title: Knowledge, attitude and practice (KAP) concerning cervical cancer and screening among rural and urban women in six provinces of the Democratic People's Republic of Korea.
abstract: BACKGROUND
  This study assessed women from the Democratic People's Republic of Korea for: (i) their level of knowledge of cervical cancer and attitudes and practices concerning cervical screening (KAP); and (ii) differences in KAP between rural and urban groups.
  
  
  METHODS
  In a descriptive cross-sectional study, a purposive sample of 200 women in 6 provinces of DPRK (rural: n=99, urban: n=101) were interviewed using a standardized questionnaire. Differences between proportions were assessed using the χ2 test. Significance was defined as p<0.05.
  
  
  RESULTS
  63% of rural and 60% of urban participants had heard of cervical cancer (p>0.05). 42% knew that it is the most common cancer of the female reproductive tract, 55% knew that all women are at risk, but only 36% were aware of cervical cancer's preventability. Some 13% of rural and 29% of urban respondents had heard of cervical cytology testing (p<0.001). Only 6% of participants had ever received a cervical cytology smear. Among the reasons for not screening, 48% mentioned a lack of awareness of cervical cytology; 47% their dislike of pelvic examinations; 17% of rural and 31% of urban interviewees reported the absence of symptoms (p<0.05); and 62% of rural and 0% of urban women mentioned travelling long distances to service delivery points (p<0.001).
  
  
  CONCLUSIONS
  There is a reasonable level of knowledge of cervical cancer among North Korean women; however, there are major gaps regarding awareness of its preventability and actual uptake of cytology screening services. There are no significant differences between rural and urban women with regard to their KAP. Large scale health promotion campaigns are needed to educate women and the community about cervical cancer and its preventability through screening. The national health care system needs to ensure that screening services are effective, accessible, feasible and acceptable to women.
authors.affiliation: International Planned Parenthood Association, East Southeast Asia and Oceania Regional Office (IPPF ESEAOR), Kuala Lumpur, Malaysia. ttran@ippf.org
authors.forename: Nguyen Toan
authors.initials: NT
authors.lastname: Tran
authors.forename: Song Il
authors.initials: SI
authors.lastname: Choe
authors.forename: Richard
authors.initials: R
authors.lastname: Taylor
authors.forename: Won Suk
authors.initials: WS
authors.lastname: Ko
authors.forename: Hae Suk
authors.initials: HS
authors.lastname: Pyo
authors.forename: Hyon Chol
authors.initials: HC
authors.lastname: So
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D056911:Democratic People's Republic of Korea; D055088:Early Detection of Cancer; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012423:Rural Health; D011795:Surveys and Questionnaires; D014504:Urban Health; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D014626:Vaginal Smears