|Year : 2022 | Volume
| Issue : 2 | Page : 85-92
Sociodemographic factors influencing knowledge, attitude, and practices regarding the prevention of common cancers among adults in urban slum, Kolkata
Paramita Sarkar, Arnab Sarkar, Rivu Basu
Department of Community Medicine, Bankura Sammilani Medical College, Bankura, West Bengal, India
|Date of Submission||20-Jul-2022|
|Date of Acceptance||23-Sep-2022|
|Date of Web Publication||10-Jan-2023|
Dr. Rivu Basu
Bankura Sammilani Medical College, Kenduadihi, Bankura - 722 102, West Bengal
Source of Support: None, Conflict of Interest: None
Context: Cancer is a serious global public health problem. Public awareness plays a big role in the prevention of cancer. Aims: This study aims to evaluate influence of sociodemographic characteristics and related factors on knowledge, attitude, and practice (KAP) regarding the prevention of common cancers. Settings and Design: This community-based observational, cross-sectional study was conducted in the slum area of urban field practice area of a tertiary care hospital, Kolkata. Materials and Methods: The survey was conducted with a sample of 415 using a semistructured questionnaire related to KAP regarding the prevention of cancers. Mann–Whitney U-test and Kruskal–Wallis test were conducted to determine group differences for sociodemographic variables. Linear correlational analysis was performed to identify associated factors and measure the strength and direction of relationships Results: Median scores for knowledge, attitude, and practice differed by sociodemographic characteristics. Positive correlations were observed between knowledge–attitude (r = 0.395, P < 0.01), attitude–practice (r = 0.391, P < 0.01), and knowledge–practice (r = 0.460, P < 0.01). Age, gender, educational status, and socioeconomic class were significantly associated with KAP score of participants. Conclusions: Knowledge about primary preventive measure was found to be less. The study found varying degrees of positive correlation between KAP. Knowledge and level of education had positive associations with attitude and adherence to preventive measures. The findings suggest a need for targeted community awareness interventions for the elderly populations, among men and those with no school education. The positive linear correlations reaffirm that better knowledge can lead to positive attitude and subsequently in good practices. Extensive health educational campaigns should be provided to the general population.
Keywords: Attitude, cancer, knowledge, practice, urban population
|How to cite this article:|
Sarkar P, Sarkar A, Basu R. Sociodemographic factors influencing knowledge, attitude, and practices regarding the prevention of common cancers among adults in urban slum, Kolkata. Muller J Med Sci Res 2022;13:85-92
|How to cite this URL:|
Sarkar P, Sarkar A, Basu R. Sociodemographic factors influencing knowledge, attitude, and practices regarding the prevention of common cancers among adults in urban slum, Kolkata. Muller J Med Sci Res [serial online] 2022 [cited 2023 Jun 2];13:85-92. Available from: https://www.mjmsr.net/text.asp?2022/13/2/85/367406
| Introduction|| |
Cancer is emerging as a major public health problem worldwide. In 2012, globally 14.1 million cases were there including 7.4 million males and 6.7 million females, and the number is expected to increase to 24 million by 2035 among which cancers of the lung, breast cancer, and cervical region topping the list., The number is so huge that each of us will be knowing a cancer patient either as a family member or relative or friend or neighbor. More than two-thirds of cancer patients seek medical help very late when there is nothing much to treat. According to the WHO in developing countries, the majority of cancer cases are detected only in advanced stages, when they are untreatable. In the case of most common cancers in India such as cervical, breast, and oral cancers, there are proven methods of screening tests for early detection. However, facilities for proper screening and management of patients are limited and awareness regarding symptoms, early clinical checkups, screening tests, and treatment methods are low here. Cancer screening test is not performed in an organized manner in any part of India. Important risk factors such as tobacco use, alcohol consumption, physical inactivity, dietary factors, and infection are well known and with this existing knowledge of risk factors, many cancer cases can be prevented. Prevention against any disease is proportional to knowledge, attitude, and practice (KAP) of the population and is reflective of the importance that is paid to health-related issues by society. Therefore, KAP studies play an important role in determining the ambiguities of society and are widely used in population-reported assessment research worldwide. The effectiveness of any disease preventive measures depends on the extent to which people change their behavior. As per health belief theory, a person is likely to take health actions if the individual believes that she/he is susceptible to the disease or would have serious effect on him if contracted. KAP surveys are the most frequently used study tool in health-seeking behavior research. Knowledge is usually assessed to see how far community knowledge corresponds to biomedical concepts. Attitude has been defined as "a learned predisposition to think, feel, and act in a particular way toward a given object or class of objects.", As such, attitude is a product of a complex interaction of beliefs, feelings, and values. Practice is usually inquired about the use of preventive measures or different health-care options. Generally, hypothetical questions are asked which hardly permits statements about actual practices, rather, it yields information on people's behaviors or on what they know should be done. Currently available data are limited to some sections of society, particularly in the slum portion of urban area on cancer prevention. The objectives of the study were to assess how different sociodemographic factors impact current patterns of knowledge and how this might influence uptake of measures to prevent cancer so that the information can be used to develop a better and need-based program for society.
| Materials and Methods|| |
This community-based observational, cross-sectional study was conducted in urban field practice area of R G Kar Medical College and Hospital, Baghbazar slum, Kolkata, from September 2018 to August 2019. Ethical clearance was taken from the institution. List of all 452 families residing in the study area, along with list of family members was obtained from urban health and training center. It was decided before starting the study that all the families in the study area were to be visited. However, 37 families expressed their unwillingness to participate and were excluded from the study. Members from the remaining 415 families were finally interviewed after taking consent. One adult member from each family was chosen by doing simple random sampling. Different factors related to cancer were gathered by using a pretested, prevalidated, and semistructured schedule. In addition to the demographic data, six items explored knowledge, 19 items focused on attitude, and six items addressed practices toward the prevention of common cancers. Respondents were asked to answer in limited as well as multiple choice formats. In the knowledge section, participant gets 1 point for the correct response and 0 for the wrong or no response. Knowledge score for the prevention of cancer consists of six items and total knowledge score ranges between zero and six points. Attitude part of schedule had been set according to the conceptual framework of health belief model constructs such as perceived susceptibility, perceived severity, perceived barrier, and perceived benefit. The participant provides their agreement with each statement on a 5-point Likert scale as; 1 = Strongly Disagree, 2 = Disagree, 3 = neither agree nor disagree, 4 = Agree, and 5 = Strongly Agree. Furthermore, reverse coding was used for negative statements. Total attitude score from four domains (perceived susceptibility, perceived severity, perceived barrier, and perceived benefit) consisting of 19 items was calculated ranging from 19 to 95. Total practice score was calculated from six items such as avoiding smoking, avoiding smokeless tobacco, avoiding alcohol, intake of fruits and vegetables regularly, physical activity regularly, and participated in any screening test. Participants get 1 point if they practice that preventive measure and get 0 score if they do not practice it. The practice score ranges from 0 to 6. Data were entered into Excel and analyzed using SPSS Statistics for Windows, version x.0 (SPSS Inc., Chicago, Ill., USA). Descriptive statistics were expressed in terms of absolute number, percentage, mean with standard deviation (SD), and median with interquartile range. Mann–Whitney U-test and Kruskal–Wallis test were used to describe associations between sociodemographics with KAP of participants. Relationships between KAP were analyzed by Spearman's correlation coefficient statistic.
| Results|| |
A total of 415 respondents had participated in this study, of which 48% (199) were male and 52% (216) were female. The mean (SD) age was 48.60 (9.93) years ranging between 26 and 68 years. More than half of the (56.9%) participants were <50 years, whereas about 12% of respondents were in the >60 years age group [Table 1]. The majority (96.9%) were currently married. About 70.6% of respondents belonged to the upper-lower socioeconomic class as per the modified Kuppuswamy Scale updated for 2017.
[Table 2 describes the responses of participants toward knowledge. Each response was scored as "yes" or "no." The scoring range of the questionnaire was 6 (maximum) to 0 (minimum). Preventive measures thought to be of importance were reducing or quitting alcohol consumption (63.9%), regular intake of fruits and vegetables (10.1%),, regular physical exercise (3.4%), clinical checkups (58.6%), and vaccination (1.6%), respectively [Table 2].
|Table 2: Knowledge regarding preventive measures of commonly occurring cancer|
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The response of study participants regarding their attitude toward cancer is shown in [Table 3]. About one-third of study participants perceived their susceptibility to cancer in future and were worried about it. The majority (57.6%) showed their disagreement that cancer is familial. Most of the participants perceived cancer as incurable disease with less survival chances. Moreover, almost all respondents agreed that cancer hampers day-to-day activity of the person and causes a financial crisis and mental pressure on both patient and the family members.
|Table 3: Attitude regarding cancer and its prevention following the health belief model|
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On adopting preventive measures, the majority of respondents showed favorable attitudes toward quitting tobacco as well as alcohol. Most of them (92%) perceived the benefits of early detection of cancer as that would cause less suffering and less financial burden on the patient. However, about 40% of respondents had unfavorable attitude for undergoing cancer screening test, as they felt no need for a screening test in an apparently healthy person and they also perceived that prior test might cause unnecessary mental stress.
Similarly, the majority had unfavorable attitudes about reducing obesity, doing regular physical exercise, and taking regular fruits and vegetables in their diet as they perceived these had no role in the prevention of cancer. About one-fourth of the participants had a current smoking habit and had taken no measures to reduce or quit smoking. Similarly, about 27.4% of participants using smokeless tobacco did not take any preventive measures so far. Eighteen percent of the study population never reduced or quitted alcohol consumption. Only 14% of the study participants consumed fruits and vegetables daily (daily consumption of 2–6.5 cups),, whereas regular physical activity (at least 150 min of moderate-intensity physical activity per week or equivalent activity) was followed by only 6.7% of the study participants. Past history of participation in cancer screening was done by very few (8.6%) among respondents [Table 4].
|Table 4: Practice regarding cancer-preventive measures taken as stated by participants|
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The association of demographic characteristics and median KAP scores is presented in [Table 5].
|Table 5: Comparison of demographic characteristics and mean knowledge, attitude, and practice scores|
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Among the demographic variables, female gender, younger age group (<=40 years), higher educational status, and upper socioeconomical class were significantly associated with higher median KAP scores (P < 0.01) [Figure 1] and [Figure 2].
|Figure 1: Bar chart showing the distribution of median knowledge, attitude, and practice scores across age groups of study participants|
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|Figure 2: Bar chart showing the distribution of median knowledge, attitude, and practice scores across education status of study participants|
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Whereas demographic variables such as marital status and caste were not significantly associated with median KAP scores. Correlation between KAP were interpreted using the following criteria: 0–0.25 = weak correlation, 0.25–0.5 = fair correlation, 0.5–0.75 = good correlation, and >0.75 = excellent correlation.
The correlation revealed significant positive linear correlations between knowledge–attitude (r = 0.395, P < 0.01), knowledge–practice (r = 0.460, P < 0.01), and attitude–practice (r = 0.391, P < 0.01). The result reaffirms the relationship between KAP with cancer preventive measures as shown in [Table 6].
|Table 6: Correlation between knowledge, attitude, and practice score regarding prevention of commonly occurring cancer (n=415)|
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| Discussion|| |
During the past few decades, the concepts about cancer have changed through a number of advancements and related studies. To achieve sustainable development goal 3 and reduce premature deaths from cancer improving the quality of life of cancer patients and improving the survival of cancer worldwide, immense emphasis has been put on community-based approaches for information dissemination and cancer prevention programs including cancer education of the people at large as also of the health personnel dealing with this disease. Unfortunately, knowledge and ideas of common people about cancer prevention are quite inadequate worldwide. To make such programs successful, some baseline data such as the status of knowledge, ideas, and attitude of public toward various cancers need to be assessed. The current study sought to evaluate KAP toward the prevention of cancer among healthy individuals. Results of the study revealed that all of the study participants in our study were aware of the term cancer as well as the relation between tobacco and cancer, which is similar to the finding of a pilot study conducted in West Bengal by Ray and Mandal and another study conducted in New Delhi by Seth et al., where the survey revealed that 98% of the respondents had heard of "Cancer" and almost 90% knew about tobacco to be a risk factor for cancer., This finding was in contrast to another study done in eastern India by Paul et al., where only 40% of participants mentioned tobacco as risk factor. Our study found that younger age (<40 years), higher educational status, and higher socioeconomical status were significantly associated with higher median knowledge scores which was similar to the study done in urban areas of North Bengal by Raychaudhuri and Mandal and also a study done in northeast India by Oswal et al., According to the health belief model perceived susceptibility, benefits, and barriers in the health-care regimen play a vital role in achieving patient care and therapeutic success. In our study, about one-third of study participants perceived their susceptibility to cancer in future and were worried about it. The majority had a favorable attitude on quitting tobacco as well as alcohol as cancer prevention measures. However, the median practice score was much lower among males than in females in this regard. The reason may be attributed to the fact that men use more tobacco products and alcohol. Regarding undergoing cancer screening tests, 40% of participants had unfavorable attitude. The current study showed that there was significant barrier in undergoing of cancer screening; due to factors such as fear of test results leading to unnecessary mental stress and felt wellness. These findings have also been documented in other studies also.,, Therefore, it needs to address these barriers to increase the uptake of screening practice through health communication. In a country like India, where especially women are hesitant to freely discuss issues related to breast and cervical cancer, grass-root level workers can facilitate communication, leading to potentially effective acceptance of screening tests. The majority of participants had unfavorable attitude toward having regular fruits and vegetables in diet, doing regular physical exercise, and reducing obesity as they perceived these had no role in the prevention of cancer. The finding was in contrast to the study done by Kumar and Singh in Arunachal Pradesh where about 33% and 43.6% of participants were in favor of fruit–vegetable consumption and daily physical exercise as cancer preventive methods. Both knowledge and practice regarding the role of vaccines were lacking among the participants which are similar to the findings of several studies done by Sujindra et al., Kumar and Singh, and Kumari et al.,, Overall median practice score toward cancer prevention was found to be higher among the younger age group (<40 years) and participants with higher educational status. Positive correlations between knowledge–attitude, knowledge–practice, and attitude–practice in this study reaffirm the relationship between KAP with cancer control measures. It is concluded that adequate knowledge can lead to positive attitude resulting in good practices. It should also be addressed by social and medical researchers foregoing achieve a fuller understanding of the underlying issues while the outcome of such studies should be utilized in policy and decision-making by government officials and members of the health-care team. The strength of the study is that majority of study participants are under 50 years of age group and are the main source of information carriers and dissemination. This emphasizes that if they have a strong knowledge base about cancer prevention, the same will also be transferred to the public at large. Our study has its own limitations as it was based on the pretested semistructured schedule and the possibility of social desirability bias could not be eliminated from the study findings. Still, it provided new insights into the perceptions and KAP of urban people residing in the slum region of Kolkata toward cancer prevention practices. There are further scopes of qualitative studies on the aspect of perceived severity, susceptibility, and barrier that will provide more insight on cancer prevention. The reason for including both women and men in sample selection was that attention should be paid to all irrespective of gender to increase the understanding of cancer and the performing of appropriate preventive practices.
| Conclusions|| |
Increasing incidence of cancers is of public health concern worldwide. Analysis of this study revealed that although the majority of participants were aware of name and symptoms of common cancers but the awareness was lacking on the prevention part. In addition, the older age group, lower educational status, lower socioeconomical status, lack of knowledge, and wrong perception toward early detection of cancer were significantly associated with the low practice score. The single largest predictor of cancer patient survival is early diagnosis. Especially in developing countries due to the recourse crunch for diagnostic and treatment facilities, a combined approach including primary prevention and a treatment care continuum has to be emphasized to ensure equitable access to affordable cancer detection and treatment services. There was a barrier among study participants in relation to undergoing screening tests. The majority of study participants had less knowledge and their health-seeking behavior and understanding of the need to undertake cancer screening were low. The reason for this could be either lack of health communication, availability of skilled manpower, equipment, or consumables, inadequate referral system, and poor overall infrastructure of health facilities to conduct screening programs. Nationwide sensitization campaign, introduction of low-cost vaccination such as HPV in national immunization program, and observing national cancer awareness day would facilitate awareness acceptance. Organizing educational program specially for the people of older age group and people of lower-educational status is crucial to increase the awareness on zc7 cancer-prevention and to reduce its burden on society.
The authors expressed their words of thanks to HOD Prof Dr.Sukamal Bisoi, Medical officer Dr. Dipika Halder, and study participants for their guidance and cooperation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Cancer Research Fund International, Cancer Facts and Figures. Worldwide Data. Available from: www.wcrf.org/int/cancer facts-figures/worldwide data. [Last accessed on 2022 Jul 20].
India State-Level Disease Burden Initiative Cancer Collaborators. The burden of cancers and their variations across the states of India: The global burden of disease study 1990-2016. Lancet Oncol 2018;19:1289-306.
Park K. Park's textbook of preventive and social medicine 26th
/2021. Jabalpur,M.P,India: Banarsidas Bhanot Publishers; 2021.
Development of an Atlas of Cancer in India. First All India Report 2001-2002: An Overview. New Delhi: ICMR, Supported by the World Health Organization; Available from: http://www.mohfw.nic.in/
. [Last accessed on 2022 Jul 20].
San Turgay A, Sari D, Türkistanli EC. Knowledge, attitudes, risk factors, and early detection of cancer relevant to the schoolteachers in Izmir, Turkey. Prev Med 2005;40:636-41.
Nene BM, Jayant K, Malvi SG, Dale PS, Deshpande R. Experience in screening for cervical cancer in rural areas of Barsi Tehsil (Maharashtra). Indian J Cancer 1994;31:34-40.
Rosenstock IM. Why people use health services. Milbank Mem Fund Q 1966;44:l94-127.
Good B. Medicine, Rationality, and Experience: An Anthropological Perspective. Cambridge: Cambridge Univ Pr; 1994.
Tannahill A. Beyond evidence – To ethics: A decision-making framework for health promotion, public health and health improvement. Health Promot Int 2008;23:380-90.
Ribeaux P, Poppleton SE. Psychology and Work: An Introduction. London: Macmillan; 1978.
Glanz K, Rimer BK, Lewis FM, editors. Health Behavior and Health Education: Theory, Research, and Practice. 3rd
ed. San Francisco: Jossey-Bass; 2002. p. 47-8.
Wani RT. Socioeconomic status scales-modified Kuppuswamy and Udai Pareekh's scale updated for 2019. J Family Med Prim Care 2019;8:1846-9.
] [Full text]
Kundapur R, Khan AM, Kakkar R. IAPSM's textbook of community medicine. First. Kundli,HR,India: Jaypee Brothers Medical Publishers; 2019;p 616-33.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd
ed. Hillsdale, N.J: L. Erlbaum Associates; 1988.p 78-81.
NCD Countdown 2030 Collaborators. NCD countdown 2030: Pathways to achieving sustainable development goal target 3.4. Lancet 2020;396:918-34.
Ray K, Mandal S. Knowledge about cancer in West Bengal – A pilot survey. Asian Pac J Cancer Prev 2004;5:205-12.
Seth T, Kotwal A, Thakur R, Singh P, Kochupillai V. Common cancers in India: Knowledge, attitudes and behaviours of urban slum dwellers in New Delhi. Public Health 2005;119:87-96.
Paul R, Sinha S, Asifullah MD, Mallick SK, Mondal J. Knowledge, attitude and practices of patients' relatives about cancer: A study from Eastern India. Int J Community Med Public Health 2017;4:1342. Available from: http://www.ijcmph.com/index.php/ijcmph/article/view/1114
. [Last accessed on 2022 Sep 04].
Raychaudhuri S, Mandal S. Current status of knowledge, attitude and practice (KAP) and screening for cervical cancer in countries at different levels of development. Asian Pac J Cancer Prev 2012;13:4221-7.
Oswal K, Kanodia R, Pradhan A, Nadkar U, Avhad M, Venkataramanan R, et al.
Assessment of knowledge and screening in oral, breast, and cervical cancer in the population of the northeast Region of India. JCO Glob Oncol 2020;6:601-9.
Saleem F, Hassali MA, Shafie AA, Awad AG, Bashir S. Association between knowledge and drug adherence in patients with hypertension in Quetta, Pakistan. Trop J Pharm Res 2011;10:125-32.
Mishra GA, Pimple SA, Shastri SS. An overview of the tobacco problem in India. Indian J Med Paediatr Oncol 2012;33:139-45.
] [Full text]
Narayana G, Suchitra MJ, Sunanda G, Ramaiah JD, Kumar BP, Veerabhadrappa KV. Knowledge, attitude, and practice toward cervical cancer among women attending obstetrics and gynecology department: A cross-sectional, hospital-based survey in South India. Indian J Cancer 2017;54:481-7.
] [Full text]
Kumari S, Singh A, Sangal R, Sharma NR. KAP study on cervical cancer and human papillomavirus vaccine acceptability among adolescent girls of Eastern UP: A cross sectional study. Int J Reprod Contracept Obstet Gynecol 2021;10:2031. Available from: https://www.ijrcog.org/index.php/ijrcog/article/view/10038
. [Last accessed on 2022 Sep 04].
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]