DOI: 10.5176/2315-4330_WNC14.35
Authors: Dr. Nalini Sirala Jagadeesh
Abstract: Purpose: This study examined whether an educative supportive nursing intervention could improve clinical indicators, knowledge and behavioral adherence among women in India with abnormal cervical smears. Design: The study was a randomized controlled trial of a 2- month intervention with 300 women in south India. The intervention included reinforced education about cervical dysplasia and cervicovaginal infections together with support for condom use and attendance at follow-up visits. Methods: The study measured clinical indicators, knowledge, and behavioral adherence at baseline and post-intervention for participants in both the intervention and attention control arms (n = 150 each). Clinical indicators included cervical visual examination, cervical smear analysis, and a symptom inventory checklist. A questionnaire measured participants’ knowledge of cervical abnormalities. Behavioral adherence was measured via a Healthy Behavioral Practice Rating Scale, which included practices related to perineal, menstrual, and sexual hygiene; glycemic control; and adherence to treatment and follow-up. Findings: At baseline, 94.7{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} of the study and attention control participants had cervicovaginal infections, including trichomoniasis (4{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}, 3.3{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}), candidiasis (34{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}, 35.3{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}), and bacterial vagionsis (56.6{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}, 58{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}). After the intervention, microscopic smear analysis showed that 17.5{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} of participants in the intervention group had persistent infections versus 34.4{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} of the participants in the attention control group (p < 0.05). The baseline Pap smears detected cervical dysplasia in 8 participants (5.3{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}) in each group. Following hysterectomy, these 16 participants were tested using vault smear analysis, which revealed benign squamous cells in 75{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} of the participants in the intervention group and in 62.5{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} of the participants in the attention control group (NS). The mean knowledge improvement score was 19.87 for the intervention group and 4. 94 for the attention control group (p < 0.001). The mean difference in the Healthy Behavioral Practice Rating was 10.96 for the intervention group and −4.60 for the attention control group (p < 0.001). Conclusions: An educative supportive nursing intervention can help to empower women with self-care. The positive effects can be disseminated by implementing the intervention in hospitals and community centers throughout India. Clinical relevance: Unlike the United States and the United Kingdom, which have systematic Pap smear screening programs, less developed countries like India may screen for cervical cancer only as part of obstetrical or gynecological consultations. Moreover, cervical dysplasia and cervicovaginal infections are rarely addressed together. An integrated approach to promoting health and preventing complications for women with either cervical dysplasia or cervicovaginal infections will help achieve greater adherence to effective behavioral practices, lower incidence of clinical signs and symptoms, and increase follow-up.
Keywords: Cervical dysplasia; cervicovaginal infection; reproductive tract infections; health promotion; knowledge; behavior; follow-up adherence
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