Date of Award

1-1-2009

Embargo Period

1-1-2009

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Graduate Studies

Additional College

College of Nursing

First Advisor

Teresa Kelechi

Second Advisor

Gail Stuart

Third Advisor

Jan Grossman

Fourth Advisor

Anthony Alberg

Fifth Advisor

David Soper

Sixth Advisor

Peter Kalivas

Abstract

Cervical cancer is a major health problem and the second leading cause of cancer deaths among women worldwide. The purposes of this dissertation are threefold; to examine cervical cancer screening methods used in developing countries, evaluate prevailing attitudes toward new human papillomavirus (HPV) vaccines and share results from a pretest of two instruments designed to measure knowledge, attitudes and beliefs about cervical cancer, human papillomavirus infection and the new vaccines among medically underserved populations. In manuscript I, direct visual inspection (DVI) is a method used to screen for cervical cancer in developing countries where population-based Papanicolaou (Pap) screening is unaffordable and incidence and death rates from cervical cancer are exceedingly high. In manuscript I, 22 studies of DVI, published between 2002 and 2006, are compared using authors' estimates of sensitivity, specificity and efficacy. International efforts to standardize DVI have resulted in significant improvements in its practice, generating comparisons to Pap testing in the United States. However, wide variations in sensitivity and specificity cause concern and expansion of DVI in low resource settings may be justified only if global health leaders cannot reduce political, financial and cultural barriers impeding introduction and acceptance of HPV vaccines. With the advent of HPV vaccines, the eradication of cervical cancer on a global scale is now a theoretical possibility. However, research currently demonstrates that life-saving, anti-cancer vaccines are not inherently acceptable to some segments of the population and that beliefs among those most at risk for cervical cancer have not been adequately explored. In manuscript II, several studies reviewed lack findings regarding barriers and facilitators to vaccine use among medically underserved, diverse populations, thereby uncovering a significant gap in existing literature. In manuscript Ill, the Preventive Health Model was used as a framework to develop and pretest two instruments designed to measure knowledge, attitudes and beliefs about cervical cancer, HPV infection and the new vaccines among medically underserved African American, Hispanic and White populations. Using cognitive interviewing, results show that changes in language and format may reduce response errors, improve comprehension and quality of data.

Rights

All rights reserved. Copyright is held by the author.

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