Transcript Participants and Methods

2nd Protocol Proposal
14th December ‘09
Introdução à Medicina I
Class 16 - 2009/2010
I. Background
II. Research Question and Aims
III. Participants and Methods
IV. Expected Results
V. References
Why are we developing this study?
 Cervical cancer has a high incidence and mortality.
 A lack of knowledge about the disease is shown in
articles previously consulted.
 Knowledge is a key first step to health education
intervention and appropriate decision-making.
 Medical students will play a major role in the future
public healthcare and education.
 We believe there is potential for better results on
prevention of cervical cancer.
What is cervical cancer?
 A slow developing malignant cancer that starts in the
tissues of the cervix.
 Human papillomavirus (HPV) is implicated in more than
99% of these cancers. (Kaplan-Myrth N, 2007, Family Physicians of Canada)
How does cervical cancer develop?
Normal
Cervix
HPV Infection
HPV Clearance
Infected
Cervix
HPV infection
must persist for
more than one year
Progression
Regression
CIN
Invasion
Cancer
How aware are people of cervical cancer?
 1st grade college students’ knowledge was uncertain
about forms of HPV transmission. There were no major
differences between genders, except for the
knowledge about the link between HPV and genital
warts (4,2%-males; 11,6%-females). (Baer H. et al, 2000, J
Community Health)
Awareness among young university students is low.
How aware are people of cervical cancer?
 “Health professionals and women had better
knowledge about HPV than other participants (…)
Overall, the knowledge of the general public about
HPV infection is poor.” (Klug SJ et al, 2008, Prev. Med.)
 “In a population sample of British women (…) only
2.5% cited HPV as the cause of cervical cancer
without prompting (…) Public education is urgently
needed.” (Marlow LA et al, 2007, Br J Cancer)
How common is cervical cancer?
 Portugal is the
country with the
greatest incidence
of cervical cancer
among the Western
Europe.
 It is also one of
the countries with
higher
mortality
rate.
I.
Background
II. Research Question and Aims
III. Participants and Methods
IV. Expected Results
V. References
Major and minor aims
Are medical students well informed about
cervical cancer? And how do they behave?
Major aim:
•
To assess medical students’ knowledge on
cervical cancer...
•
Link between cervical cancer and HPV infection
•
Methods of prevention and detection
•
(...)
Major and minor aims
... and their behaviour in regard to this problem.
•
•
•
•
Number of sexual partners
Age of sexual activity initiation
Vaccine
Others
Secondary aims:
• To compare the results between male and female medical
students’.
• To confront differences involving basic and clinical grades.
• To associate the students’ behaviour with the level of
knowledge shown.
I.
Background
II. Research Question and Aims
III. Participants and Methods
IV. Expected Results
V. References
Study design
•
Observational
•
Analytic
•
Cross sectional
•
Unit of analysis: individual
Inclusion & exclusion criteria
Inclusion Criteria:
•
FMUP’s student (available population)
Exclusion criteria:
•
No questionnaire obtained (no response or no
contact with the subject, after two attempts);
•
Classes 16 and 15 of the 1stgrade
Study participants & sampling methods
Target Population:
•
Medical students;
Sampling Methods:
1. Stratification of the sample, according to the
students’ grades
2. Random group sample (to select which classes
we’ll select as a sample)
Study participants & sampling methods
FMUP’s classes
Average number
of students per
class in each
grade
Random selection of
enough classes to
apply the
questionnaire to
about 100 students
per grade
Study participants & sampling methods
Selection of date and
schedule to apply the
questionnaire to each
class
Selection of other
date and schedule
to apply the
questionnaire to
the missing
students
Application of the
questionnaire to the
students of the class
no
All the
students are
present?
yes
End
Data collection methods. Questionnaire.
Main objectives in the design (Leung WC, 2001, StudentBMJ)
•
•
To maximize the response rate
•
Simplicity, shortness and clearness
•
Close-ended questions only
•
Sensitive questions last
To obtain accurate and relevant information for our survey
•
Different types of questions
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Reversed coded questions
•
Good question quality
Data collection methods. Questionnaire.
Characteristics of the questionnaire:
•
Self-administered, 4-paged; to be applied in groups
(classes), during obligatory practical sessions.
•
Two sections:
•
Section A – Knowledge
•
Section B – Personal data and behaviour
•
Each question has a “Comments” area.
•
Will be piloted for clarity in a random 1st grade class.
•
Questions will be coded for an easier analysis.
Data collection methods. Questionnaire.
‘Introduction’
Questionnaire ID
Title and logo
Objective
Anonymity
Confidentiality
Instructions
Data collection methods. Questionnaire.
‘Questions’
Variables description
•
Each question generates one or more variables.
•
Analysed variables:
•
Global knowledge of cervical cancer (using a scale); degree of
preoccupation of being infected; degree of self-evaluated knowledge;
frequency of pap smearing  ordinal variables; outcomes in scales
•
Knowledge of specific subjects – questions 2 to 5 (e.g, of the causal link
between HPV and cervical cancer)  nominal variables; outcomes: yes/no
•
Age of initiation of sexual activity; number of sexual partners in lifetime
and in the last 12 months  quantitative variables; outcomes will be
categorized
•
Having started sexual activity; use of condom; being vaccinated; having
done a pap smear  nominal variables; outcomes = yes/no
•
Independent variables:
age, gender
Planned statistical analysis
•
Analysis of each question according to their
previously determined codes.
•
Treatment of the results will be made in SPSS ©
(Statistical Package for Social Sciences).
•
Descriptive statistics
•
Comparative statistics, according to several
interest groups: gender, grade, having or not
started sexual activity, using or not using
condom, etc.
•
Results in tables and graphs.
I.
Background
II. Research Question and Aims
III. Participants and Methods
IV. Expected Results
V. References
Basic grades vs clinical grades
 Knowledge and behaviour of students from the
clinical grades (4th, 5th & 6th) will be better than those
of students in the basic ones (1st, 2nd & 3rd);

Awareness should increase with the grades.
Males vs females
 Comparing the female subjects with male ones it
should be noticed a slight difference in knowledge
and alertness on this matter.
 However, concerning to genders, the difference
between men and women may be more evident in the
undergraduate years than in the post-graduate ones.
I.
Background
II. Research Question and Aims
III. Participants and Methods
IV. Expected Results
V. References
Baer H, Allen S, Braun L. Knowledge of human papillomavirus infection among young adult men and
women: implications for health education and research. J Community Health. 2000 Feb;25(1):67-78.
Gerhardt CA, Pong K, Kollar LM, Hillard PJ, Rosenthal SL. Adolescents’ Knowledge of Human
Papillomavirus and Cervical Dysplasia. J Pediatr Adolesc Gynecol. 2000 Feb;13(1):15-20.
Holcomb B, Bailey JM, Crawford K, Ruffin MT 4th. Adults' knowledge and behaviors related to human
papillomavirus infection. J Am Board Fam Pract. 2004 Jan-Feb;17(1):26-31.
Kaplan-Myrth N, Dollin J. Cervical cancer awareness and HPV prevention in Canada. Can Fam
Physician. 2007 Apr;53(4):693-6, 697.
Klug SJ, Hukelmann M, Blettner M. Knowledge about infection with human papillomavirus: a
systematic review. Prev Med. 2008 Feb;46(2):87-98. Epub 2007 Sep 14.
Lambert EC. College students' knowledge of human papillomavirus and effectiveness of a brief
educational intervention. J Am Board Fam Pract. 2001 May-Jun;14(3):178-83.
Leung WC. How to design a questionnaire. studentBMJ (2001);09:171-216
Marlow LA, Waller J, Wardle J. Public awareness that HPV is a risk factor for cervical cancer.
Br J Cancer. 2007 Sep 3;97(5):691-4. Epub 2007 Aug 7.
Pitts M, Clarke T. Human papillomavirus infections and risks of cervical cancer: what do
women know? Health Educ Res. 2002 Dec;17(6):706-14.
Tiro JA, Meissner HI, Kobrin S, Chollette V. What do women in the U.S. know about human
papillomavirus and cervical cancer? Cancer Epidemiol Biomarkers Prev. 2007 Feb;16(2):28894.
Yacobi E, Tennant C, Ferrante J, Pal N, Roetzheim R. University students' knowledge and
awareness of HPV. Prev Med. 1999 Jun;28(6):535-41.