An exploratory study of knowledge, attitudes, and practices toward HPV associated anal cancer among Pakistani population

Usman Ayub Awan; Wajiha Naeem; Aamer Ali Khattak; Tahir Mahmood; Shehrish Kamran; Suliman Khan; Xingyi Guo; Zhao Yongjing; Jianbo Liu; Abdul Nasir

doi:10.3389/fonc.2023.1257401

An exploratory study of knowledge, attitudes, and practices toward HPV associated anal cancer among Pakistani population

Front Oncol. 2023 Oct 25:13:1257401. doi: 10.3389/fonc.2023.1257401. eCollection 2023.

Authors

Usman Ayub Awan^{1

2}, Wajiha Naeem², Aamer Ali Khattak², Tahir Mahmood³, Shehrish Kamran⁴, Suliman Khan^{1

2}, Xingyi Guo^{5

6}, Zhao Yongjing⁷, Jianbo Liu⁸, Abdul Nasir¹

Affiliations

¹ Medical Research Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
² Department of Medical Laboratory Technology, The University of Haripur, Haripur, Khyber Pakhtunkhwa, Pakistan.
³ School of Computing, Engineering and Physical Sciences, University of the West of Scotland, Paisley, United Kingdom.
⁴ Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC), Lahore, Pakistan.
⁵ Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, United States.
⁶ Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States.
⁷ Zhengzhou Key Laboratory of Children's Infection and Immunity , Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China.
⁸ Henan Key Laboratory of Precision Diagnosis of Respiratory Infectious Diseases, Zhengzhou Key Laboratory of Precision Diagnosis of Respiratory Infectious Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.

Abstract

Background: Anal cancer, mainly attributed to human papillomavirus (HPV) infection, is rising in prevalence among the general population in Pakistan. This study aimed to examine the knowledge, attitudes, and practices (KAP) towards anal cancer screening and HPV of the general population in Pakistan.

Method: We surveyed anal cancer KAP using social media and snowball sampling from December 2022 to May 2023. The questionnaire had 16 knowledge, 12 attitudes, 6 practice questions, and socio-demographic variables. We applied validity criteria for inclusion and exclusion and used cutoffs ≥50% for each KAP category. We analyzed data in R with Guttman's λ2 for reliability, did univariate and bivariate analysis, and reported frequencies, percentages, p-values, coefficients, odds ratios, and 95% confidence intervals.

Results: We surveyed 1620 people and discovered low awareness of HPV and anal cancer causes prevention, and screening (11%-24%), high stigma and embarrassment for screening (54%-70%), strong moral beliefs (89%), condom nonuse (91%), and low engagement in health services and programs (9.1%-14%). Knowledge (75.23%, OR = 1.0984, p = 0.05) was shaped by socio-demographic factors, attitude, and practice, with higher education enhancing knowledge (OR = 1.0984, p = 0.05). Attitude (78.45%, OR = 6.6052, p< 0.001) was influenced by socio-demographic factors, practice, and knowledge as well. Younger females, single, unemployed, students, living with more family members, earning more income, and residing in Islamabad had a more positive attitude (ORs from 1.0115 to 6.6052, p< 0.05), while religion did not affect attitude (p = 0.51). Practice (9.16%, OR = 0.1820, p< 0.001) was determined by socio-demographic factors, knowledge, and attitude. Older males, employed teachers, living with more family members, earning less income, and residing in Islamabad had better practice (ORs from 0.1323 to 3.8431, p< 0.05), but marital status and religion did not influence practice (p > 0.05).

Conclusion: Pakistani young adults need more education, awareness, health services, and programs on HPV and anal cancer, as they have low awareness, high stigma, and socio-cultural challenges. In addition, it is recommended for more research and policy initiatives are needed to address socio-cultural factors and increase anal Pap to overcome anal cancer.

Keywords: HPV vaccine; Pakistan; anal cancer screening; anal pap test; healthcare; human papillomavirus; immunization; public health.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The Science and Technology Developmental Plan of Henan Province (Grant No.232102520025), The National Foreign Expert Program of China (Grant No. QN2022026001L), and Zhengzhou University start-up grant for high talent full time researchers.