Rural Zulu women's knowledge of and attitudes towards Pap smears and adherence to cervical screening.

Background: Cervical cancer is the most common form of cancer in black women in South Africa and has almost a 60% mortality rate. However, adherence to cervical screening programmes of black women living in rural South Africa is not universal.

Aim: The aim of this study was to gain a better understanding of rural Zulu women's knowledge of and attitudes towards Pap smear tests, and their reasons for participation or non-compliance with cervical screening.

Setting: This study was conducted at the gynaecology and antenatal clinics in a secondary referral hospital in rural KwaZulu-Natal.

Methods: A hospital-based cross-sectional study was undertaken in the form of a semi-structured patient questionnaire survey with open and closed questions. The responses to the open-ended questions were manually analysed by the authors using a thematic approach. Outcome measures included whether the woman had a previous Pap smear, her understanding of the cervical screening programme and causes of cervical cancer.

Results: This study included a total analysis of 234 responses. The mean age was 29 years (s.d. = 8.3 years). Overall, 32.5% of women had previously had a Pap smear. Among the responders, 33.3% were human immunodeficiency virus (HIV)-positive and 53.0% were HIV-negative. Only 19.2% of women understood that a Pap smear was related to screening for cervical cancer.

Conclusions: This study illustrated a poor understanding of cervical screening, which may result in the low level of uptake of Pap smear reported; this is particularly concerning in HIV-positive women, who are at higher risk of developing cervical cancer. Urgent and extensive public health campaigning is required within rural South Africa to improve cervical screening uptake and decrease cervical cancer mortality.