15-Cervical Cancer Perceived Risks and Associated Factors Among Women in Saudi Arabia A Cross-Sectional Study

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Ibrahim et al.

Cervical cancer perceived risk and associated factors review

ORIGINAL RESEARCH ARTICLE

Cervical cancer perceived risks and associated factors among women


in Saudi Arabia: A cross-sectional study
DOI: 10.29063/ajrh2022/v26i7s.2

Heba A. Ibrahim1, Mohammed H. Nahari2*, Mohammed A. Alshahrani2, DaifAllah D. Al-Thubaity1,


Wafaa T. Elgzar1, Hanan A. El Sayed3,4, Samiha H. Sayed5,6
Department of Maternity and Childhood Nursing, Nursing college, Najran University, Saudi Arabia1; Department of
Clinical Laboratory Sciences, Najran University Najran, Saudi Arabia2; Applied College, Tabuk University, Saudi
Arabia3; Department of Community Health Nursing, Faculty of Nursing, Benha University, Egypt4; Department of
Community Health Nursing, Faculty of Nursing, Damanhour University, Egypt5; Department of Public Health, College
of Health Sciences, Saudi Electronic University, Saudi Arabia6
*
For Correspondence: Email: [email protected]; Phone: +66548514301

Abstract
Examining the risk perception of one of the most life-threatening cancers among women, such as cervical cancer, will guide the
development of targeted advocacy and educational programs to reduce the burden of the disease. The current study investigated
cervical cancer perceived risks and associated factors among Saudi women. A cross-sectional study was conducted through a social
media-based survey, which conveniently targeted 1085 Saudi women in Najran city. The survey questionnaire consisted of four
parts: basic sociodemographic data, cervical cancer knowledge quiz, attitude scale, and risk perception Scale. The present study
confirmed that 57.4% of the study participants had high-risk perception regarding cervical cancer. Among the study participants,
42.6% had a low perception of the risk of cervical cancer, 57.3% had unsatisfactory knowledge, while 59.4% had a positive attitude
(59.4%) towards cervical cancer prevention and its screening. The binary logistic regression proved that the positive significant
factors associated with risk perception were higher education [AOR=3.105 (1.300 - 7.418), p=0.011], increasing age [AOR=1.191
(1.043-1.359), p=0.005], longer duration of marriage [AOR=3.123 (1.112 - 8.767), p=0.031], having family history of
cancer/cervical cancer [AOR=4.498 (1.119 - 18.085), p=0.034], satisfactory knowledge [AOR=2.304 (1.289 - 4.116), p=0.005], and
positive attitude [AOR=3.248 (2.532 - 4.166), p=0.000]. We conclude that more than half of the women in Najran city had high
cervical cancer-related risk perception while more than two-fifths perceived low risk with unsatisfactory knowledge and a positive
attitude. These results highlight the pressing need to develop cervical cancer health education programs to foster risk perception as
a driving strategy for the prevention of cervical cancer in Saudi Arabian women. (Afr J Reprod Health 2022; 26[7s]:13-22).

Keywords: Cervical cancer, risk perception, Saudi Arabia

Résumé
L'examen de la perception du risque de l'un des cancers les plus mortels chez les femmes, comme le cancer du col de l'utérus, guidera
l'élaboration de programmes ciblés de sensibilisation et d'éducation pour réduire le fardeau de la maladie. La présente étude a
examiné les risques perçus du cancer du col de l'utérus et les facteurs associés chez les femmes saoudiennes. Une étude transversale
a été menée par le biais d'une enquête basée sur les médias sociaux, qui ciblait commodément 1085 femmes saoudiennes dans la
ville de Najran. Le questionnaire de l'enquête comportait quatre parties: données sociodémographiques de base, quiz sur les
connaissances sur le cancer du col de l'utérus, échelle d'attitude et échelle de perception du risque. La présente étude a confirmé que
57,4 % des participants à l'étude avaient une perception à haut risque concernant le cancer du col de l'utérus. Parmi les participants
à l'étude, 42,6 % avaient une faible perception du risque de cancer du col de l'utérus, 57,3 % avaient des connaissances
insatisfaisantes, tandis que 59,4 % avaient une attitude positive (59,4 %) envers la prévention du cancer du col de l'utérus et son
dépistage. La régression logistique binaire a prouvé que les facteurs significatifs positifs associés à la perception du risque étaient
l'éducation supérieure [AOR=3,105 (1,300 - 7,418), p=0,011], l'âge croissant [AOR=1,191 (1,043-1,359), p=0,005], l'allongement
durée du mariage [AOR=3,123 (1,112 - 8,767), p=0,031], ayant des antécédents familiaux de cancer/cancer du col de l'utérus
[AOR=4,498 (1,119 - 18,085), p=0,034], connaissance satisfaisante [AOR=2,304 (1,289 - 4,116), p=0,005], et attitude positive
[AOR=3,248 (2,532 - 4,166), p=0,000]. Nous concluons que plus de la moitié des femmes de la ville de Najran avaient une
perception élevée du risque lié au cancer du col de l'utérus tandis que plus des deux cinquièmes percevaient un faible risque avec
des connaissances insatisfaisantes et une attitude positive. Ces résultats mettent en évidence le besoin pressant de développer des
programmes d'éducation à la santé sur le cancer du col de l'utérus afin de favoriser la perception du risque en tant que stratégie
motrice pour la prévention du cancer du col de l'utérus chez les femmes saoudiennes. (Afr J Reprod Health 2022; 26[7s]:13-22).

Mots-clés: Cancer du col de l'utérus, perception du risque, Arabie Saoudite

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Ibrahim et al. Cervical cancer perceived risk and associated factors

Introduction the high cost of CC screening, poor individual


health-seeking behaviors, and limited social
Cervical cancer (CC) is widespread cancer among networks. The overarching influence is risk
women in middle age and ranks as the fourth one perception, evidenced as a driving force for health-
universally. Reports indicate 1.9 cases of CC per related decision-making and preventive health
100,000 women in Saudi Arabia1,2. CC ranks as the actions15,16. It denotes the individual awareness of
eighth most common cancer in Saudi Arabia, women’s vulnerability for getting a specific health
especially among women aged between 14 and 45 threat and its associated health influence17.
years. The Saudi Information Centre on human Risk perception is greatly targeted in
papilloma virus (HPV) and CC estimated that 2.5% numerous theory-driven interventions as a central
of women were diagnosed with infection with the construct in behavioral change modification. These
human papillomavirus (HPV)3. The World Health include but are not limited to, health promotion
Organization declared that HPV infection is roughly model18, self-regulation model19 and protection
responsible for all cases of CC4. Other risk factors motivation theory20, and health belief model21.
that predispose to CC include early sexual debut Consequently, perceiving the CC risk might
(<16 years old), multiple sexual partners, exposure encourage women to conduct CC screening and get
to hormones, genetic factors, smoking high parity, HPV vaccine to safeguard their health.
and low socioeconomic status. The transition of Consequently, it is essential to recognize the
precancerous lesion to invasive CC takes up to 20 determinants of individuals’ risk perception and the
years5-7. associated factors to base the development of
Previous studies indicate that Saudi women efficient risk communication to motivate the
display low awareness about the prevention and adoption of health-promoting behaviors17,22.
screening of CC and ignore the effect of HPV In consonance with Saudi vision 2030, which
infection and the importance of vaccination8,9. highlights the importance of prevention, a great
While nearly one-third of Saudi women have been effort is required to foster the implementation of the
reported to be positive for HPV DNA10, a study in national CC screening program to be accessible and
the Aseer region had shown that the awareness of affordable for all women. Furthermore, efforts are
Saudi females regarding CC and its screening required to encourage CC preventive measures
behaviors were relatively poor. Furthermore, through in-depth understanding and addressing the
screening practices in the country are minimal and obstacles for such prevention among the target
mostly performed based on the physicians’ group23,24. Therefore, the present study investigated
instructions. More attention is needed to increase CC perceived risk and associated factors among
women's knowledge and practices regarding CC Saudi women in Najran city.
screening11. Regrettably, in developing countries,
including Saudi Arabia, most women represent with Methods
clinically progressive CC stages that require
extensive survival therapy12. Precancerous cervical Study design and subjects
lesion screening is recommended and should be
started three years after marriage up to sixty-five A cross-sectional design was adopted for this study.
years of age. Evidence exist to indicate that HPV It was conducted in Najran city, KSA, considered
testing and vaccination can effectively prevented the major city in the Najran region. According to the
CC9,13. Saudi Demographic and Health Survey (2016),
Several factors have been identified at the 136,090 women aged 20 to 60 years were
community and individual levels that serve as interviewed in the Najran region, representing
obstacles to CC screening among women. Among 53.6% of the total females in the region and nearly
these factors, include supply factors - poorly one-quarter of the whole population25. The
prepared health facilities and lack of national CC researchers used a convenience sampling technique
screening programs14, while demand factors are the to recruit participants who met the inclusion criteria:
low level of CC-related knowledge, cultural norms, married women aged 18 to 65 years, can read, and

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Ibrahim et al. Cervical cancer perceived risk and associated factors

write, are free from mental illness, and agreed to alpha, and its result indicated good internal
participate in the study. consistency (r= 0.823).
The sample size was determined using the The fourth section obtained information on
Epi-info free sample size calculator according to the CC attitude scale. It was adapted from a previous
following parameters: population size = 136090; study by Getaneh et al., 202130, which comprises
50%, anticipated frequency of low perceived CC nine items ranked on a 5-points Likert scale from
risk among Najran women, 5% absolute precision, strongly agree (5) to strongly disagree (1). Please,
95.0% confidence interval, and 1% design effect. input some of the questions that were asked in the
The calculated sample size was 1075 participants, attitude scale here. The overall scale score ranged
and the final total number of women included in the from 9 to 45. The participant was considered to have
study was 1150 to compensate for unmatched a negative attitude if her overall score fell between
criteria. Sixty-five sheets were excluded because of (9 -27) and a positive attitude if her overall score
incongruent data, so data analysis was conducted on was between (28 -45). The reliability of the attitude
questionnaire retrieved from 1085 women. scale was assessed using Cronbach’s alpha, and its
result indicated good internal consistency (r=
Data collection instrument 0.785). In addition, the researcher translated the
Data was collected using an online survey. It was questionnaire into the Arabic language, and it was
developed by researchers after reviewing the related examined for face, content, and construct validity
literature and contained four sections: by a jury of six experts in the specialty and
Section 1 included the participants’ basic portrayed a good Content Validity Index
sociodemographic data including age, residence, (CVI=0.79).
education, monthly income, history of gynecologic Pilot testing
operations, genital infection, contraceptive used,
HPV vaccine, pap smear screening and family The provisional data collection form was tested on
history of CC, duration of the marriage, gravidity, 100 women beyond the predetermined sample size.
and parity. It aimed to examine the women’s acceptability and
The second section was elicitation of risks comprehension of the questions, clarify ambiguity
using the risk perception scale. It was adapted from (if present). Minor modifications were done
a previous study26.27. It contained ten items scored accordingly.
on a five-point Likert scale (1-5) from strongly Data collection procedure
disagree to strongly agree (please list some of the
Data was collected between the beginning of
questions asked in the scale). The overall risk
October 2021 until the end of January 2022. An
perception score was obtained (10-50) and
online survey was disseminated through numerous
categorized as low (10-30) and high (30-50) levels.
social media platforms (Facebook, Twitter,
Its reliability was investigated using Cronbach’s
Telegram, WhatsApp, and Instagram). The time
alpha which reflected good internal consistency (r=
elapsed for filling the questionnaire was 10-14
0.799).
minutes, with a high response rate among the Najran
The third section was the CC knowledge
females.
quiz. It was adapted from prior studies28,29 and
comprised 14 dichotomous (yes/no) questions to Data analysis
assess the participants' knowledge regarding CC Data analysis was performed using the Statistical IBM
risk factors, symptoms, and screening measures. software, version 23 (IBM Corp., Armonk, N.Y.,
Please, insert some of the questions under USA). The participants' basic data and personal/family
knowledge that were asked here. The incorrect history were represented using descriptive statistics.
answer scored zero, and the correct answer scored Knowledge, attitude, and risk perception toward CC
one. Therefore, the overall quiz score was estimated were described in terms of numbers & percentages.
(14) and leveled into unsatisfactory (0- 8) and Binary logistic regression was performed to assess the
satisfactory (9-14) knowledge. The reliability of the predictors of CC risk perception. The adopted
knowledge quiz was assessed using Cronbach’s significance level in the current study was 0.05.

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Ibrahim et al. Cervical cancer perceived risk and associated factors

Results Table 1: Participants' basic data (n= 1085)


Basic data No (1085) %
Table 1 shows that most of the study participants Marital status
were married (91.7%) and were urban residents Married 995 91.7
(93.9%), highly educated (65.3%), and had Divorced 68 6.3
Widow 22 2.0
adequate monthly income (85.7%). Many
Residence
participants report having had gynecologic Rural 66 6.1
operation (17.9%), genital infection (47.6%), Urban 1019 93.9
contraceptive use (74.6%), while only 3.3 % Education
reported a family history of cancer (3.3%). Nearly Secondary education 377 34.7
all the study participants reported no previous Pap University/postgraduate education 708 65.3
testing (98.0%) or HPV vaccination (99.0%). The Monthly income
Not enough 155 14.3
mean age of the study participants was 37.8 (add Enough 930 85.7
Standard deviation), while the mean of their History of gynecologic operations
marriage-age (23.03), marriage duration (15.17), Yes 194 17.9
gravidity (4.34), and parity (3.59). Note that all No 891 82.1
percentages must be given in one decimal place History of genital infection
Yes 517 47.6
only.
No 568 52.4
Table 2 illustrates that 39.2% of the study History of contraceptive use
participants thought that they would not have CC in Yes 809 74.6
the future. By contrast, 44.7% and 59.2% of the No 276 25.4
study participants reported a low chance of getting Family history of cancer and/or CC
CC in the next few years or at any time point of their Yes 36 3.3
No 1049 96.7
life, respectively. Regarding CC seriousness, 56.4%
perceive that just the thought of CC could scare History of HPV vaccination
Yes 11 1.0
them, while 76.2% of them would experience No 1074 99.0
increasing heartbeats. Around four-fifths (81.0% History of pap smear screening
and 79.0%) of the study participants reported that Yes 22 2.0
they would be afraid to think about CC and consider No 1063 98.0
that the problems caused by CC often take a long Age 37.79(7.41)
Marriage Age mean (SD) 23.03(4.95)
time. The fact that CC would threaten the 15.17(9.73)
Marriage duration mean (SD)
relationship with their husbands was agreed to by Gravidity mean (SD) 4.34(2.89)
56.3%, while 81.0% reported that if they had CC, Parity mean (SD) 3.59(2.35)
their whole life would change. Lastly, 76.3% of the
study participants thought that CC would end their Having a family history of CC increased the chance
life within five years. of having higher CC risk perception four times
Table 3 illustrates that 57.3% of the study compared with families with no CC history
participants have unsatisfactory CC knowledge and [AOR=4.498 (1.119 - 18.085), p=0.034]. Besides,
59.4% have a positive attitude towards it. Besides, when taking unsatisfactory knowledge as a
57.4% of the study participants have a higher risk reference, women with satisfactory knowledge have
perception regarding CC. a 2.3 higher probability of having high CC risk
Based on the binary logistic regression perception [AOR=2.304(1.289 - 4.116), p=0.005].
shown on Table 4, education, family history of CC, Positive CC attitudes increased the probability of
CC knowledge and attitude, age, and marriage high CC perceived risk 3.24 times than negative
duration are significant associated factors for CC attitudes [AOR=3.248 (2.532 - 4.166), p=0.000]. In
risk perception. University or postgraduate addition, increasing age and marriage duration
participants had three-time higher probability of increased the woman probability to have high CC
having high CC risk perception when compared perceived risk [AOR=1.191 (1.043-1.359),
with secondary school education [AOR=3.105 p=0.005] and [AOR=3.123 (1.112 - 8.767),
(1.300 - 7.418), p=0.011]. p=0.031].
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Ibrahim et al. Cervical cancer perceived risk and associated factors

Table 2: Perceived risk for CC (n= 1085)

Strongly Strongly
Disagree Sometimes Agree
Items disagree agree
No % No % No % No % No %
It is likely that I will get CC in the future 110 10.1 316 29.1 390 35.9 172 15.9 97 8.9
My chances of getting CC in the next few years
155 14.3 341 31.4 349 32.2 151 13.9 89 8.2
are high
I feel I will get CC sometime during my life 156 14.4 345 31.8 285 26.3 167 15.4 132 12.2
The thought of CC scares me 20 1.8 190 17.5 262 24.1 415 38.2 198 18.2
When I think about CC, my heart beats faster 162 14.9 82 7.6 15 1.1 488 45.0 338 31.2
I am afraid to think about CC 51 4.7 45 4.2 110 10.1 450 41.5 429 39.5
Problems I would experience with CC would last 13 1.2 46 4.2 169 15.6 497 45.8 360 33.2
CCl would
ti threaten a relationship with my 20 1.8 190 17.5 264 24.3 417 38.4 194 17.9
husband
If I had CC, my whole life would change 15 1.4 45 4.1 146 13.5 445 41.0 434 40.0
If I developed CC, I would not live longer than
165 15.2 44 4.1 48 4.4 471 43.4 357 32.9
5 years

Table 3: Participants' overall knowledge and attitude, vaccination). The reason is probably attributed to
and perceived risk toward CC (n=1085) the cultural barriers, especially that most of them
Parameter No % were highly educated. A Saudi qualitative study by
Overall knowledge Jradi and Bawazir31 uncovered these cultural
Unsatisfactory
622 57.3 concerns regarding sexually transmitted infection. It
Satisfactory
463 42.7 explored that the Saudi women have credence that
being a religious and conservative population,
Overall attitudes
deemed them at no risk for such diseases.
441 40.6
Negative Four studies reported similar findings. An
644 59.4 Ethiopian study by Getaneh et al.30 appraised the
Positive
Overall risk perception female college students’ CC-related knowledge,
462 42.6 perceptions and attitudes. More than half (56.8%) of
Low
623 57.4 the participants reported being at risk for acquiring
High
CC. Chisale Mabotja et al.32 reported high mean
Discussion scores for the perceived severity and susceptibility
among African women in studying their beliefs and
The current study showed that more than half perceptions toward CC and its screening. Russell et
(57.4%) of the studied women had a high CC risk al.33 investigated the HPV vaccine acceptability,
perception, whereas the rest (42.6%) had low-risk and risk perception for CC in Africa and showed
perception. Specifically, around two-fifths of them that more than half (57.0%) of the studied women
disagree that they are vulnerable to acquisition of had moderate-to-high risk perception for HPV and
CC either in the future (39.2%), within a few years CC. A related study in Riyadh by Aldohaian et al.24
(45.7%), or at any time during life (46.2%). reported a modest women’s reporting of
However, the highest percentage of the participants susceptibility to CC. The study also depicted higher
agreed on the severity of the disease and reported motivation and perceived benefits of CC and its
that they were afraid of getting the disease and screening with lower barriers despite having no
thought that it could disrupt their marital prior Pap testing or HPV vaccination among most
relationship and their whole life. However, this was women.
not translated into action where most of the studied By contrast, an Iranian qualitative study
women did not take any preventive step against CC exploring the role of risk perception and knowledge
(almost all had no previous Pap testing or HPV concerning CC and screening by Taghizadeh Asl

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Ibrahim et al. Cervical cancer perceived risk and associated factors

Table 4: Binary logistic regression of participants' below average (50.0%) or average (32.0%) risk-
perceived risk of cervical cancer and associated factors perception. This figure can be attributed to the poor
(1085) CC-related knowledge among most participants. A
Variables CC risk perception P- higher figure was portrayed in Uganda by Mukama
predictors value et al.36, where the highest percent of the respondents
AOR [95%CI] perceived their vulnerability to CC (76.0%) and the
Marital status
Reference 0.695
disease severity (94.6%). This can be attributed to
Married
Divorced 0.855 [0.284 - 2.576] 0.781 the various background criteria of the studied
Widowed 3.657 [0.156 - 85.780] 0.421 women in Mukama’s study. Most of them were
Residence primarily educated (58.9%), rural residents
Rural Reference (67.8%), and the culture difference in the first
Urban 1.132 [0.583- 2.197] 0.714 regard.
Education
Secondary school Reference
The current study confirmed numerous
University or 3.105 [1.300 - 7.418] 0.011* significant and positive factors associated with CC
postgraduate risk perception, including the educational level,
Monthly income marriage duration, age, CC family history,
Not enough Reference knowledge, and attitude. Women with high
Enough 1.787 [0.739 - 4.321] 0.197 education and longer marriage duration have a
Family history of
CC
three-times higher probability of having higher CC
No Reference risk perception. Increasing women's age, nearly
Yes 4.498 [1.119 - 18.085] 0.034* double their probability of high-risk perception.
Overall Greater than the four-fold probability for increasing
knowledge CC risk perception was proved for those with
Unsatisfactory Reference positive family history. Evidence also revealed
Satisfactory 2.304 [1.289 - 4.116] 0.005* varied associated factors with the women’s CC risk
Overall attitudes perception. First, A Saudi study by Aldohaian et al24
Negative Reference
proved that the women’s education and CC family
Positive 3.248 [2.532 - 0.000*
4.166] history were significantly associated with their
Age 1.191 [1.043-1.359] 0.010* belief in higher susceptibility for CC. Second, a
Marriage age 0.997 [0.900 - 1.105] 0.956 Saudi study by Salem et al35 proved that CC risk
Marriage 3.123 [1.112 - 8.767] 0.031* perception was significantly higher among older
duration
1.027 [0.894 - 1.180] 0.710
(>40) and married women and previous history of
Gravidity
Parity 0.854 [0.684-1.066] 0.164 CC screening. Third, an African study by Opoku et
al37 demonstrated that CC risk perception was
et al.34 revealed an overall low-risk perception for significantly associated with women’s screening
CC with much lower perceived susceptibility and willingness and higher education and knowledge
aggravated perception of severity. This figure was about CC.
mainly attributed to the limited CC knowledge and Distinctly, the risk perception is basically
misconception among study participants. They shaped by the individuals’ knowledge and
overestimated the hereditary role in CC incidence attitudinal beliefs, which provide internal power and
and did not distinguish between CC and sexually base for rational evaluation of their risk level.
transmitted infections, especially since most had no Aldohaian et al24, Annan et al38, Salem et al35,
family history and no symptoms. Besides, the Opoku et al37. The present study portrayed that
sociocultural barriers for communicating matters having a satisfactory knowledge doubled the
related to CC. Another Saudi study in Al Hassa by probability of having higher CC risk perception,
Salem et al.35 examined the CC perceived risk and where 42.7% of the studied women have
screening barriers. It portrayed that only 18.0% of satisfactory CC-related knowledge levels, and
the studied female teachers had above average risk 57.3% of them had unsatisfactory levels. This
perception to CC, whereas the highest percent had explains why more than half of the study

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Ibrahim et al. Cervical cancer perceived risk and associated factors

participants had a higher risk perception for cervical CC screening and HPV vaccination among most
cancer. In unity, Annan et al38, in an analysis of the studied women despite the prevailing poor
mediating influence of the perceived CC knowledge about CC and its risk factors. This
seriousness on its related knowledge and screening uncovered the essential role of women’s attitude in
behaviors, confirmed that increased CC knowledge shaping their subsequent health behavior for CC
was significantly related to increased perceived prevention based on evaluating and perceiving its
susceptibility and seriousness of CC and the severity.
perceived benefits of CC screening behaviors. On the contrary, a Saudi study by Alnafisah
Moreover, Salem et al35 and Opoku et al37 confirmed 43
et al reported a negative attitude toward CC and its
that those with higher knowledge scores about CC preventive measures among the highest percent of
and its risk factors have higher risk perception. the studied women in the Qassim region. Moreover,
Three studies declared a similar trend for a Turkish study by Yanikkerem et al44 portrayed
unsatisfactory CC-related knowledge. First, a negative CC-related beliefs and attitudes with low
recent Saudi study (in Al Madinah Province) by health motivation levels among most studied
Zahid et al39 reported a low-to-moderate CC women. This is mainly due to this contradictory
knowledge concerning its symptoms and study's prevailing deficient knowledge and lower
prevention. Second, a systematic review in India by educational levels. Besides, the reported cultural
Taneja et al40 concluded a fair knowledge toward barriers to discussing sexual-related issues with the
CC and its screening among Indian women; health care providers and high perceived barriers,
however, a gap was also present in its especially among women belonging to a low
transformation into practice. Third, AlHarfi et al41 socioeconomic group.
found that the studied Saudi women had a basic
knowledge about CC, but 31.8% had an idea about Conclusion
HPV as a risk factor for CC while only 21.1% had
prior knowledge about the HPV vaccine and Pap The current study portrayed a higher risk perception
testing. In contrast, a higher figure was portrayed by regarding cervical cancer among more than half of
two Ethiopian studies, which revealed that the the Saudi women in Najran city. Moreover, more
highest percent of the participants had either good than half had a positive cervical cancer-related
(59.3%) Getaneh et al30 or adequate (55.7%) attitude but unsatisfactory knowledge about its risk
Wakwoya et al28 knowledge about CC and its factors, symptoms, and screening. Women with
screening. This may be attributed to the cultural higher education levels and longer marriage
variation between countries that open or close the duration have a three-time higher probability for
discussion or communication about such sexual- higher risk perception. Increasing women's age,
related issues and the held personal attitude toward nearly double their probability of high-risk
such issues. perception. Positive family history for cancer/CC
The current study confirmed that those who increases the probability for higher CC risk
had a positive CC-related attitude had a three-folded perception by more than four-fold. Besides, women
probability of increasing risk perception where with satisfactory knowledge have more than double
59.4% of the participants had a positive attitude and the probability of having higher risk perception.
the rest (40.6%) had a negative attitude. This may More than three-folded probability for the higher
be related to the higher level of education among the risk perception was associated with having a
highest percentage of them, which also justifies the positive attitude toward it.
higher risk perception among more than half of
them. Similarly, Getaneh et al30 depicted a favorable Recommendations
attitude among the highest percent of the
respondents (67.7%), whereas the rest (32.3%) of Based on the findings as mentioned earlier, it is
them had an unfavorable attitude towards CC and its recommended to:
screening. A Saudi study conducted in Makka by - Develop targeted health education programs for
Alfalogy et al42 portrayed a positive attitude towards women to enrich their knowledge about cervical

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Ibrahim et al. Cervical cancer perceived risk and associated factors

cancer and its symptoms, risk factors, and screening of the study and analysis and interpretation of data,
recommendations. drafting the article and revising it critically for
- Social-mass-media-based campaigns to foster important intellectual content, final approval of the
the women’s risk perception about cervical version to be submitted. Elgzar- The conception and
cancer design of the study, drafting the article or revising it
critically for important intellectual content, and
- Enacting awareness-raising programs through
final approval of the version to be submitted. El
the ministry of health to cut down the culture of
Sayed- drafting the article and revising it critically
silence surrounding the sexual-related issues in
for important intellectual content, and final approval
Saudi Arabia.
of the version to be submitted. Sayed- The
conception and design of the study and analysis and
Ethical consideration interpretation of data, drafting the article and
Ethical approval to conduct the study was obtained revising it critically for important intellectual
from the Deanship of Scientific Research at the content.
University of Najran (NU/RG/MRC/11/1).
Informed consent was taken from each participant Acknowledgement
before proceeding to the questionnaire, with an
adequate explanation of the study purpose on the The authors are thankful to the Deanship of
Scientific Research at Najran University for funding
front page of the questionnaire. They were informed
this work under the General Research Funding
that their information was confidential and used
program grant code (NU/RG/MRC/11/1).
only for research purposes, and anonymity of the
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