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Papanicolaou Test Status Among Inner-City Adolescent Girls in Accra, Ghana Collins Kwesi Asamoa-Afriyie Walden University

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Papanicolaou Test Status Among Inner-City Adolescent Girls in Accra, Ghana Collins Kwesi Asamoa-Afriyie Walden University Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2019 Papanicolaou Test Status Among Inner-City Adolescent Girls in Accra, Ghana Collins Kwesi Asamoa-Afriyie Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Epidemiology Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Collins K. Asamoa-Afriyie has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Paige Wermuth, Committee Chairperson, Public Health Faculty Dr. Richard Palmer, Committee Member, Public Health Faculty Dr. Mary Lou Gutierrez, University Reviewer, Public Health Faculty The Office of the Provost Walden University 2019 Abstract Papanicolaou Test Status Among Inner-City Adolescent Girls in Accra, Ghana by Collins K. Asamoa-Afriyie MPH, Rutgers University-School of Public Health, 2008 BS, Bloomfield College, 2005 AS, Essex County College, 2004 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University September 2019 Abstract Cervical cancer is an emerging public health problem in developing countries. Globally, it is the 3rd most common malignancy in women after breast and colorectal cancers and 4th most frequent cancer in women, with an estimated 570,000 new cases and 311,000 deaths in 2018. Cervical cancer screening in the developed countries is credited with the reductions in cervical cancer morbidity and mortality during the last 50 years. However, nearly 90% of cervical cancer deaths occur in less developed countries. Ghana has a cervical cancer rate of 26.4%. Further, it is the highest cancer incidence faced among women 25 to 44 years and has a mortality rate of 17.4% in this age group. Knowledge, culture, attitude, and beliefs are known to limit women’s participation in Pap test screening programs. Guided by the health belief model, the purpose of this quantitative study was to examine how knowledge, attitude, culture, and religious beliefs affected intent to seek Pap test screening among adolescent girls in Accra, Ghana. A total of 155 participants ages 16 to 20 years completed a 30-item questionnaire. Descriptive frequencies were calculated. Correlation and Chi-square tests were also performed to assess associations with intent to screen with Pap test. Most girls (92%) had never heard about Pap test screening. There were statistically significant correlations between cervical cancer knowledge (p=0.032) and attitude (p=0.001) with intent to participate in Pap test screening. However, culture (p=0.049) and religious beliefs (p=0.529) were not significantly associated with screening intent. The implications for social change include informing practice and research on how cervical cancer prevention programs can be tailored to girls living in countries where different cultural and religious values are practiced. Papanicolaou Test Status Among Inner-City Adolescent Girls in Accra, Ghana by Collins K. Asamoa-Afriyie MPH, Rutgers University-School of Public Health, 2008 BS, Bloomfield College, 2005 AS, Essex County College, 2004 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University September 2019 Dedication Philippians 4: 13 states that I can do all things through Christ who strengthens me and Mathew 19:26 states that with man this is impossible but with God all things are possible. Yes, these two biblical verses kept me strong and motivated to come this far. I dedicate this Dissertation to God Almighty who has been my provider, counselor, and led me throughout my stay and studies here in the United States of America. Lord, without you I am nothing. To you and only you be the glory, Amen. My beloved wife, Mrs. Jennifer Asamoa-Afriyie, and our beautiful daughters Christble and Micayla. Without your supports, it would have been difficult to continue. Dear, I remember many days that I sleep in the study rooms and you brought me food because I would be hungry. I spent little time at home but you kept the faith. Thank you so much for your care and support. To Christable and Micayla, sometimes you would ask “Daddy what time are you coming home?” because I would be at the library so late. Thank you all for your understanding. My sisters Mary Asamoa-Kye and Rose Asamoa. Your financial and moral support helped me to further my education from Ghana and my abroad. Sister Mary, may God bless you. Sister Rose, Rest in perfect peace. I am so sorry that you did not live to see this day. Your money for my education propelled me to achieve this academic pinnacle. My brother -in-Law, Mr. Maxwell Kyei. I cannot thank you enough for your help. You took me under your wings when my father died before I completed elementary school. Mr. Kyei, I cannot thank you enough. May God continue to bless you. Acknowledgments My road to achievement throughout this Doctoral Program was paved with the tremendous efforts of many people who worked patiently and diligently to assist me as I came to the dead ends sometime during this process. Without the assistance from these individuals who formed my dissertation committee, this Doctoral Program would have been difficult to complete. I would first like to thank my committee chair, Dr. Paige Wermuth. I sincerely express my profound gratitude to her. She had been an inspiration to me throughout these years. Her guidance, encouragements, and feedbacks were invaluable and helped me to come this far. The time that she dedicated to my research and development will never be forgotten. I thank her so much and I am forever grateful. I would also like to extend my profound gratitude to Dr. Richard Palmer. Dr. Palmer was an integral member of my dissertation committee. He was the “missing link” to my success. His knowledge of research taught me incredible amounts of lessons. I am also grateful to Dr. Mary Lou Gutierrez for her reviews, feedbacks, and support. I am blessed to have you to review my research. I am what I am personally, academically, and professionally in part due to all of you and I am forever grateful. Table of Contents List of Tables ................................................................................................................... viii List of Figures ..................................................................................................................... x Chapter 1: Introduction to the Study ................................................................................... 1 Introduction ................................................................................................................... 1 Background of the Study .............................................................................................. 2 Problem Statement ........................................................................................................ 3 Purpose of the Study ..................................................................................................... 4 Research Questions and Hypotheses ............................................................................ 5 Nature of the Study ....................................................................................................... 6 Theoretical Framework ................................................................................................. 7 Definitions of Terms ..................................................................................................... 9 Assumptions ................................................................................................................ 11 Scope ........................................................................................................................... 12 Delimitations ............................................................................................................... 12 Limitations .................................................................................................................. 13 Significance of the Study ............................................................................................ 15 Summary and Transition ............................................................................................. 16 Chapter 2: Literature Review ............................................................................................ 19 Introduction ................................................................................................................. 19 Literature Search Strategy............................................................................ …….…..20 Literature Review.......................................................................................... ………..21 i Theoretical Framework ............................................................................................... 22 Effectiveness of the Pap Test for the Detection of Cervical Cancer ..................... 23 Early Diagnosis…………………………………….…………………………….24 Guidelines
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