Graduation Date

Summer 8-9-2019

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Medical Sciences Interdepartmental Area

First Advisor

Dr. Amber D. Donnelly

Abstract

Three hundred surveys listing 31 questions were distributed amongst women and men at Sidra Medicine, Doha, State of Qatar, to assess knowledge and perceptions of: Cervical cancer (CxCa); preventive Pap test screening; Human Papilloma Virus (HPV) vaccination; and, need for population-based screening. Survey questions captured categorical statistical data through four categories: (1) Socio-demographic; (2) Healthcare Services; (3) Health Literacy; and, (4) Self-efficacy and Perceptions. Hypothesis 1: 12 survey questions pertaining to CxCa and Pap testing revealed 8 statistically-significant dependencies; notably, 70% of respondents were aware of CxCa; however, 31.8% were unaware that CxCa may be curable; 33.7% were unaware of the Pap test; and, 35.2% were unaware that HPV vaccination may protect against CxCa. Hypothesis 2: Two survey questions pertaining to screening practice revealed no statistically-significant dependencies; however, 67.4% of respondents strongly agreed for establishment of population-based screening in Qatar. Hypothesis 3: Three salient parallels were revealed between the Qatar and US clinical experiences: (1) Greater than 60% of symptomatic women in Qatar presented with Stage II/III CxCa in 2014, relative to 60% of women in the US with inoperable disease before 1957; (2) Estimated CxCa death rates in Qatar are 26.7%, relative to 32.2% in the US; and, (3) The burden of CxCa was under-estimated prior to emergence of death registries and epidemiologic data in the US in 1914 and 1952 respectively, relative to 2014 in Qatar.

Impediments to Pap test development and application in the US stemmed from macro-dynamics (i.e., societal, economic, political situations); and, reactive micro-dynamics (i.e., professional conflicts, skepticism, conceptualization of cervical precancer). Pap test screening practices in the State of Qatar may be optimized through: (1) Tumor Registry for inclusion of precancer cases to ascertain actual CxCa incidence; (2) Organized screening with initial call to screening for asymptomatic women deemed at risk; and, (3) Reallocation of financial resources to support expanded screening for all women.

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