Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2016 Perceptions of Cameroonian Women Regarding Cervical Cancer Prevention Anna Nkapsah Nji Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Public Health Education and Promotion 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 Anna Nkapsah Nji 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. Raymond Panas, Committee Chairperson, Health Services Faculty Dr. Kimberly Dixon-Lawson, Committee Member, Health Services Faculty Dr. Vibha Kumar, University Reviewer, Health Services Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2016 Abstract Perceptions of Cameroonian Women Regarding Cervical Cancer Prevention by Anna Nkapsah Nji B. N.C, Johns Hopkins University School of Nursing, 2003 M.S.N, University of Maryland School of Nursing Baltimore, 2001 M.P.H, University of Maryland School of Nursing Baltimore, 2001 B.S University of Maryland School of Nursing Baltimore, 1999 R.N, University of Yaoundé Cameroon School of Nursing, 1989 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Health Sciences Walden University May 2016 Abstract Women in Cameroon as well as those residing in the Maryland-Washington Metropolitan area and the Diasporas suffer a disproportionate rate of cervical cancer morbidity and mortality due to the vast disproportion in the distribution of healthcare services. The widespread human papillomavirus (HPV) vaccination holds promise for helping to attenuate the disproportion in cervical cancer screening and prevention services. Literature from other countries including Cameroon suggests that barriers to the uptake of cervical cancer screening include: culture, religion, the psychological impact of embarrassment, the influence of husbands, cost, discomfort, and vulnerability. The purpose of this study was to gain an understanding of the perceptions of the Cameroonian women regarding cervical cancer prevention, taking into consideration parental attitudes, their knowledge, and their beliefs about the acceptance and usage of the HPV vaccines and other screening services. A survey was designed from a combination of 2 separate instruments as developed, tested, and validated by Kahn et al. (2008) and Griffioen et al. (2012) for this qualitative study. The open-ended survey questions were completed by women who volunteered to participate. Data were collected between April and May, 2015. Eighty women volunteered to participate but only 30 were able to return the completed survey. Using the NVivo software version 10, data were inductively coded, analyzed, and major themes were derived. Results showed that although the women knew about HPV, the vaccines, and Pap test, there was still a need for more education. The results of this study will be provided to law makers in Cameroon to reconsider the educational needs and distribution of healthcare services for women in Cameroon. Perceptions of Cameroonian Women Regarding Cervical Cancer Prevention by Anna Nkapsah Nji B. N.C, Johns Hopkins University School of Nursing, 2003 M.S.N, University of Maryland School of Nursing Baltimore, 2001 M.P.H, University of Maryland School of Nursing Baltimore, 2001 B.S University of Maryland School of Nursing Baltimore, 1999 R.N, University of Yaoundé Cameroon School of Nursing, 1989 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Health Sciences Walden University May 2016 Dedication I dedicate my dissertation work to my family and many friends. A supernatural force from my late husband Gandhi stood firm besides me through all the difficult times. Although in spirit, his impact was greatly felt. A special feeling of gratitude to my precious children Lovette M, Edna A, and Asanji C, as well as my nephew Blaise N who have been through all sorts of trials and tribulations with me after the passing of my husband and their father. My children have been the center of my life and my stronghold. Thank you for your understanding, consolation, inspiration, words of encouragement. Your push for tenacity rings in my ears. A special gratitude goes to my son Asanji C for the tremendous effort to edit and format this paper using his computer skills and talents. Special regards to my younger sister Rita who kept pushing that I complete this program before I celebrate my 50th birthday and to my big sister Esther A, who helped to proofread some of my essays, cooked for me, and assisted in many ways so I could have time to study. I also dedicate this dissertation to my friends and classmates who supported me throughout the process. I will always appreciate the faculty of Gandhi Health Career Services, especially Mr. Joseph, Mr. Ekiko S, Ms. Lisa B, Ms. Karen M, Ms. Elaine H, Mr. Obinna, Mr. Elvis T, Mr. Divine K and Dr. Clark for their words of encouragements and motivation. I dedicate this work and give special thanks to my very good friends Valentine A and Clement G for the many hours you spent proof reading my essays reminding me of due dates and for being there for me through this doctoral journey. Thank you very much. Acknowledgments First and foremost, my gratitude to the one above all of us, divine intervention from the omnipresent God, for answering my prayers for giving me the strength to plod on despite my established precedents of wanting to give up and throw in the towel. This dissertation would have remained a dream had it not been for the almighty. Thank you so much, Dear Lord. I would like to express the deepest appreciation to my committee chair Dr. Raymond Panas, for his countless hours of reflection, reading, encouragement, and most of all patience throughout the entire process. Dr. Panas has shown the attitude and the substance of a genius: he continually and persuasively conveyed a spirit of adventure in regard to research and scholarship as well as the excitement of accomplishing my ultimate goal of walking on the stage to receive the doctorate degree. Without his supervision, inspiration, motivation, and constant help this dissertation would not have been possible. A special thanks to Dr. Kimberly Dixon-Lawson and Dr. Rosemary Walker for accepting to serve on my committee and for sharing their expertise and precious time in reviewing my work. I cannot find words to express my gratitude to all my committee members. It gives me great pleasure in acknowledging all your help. Please accept my immense gratitude for everything. Table of Contents List of Tables .......................................................................................................................v List of Figures .................................................................................................................... vi Chapter 1: Introduction to the Study ....................................................................................1 Introduction ....................................................................................................................1 Background of the Study ........................................................................................ 5 Problem Statement ................................................................................................ 21 Purpose of the Study ............................................................................................. 22 Nature of the Study ............................................................................................... 22 Research Questions ............................................................................................... 23 Theoretical Base and Conceptual Framework ...................................................... 24 The Health Belief Model ...................................................................................... 25 An Integration of the HBM and TPB .................................................................... 29 Framework Summary............................................................................................ 30 Operational Definitions of Terms ................................................................................31 Assumptions .................................................................................................................35 Limitation .....................................................................................................................35 Delimitations ................................................................................................................37 Significance of the Study .............................................................................................37 Implications for Interventions and Effect on Social Change .......................................38 Summary ......................................................................................................................40 Chapter 2: Literature Review .............................................................................................42