CC screening into existing STI services in drop-in or outreach
clinics, HPV-DNA self-sampling, and integrating sex-workers-specific services in
public health facilities. Follow-up was deemed the main challenge in providing and
enhancing CC healthcare to FSWs with rates of loss to follow-up ranging from 35 to
60%.

6. Hye young shin, Soo Yeon Song et al (10 October, 2021) conducted a study aimed
to identify the distinct barriers and knowledge level of cervical cancer screening
among female university students and establish intervention strategies to overcome
these barriers. The participants’ ages were 21.92 ± 1.26 years. The knowledge levels
for cervical cancer and screening were low to moderate. The four main themes that
emerged as barriers to cervical cancer screening through the FGIs were: 1) socio-
cultural barrier: conservative social perception of unmarried women’s sexual life, 2)
knowledge barrier: lack of knowledge and information, 3) psychological barrier:
discomfort, and 4) practical barrier: time-consuming. The three themes Identified for
strategies were: 1) socio-cultural intervention: changing social perceptions and
ensuring confidentiality, 2) educational intervention: improvement of knowledge and
35
 accessibility, and 3) alternative screening intervention: comfortable screening
methods.

Section- C
Literature related to knowledge and perception towards HPV vaccine.

1. C Genovese, V La Fauci, A Squeri, et al (2018) conducted a study in the

literature regarding the timing of adverse effects like autoimmune disease following
HPV vaccination. Case reports frequently indicate the development of one of these
events, but there isn't a clear correlation between them, and there isn't any supporting
data. Six trials on the bivalent and quadrivalent HPV vaccines are the subject of a
meta-analysis that we conducted. There were 243,289 participants in the vaccination
group and 248,820 participants in the control groups overall in the meta-analysis. A
Jadad score of three or four was obtained in four out of the six trials, indicating a
satisfactory level of trial quality. Across the six trials, musculoskeletal, CNS, and
endocrinological diseases were the most common types of autoimmune disease seen.
The meta-analysis's findings showed no association between autoimmune diseases
and HPV Vaccine.

2. Cristina Mendes De Oliveira, José Humberto TG Fregnani, et al (2019)

conducted a study The most prevalent biological agent transmitted through
sexual contact, HPV is the source of numerous diseases in both men and women,
including cancer and precancerous lesions. Worldwide, there are three preventive
HPV vaccines targeting high-risk HPV types: the 2-, 4-, and 9-valent vaccines. The
three vaccines are made from purified L1 protein, which self-assembles to form
empty shells unique to HPV types, and are produced using recombinant DNA
technology. This non-systematic study seeks to highlight the difficulties and obstacles
facing the adoption of the HPV vaccination while summarising the epidemiology of
HPV and the creation of the vaccine, reviewing the historic trials of the HPV vaccine,
and presenting the most noteworthy outcomes from clinical trials and the real world.

3. Zenobia CY Chan, Tak Sing Chan, et al (2012) conducted the study that
women's views about HPV vaccination and their understanding of it were
investigated and described using a systematic review.We obtained and examined
thirty-six articles in all. In relation to HPV and HPV vaccine, four primary themes
were found: "knowledge regarding HPV or cervical cancer," "attitudes towards HPV
vaccination," "factors affecting the acceptance of HPV vaccination," and "intention to
receive HPV vaccination."

4. Giuseppe La Torre, Chiara De Waure, et al (2007) conducted the study

that pooled analysis of randomised clinical trials (RCTs) was conducted to
determine the effectiveness of the HPV vaccine in preventing persistent cervical

36
 infections. Five research were chosen. The initial meta-analysis, encompassing all
trials, demonstrated a noteworthy decrease in the cohort of vaccinated individuals'
risk of HPV-16 infection [RR 0.10 (95% CI: 0.07–0.15)]. With solely papers on
bivalent and tetravalent vaccines included, the second and third meta-analyses
revealed an R-squared of 0.13 (95% CI: 0.09–0.20) for HPV 16 infections and 0.22
(95% CI: 0.13–0.38) for HPV 18 infections. Although the HPV vaccination has a
high success rate in preventing persistent infection, more research is required to
determine the optimal immunisation period and long-term vaccine efficacy.

5. Sharon JM Kessels, Helen S Marshall, et al (2012) conducted the study in

which just 5 studies included data on programme completion; the rest were surveys
or retrospective evaluations of data. The majority (20/25) were carried out in the
United States. Positive attitudes towards vaccination, having health insurance, being
older, having received childhood vaccinations, having better knowledge about
vaccines, using healthcare services more frequently, and having a healthcare
practitioner as a source of information were all linked to increased vaccine uptake.
African American girls were less likely to have started or finished the three-dose
vaccination series in US settings. Adolescent girls and women in a growing number
of nations have had access to the Human Papillomavirus (HPV) vaccination since
2006, which offers protection against the virus that causes cervical cancer. The
vaccine series is offered in three doses over 6 months, and the aim of this study was
to identify factors associated with initiation and/or discontinuation of the three-dose
series in (pre)adolescent girls. Previous studies considered intention to vaccinate
rather than actual vaccination.

6. Edison J Mavundza, Chinwe J Iwu-Jaja, et al (2021) The most prevalent sexually

transmitted infection in the world is caused by the human papillomavirus (HPV). A
persistent infection with high-risk HPV types can lead to diseases, even though the
majority of HPV infections are brief and asymptomatic. Despite the fact that there are
currently three safe and effective prophylactic HPV vaccines in use worldwide, the
vaccination rate for HPV is still low. The impact of the initiatives to increase HPV
vaccination coverage is assessed in this review. For eligible studies, we looked
through the reference lists of pertinent publications and searched the Cochrane
Central Register of Controlled Trials, PubMed, Web of Science, Scopus, and the
World Health Organization International Clinical Trials Registry Platform. 35 studies
satisfied the requirements for inclusion. According to our review, a number of
evaluated interventions, such as provider prompts, training, training plus assessment
and feedback, funding, multicomponent interventions, outreach and reminders,
financial incentives plus reminders, narrative education, and brief motivational
behavioral interventions, have increased the coverage of HPV vaccinations. However,
high-income nations, primarily the United States of America, were the sites of the
intervention's evaluation. Thus, research is required to assess the impact of these
interventions in low- and middle-income nations where the prevalence of HPV is high
and there are few programs for HPV vaccination.
7.
SUMMARY

37
This chapter includes a review of the literature divided into three sections: research on cervical
cancer, research on cervical cancer screening, research on the HPV vaccine, and research on
nursing university students' perceptions and knowledge of cervical cancer screening and the HPV
vaccine.The evaluation of the literature has given the researcher a thorough understanding of the
issue and expanded their perspective, both of which are crucial for developing the conceptual
framework and device. Literature provided an in-depth examination of function and enabled the
gathering of knowledge to support a comprehensive understanding of the issue.

38
CHAPTER 3

CHAPTER-III

METHODOLOGY

39
“Everything comes to us that belongs to us if we create the capacity to receive it.”
(Rabindranath Tagore)

The methodology of the research indicates the general pattern of organizing the procedure for
gathering valid and reliable data for an investigation. The present chapter provides a brief
description of different steps to evaluate the effectiveness of structured teaching program on
cervical cancer screening and HPV vaccine. This chapter deals with the research approach,
research design, variables under study, setting, population, the sample and sampling technique. It
further deals with the development and description of tools, planning of structured teaching
program, procedure for data collection and plan for data analysis.

RESEARCH APPROACH

A research approach tells the researcher as to what data to collect and how to analyze it. It is
overall plan or blueprint chosen to carry out the study. It also suggests the possible conclusion to
be drawn from the data. The research approach used for this study was quantitative research to
accomplish the objectives of the study.
According to Sharma S.K. (2011) “Quantitative research design is the master plan specifying the
methods and procedure for collecting and analyzing the needed information in a research study.”
Hence the quantitative research approach was adopted for the present study because the primary
objectives of the study were to determine the effectiveness of the teaching programme

RESEARCH DESIGN

Research design refers to strategies that the researcher adopts to develop information that is
accurate, objective and meaningful.

40
 According to Polit and Beck (2011), Research design is overall plan for addressing a research
question, including specification for enhancing the integrity of the study.
According to Green and Tull, "It is the specification of techniques and processes for
obtaining the information required. It is the over-all operational pattern or framework of
the project which states what data is to be gathered from which source by what processes."

According to Kothari (2004), research design is a plan, a roadmap and blueprint strategy
of investigation conceived so as to obtain answers to research questions.

The research design is selected for this study was PRE-EXPERIMENTAL PRE TEST
POST TEST DESIGN which was suited to assess the level of knowledge and perception
and effectiveness of structured teaching programme among 60 nursing college students.

GROUP K1 X K2

60 nursing students of DAY1 DAY2

DAY8
Sumita Institute of Structured knowledge Structured teaching
Structured knowledge
Nursing and questionnaires and programme on cervical
and perception
Paramedical Sciences Perception cancer screening and
questionnaires on
questionnairs HPV vaccine
cervical cancer and
HPV vaccine
TABLE 1: SYMBOLIC REPRESENTATION OF PRE -EXPERIMENTAL DESIGN
KEYS:
• K1-Is the pre-test knowledge and perception questionnaires of the students.
• X-Is the structured teaching program on screening of cervical cancer and HPV vaccine
• K2-Is the post- test knowledge and perception questionnaires of the students.

ATTRIBUTE VARIABLES:
RESEARCH
RESEARCH DESIGN: DEMOGRAPHIC DATA
APPROACH:
PRE EXPERIMENTAL INDEPENDENT VARIABLE:
QUANTITATIVE
PRE TEST POST TEST STRUTURED TEACHING
RESEARCH
DESIGN PROGRAMME
41
DEPENDENT VARIABLE:

KNOWLEDGE AND
PERCEPTION
 STUDY SETTING:
POPULATION:
SAMPLE AND SAMPLE SIZE:
SUMITRA INSTITUTE
NURSING COLLEGE OF NURSING AND
60 NURSING COLLEGE
STUDENTS AT INSTITUTE STUDENTS PARAMEDICAL
SCIENCES, GREATER
NOIDA

DATA COLLECTION TOOL

SAMPLING AND TECHNIQUE:
FINDINGS,
TECHNIQUE:
STRUCTURED KNOWLEDGE SUMMARY AND
PURPOSIVE AND PERCEPTION CONCLUSIONS
SAMPLING QUESTIONNAIRES

SCHEMATIC REPRESENTATION OF RESEARCH DESIGN

42
 VARIABLES UNDER THE STUDY

According to POLIT and BECK (2011) “A variable is the name implies something that varies, a
variable is quality of an organism, group or situation that takes different values”. A variable is a
symbol to which numerates or values are assigned.

TYPES OF VARIABLES :-

• Dependent variable
• Independent variable
• Extraneous variable

Dependent variable
The dependent variable is the condition or characteristics that appears or disappear as a result of
independent variable. In the present study, knowledge and perception of the students through
teaching program assisted knowledge and perception interview schedule formed the dependent
variables.

Independent variable
The independent variables are a condition or characteristics that the researcher manipulates or
controls in an attempt to ascertain their relationship to observed phenomenon. In this research
study, independent variable was structured teaching program on screening of cervical cancer and
HPV vaccine.

Extraneous variable
The extraneous variable is any variables that we are not intentionally studying in our study.
When we run an experiment, we are looking to see if one variable has an effect on another
variable. For eg- Television, magazine, Newspaper, Internet etc.

43
 SETTING OF THE STUDY

According to POLIT and BECK (2011) “setting is a physical location and condition in which
data collection takes place the study”

The selection of appropriate set up is important because the set up can influence the way people
behave or feel and how they respond. The researcher needs to decide where the data will be
collected. In this study setting was selected in a nursing college of Delhi, NCR.

CRITERIA FOR THE SELECTION OF THE SETTING:

-Familiarity with the setting.

-Geographical proximity of setting.
-Feasibility of conducting the study.
-Administrative approval and expectation of co-operations for the study.
-Easy access to subjects.

POPULATION
Polit and Beck (2011) describe population as the entire aggregation of cases that meet a
designated set of criteria. The need for defining a population for a research project arises out of
the requirement to specify the group which the result of the study can be applied. The population
for the present study comprised of students of age group of 16-24 years.

SAMPLE
The subject of population selected to participate in research study “a sample is a small portion of
population selected for observation and analysis” as stated by Polit and Beck (2011).
In the present study, samples are nursing college students at the Sumitra Institute of Nursing and
Paramedical Sciences.

44
 SAMPLE SIZE
The sample size for the present study comprised 60 students who were in the age group between
16-24 years of age, studying in nursing college of Delhi, NCR.

SAMPLING TECHNIQUE
Sampling is a process of selecting a part of the assigned population to represent the entire
population. The procedure of sampling should be systematically organized. This helps to
eliminate the data bias that can occur during sample selection, which is mostly carried out
in consistently.

Non-probability sampling is a technique wherein the samples are gathered in a process

does not give all the individuals in the population equal chances of being selected. In other
words, in this type of sampling every subject does not have equal chance to be because
elements are chosen by choice not by chance through non- random sampling.

In this study Non-probability Purposive Sampling Technique was adopted to select the
nursing students in selected nursing colleges of Delhi, NCR.

For present study 60 nursing college students were selected using purposive sampling
technique method.

INCLUSION CRITERIA

- Students who can speak Hindi/English.

- Students who were available during the time of the study.
- Students who were willing to participate.

EXCLUSION CRITERIA
- Students who are not willing to participate.
- Students who are under the age of 16 years of age.

45
 DATA COLLECTION TOOLS AND TECHNIQUE
The most important and crucial aspect of any investigation is the collection of appropriate
information, which provides necessary data for the study.
Data collection tools are the device a researcher uses to collect the data. The type of data
collection tool required depend on the nature of the data gathered to answer the research
question. Polit and Beck, (2011). A search for the literature was made for the purpose of
locating an appropriate tool.

SELECTION OF TOOLS
According to Treece and treece, (2019), the instrument selection in a research should as far as
possible be the vehicle that would best obtaining data for conclusion pertinent of the study.
Based on the objectives of the study the following tools were used by the researcher.

DESCRIPTION AND DEVELOPMENT OF TOOLS

DEVELOPMENT OF TOOLS

Tool was developed by reviewing research and non-research literature.

The following steps were used to develop tools:

• Reviewing of research and research literature of cervical cancer screening and

HPV Vaccine.
• Consultation with the guide
• Seeking options and suggestion from experts
• Validation of tools.
• Establishing reliability of the tool by applying suitable statistical procedure
• Final draft of the tool

DESCRIPTION OF THE DATA COLLECTION TOOL

In order to determine the assess the effectiveness of structured teaching programme

regarding cervical cancer screening and HPV vaccine in terms of knowledge and

46
perception among students of selected nursing colleges of Delhi, NCR , structured
knowledge and perception questionnaires were used with the total number of 23 items in
each questionnaire as shown in appendix . For convenience the tool was divided as:

Tool A: Demographic profile

Tool B: Structured knowledge questionnaire on cervical cancer screening and
HPV Vaccine.
Tool C: Structured Perception questionnaire on cervical cancer screening and
HPV Vaccine.

TOOL A:
DEMOGRAPHIC PROFILE: It consists of age, gender, religion, marital status, type of
family, family income per month, education, have you heard about pap smear.
TOOL B:
STRUCTURED KNOWLEDGE QUESTIONNAIRE: It consists of 23 multiple choice
questions to assess knowledge on cervical cancer screening and HPV Vaccine and
knowledge score was classified as poor, moderate and adequate.

SCORE CRITERIA FREQUENCY

PERCENTAGE
0-7 POOR 0%
8-15 MODERATE 18.3%
16-23 ADEQUATE 81.66%

TOOL C:

STRUCTURED PERCEPTION QUESTIONNAIRE: It consists of 23 multiple choice

questions to assess knowledge on cervical cancer screening and HPV Vaccine and
perception score was classified as very dissatisfied, dissatisfied, neutral, satisfied and very
satisfied.

47
 PERCEPTION LEVEL CATEGORY FREQUENCY
PERCENTAGE

VERY DISSATISFIED 1-23 0%

DISSATISFIED 24-46 0%
NEUTRAL 47-69 0%
SATISFIED 70-92 75%
VERY SATISFIED 93-115 25%

CONTENT VALIDITY OF THE TOOL

According to Treece and Treece, Validity refers to an instrument or test actually testing
what it is supposed to be testing. According to American Psychological Foundation,
'Validity is the appropriateness, meaning, full ness, and usefulness of the interference made
from the scoring of the instrument'.

Content validity of tool was obtained by submitting the tool to 5 experts in Nightingale
institute of Nursing. Experts were requested to give their opinion about relevance, clarity
and appropriateness of the items. Suggestions were received to modify some items in the
tool, necessary modification were incorporated based on the expert suggestion, the tool
was found to be valid for the study.

RELIABILITY OF THE TOOL

'Reliability is defined as the ability of an instrument to create reproducible results'.

Therefore, reliability is concerned with consistency of the measurement tools. A tool can
only be considered reliable if it measures an attribute with similar results on repeated use.

48
Each questionnaire having 23 items were administered to nursing college students.

DEVELOPMENT AND DESCRIPTION OF STRUCTURED

TEACHING PROGRAMME

Polit and beck state the instrument as a written device that the researcher uses to collect data.
One of the objective of the data was to identify the knowledge and perception of Nursing
Students present in Nursing college.
The following steps were used to develop lecture cum discussion:
1. Reviewing of research and non- research literature of cervical cancer screening and
HPV Vaccine among nursing college students.
2. First draft was made
3. Consultation with the guide
4. Seeking opinion and suggestions from experts
5. Validation
6. Final draft of lesson plan formed.

PROCEDURE FOR DATA COLLECTION

Formal administrative permission was taken from the principal of the Sumitra institute of nursing
and paramedical science, in Greater Noida, final data collection was done from 22 Feb 2024 to
29 Feb, 2024. 60 nursing students were selected by the convenient sampling technique to obtain
free and Frank responses.
After obtaining informed consent from the subject on day one, the pre – test of knowledge
regarding cervical cancer was carried out by the knowledge and perception questionnaires
followed by the structured teaching program to clarify their doubts. On the day of post – test
knowledge as identical to pre – test was carried out to evaluate the effectiveness of structured
teaching program on the sample subject.
Data was collected in following steps:

GROUP K1 X K2

60 nursing students of DAY1 DAY2 DAY8

Sumitra Institute of Structured knowledge Structured teaching Structured knowledge
Nursing and questionnaires and programme on cervical and perception
Paramedical Sciences Perception cancer screening and questionnaires on
questionnaires HPV vaccine cervical cancer and

49
 HPV vaccine
ETHICAL CONSIDERATION

Formal permission was taken from the principal of Nightingale Institute of Nursing
Ethical permission from ethical committee
Permission was obtained from Principal of Sumitra Institute of Nursing and Paramedical
Sciences.
Anonymity and confidentiality of the participants has been maintained

PLAN FOR DATA ANALYSIS

The data were planned to be analyzed by using both descriptive and inferential statistics and the
following plan for data analysis has been worked out.
The findings are presented according to the objectives set for the study. The data will be
organized under the following headings:

SECTION 1: Findings related to frequency and percentage distribution of nursing college

students in terms of demographic variables.
SECTION 2: Findings related to level of knowledge and perception regarding cervical cancer
screening and HPV vaccine before and after the structured teaching program given to nursing
students.
SECTION 3: Findings related to association between post-test knowledge score of nursing
college students with selected demographic variables
1. Mean, medians and standard deviation would be used to describe the pre – test and post –
test knowledge scores
2. T value would be calculated to the pre – test and post – test knowledge score
SECTION 4: Findings related to association between post-test perception score of nursing
college students with selected demographic variables.

50
Chi – square would be computed to find out the association between post – test knowledge and
selected demographic variables and the association between post – test perception and selected
demographic variables

SUMMARY

This chapter dealt with methodology, adopted for the study. It included research approach
research design, variables under study, setting, sample and sampling technique, development of
the structured teaching program, procedure for data collection and collection and plan for data
analysis.

51
CHAPTER-4

CHAPTER-4

52
 ANALYSIS AND INTERPRETATION OF DATA

This chapter deals with the analysis and interpretations of data collected from 60 nursing
students of selected nursing college with the help of structured knowledge and perception
questionnaire. The present study ‘A pre-experimental study to assess the effectiveness of
structured teaching programs regarding cervical cancer screening and HPV vaccine in terms of
knowledge and perception among students of selected nursing colleges of Delhi, NCR

OBJECTIVES OF THE STUDY

● To assess the level of knowledge regarding cervical cancer screening and HPV vaccine
among nursing students.
● To assess the level of perception regarding cervical cancer screening and HPV vaccine
among nursing students.
● To evaluate the effectiveness of STP on level of knowledge and perception regarding
cervical cancer screening and HPV vaccine among student in selected groups.
● To find out the association between post-test knowledge and Perception score regarding
cervical cancer and HPV vaccine among students in selected groups.

HYPOTHESIS
● H1 -There will be significant difference between the mean pre-test knowledge score and
mean post-test knowledge score of the nursing students regarding cervical cancer
screening and HPV vaccine
● H2- There will be significant difference between the mean pre-test perception score and
mean post-test perception score of the nursing students regarding cervical cancer
screening and HPV vaccine.
● H3-There will be significant association between post-test knowledge scores regarding
cervical cancer screening and HPV vaccine among nursing students with the selected
demographic variables at the 0.05 level of significance.
● H4-There will be significant association between post -test perception scores
regarding cervical cancer screening and HPV vaccine among nursing students with
the selected demographic variables at the 0.05 level of significance.

53
 ORGANISATION AND PRESENTATION OF DATA

SECTION 1: Findings related to frequency and percentage distribution of nursing college

students in terms of demographic variables.
SECTION 2: Findings related to level of knowledge and perception regarding cervical cancer
screening and HPV vaccine before and after the structured teaching program given to nursing
students.
SECTION 3: Findings related to association between post test knowledge
score of nursing college students with selected demographic variables
SECTION 4: Findings related to association between post test perception
score of nursing college students with selected demographic variables

SECTION 1

FINDINGS RELATED TO FREQUENCY AND PERCENTAGE

DISTRIBUTION OF NURSING COLLEGE STUDENTS IN TERMS
OF DEMOGRAPHIC VARIABLES.

This section describes the demographic characteristics of the subjects of the study. The
study consists of 60 samples. The data obtained described the characteristics pertaining to
their AGE, GENDER, RELIGION, MARITAL STATUS, TYPE OF FAMILY, FAMILY
INCOME PER MONTH, EDUCATION, HAVE YOU HEARD ABOUT PAP SMEAR.
Frequency and percentage distribution were computed for describing the sample
characteristics.

TABLE-2

54
FREQUENCY AND PERCENTAGE DISTRIBUTION OF NURSING
COLLEGE STUDENTS IN TERMS OF DEMOGRAPHIC VARIABLES
N= 60

S.NO. DEMOGRAPHIC FREQUENCY PERCENTAGE

DATA
1 AGE
a) 16-18 10 16.66%
b)18-20 39 65%
c)20-22 7 11.66%
d)22-24 4 6.6%

2 GENDER
a) Female 47 78.33%
b) Male 13 21.66%

3 RELIGION
a) Hindu 50 83.33%
b) Christian 5 8.33%
c) Muslim 3 5%
d) Sikh 2 3.33%

4 MARITAL STATUS
a) Married 1 1.6%
b) Unmarried 59 98.3%

5 TYPE OF FAMILY
a) Nuclear family 31 51.66%
b) Grandparent family 7 11.66%

55
 c) Joint family 19 31.66%
d) Single parent 3 5%

6 FAMILY INCOME
a) < 10,000 10 16.6%
b) 10,000 - 50,000 36 60%
c) > 50,000 5 8.3%
d) 50,000 – 80,000 9 15%

7 EDUCATION
a) GNM 1st year 27 45%
b) BSC 1st year 33 55%
c) PBBSC 1st year 0 0%
d) MSC 1st year 0 0%

8 HAVE YOU EVER

HEARD ABOUT PAP
SMEAR?
a) Yes
16 26.6%
b) No
44 73.3%

Considering the age in pre- experimental, majority of nursing college students belong to age
group 18-20 years i.e. 39(65%), students belong to 16-18 years are 10 (16.6), students belong to
20-22 years are 7 (11.6%) and students belong to 22-24 years are 4 (6.6).
Maximum of nursing students are female i.e.47 (78.3%) and males are 13 (21.6%).
Regarding the religion of pre- experimental group, majority of nursing students belong to Hindu
religion i.e. 50 (83.3%), Christians are 5 (8.3%), Muslims are 3 (5%) and Sikhs are 2 (3.3%).
The unmarried nursing students are 59 (98.3%) in the pre-experimental group which is maximum
in the and married one are 1 (1.6%).
Regarding the type of family in the group, majority of nursing students belong to nuclear family
i.e. 31 (51.6%), students belong to grandparent family are 7 (11.6%), nursing students belong to
joint family are 19 (31.6%) and students belong to single parent are 3 (5%).

56
Maximum of nursing students belong to family income 10,000-50,000 i.e. 36 (60%), students
belong to family income <10,000 are 10 (16.6%), students belong to family income >50,000 are
5 (8.3%) and students belong to family income 50,000-80,000 are 9 (15%).
Majority of nursing students are from BSC 1st year i.e. 33 (55%), students from GNM 1st year are
27 (45%), PBBSC 1st year students are 0 and MSC 1st year students are 0.
A good no. of nursing students do not know about PAP SMEAR i.e. 44 (73.3%) and students
who knew about PAP SMEAR are 16 (26.6%).

GRAPHICAL REPRESENTATION OF DATA

AGE PERCENTAGE
12% 7% 17%

65%

16-18 YR 18-20 YR 20-22 YR 22-24 YR

57
FIGURE 2: PIE CHART SHOWS THE FREQUENCY PERCENTAGE
DISTRIBUTION OF NURSING COLLEGE STUDENTS BY AGE

GENDER

0.783

21.60%

FEMALE MALE
FEMALE MALE Column1

FIGURE 3: BAR GRAPH SHOWS THE FREQUENCY PERCENTAGE

DISTRIBUTION OF NURSING STUDENTS BY GENDER

RELIGION

SIKH

MUSLIM

CHRISTIAN

HINDU

0.00% 20.00% 40.00% 60.00% 80.00% 100.00%

HINDU CHRISTIAN MUSLIM SIKH

58
FIGURE 4: BAR GRAPH SHOWS THE FREQUENCY PERCENTAGE
DISTRIBUTION OF NURSING STUDENTS BY RELIGION

MARITAL STATUS

UNMARRIED

MARRIED

0.00% 20.00% 40.00% 60.00% 80.00% 100.00%

UNMARRIED Column1

FIGURE 5: BAR GRAPH SHOWS THE FREQUENCY PERCENTAGE

DISTRIBUTION OF NURSING STUDENTS BY MARITAL STATUS

TYPE OF FAMILY

51.60% 11.60% 31.60% 120.00%

NUCLEAR FAMILY GRANDPARENT JOINT FAMILY SINGLE PARENT

FAMILY

TYPE OF FAMILY

FIGURE 6: BAR GRAPH SHOWS FREQUENCY PERCENTAGE

DISTRIBUTION OF NURSING STUDENTS BY TYPE OF FAMILY
59
 FAMILY INCOME
70.00%
60.00% 60%
50.00%
40.00% FAMILY INCOME
30.00%
20.00% 17% 15%
10.00% 8%
0.00%
<10,000 10,000- >50,000 50,000-
50,000 80,000

FIGURE 7: LINE GRAPH SHOWS THE FREQUENCY %AGE

DISTRIBUTION OF NURSING STUDENTS BY FAMILY INCOME

EDUCATION
60%
50%
40%
30%
20%
10%
0%
GNM 1ST YR
BSC 1ST YR
PBBSC 1ST
YR MSC 1ST YR

EDUCATION

FIGURE 8: LINE GRAPH SHOWS THE FREQUENCY %AGE

DISTRIBUTION OF NURSING STUDENTS BY EDUCATION

60
 HAVE YOU HEARD ABOUT PAP SMEAR
HAVE YOU HEARD ABOUT PAP SMEAR
80.00%
73.30%
70.00%
60.00%
50.00%
40.00%
30.00%
26.60%
20.00%
10.00%
0.00% 0.00% 0.00%
YES NO

FIGURE 9: LINE GRAPH SHOWS THE FREQUENCY %AGE

DISTRIBUTION ON THE BASIS OF KNOWLEDGE ABOUT TOPIC

SECTION II
FINDINGS RELATED TO EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAM REGARDING CERVICAL CANCER
SCREENING AND HPV VACCINE BEFORE AND AFTER THE
TEACHING PROGRAM GIVEN TO SELECTED NURSING COLLEGE
STUDENTS.

This section deals with findings related to frequency and percentage distribution of
knowledge and perception scores of nursing college students regarding cervical cancer and
HPV vaccine.. The knowledge and perception score were obtained through structured
knowledge questionnaire. The data were described, analysed using descriptive and
inferential statistics.

61
 TABLE-3

FREQUENCY AND PERCENTAGE DISTRIBUTION OF PRE TEST

AND POST TEST KNOWLEDGE SCORES REGARDING CERVICAL
CANCER SCREENING AND HPV VACCIBE AMONG NURSING
STUDENTS
N=60
KNOWLEDGE CATEGORY PRE TEST POST TEST
LEVEL
FREQUENCY FREQUENCY
PERCENTAGE PERCENTAGE

POOR 0-7 85% 0%

MODERATE 8-15 15% 18.33%
ADEQUATE 16-23 0% 81.66%

Data presented in the table shows that the knowledge score of nursing students in pre
test was assessed which revealed 85% of them had poor knowledge, 15% had moderate
knowledge and none of them had adequate knowledge. The knowledge score of nursing
students in post test was assessed and table reveals that 81.66% of them had adequate
knowledge, 18.33% of them had moderate knowledge and none of them had poor
knowledge.

90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
PRE TEST POST TEST
FREQUENCY FREQUENCY
PERCENTAGE PERCENTAGE

ADEQUATE 16-23 MODERATE 8-15 POOR 0-7

62
 FIGURE 10: BAR GRAPH DEPICTING THE FREQUENCY AND PERCENTAGE
DISTRIBUTION OF PRE TEST AND POST TEST KNOWLEDGE SCORE OF
NURSING STUDENTS REGARDING CERVICAL CANCER AND HPV VACCINE

SECTION-III
FINDINGS RELATED TO EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAM REGARDING CERVICAL CANCER
SCREENING AND HPV VACCINE AMONG NURSING STUDENTS

H1- There will be significant difference between the mean pre-test knowledge score and mean
post-test knowledge score of the nursing students regarding cervical cancer screening and HPV
vaccine.

TABLE 4

MEAN, MEAN DIFFERENCE, STANDARD DEVIATION, T-VALUE OF

KNOWLEDGE SCORE REGARDING CERVICAL CANCER SCREENING AND
HPV VACCINE AMONG NURSING STUDENTS

N=60
MAXIMUM

KNOWLEDGE SCORE MEAN SD MEAN PAIRED

TESTS DIFFERENC T- TEST

PRE TEST 23 4.7 2.8 13.33 24.03

5

63
POST TEST 23 18.3 5.6
6

df (59) = 2.0010 at 0.05 level of significance

The data represented in table indicates that mean post test score that is 18.3 with standard
deviation 5.66 is higher than the calculated pre-test score that is 4.7 mean with standard
deviation 2.85 with mean difference of 13.33 and calculated paired t test value is 24.03
which is higher than the t value that is 2.0010 at df (59) at the level of 0.05 significance.
Hence the H1 is selected.

TABLE-5

FREQUENCY AND PERCENTAGE DISTRIBUTION OF PRE TEST

AND POST TEST PERCEPTION SCORES REGARDING CERVICAL
CANCER SCREENING AND HPV VACCIBE AMONG NURSING
STUDENTS

N=60
PERCEPTION LEVEL CATEGORY PRE TEST POST TEST

FREQUENCY FREQUENCY
PERCENTAGE PERCENTAGE

VERY DISSATISFIED 1-23 0% 0%

DISSATISFIED 24-46 65% 0%
NEUTRAL 47-69 35% 0%

64
 SATISFIED 70-92 0% 75%
VERY SATISFIED 93-115 0% 25%

Data presented in the table shows that the perception score of nursing students in pre test was
assessed which revealed that 0% of the perception level is very dissatisfied, 60% of perception
level is dissatisfied, 40% of perception level is neutral, 0% of perception level is satisfied and 0%
of perception level is very satisfied. Perception level of nursing students in post- test was
assessed and table reveals that 0% of the perception level is very dissatisfied, 0% of perception
level is dissatisfied, 0% of perception level is neutral, 56.6% of perception level is satisfied and
43.3% of perception level is very satisfied.

75%
80%
65%
70%
60%
50%
35%
40%
25%
30%
20%
10% 0% 0%0% 0%0%0%
0%
PRE TEST POST TEST
FREQUENCY FREQUENCY
PERCENTAGE PERCENTAGE

VERY DISSATISFIED DISSATISFIED NEUTRAL

SATISFIED VERY SATISFIED

FIGURE 11: BAR GRAPH DEPICTING THE FREQUENCY AND PERCENTAGE

DISTRIBUTION OF PRE TEST AND POST TEST PERCEPTION SCORE OF
NURSING STUDENTS REGARDING CERVICAL CANCER AND HPV VACCINE

TABLE-6

MEAN, MEAN DIFFERENCE, STANDARD DEVIATION, T-VALUE OF

PERCEPTION SCORE REGARDING CERVICAL CANCER SCREENING AND
HPV VACCINE AMONG NUSING STUDENTS

65
 H2- There will be significant difference between the mean pre-test perception score and
mean post-test perception score of the nursing students regarding cervical cancer screening
and HPV vaccine.

N=60

PERCEPTION MAXIMUM MEAN SD MEAN PAIRED

SCORE SCORE DIFFERENCE T -TEST

PRE TEST 115 43.05 80.04 43.7 46.68

POST TEST 115 86.75 97.07

df (59) = 2.0010 at 0.05 level of significance

The data represented in table indicates that mean post test score that is 86.75 with standard
deviation 97.07 is higher than the calculated mean pre-test score that is 43.05 with standard
deviation 80.04 with mean difference of 43.7 and calculated paired t test value is 46.68
which is higher than the t value that is 2.0010 at df (59) at the level of 0.05 significance.
Hence the H2 is selected.

SECTION IV

FINDINGS RELATED TO ASSOCIATION OF POST TEST

KNOWLEDGE AND PERCEPTION SCORES WITH SELECTED
DEMOGRAPHIC VARIABLES

This section describes the findings related to association of post-test knowledge scores
with selected demographic variables : AGE, GENDER, RELIGION, MARITAL STATUS,
TYPE OF FAMILY, FAMILY INCOME, EDUCATION, HAVE YOU EVER HEARD
ABOUT PAP SMEAR.

To determine the association CHI SQUARE was used.

66
I. H3- There will be significant association between post-test knowledge scores
regarding cervical cancer screening and HPV vaccine among nursing students with the
selected demographic variables at the 0.05 level of significance.

TABLE 7

CHI SQUARE TEST SHOWING ASSOCIATION B/W POST TEST

KNOWLEDGE SCORE AND SELECTED DEMOGRAPHIC
VARIABLES

N=60

S.NO. DEMOGRAPHIC KNOWLEDGE CHI NS/ S

VARIABLES SCORES SQUARE
df
TEST
BELOW ABOVE

MEAN MEAN

1 AGE

a] 16-18 4 4

b] 18-20 31 8 1 1.2 NS

67
 c] 20-22 4 4

d]22-24 3 1

2 GENDER

a] Female 19 28 1 0.014 NS

b] Male 5 8

3 RELIGION

a] Hindu 6 44

b] Christian 1 3 1 0.006 NS
c] Muslim 0 3

d] Sikh 0 1

MARITAL
STATUS

a] Married
4 0 1 1 0.024 NS
b] Unmarried
51 8

5 TYPE OF
FAMILY

a] Nuclear family
3 28 2 2.433 NS
b] Grandparent
family 2 5

c] Joint family

d] Single parent 5 14

0 3

68
 6 FAMILY
INCOME

a] < 10,000
8 2 2 2.07 NS
b] 10,000-50,000
32 4
c] > 50,000
4 1
d] 50,000- 80,000
6 3

7 EDUCATION

a] GNM 1st year 3 27

b] BSC 1st year 4 29 1 0.017 NS

c] PBBSC 1st year
0 0
d] MSC 1st year
0 0

8 HAVE YOU
EVER HEARD
ABOUT PAP
SMEAR?

a] YES 1 3.09 NS

b] NO 3 13

2 42

NS= NOT SIGNIFICANT, S= SIGNIFICANT

INTERPRETATION

The data presented in Table 7 revealed that the Chi Square Test was used to find out the
association between the post -test knowledge scores with the demographic variables. It is
evident that the demographic variables (AGE, GENDER, RELIGION, MARITAL
STATUS, TYPE OF FAMILY, FAMILY INCOME, EDUCATION, HAVE YOU EVER

69
HEARD ABOUT PAP SMEAR) have no association with mean post- test and there is no
significance. Hence the H3 is rejected.

II. H4- There will be significant association between post -test perception scores
regarding cervical cancer screening and HPV vaccine among nursing students with
the selected demographic variables at the 0.05 level of significance.

TABLE 8

CHI SQUARE TEST SHOWING ASSOCIATION B/W POST TEST

PERCEPTION SCORE AND SELECTED DEMOGRAPHIC
VARIABLES.

N=60

S.NO. DEMOGRAPHIC PERCEPTION CHI

VARIABLES SCORE SQUA
RE
Below Above
D TEST NS/
Mean Mean f S

1 AGE 1
a) 16-18 3 7 1.036 NS
b)18-20
9 30
c)20-22
3 4
d)22-24
1 3

2 GENDER 1 4.19 S
a) Female 3 10
b) Male

70
 7 40

3 RELIGION 1 7.37 S
a) Hindu 3 47
b) Christian
1 4
c) Muslim
2 0
d) Sikh
1 2

4 MARITAL STATUS 1 0.12 NS

a) Married 0 1
b) Unmarried
7 52

5 TYPE OF FAMILY 1 40.56

a) Nuclear family 10 21 S
b) Grandparent family
3 4
c) Joint family
9 10
d) Single parent
1 2

6 FAMILY INCOME 1 NS
a) < 10,000 1 9 2.55
b) 10,000 - 50,000
4 32
c) > 50,000
2 3
d) 50,000 – 80,000

71
 3 6

7 EDUCATION 1 15.98 S
a) GNM 1st year 7 4
b) BSC 1st year
4 29
c) PBBSC 1st year
0 0
d) MSC 1st year
0 0

8 HAVE YOU EVER

HEARD ABOUT PAP
SMEAR? 1 9.29 S

a) Yes 4 10
b) No
6 40

NS= NOT SIGNIFICANT, S= SIGNIFICANT

INTERPRETATION

The data presented in table 8 revealed that the Chi Square Test was obtained to find out the
association between the post test perception scores with the demographic variables. It is
evident that some demographic variables [AGE, GENDER, RELIGION, MARITAL
STATUS, TYPE OF FAMILY, FAMILY INCOME, EDUCATION, HAVE YOU EVER
HEARD ABOUT PAP SMEAR] has association and some has no association with the
mean post test and there is no significance. Hence the H4 is rejected.

SUMMARY

This chapter dealt with the analysis and interpretation of data collection from 60 nursing
students present at selected nursing college of Delhi, NCR. Descriptive and inferential
statistics were used in the analysis of data. This chapter includes analysis and interpretation
of sample characteristics, findings related to frequency percentage level of knowledge,

72
mean, standard deviation of knowledge score, association between post- test and
knowledge score with demographic variables and association between post- test and
perception score with demographic variables. Pie charts and Bar diagrams are used to
make graphical representation of demographic data.

73
CHAPTER 5

CHAPTER V
RESULTS

74
 PROBLEM STATEMENT

A PRE-EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME REGARDING CERVICAL CANCER
SCREENING AND HPV VACCINE IN TERMS OF KNOWLEDGE AND PERCEPTION
AMONG STUDENTS OF SELECTED NURSING COLLEGES OF DELHI, NCR.

OBJECTIVES OF THE STUDY

● To assess the level of knowledge regarding cervical cancer screening and HPV vaccine
among nursing students.
● To assess the level of perception regarding cervical cancer screening and HPV vaccine
among nursing students.
● To evaluate the effectiveness of STP on level of knowledge and perception regarding
cervical cancer screening and HPV vaccine among student in selected groups.
● To find out the association between post-test knowledge and Perception score regarding
cervical cancer and HPV vaccine among students in selected groups.

HYPOTHESIS

● H1 -There will be significant difference between the mean pre-test knowledge score and
mean post-test knowledge score of the nursing students regarding cervical cancer
screening and HPV vaccine
● H2- There will be significant difference between the mean pre-test perception score and
mean post-test perception score of the nursing students regarding cervical cancer
screening and HPV vaccine.
● H3-There will be significant association between post test knowledge scores regarding
cervical cancer screening and HPV vaccine among nursing students with the selected
demographic variables at the 0.05 level of significance.

75
 ● H4-There will be significant association between post -test perception scores
regarding cervical cancer screening and HPV vaccine among nursing students with
the selected demographic variables at the 0.05 level of significance.

MAJOR FINDINGS OF THE STUDY

The data was collected, analysed and interpreted in terms of objectives, descriptive and
inferential statistics were used for analysis of the data. The level of significance set for testing
hypothesis was 0.05 using test.

SECTION-I
FINDINGS RELATED TO FREQUENCY AND PERCENTAGE DISTRIBUTION OF
NURSING COLLEGE STUDENTS IN TERMS OF DEMOGRAPHIC VARIABLES.

This section describes the demographic characteristics of the subjects of the study. The study
consists of 60 samples. The data obtained described the characteristics pertaining to their AGE,
GENDER, RELIGION, MARITAL STATUS, TYPE OF FAMILY, FAMILY INCOME PER
MONTH, EDUCATION, HAVE YOU HEARD ABOUT PAP SMEAR.

Frequency and percentage distribution were computed for describing the sample characteristics.
Considering the age in pre- experimental, majority of nursing college students belong to age
group 18-20 years i.e. 39(65%), students belong to 16-18 years are 10 (16.6), students belong to
20-22 years are 7 (11.6%) and students belong to 22-24 years are 4 (6.6).
Maximum of nursing students are female i.e.47 (78.3%) and males are 13 (21.6%).
Regarding the religion of pre- experimental group, majority of nursing students belong to hindu
religion i.e. 50 (83.3%), Christians are 5 (8.3%), Muslims are 3 (5%) and Sikhs are 2 (3.3%).
The unmarried nursing students are 59 (98.3%) in the pre experimental group which is maximum
in the and married one are 1 (1.6%).
Regarding the type of family in the group, majority of nursing students belong to nuclear family
i.e. 31 (51.6%), students belong to grandparent family are 7 (11.6%), nursing students belong to
joint family are 19 (31.6%) and students belong to single parent are 3 (5%).

76
Maximum of nursing students belong to family income 10,000-50,000 i.e. 36 (60%), students
belong to family income <10,000 are 10 (16.6%), students belong to family income >50,000 are
5 (8.3%) and students belong to family income 50,000-80,000 are 9 (15%).
Majority of nursing students are from BSC 1st year i.e. 33 (55%), students from GNM 1st year are
27 (45%), PBBSC 1st year students are 0 and MSC 1st year students are 0.
A good no. of nursing students do not know about PAP SMEAR i.e. 44 (73.3%) and students
who knew about PAP SMEAR are 16 (26.6%).

SECTION-II
FINDINGS RELATED TO EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAM REGARDING CERVICAL CANCER SCREENING AND HPV VACCINE
BEFORE AND AFTER THE TEACHING PROGRAM GIVEN TO SELECTED
NURSING COLLEGE STUDENTS.

1. The knowledge score of nursing students in pre test was assessed which revealed 85% of
them had poor knowledge, 15% had moderate knowledge and none of them had adequate
knowledge. The knowledge score of nursing students in post test was assessed and table
reveals that 81.66% of them had adequate knowledge, 18.33% of them had moderate
knowledge and none of them had poor knowledge (shown in table 3).

2. The perception score of nursing students in pre test was assessed which revealed that 0%
of the perception level is very dissatisfied, 65% of perception level is dissatisfied, 35% of
perception level is neutral, 0% of perception level is satisfied and 0% of perception level
is very satisfied. Perception level of nursing students in post- test was assessed and table
reveals that 0% of the perception level is very dissatisfied, 0% of perception level is
dissatisfied, 0% of perception level is neutral, 75% of perception level is satisfied and
25% of perception level is very satisfied (shown in table 5).

SECTION-III
FINDINGS RELATED TO EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAM REGARDING CERVICAL CANCER SCREENING AND HPV VACCINE
AMONG NURSING STUDENTS.

1. Mean post-test knowledge score that is 18.3 with standard deviation 5.66 is higher than
the calculated pre-test score that is 4.7 mean with standard deviation 2.85 with mean

77
 difference of 13.33 and calculated paired t test value is 24.03 which is higher than the t
value that is 2.0010 at df (59) at the level of 0.05 significance. Hence the H1 is selected.

2. Mean post-test perception score that is 86.75 with standard deviation 97.07 is higher than
the calculated mean pre-test score that is 43.05 with standard deviation 80.04 with mean
difference of 43.7 and calculated paired t test value is 46.68 which is higher than the t
value that is 2.0010 at df (59) at the level of 0.05 significance. Hence the H2 is selected.

SECTION-IV
FINDINGS RELATED TO ASSOCIATION OF POST TEST KNOWLEDGE AND
PERCEPTION SCORES WITH SELECTED DEMOGRAPHIC VARIABLES.

The Chi Square Test was used to find out the association between the post -test knowledge
scores with the demographic variables. It is evident that the demographic variables have no
association with mean post- test and there is no significance. Hence the H3 is rejected.
The Chi Square Test was obtained to find out the association between the post test perception
scores with the demographic variables. It is evident that some demographic variables have
association with the mean post-test and some have no association with mean post test and there is
no significance. Hence the H4 is rejected.

SUMMARY
This chapter deals with findings related to frequency and percentage distribution of nursing
college students in terms of demographic variables, assessment of knowledge and perception
score, effectiveness of structured teaching program, association of knowledge and perception
score with demographic variables.

78
CHAPTER 6

CHAPTER VI
79
 DISCUSSION, SUMMARY, CONCLUSION, NURSING IMPLICATIONS,
DELIMITATION AND RECOMMENDATIONS

This chapter deals with the discussion, summary, conclusion, implication for nursing practice.
Recommendations for future research in the field of nursing have also been presented.

DISCUSSION
The present study was focused on the effectiveness of structured teaching programs regarding
cervical cancer screening and HPV vaccine in terms of knowledge and perception among
students of selected nursing colleges of Delhi, NCR
There are many studies included in the chapter of review of literature on the statement given.
Neha Taneja, Bhavika Chawla et al (April 30,2021) conducted a study giving information on
Cervical most cancers among ladies become 40.22%. expertise of hazard factors and symptoms
and signs and symptoms changed into fairly adequate a few of the women. 32.68 % of women
knew that early age of marriage became a threat element for Cervical most cancers observed via
23.01% women who cited that early age of initiation of sexual hobby turned into a commonplace
risk component for Cervical most cancers. Inter menstrual bleeding and foul smelling discharge
become the most common signal and symptom suggested in 30.75 % and 28.86% ladies
respectively. Understanding, attitude and practice concerning Cervical cancer screening become
seen in 20.31%, 43.64% and 13.22% of women.

SUMMARY
The present study was conducted with the aim to assess the effectiveness of structured teaching
programme regarding cervical cancer screening and HPV vaccine in terms of knowledge and
perception among students of selected nursing colleges of Delhi, NCR.
A review of related research and literature helped the investigator to conceptualize the study and
to develop appropriate tool to measure the effectiveness of structured teaching programme
regarding cervical cancer screening and HPV vaccine.
Formal administrative permission was taken from the principal of the Sumitra institute of nursing
and paramedical science, in Greater Noida, final data collection was done from 22 Feb 2024 to
29 Feb, 2024. 60 nursing students were selected by the convenient sampling technique. obtain
free and Frank responses

80
After obtaining informed consent from the subject on day one, the pre – test of knowledge
regarding cervical cancer was carried out by the knowledge and perception questionnaires
followed by the structured teaching program to clarify their doubts. On the day of post – test
knowledge as identical to pre – test was carried out to evaluate the effectiveness of structured
teaching program on the sample subject.Data analysis was done using descriptive and inferential
statistics. The Chi Square Test was used to find out the association between knowledge with
demographic variables and the association between perception with demographic variables.
Results collected from the study revealed the majority of the nursing students had adequate
knowledge regarding cervical cancer screening and HPV vaccine after implementation of
structured teaching programme

PROBLEM STATEMENT
A PRE-EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF
STRUCTURED TEACHING PROGRAMME REGARDING CERVICAL CANCER
SCREENING AND HPV VACCINE IN TERMS OF KNOWLEDGE AND PERCEPTION
AMONG STUDENTS OF SELECTED NURSING COLLEGES OF DELHI, NCR.

OBJECTIVE TO THE STUDY

● To assess the level of knowledge regarding cervical cancer screening and HPV vaccine
among nursing students.
● To assess the level of perception regarding cervical cancer screening and HPV vaccine
among nursing students.
● To evaluate the effectiveness of STP on level of knowledge and perception regarding
cervical cancer screening and HPV vaccine among student in selected groups.
● To find out the association between post-test knowledge and Perception score regarding
cervical cancer and HPV vaccine among students in selected groups.

81
 HYPOTHESES

● H1 -There will be significant difference between the mean pre-test knowledge score and
mean post-test knowledge score of the nursing students regarding cervical cancer
screening and HPV vaccine
● H2- There will be significant difference between the mean pre-test perception score and
mean post-test perception score of the nursing students regarding cervical cancer
screening and HPV vaccine.
● H3-There will be significant association between post-test knowledge scores regarding
cervical cancer screening and HPV vaccine among nursing students with the selected
demographic variables at the 0.05 level of significance.

● H4-There will be significant association between post -test perception scores

regarding cervical cancer screening and HPV vaccine among nursing students with
the selected demographic variables at the 0.05 level of significance.

CONCLUSION

The following conclusion were drawn from the following study:

 The present study aimed at evaluating the effectiveness of structured teaching programs
regarding cervical cancer screening and HPV vaccine in terms of knowledge and
perception among students of selected nursing colleges of Delhi, NCR.
 The knowledge score of nursing students in pre-test was assessed which revealed 85% of
them had poor knowledge, 15% had moderate knowledge and none of them had adequate
knowledge. The knowledge score of nursing students in post-test was assessed and table
reveals that 81.66% of them had adequate knowledge, 18.33% of them had moderate
knowledge and none of them had poor knowledge.

 Perception score of nursing students in pre-test was assessed which revealed that 0% of
the perception level is very dissatisfied, 65% of perception level is dissatisfied, 35% of
perception level is neutral, 0% of perception level is satisfied and 0% of perception level
is very satisfied. Perception level of nursing students in post- test was assessed and table
reveals that 0% of the perception level is very dissatisfied, 0% of perception level is
dissatisfied, 0% of perception level is neutral, 75% of perception level is satisfied and
25% of perception level is very satisfied.

82
  There is significantly no association between post-test knowledge and perception scores
with selected demographic variables.

NURSING IMPLICATIONS
The result of this study stresses the concern on evidence-based practice and quality teaching
delivered to nursing college students. The present study has following implications relating to
nursing practice, nursing education, nursing administration and nursing research.

NURSING PRACTICE:
 Nurses play an important role in motivating students to have effective awareness
regarding cervical cancer.

 Nurses can organize teaching sessions for school going and college going students to
improve their knowledge.

 There must be separate health education department for nurses to develop health
education material for nursing students and other group of people.

NURSING EDUCATION
 Nursing curriculum should include different methods of techniques and other therapy to
sensitize the student nurse to give structured teaching programme as an effective
technique to improve knowledge among nursing college students.

 Nursing students can be encouraged to impart the knowledge of cervical cancer screening
and HPV vaccine to other.

 Findings of the study will help the nursing students to understand the importance of
structured teaching program techniques to improve knowledge among nursing college
students.

NURSING ADMINISTRATION
 Nurse administrator should organize educational program for the nursing students and
nursing staff to update the knowledge related to sexual assault.

83
  Program actively and also to conduct education program for improving knowledge in
terms of cervical cancer among nursing college students.

 The administrator must see that every nurse have an adequate knowledge and skills in
giving structured teaching programme among nursing college students.

NURSING RESEARCH
 More nursing researches should be conducted as research studies conducted by Indian
nurses in this area regarding improvement of knowledge among nursing college students
regarding cervical cancer screening and HPV vaccine.

 A research study can be done with larger sample using different methods of techniques
regarding cervical cancer screening and HPV vaccine among nursing college students

DELIMITATION
The study is limited to:
● Assessment of knowledge limited to a written response only through a structure teaching
knowledge questionnaire.
● The students who are willing to participate in the study
● The nursing students who are available at the time of data collection

RECOMMENDATIONS

 This study can be replicated on the large samples of nursing college students in different
setting, so that the findings can be generalized to larger population.

 A pre-experimental study can be conducted in order to assess effectiveness of structural

teaching programs in terms of knowledge of nursing students on cervical cancer and HPV
vaccine at large scale.

 Mass awareness program should be developed by government to raise the level of

knowledge and perception related to cervical cancer.

 Teaching can also be given to school students with college students and to other field
students.

84
 SUMMARY

This chapter deals with the discussion, summary, conclusion, implication for implication for
nursing practice, recommendations for future research in the field have also been presented.

85
REFERENCES

86
 BOOK REFERENCE:

1. Sharma S.K., “Nursing Research and Statistics”, 4th edition, Elsevier publication,
page no. 290- 294; 326- 333.
2. Sharma S.K., “Nursing Research and Statistics”, 3rd edition, Elsevier publication,
page no. 78-81; 96-100.
3. Dutta DC, “Textbook of Obstetrics and Gynecology”, 10th edition, Jaypee Brothers
publication, page no. 284- 296.
4. Suddarth and Brunner, “Medical and Surgical Nursing”, South Asian edition,
Wolters Kluwer, page no. 1429- 1432

WEBSITE REFERENCE:

1. http://www.who.int/mediacentre/factsheets/fs380/en/
2. http://waocp.com/journal/index.php/apjcc/article/view/246
3. https://www.sciencedirect.com/science/article/pii/S2213398420302207
4. https://www.frontiersin.org/journals/public-health/articles/10.3389/
fpubh.2021.616456/full
5. https://www.bio-conferences.org/articles/bioconf/abs/2024/05/
bioconf_rtbs2024_01029/bioconf_rtbs2024_01029.html
6. https://karger.com/acy/article-abstract/63/2/159/10137
7. https://www.wcrf.org/cancer-trends/worldwide-cancer-data/
8. http://www.who.int/en/news-room/fact-sheets/detail/sexually-
transmitted-...
9. https://gco.iarc.fr/today/online-analysis-map?
v=2020&mode=cancer&mode_po...
10. https://www.cancer.org.au/cancer-information/types-of-cancer/cervical-
cancer
11. http://www.mcancer.org/gynecologic-cancers/cervical/awareness
12. https://cancerspecialistpune.com/cervical-cancer-2/
13. https://www.cancer.gov/types/cervical/survival
14. https://www.spectrumhealthlakeland.org/medical-services/womens-health-
services/well-woman-exams

87
15. https://www.mayoclinic.org/tests-procedures/pap-smear/about/pac-
20394841
16. https://www.cdc.gov/hpv/parents/vaccinesafety.html
17. https://www.cdc.gov/vaccines/vpd/hpv/public/index.html
18. https://www.mdpi.com/1999-4915/15/7/1440
19. https://www.tmcaz.com/health-library/conditions/en/con-20167638

88
APPENDICES

89
90
 APPENDIX 2

LETTER SEEKING EXPERT OPINION AND SUGGESTIONS FOR

CONTENT VALIDITY OF RESEARCH TOOLS

To
………………………..............
…………………………………
Subject: Letter seeking expert opinion on content validity of structured knowledge
questionnaire and perspective questionnaire, for assessing the effectiveness of structured
teaching programs regarding screening of cervical cancer and HPV vaccine in terms of
knowledge and perception among students of selected nursing colleges of Delhi, NCR
Dear Sir/Madam,
We students of B.Sc. Nursing final year 16th batch (group-c) student of Nightingale Institute of
Nursing, Noida. We have selected under mentioned topic for our research project to be submitted
to Chaudhary Charan Singh University, Meerut, as a partial fulfilment of university requirement
for the award of B.Sc. Nursing degree.

Topic: A pre-experimental study to assess the effectiveness of structured teaching

programs regarding screening of cervical cancer screening and HPV vaccine in terms of
knowledge and perception among students of selected nursing colleges of Delhi, NCR

The following objectives were selected for the study:

>To assess the level of knowledge regarding cervical cancer and HPV vaccine and among
student in the selected group.
>to assess the level of knowledge regarding cervical cancer and HPV vaccine among teenagers.
>To assess the effectiveness of STP on level of knowledge and perception regarding cervical
cancer screening and HPV vaccine among student in selected groups.
>To determine the association between post test level of knowledge score regarding cervical
cancer and HPV vaccine among students in selected groups.

91
>to determine the association between the post level of perception score regarding cervical
cancer and HPV vaccine among students in selected groups.
In this connection we have prepared self-administered structured knowledge and perception
questionnaire for assessing the knowledge and perceptions of nursing students regarding cervical
cancer screening and HPV vaccine.
We request you to kindly go through the self- administered structured knowledge questionnaire
and perception questionnaire and give your expert opinion and suggestion for any modification
and improvement in the content. Your esteemed opinions and critical comments will provide the
required direction and contribute immensely to be quality content of my final research.
Looking forward for your valuable guidance and suggestions
Thanking you

Yours` sincerely
Students of BSC Nursing IV Year (GROUP-C),
CHARU GERA
CHARU PANDEY
DIKSHA SHEEL
DISHA SHARMA
DIYA SAMARTH
VINITA MEHRA
Nightingale Institute of Nursing.
Noida.

Enclosure:
Tools for validation
1. Demographic
2. Self-administered structured knowledge questionnaire
3. 3.self- administered structured perception questionnaire

92
 APPENDIX 3
A CRITERIA RATING SCALE FOR EXPERT OPINION REGARDING
CONTENT VALIDITY OF RESEARCH TOOLS

INSTRUCTION
Please go through the criteria listed below which has been formulated a pre-experimental study
to assess the effectiveness of structured teaching programme regarding cervical cancer screening
and HPV vaccine in terms of knowledge and perception among students of selected nursing
colleges of Delhi, NCR

There are three alternative response columns given. Kindly put a tick (√) mark in the appropriate
column.
COLUMN I-Strongly Agree
COLUMN II-Agree
COLUMN III-Disagree
Kindly report your responses with appropriate comments/remarks and suggestions in the remark
column, as your valuable comment will help the researcher to improve his/her effort.

S.No. Criteria I II III Remarks

Strongly Agree Disagree
Agree

1. Formulation of objectives

a) Comprehensive enough for

the participants
b) Realistic to achieve
c) Objectives are in terms of
respondents

2. Selection of the content

a) Content provides accurate

93
 information as per the
objectives.
b) Content is relevant.
c) Content is appropriate
d) Content is according to the
level of the respondents

3. Organization of contents

a) Logical sequence
b) Maintains correlation
c) Integration of the content.

4. Language

a) Simple and easy to

understand.
b) Scientific terms explained.

5. Feasibility / Practicability

a) The tool content acceptable

to the participants
b) The tool content is to the
level of the participants
understanding.
c) The tool content is
conventional to handle and
conduct.
d) The tool content is
interesting to the
participants.

94
 e) The tool content is
economical in terms of cost
effort and time

Suggestions: Signature of the

Validator

APPENDIX-4

CONTENT VALIDITY CERTIFICATE

We hereby certify that we have validated the tool of Group C students of B.SC Nursing 4th Year
of Nightingale Institute of Nursing, Noida who are undertaking a “A pre-experimental study to
assess the effectiveness of structured teaching programme regarding cervical cancer
screening and HPV vaccine in terms of knowledge and perception among students of
selected nursing colleges of Delhi, NCR”

Date: Signature of the expert

95
Place: - NOIDA Name:

Designation:

APPENDIX-5

INFORMED CONSENT

I am giving my consent to participate in the research study “A pre-experimental study to assess

the effectiveness of structured teaching programme regarding cervical cancer screening
and HPV vaccine in terms of knowledge and perception among students of selected nursing
colleges of Delhi, NCR”

I have been informed that my participants is entirely voluntary and that even after the study
begins can refuse to answer (or) participate at any point of time during the study have been fully
informed about the nature of the study, the researcher responsibility, and benefits for this study.

96
 Date:

Place: - NOIDA

Signature of Participation

APPENDIX 6
DEMOGRAPHIC PERFORMA
Instructions:
The evaluator is requested to go through the criteria listed before for evaluation of the data
collection tool.
In the criteria checklist there are 3 main columns and a remark column. The validation is done in
terms of appropriateness, relevance and accuracy.
In each sub column I- agree, column II- Disagree

Item No. Appropriateness Relevance Accuracy

I II I II I II Remarks

97
Any suggestions:
…………………………………………………………………………………………………..
…………………………………………………………………………………………………..
…………………………………………………………………………………………………..

Signature of the Validator

Name:
Designation:

APPENDIX 7
CRITERIA CHECKLIST FOR VALIDATION OF THE TOOL
Instructions:
Kindly review the items in the structured knowledge questionnaire of cervical cancer screening
and HPV vaccine among nursing students at selected colleges of Delhi, NCR kindly give your
suggestions regarding accuracy, relevance and appropriateness of the items.
There are two columns namely agree and disagree.
Kindly mark (√) against specific columns.
If there are any suggestions and correction, please mention in the remark’s columns.
Checklist for the validation of structured knowledge questionnaire for assessing the
knowledge and perception of cervical cancer screening and HPV vaccine among teenagers.

Item Agree Disagre Remark Ite Agre Disagree Remark

98
 No. e m e
No.

1 13

2 14

3 15

4 16

5 17

6 18

7 19

8 20

9 21

10 22

11 23

12

Any suggestions:
………………………………………………………………………………………………………
………………………………………………………………………………………………………
Signature of validator

APPENDIX 8
LIST OF VALIDATORS:
1} MS. SWATI SAIN
(NURSING LECTURER)
NIGHTINGALE INSTITUTE OF NURSING, NOIDA
2} MS. SOROJINI
(NURSING LECTURER)
NIGHTINGALE INSTITUTE OF NURSING, NOIDA

99
3} MS. NISHA
(NURSING LECTURER)
NIGHTINGALE INSTITUTE OF NURSING, NOIDA
4} MS. VIDHYA
(NURSING LECTURER)
NIGHTINGALE INSTITUTE OF NURSING, NOIDA
5} MS. SANATOMBI
(NURSING LECTURER)
NIGHTINGALE INSTITUTE OF NURSING, NOIDA

APPENDIX 9
TOOL 1

DEMOGRAPHIC VARIABLES

QUESTIONNAIRE
Instructions: The following session contains questions pertaining to your personal data. You are
requested to kindly read and answer the questions. Give only one appropriate answer. Your

100
answers will be kept confidential and will be used only for the study purpose. Kindly answer all
questions.
SAMPLE NO: Date:

1. AGE [In years]

a.16-18
b.18-20
c.20-22
d 22-24
2. GENDER
a. Female
b. Male
3. RELIGION
a. Hindu
b. Christian
c. Muslim
d. Sikh
4. MARITAL STATUS
a. Married
b. Unmarried
5. TYPE OF FAMILY
a. Nuclear Family
b. Grandparent Family
c. Joint Family
d. Single Parent
6. FAMILY INCOME [ Per month]
a. < 10, 000

101
b. 10, 000 - 50,000
. c. > 50,000
d. 50,000 - 80,000
7. EDUCATION
a. GNM 1st year
b. BSC 1st year
c. PBBSC 1st year
d. MSC 1st year
8. Have you ever heard about Pap Smear?
a. Yes
b. No
If yes, how did you find out?
a. Mass Media b. Newspaper
c. Poster d. Any other source

APPENDIX 10
TOOL 2
KNOWLEDGE QUESTIONNAIRE

1Q. The location of the cervix in the body is-

a. In the ovaries
b. In the chest
c. In the bladder

102
d. At the lower part of the uterus

2Q. The part of the cervix where most cancer develop is-
a. External lining
b. Internal lining
c. Lymph nodes
d. None of the above

3Q. Cervical cancer is -

a. Malignant tumor
b. Mass of cervix
c. Cysts
d. Collection of blood clot

4Q. The pathogen that causes cervical cancer is:

a. Bacteria
b. A fungus
3.A virus
4.None of the above

5Q. The following is not a risk for cervical cancer:-

1.Multiple sexual partner
2.Endocervical polyps
3.Smoking
4.Human papilloma virus

6Q. After cervical cancer is spread, it can cause:

103
a. Swollen legs
b. Bone pain
c. Pelvic pain
d. All of the above

7Q. The most common type of cervical cancer is-

a. Adenocarcinoma
b. Squamous cell carcinoma
c. Adeno squamous carcinoma
d. All of the above

8Q. The type of cancer that develops from cells in ectocervix is:
a. Adenocarcinoma
b. Squamous cell carcinoma
c. Basal cell carcinoma
d. Renal cell carcinoma

9Q. The region where cancer cells can be found during the 3rd stage of cervical cancer :
a. Lower part of the vagina
b. Lower part of the pelvic wall
c. Lymph node in the pelvic
d. All of the above

10Q.The stage of cervical cancer where cancer cells spread to the upper part of vagina but not
yet spread to pelvic wall:
a. Stage I
b. Stage II

104
c. Stage III
d. Stage IV

11Q. Life expectancy after being diagnosed with cervical cancer :-

a. 1 year
b.5-7 years
c. More than 10 years
d. 2 years

12Q.The survival rate of people at early stage of cervical cancer is :

a.50%
b.91%
c.72%
d.95%

13Q. Chances of cervical cancer get lower by:

a. vaccination
b. screening
c. healthy choices
d. All of the above

14Q. The screening test used to investigate cervical cancer is:

a. Pap smear
b. Mammogram
c. Breast examination
d. None of the above

105
15Q. The women start cervical cancer screening at-
a. No later than age 18
b. At age 25
c. No later than age 30
d. None of the above

16Q. The test used to screen cervical cancer is :-

a. Urine test
b. Primary HPV test
c. Blood test
d. Stool test

17Q.Cervical cancer screening is reliable upto:

a.80%-90%
b.40%-60%
c.30%-70%
d. none of the above

18Q. The country that first introduced HPV vaccine is:

a. United States
b. Japan
c. Russia
d. China

19Q. The vaccination series starts at the age of:

a. 12 years
b. 10 years

106
c.17 years
d.9 years

20Q. HPV vaccine protects against:

a. Genital warts
b. Vaginal cancer
c. Cervical cancer
d. All of the above

21Q.The WHO Recommendation on HPV vaccination schedule was updated on:

a.25th October 2023
b.20th March 2022
c.14th September 2023
d. 20th December 2022
22Q. The site of administration of HPV vaccine is:
a. Deltoid region of the upper arm
b. Higher anterolateral area of the thigh
c. Both 1 and 2
4. None of the above
23Q.A three dose series of HPV vaccine is:
a. 0, 1-2 ,6 months
b. 0, 3-4,12 months
c. 0, 2-3, 6 months
d.0, 1-2, 12 months

107
 APPENDIX 11
TOOL 3
PERCEPTION QUESTIONNAIRS
STRONGL DISAGRE NEITHER AGREE STRONGL
Y E AGREE Y AGREE
DISAGRE NOR
E DISAGRE
E

1.I think

108
cervical
cancer starts
when cells
lining the
cervix begin
to grow out
of control.

2.I think a
virus called
‘human
papilloma
virus’ HPV
causes
cervical
cancer.

3.HIV
positive
women have
higher risk of
developing
cervical
cancer

4.HPV
infection
occurs only
in women.

5.I think
having
multiple sex
partners can
increase
exposure to
HPV.

6.I think
cervical

109
cancer can
cause death
in women

7.I believe
cervical
Cancer is
caused due
to having sex
intercourse
at early age

8.i suspect
that smoking
is the cause
of cervical
cancer

9.I suspect
weight loss
is the
symptom of
cervical
cancer

10.I believe
unusual
vaginal
bleeding
could be a
sign of
cervical
cancer

11.I believe
constant
pelvic pain is
the symptom
of cervical

110
cancer

12.I suspect
that the
person might
suffer from
cervical
cancer again

13.I feel
women
having pain
during
sexual
intercourse
should get
screening
test for
cervical
cancer.

14.I believe
screening
can detect
cervical
infection so
they do not
develop into
cancer

15.i believe
women
should get
thorough
screening
test after 35y

16.The use
of condom
can
completely
prevent HPV

111
infection.

17. I believe
surgery is the
only
treatment to
cure cancer
of cervix.

18. I believe
that
vaccination
is important
in order to
evade
cervical
cancer.

19. Someone
who received
an HPV
vaccination
cannot
develop
cervical
cancer.

20.I think
HPV vaccine
cannot
protect
genital warts

21.I believe
there could
be some side
effects of
HPV vaccine

22.Muscle
pain can
occur due to

112
HPV vaccine
shot

23.I believe
adolescents
should be
seated for 15
minutes after
vaccination
to prevent
fainting

APPENDIX 12
INTERPRETATION OF KNOWLEDGE SCORES

SCORE CRITERIA
0-7 POOR
8-15 MODERATE
16-23 ADEQUATE

113
 APPENDIX 13

KNOWLEDGE QUESTIONNAIRE
ANSWER KEY:

QUES. NO. ANSWERS

Q1 D
Q2 A
Q3 A
Q4 D
Q5 C
Q6 D
Q7 B
Q8 B
Q9 B
Q10 B
Q11 B

114
 Q12 B
Q13 D
Q14 A
Q15 B
Q16 B
Q17 A
Q18 A
Q19 D
Q20 D
Q21 D
Q22 C
Q23 A

APPENDIX 14
INTERPRETATION OF PERCEPTION QUESTIONNAIRE

PERCEPTION LEVEL CATEGORY

VERY DISSATISFIED 1-23

DISSATISFIED 24-46
NEUTRAL 47-69

SATISFIED 70-92

115
 VERY SATISFIED 93-115

APPENDIX 15

PERCEPTION QUESTIONNAIRE
ANSWER KEY:

QUES. NO. ANSWERS

Q1 STRONGLY AGREE
Q2 STRONGLY AGREE
Q3 AGREE
Q4 STRONGLY DISAGREE
Q5 STRONGLY AGREE
Q6 AGREE
Q7 AGREE
Q8 AGREE

116
 Q9 STRONGLY AGREE
Q10 STRONGLY AGREE
Q11 STRONGLY AGREE
Q12 AGREE
Q13 STRONGLY AGREE
Q14 STRONGLY AGREE
Q15 DISAGREE
Q16 NEITHER AGREE NOR DISAGREE
Q17 STRONGLY AGREE
Q18 STRONGLY AGREE
Q19 AGREE
Q20 DISAGREE
Q21 AGREE
Q22 STRONGLY AGREE
Q23 STRONGLY AGREE

APPENDIX 16
LESSON PLAN

BACK GROUND INFORMATION

NAME OF THE INSTRUCTOR: CHARU GERA, CHARU PANDEY, DIKSHA SHEEL,
DISHA SHARMA, DIYA SAMARTH, VINITA MEHRA
ТОРІС: CERVICAL CANCER AND HPV VACCINE
LECTURE GIVEN TO: BSC AND GNM 1ST YEAR
NO OF STUDENTS: 60
VENUE: SUMITRA INSTITUTE OF NURSING AND PARAMEDICAL SCIENCE
TIME: 2 HOURS

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METHOD OF TEACHING: LECTURE CUM DISCUSSION
AV AIDS: CHARTS, FLASH CARDS, LEAFLETS, POWERPOINT PRESENTATION

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GENERAL OBJECTIVE
By the end of planned teaching programme, the students will:
- acquire knowledge about cervical cancer, its risk factors, signs and symptoms and treatment.
- understand the preventive and control measures of cervical cancer
- utilize the knowledge in early detection of cervical cancer

SPECIFIC OBJECTIVE
By the end of planned teaching programme, the students will be able to:
-define cervical cancer
- list down the causes of cervical cancer.
- list down the risk factors of cervical cancer.
- explain the types and stages of cervical cancer.
- explain the prognosis and survival rates of cervical cancer.
- enumerate sign and symptoms of cervical cancer.
- explain the different diagnostic measures /screening of cervical cancer
- explain the prevention and treatment of cervical cancer.

119
TIME SPECIFIC CONTEN TEACHING EVALUATIO
OBJECTIVE T LEARNING N
ACTIVITY
2mi INTRODUCTION

n Cervical cancer is the

fifth most common
cancer in humans,
the second most
common cancer in
women worldwide
and the most

common cancer
cause of death in the
developing countries.
Sexually transmitted
human papilloma
virus (HPV) infection
is the most
important risk factor
for cervical
intraepithelial
neoplasia and
invasive cervical
cancer.

ANNOUNCEMENT
OF THE TOPIC

in this session we will

be discussing about
cervical cancer and
HPV vaccine, one of
the preventions that
helps in preventing
cervical cancer.

120
.

121
.TI SPECIFI CONTENT TEACHER EVALUAT
ME C LEARNING ION
OBJECTI ACTIVITIES
VE
1mi To define DEFINITION the teacher helps What is
cervical the student to define cervical
n cancer?
Cervical cancer is
using PowerPoint. cancer?
a malignant
tumor of the
cervix, the
lowermost part of
the uterus,
Cervical cancer is
a cancer arising
from the cervix. It
is due to the
abnormal growth
of cells that have
the ability to
invade or spread
to other parts of
the body.

RISK FACTORS

>Started
having sex before
age 18 or within a The teacher helps
2mi the student to
To list down year of starting
n What are risk
the risk factors your period explain the risk
factor and
of cervical factors and causes
> Have multiple causes of
cancer of cervical cancer
sexual partners, cervical
using PowerPoint
which increases cancer?
slides.
exposure to HPV

>Take birth
control pills,
especially for

122
longer than 5
years

> Smoke
cigarettes

> Have a
weakened immun
e system, so your
body is less able
to fight infections.

> Have a sexually

transmitted
disease (STD)

>Haven't been
vaccinated
against HPV.

>Have had three

or more
pregnancies.

>Were exposed
in the womb to
DES, a drug given
to some women
between 1948
and 1971 to
prevent
miscarriage; a
rare risk factor.

>Are obese,
which may make
it harder to
diagnose cervical
cancer

>Have low

123
 income or are
without medical
insurance, which
means you may
not be screened
for cervical
cancer

SIGN AND
SYMPTOMS
Precancerous
changes in
cervical cells
rarely cause
3mi symptoms. The
only way to know
n if there are
abnormal cells The teacher helps
that may develop the student to
into cancer is to explain the sign and
have a cervical symptoms of
To enumerate screening test. If cervical cancer
the sign and early cell changes using PowerPoint
symptoms of develop into slides.
cervical cancer cervical cancer,
the most common
signs include:

• vaginal What are

bleeding between signs and

124
periods symptoms of
cervical
• menstrual
cancer?
bleeding that is
longer or heavier
than usual

• pain during
intercourse

• bleeding after
intercourse

• pelvic pain

• a change in
your vaginal
discharge such as
more discharge
or it may have a
strong or unusual
color or smell

• vaginal
bleeding after
menopause. You
might not
notice symptoms
of cervical
cancer until it’s
far along.

Early signs of
cervical cancer
include:

• Pain when you

have sex

• Unusual vaginal
bleeding, such as
after sex,
between periods,
after menopause,

125
or after a pelvic
exam.

• Unusual vaginal
discharge that is
watery, bloody,
and/or has a
strong odour

After it has
spread, the
cancer can
cause:

• Pelvic pain

• Trouble peeing•
Swollen legs

• Kidney failure

• Bone pain

• Weight loss and

lack of appetite

• Fatigue

• Backache

• Stomach pain

126
 TYPES OF
CERVICAL
CANCER

There are mainly

two types of
cervical Cancer

1.SQUAMOUS
CELL
CARCINOMA –

Most cervical
cancer (up to
4mi 90%) are
n squamous cell
The teacher helps
carcinoma.
the student to
squamous cells explain the types
are thin, flat, and stages of
skin-like cells that cervical cancer
line the surface of using PowerPoint
the cervix slides.
This cancer
To explain the develops from
types of cells in the
cervical cancer ectocervix (cervix
joins)

2.ADENOCARCI
NOMA - cervical
adenocarcinoma
develop in the What are
glandular cells of types of

127
the endocervix cervical
(cervical canal) cancer?
these cells
produce mucus -
a sticky fluid. It
keeps the cervix,
womb, ovaries
and fallopian
tubes healthy by
protecting them
from bacteria and
infection. There
are gland cells
scattered along
the lining of the
narrow passage
that runs from
the cervix up into
the womb. This
passage is called
cervical canal.

STAGES OF
CERVICAL
CANCER

Stage I

The cancer is
found only in the
cervix

128
 Stage II

The cancer has

spread from the
cervix to the
upper part of the
vagina or the
tissue around the
uterus. It has not
spread to the
pelvic wall. (The
pelvic wall is the
5mi muscle and
connective
n tissues that line
the insides of the
pelvic bones.)
Cancer cells may
also be found in
the lymph nodes
in the pelvis.

Stage III The teacher helps

the student to
The cancer has explain stages of
spread to the cervical cancer
lower part of the using PowerPoint
vagina or to the slides.
pelvic wall. It may
block the flow of
urine to the
To explain the bladder. Cancer
stages of
cells may also be
cervical cancer
found in the
lymph nodes in
the pelvis.

Stage IV What are the

stages of
The cancer has

129
 cervical
spread to other cancer?
body parts within
or outside the
pelvis. Cancer
cells may be
found in the
bladder, rectum,
abdomen, liver,
intestines, or
lungs

PROGNOSIS
AND SURVIVAL
RATE OF
CERVICAL
CANCER

The 5-year
relative survival
rates for cervical
cancer are as
follows: When
cervical cancer is
diagnosed at an
early stage, the
5-year relative
survival rate is
91%. When
cervical cancer is
diagnosed after it
has spread to
nearby tissues,
organs, or
regional lymph
nodes, the 5-year
relative survival
rate is 60%

130
 DIAGNOSIS AND
2mi SCREENING

n Cervical cancer
screening is used
to find changes in
the cells of the
cervix that could
lead to cancer.
Screening
includes cervical
cytology (also
called the Pap
test or Pap
smear), testing The teacher helps to
for human understand using
papillomavirus PowerPoint slides.
(HPV), or both.
Most women
should have
cervical cancer
screening on a
regular basis.

PAP SMEAR: A
Pap smear, also
called a Pap test,
is a procedure to
To explain the
test for cervical
prognosis and
cancer in women.
survival rate of
A Pap smear
cervical cancer
involves
collecting cells
What are
from your cervix prognosis and
the lower, narrow survival rate?
end of your

131
 uterus that's at
the top of your
vagina. Detecting
cervical cancer
early with a Pap
smear gives you
4mi a greater chance
n at a cure.

TREATMENT AND
PREVENTION

Prevention of
cervical cancer
:-

Primary
prevention

1.Education to
reduce high risk The teacher helps
sexual behavior the student to
explain the
2.Measures to
diagnosis and
reduce/avoid
screening of cervical
exposure to HPV
cancer using
and other STIs
PowerPoint slides.
3.Avoiding/
minimizing other
To explain the risk factors, like
diagnosis and early marriage/
screening of
child bearing,
cervical cancer
smoking

4.Administration
of Antioxidants

5. Diagnosis of
HPV infection
What are

132
 - Macroscopic diagnosis and
screening of
- Cytological
cervical
- HPV DNA testing cancer?
by ultra
spectrophotometr
y

- Colposcopy

- Histological

Treatment of
HPV infection-
The teacher helps
No specific
the student to
therapy.
explain the
- Surgical removal treatment of cervical
cancer using
- local ablation :-
PowerPoint slides.
. Cryotherapy

. Diathermy
3mi . Laser
n - Administration
of interferon.

HPV
VACCINATION

Human
papillomavirus,
also called HPV, is
spread by sexual
activity. Some

133
 strains of HPV
cause genital
warts. Other HPV
strains can cause
cancers.

Most of the time,

the body can find
To explain the and clear out
treatment and HPV. But if the
prevention of virus stays in the
cervical cancer body for a long
time, it can cause
cancer. Getting
vaccinated
against HPV helps
prevent cancer in
men and women What are
treatment
and
EPIDEMIOLOGY prevention of
OF HUMAN cervical
PAPILLOMAVIR cancer?
US

HPV infections
and cervical
precancers have
dropped since
2006, when HPV
vaccines were
first used in the
United States.

Among teen girls,

infections with
HPV types that
cause most HPV
cancers and
genital warts

134
have dropped 88
percent.

Among young
adult women,
infections with
HPV types that
cause most HPV
cancers and
genital warts
have dropped 81
percent.

Among
vaccinated
women, the
percentage of
cervical
precancers
caused by the
HPV types most
often linked to
cervical cancer
has dropped by
40 percent
PREVENTION OF
HPV

HPV can cause

several kinds of
cancer.

Only cervical
cancer can be
detected early
with a screening
test.

The other cancers

caused by HPV
may not be
detected until

135
they are more
serious.

HPV vaccination
prevents
infections that
cause these
cancers.

TYPES OF HPV
VACCINE

Three HPV
vaccines—

1) 9-valent HPV
vaccine (Gardasil
9,

9vHPV),

2) Quadrivalent
HPV vaccine
(Gardasil, 4vHPV)

3) Bivalent HPV
vaccine (Cervix
2vHPV)

These have been

licensed by the
U.S. Food and
Drug
Administration
(FDA). All three
HPV vaccines
protect against
HPV types 16 and
18 that cause
most HPV cancers

136
ACTION OF HPV
VACCINE

The HPV vaccine

protects against
genital warts and
most cases of
cervical cancer.

It protects against
cancer of the
vagina, vulva,
penis or anus
caused by HPV.

The HPV vaccine

also protects
against mouth
throat head and
neck cancer.

3. The vaccine
gives the body a
safe way to build
immune system
awareness of
some HPV strains.
This means the
body has an
easier time
clearing out those
strains of the
virus if a person
catches them
later.

WHO - UPDATED
RECOMMENDATIO
NS ON HPV
VACCINATION
SCHEDULE:

On 20 December

137
2022, WHO has
updated its
recommendations
for the human
papillomavirus
(HPV) vaccine.
Cervical cancer is
the fourth most
common type of
cancer in women,
and more than
95% of cervical
cancer is caused
by sexually
transmitted HPV.

The primary
target of
vaccination is
girls aged 9-14,
prior to the start
of sexual
activity. The
vaccination of
secondary targets
such as boys and
older females is
recommended
where feasible
and affordable.

WHO now
recommends: A
one or two-dose
schedule for girls
aged 9-14 years

A one or two-dose
schedule for girls
and women aged
15-20 years

138
Two doses with a
6-month interval
for women older
than 21 years

SIDE EFFECTS
OF HPV
VACCINE

The most
common side
effects of HPV
vaccine are
usually mild and
include:

1) Pain, redness,
or swelling in the
arm where the
shot was given

2) Fever

3) Dizziness or
fainting

4)Headache

5)Nausea

6)Muscle or joint
pain

7) Very rarely,
severe
(anaphylactic)
allergic reactions
might occur after
vaccination.

To prevent
fainting and
injuries from
fainting,
adolescents

139
should be seated
or lying down
during
vaccination and
for 15 minutes
after getting the
shot.

SUMMARY

140
Cervical cancer happens when cells in the cervix, the lower part of the uterus that connects to the
vagina, start to become abnormal. Small changes in the cell DNA tells them to multiply out-of-
control, and cells accumulate in growths called tumors. In a small percentage of people,
however, the virus survives for years. This contributes to the process that causes some cervical
cells to become cancer cells. You can reduce your risk of developing cervical cancer by having
screening tests and receiving a vaccine that protects against HPV infection. When cervical cancer
happens, it's often first treated with surgery to remove the cancer. Other treatments may include
medicines to kill the cancer cells. Options might include chemotherapy and targeted therapy
medicines. Radiation therapy with powerful energy beams also may be used. Sometimes
treatment combines radiation with low-dose chemotherapy.

BIBLIOGRAPHY

141
BOOK REFERENCE:

1. Dutta DC, “Textbook of Obstetrics and Gynecology”, 10th edition, Jaypee Brothers
publication, page no. 284- 296.
2. Suddarth and Brunner, “Medical and Surgical Nursing”, South Asian edition,
Wolters Kluwer, page no. 1429- 1432

WEBSITE REFERENCE:
1. https://www.cancer.org.au/cancer-information/types-of-cancer/cervical-cancer
1. http://www.mcancer.org/gynecologic-cancers/cervical/awareness
2. https://cancerspecialistpune.com/cervical-cancer-2/
3. https://www.cancer.gov/types/cervical/survival
4. https://www.spectrumhealthlakeland.org/medical-services/womens-health-services/well-
woman-exams
5. https://www.mayoclinic.org/tests-procedures/pap-smear/about/pac-20394841
6. https://www.cdc.gov/hpv/parents/vaccinesafety.html
7. https://www.cdc.gov/vaccines/vpd/hpv/public/index.html
8. https://www.mdpi.com/1999-4915/15/7/1440
9. https://www.tmcaz.com/health-library/conditions/en/con-20167638

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PHOTOGRAPHS

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