Cervical cancer is a major public health concern and remains one of the most common cancers affecting women worldwide. It develops in the cells of the cervix, the lower part of the uterus that connects to the vagina. Persistent infection with high-risk types of Human Papillomavirus (HPV), particularly HPV types 16 and 18, has been identified as the primary etiological factor for cervical cancer. The disease progresses slowly through precancerous lesions, providing an opportunity for early detection and prevention through appropriate screening and vaccination strategies. Globally, cervical cancer is the fourth most common cancer among women and the fourth leading cause of cancer-related deaths. According to the World Health Organization (WHO), approximately 660,000 new cases and 350,000 deaths from cervical cancer occurred worldwide in 2022. More than 85% of these deaths occur in low- and middle-income countries where organized screening programs and vaccination coverage are inadequate. Despite being largely preventable, cervical cancer continues to pose a significant burden due to lack of awareness, delayed diagnosis, and limited access to preventive healthcare services. India contributes substantially to the global burden of cervical cancer. According to the Global Cancer Observatory (GLOBOCAN 2022), cervical cancer is the second most common cancer among Indian women and remains one of the leading causes of cancer-related mortality. India accounts for nearly one-fifth of the global cervical cancer burden, with thousands of new cases and deaths reported annually. The disease disproportionately affects women from rural areas, lower socioeconomic groups, and those with limited access to healthcare facilities. Several social, cultural, and economic factors contribute to the high incidence and mortality rates associated with cervical cancer in India. The development of cervical cancer is associated with several risk factors, including early age at marriage, early onset of sexual activity, multiple sexual partners, multiparity, poor genital hygiene, long-term use of oral contraceptives, smoking, immunosuppression, and persistent HPV infection. In India, many of these risk factors are prevalent due to socioeconomic inequalities and limited reproductive health awareness. Furthermore, lack of knowledge regarding cervical cancer symptoms often results in delayed healthcare seeking behavior, leading to diagnosis at advanced stages when treatment outcomes are less favorable. Cervical cancer is unique among cancers because it can be effectively prevented through regular screening and HPV vaccination. Screening methods such as the Papanicolaou (Pap) smear test, Visual Inspection with Acetic Acid (VIA), and HPV DNA testing help detect precancerous lesions before they progress to invasive cancer. Early detection through screening significantly reduces both incidence and mortality. Recognizing the importance of early detection, the Government of India has incorporated cervical cancer screening into the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD). However, screening coverage remains low, particularly in rural and underserved populations. Human Papillomavirus vaccination represents a major advancement in cervical cancer prevention. The vaccine protects against high-risk HPV strains responsible for the majority of cervical cancer cases. The WHO recommends vaccination of adolescent girls before exposure to HPV infection. In India, the introduction of indigenous HPV vaccines and the inclusion of HPV vaccination in public health initiatives have created opportunities for reducing cervical cancer burden. Nevertheless, vaccine uptake remains suboptimal due to inadequate awareness, misconceptions regarding vaccine safety and efficacy, cultural beliefs, financial constraints, and lack of healthcare provider recommendations. Awareness plays a critical role in the successful implementation of cervical cancer prevention strategies. Women who possess adequate knowledge regarding cervical cancer risk factors, symptoms, screening procedures, and HPV vaccination are more likely to participate in preventive practices. Unfortunately, studies conducted across different regions of India consistently demonstrate inadequate awareness among women. A study conducted by Bansal et al. (2015) among women in North India reported that although many participants had heard about cervical cancer, detailed knowledge regarding screening and preventive measures was poor. Similarly, Aswathy et al. (2012) found that awareness regarding Pap smear testing among women in Kerala was limited despite relatively high literacy rates. The study highlighted the need for strengthening health education programs to improve screening uptake. Research conducted by Singh et al. (2018) revealed that awareness regarding cervical cancer and HPV infection among Indian women was unsatisfactory, particularly among women from rural backgrounds. The authors reported that educational status, socioeconomic conditions, and healthcare accessibility significantly influenced awareness levels. Likewise, Pandey et al. (2019) observed poor knowledge and low acceptance of HPV vaccination among women and adolescent girls, emphasizing the need for targeted educational interventions. Another community-based study by Nene et al. (2007) demonstrated that participation in cervical cancer screening programs was strongly influenced by awareness, educational level, family support, and recommendations from healthcare providers. Women with better knowledge were more likely to undergo screening and adopt preventive health behaviors. Similar findings have been reported by Bhatla and Singhal (2020), who emphasized that increasing public awareness is essential for achieving the WHO strategy for cervical cancer elimination. Attitude towards cervical cancer screening and HPV vaccination is another important determinant of preventive behavior. Even when awareness is limited, positive attitudes can facilitate acceptance of health interventions if appropriate information and services are made available. Studies conducted in various parts of India indicate that many women are willing to undergo screening and vaccination once they understand the benefits of prevention. However, fear, embarrassment, social stigma, misconceptions, and concerns regarding cost continue to act as barriers. India has committed to the WHO Global Strategy for the Elimination of Cervical Cancer, which aims to achieve 90% HPV vaccination coverage, 70% screening coverage, and 90% treatment coverage by 2030. Achieving these targets requires a comprehensive understanding of current levels of awareness and attitudes among women. Identifying knowledge gaps and barriers to screening and vaccination is essential for developing effective public health interventions, educational campaigns, and healthcare policies. Therefore, the present study was undertaken to assess public awareness and attitudes towards cervical cancer screening and HPV vaccination among women. The findings of this study may contribute to the development of targeted health education programs and strategies aimed at improving the uptake of cervical cancer preventive services and reducing the burden of cervical cancer in India. Aim of the Study To assess public awareness and attitude towards cervical cancer screening and HPV vaccination among women.

Study Design A community-based cross-sectional descriptive study was conducted to assess the level of awareness and attitudes towards cervical cancer screening and Human Papillomavirus (HPV) vaccination among women. The study employed a quantitative research approach to obtain information regarding participants' knowledge, awareness, and perceptions related to cervical cancer prevention. Study Setting The study was conducted in selected urban and rural communities of Jabalpur District, India. The selected communities were chosen based on accessibility, population density, and willingness of local authorities to facilitate data collection Study Population The study population comprised women aged 18–49 years residing in the selected communities during the study period. This age group was selected because women in this reproductive age range are considered an important target population for cervical cancer awareness, screening, and HPV vaccination programs. Sample Size The sample size for the study was 300 women. The sample size was determined based on previous studies assessing awareness regarding cervical cancer and HPV vaccination among women, considering a confidence level of 95%, margin of error of 5%, and expected prevalence of awareness. To account for non-response, additional participants were included. Sampling Technique A non-probability convenience sampling technique was used for selecting study participants. Eligible women available during the period of data collection and willing to participate in the study were approached and recruited until the required sample size was achieved. Inclusion Criteria Women who: 1. Were between 18 and 49 years of age. 2. Were permanent residents of the selected community. 3. Were willing to participate in the study. 4. Could understand and communicate in Hindi or English. 5. Provided written informed consent. Exclusion Criteria Women who: 1. Had been diagnosed with cervical cancer. 2. Were healthcare professionals or medical students. 3. Were seriously ill during the period of data collection. 4. Were unavailable after two consecutive visits. Data Collection Tool A structured questionnaire consisting of: Socio-demographic variables: Age, Education, Occupation, Marital status, Residence Awareness regarding: Cervical cancer, Risk factors, Symptoms, Screening methods, HPV vaccination Attitude assessment: Willingness to undergo screening, Acceptance of HPV vaccination, Perceived benefits of prevention Ethical Considerations Ethical approval was obtained from the Institutional Ethics Committee of Sukh Sagar Medical College & Hospital, Jabalpur, Madhya Pradesh. The following ethical principles were maintained: • Voluntary participation • Written informed consent • Confidentiality of participant information • Right to withdraw at any stage • Privacy during interviews • Use of collected information solely for research purposes Statistical Analysis Data were entered into Microsoft Excel and analyzed using SPSS version 25. Descriptive statistics such as frequency, percentage, mean, and standard deviation were used. Chi-square test was applied to assess associations. Statistical significance was considered at p<0.05.

Table 1: Distribution of Participants According to Age (N=300) Age Group (Years) Frequency (n) Percentage (%) 18–25 82 27.3 26–35 106 35.3 36–45 74 24.7 46–49 38 12.7 Total 300 100 Table 1 shows the distribution of study participants according to their age. Out of the total 300 women included in the study, the highest proportion of participants belonged to the age group of 26–35 years, accounting for 106 (35.3%) women. This was followed by the age group of 18–25 years, which comprised 82 (27.3%) participants. A total of 74 (24.7%) women were in the age group of 36–45 years, while the lowest proportion of participants, 38 (12.7%), belonged to the age group of 46–49 years. The findings indicate that the majority of respondents (62.6%) were within the younger and middle reproductive age groups of 18–35 years. This age distribution is particularly important because women in this age range are more likely to benefit from cervical cancer awareness programs, screening services, and HPV vaccination initiatives. Furthermore, this age group represents a key target population for preventive health education as they are at an appropriate stage for adopting cervical cancer prevention practices. Table 2: Educational Status of Participants Educational Status Frequency (n) Percentage (%) Primary Education 48 16 Secondary Education 86 28.7 Higher Secondary Education 78 26 Graduate and Above 88 29.3 Total 300 100 Table 2 presents the distribution of participants according to their educational status. Among the 300 women included in the study, the highest proportion of participants, 88 (29.3%), had attained graduation and above level education. This was followed by 86 (28.7%) women who had completed secondary education. A total of 78 (26.0%) participants had completed higher secondary education, while 48 (16.0%) women had only primary education. Thus, more than half of the study participants (55.3%) had completed higher secondary education or graduation and above, indicating a relatively good educational background among the respondents. Table 3: Awareness Regarding Cervical Cancer Awareness Variable Yes n (%) No n (%) Heard of cervical cancer 186 (62) 114 (38) Aware of risk factors 122 (40.7) 178 (59.3) Aware of symptoms 118 (39.3) 182 (60.7) Table 3 shows the awareness of participants regarding cervical cancer. Among the 300 respondents, 186 (62.0%) had heard about cervical cancer. However, awareness regarding risk factors and signs and symptoms was considerably lower, with only 122 (40.7%) and 118 (39.3%) participants reporting awareness, respectively. The findings indicate that although general awareness of cervical cancer was moderate, detailed knowledge regarding its risk factors and symptoms remained insufficient among the study population. Table 4: Awareness Regarding Cervical Cancer Screening Screening Awareness Frequency Percentage Aware 114 38 Not Aware 186 62 Total 300 100 Table 4 depicts the awareness of participants regarding cervical cancer screening. Out of 300 respondents, only 114 (38.0%) women were aware of cervical cancer screening methods, whereas 186 (62.0%) participants reported no awareness. The findings indicate inadequate knowledge regarding cervical cancer screening among the majority of women, highlighting the need for enhanced health education and awareness programs to promote early detection and prevention of cervical cancer. Table 5: Awareness Regarding HPV Vaccination HPV Vaccination Awareness Frequency Percentage Aware 102 34 Not Aware 198 66 Total 300 100 Table 5 shows the awareness of participants regarding HPV vaccination. Among the 300 women surveyed, only 102 (34.0%) participants were aware of the HPV vaccine, while 198 (66.0%) reported no awareness. The findings reveal a low level of knowledge regarding HPV vaccination among the study population, highlighting the need for comprehensive health education and awareness initiatives to promote vaccine acceptance and cervical cancer prevention. Table 6: Attitude Towards Screening and Vaccination Attitude Level Frequency Percentage Positive 213 71 Negative 87 29 Total 300 100 Table 6 depicts the attitude of participants towards cervical cancer screening and HPV vaccination. Among the 300 women surveyed, 213 (71.0%) demonstrated a positive attitude, whereas 87 (29.0%) exhibited a negative attitude. The findings indicate that despite limited awareness regarding cervical cancer prevention, the majority of participants were favorably disposed towards screening and vaccination, suggesting potential acceptance of preventive services if adequate information and access are provided. Table 7: Association Between Education and Awareness Educational Status Good Awareness n (%) Poor Awareness n (%) Total Primary Education 10 (20.8) 38 (79.2) 48 Secondary Education 28 (32.6) 58 (67.4) 86 Higher Secondary Education 40 (51.3) 38 (48.7) 78 Graduate and Above 68 (77.3) 20 (22.7) 88 Total 146 (48.7) 154 (51.3) 300 χ² = 24.68, p < 0.05 (Significant) Table 7 shows the association between educational status and awareness regarding cervical cancer screening and HPV vaccination. The proportion of women with good awareness increased with higher educational attainment, ranging from 20.8% among women with primary education to 77.3% among graduates and above. The Chi-square test revealed a statistically significant association between educational status and awareness (χ² = 24.68, df = 3, p < 0.05). These findings suggest that education is an important determinant of awareness regarding cervical cancer prevention.

The present study assessed awareness and attitudes toward cervical cancer screening and HPV vaccination among women. In the present study, 62% of women had heard about cervical cancer, while awareness regarding risk factors (40.7%) and symptoms (39.3%) was comparatively low. These findings indicate that although general awareness exists, detailed knowledge regarding cervical cancer remains inadequate. Similar findings were reported by Bansal et al. (2015), who observed that while a majority of women had heard about cervical cancer, only a small proportion had correct knowledge about its risk factors and prevention strategies. Likewise, Aswathy et al. (2012) in Kerala reported poor awareness regarding cervical cancer screening despite relatively high literacy levels, emphasizing that education alone does not guarantee adequate health knowledge. The low level of awareness regarding risk factors and symptoms in the present study is concerning because lack of knowledge may delay early health-seeking behavior. According to the National Cancer Registry Programme (ICMR, 2023), a large proportion of cervical cancer cases in India are diagnosed at advanced stages, largely due to poor awareness and delayed screening. The present study revealed that only 38% of participants were aware of cervical cancer screening methods such as Pap smear, VIA, or HPV testing. This finding indicates poor utilization potential of preventive services. Comparable results were observed by Singh et al. (2018), who reported low awareness and poor uptake of cervical cancer screening among Indian women, particularly in rural populations. Similarly, a study by Nene et al. (2007) found that participation in screening programs was significantly associated with awareness and health education exposure. The Government of India has integrated cervical cancer screening under the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), yet coverage remains low. According to Ministry of Health and Family Welfare (MoHFW, 2023), screening coverage among eligible women in India is still far below desired levels, mainly due to lack of awareness, limited access, and sociocultural barriers. In the present study, only 34% of women were aware of HPV vaccination. This finding reflects poor awareness of one of the most effective preventive measures against cervical cancer. Similar findings were reported by Pandey et al. (2019), who found low awareness and limited acceptance of HPV vaccination among women and adolescent girls in India. Bhatla and Singhal (2020) also highlighted that despite availability of HPV vaccines, uptake remains low due to inadequate awareness and misconceptions regarding safety and efficacy. The low awareness observed in the present study may be attributed to lack of structured vaccination programs, limited school-based vaccination initiatives, and insufficient counseling by healthcare providers. WHO (2024) emphasizes that HPV vaccination before sexual debut is crucial for effective prevention of cervical cancer, yet awareness and acceptance remain major challenges in low- and middle-income countries like India. Despite low awareness levels, the present study found that 71% of participants had a positive attitude towards cervical cancer screening and HPV vaccination. This indicates willingness among women to adopt preventive measures if appropriate information and services are provided. This finding is consistent with Singh et al. (2018), who reported that although awareness was low, many women expressed positive attitudes towards screening once informed. Similarly, studies conducted in various Indian states have shown that women are receptive to cervical cancer screening when barriers such as fear, stigma, and lack of information are addressed. Positive attitude is a crucial determinant of health behavior. According to the Health Belief Model, perceived benefits and perceived seriousness significantly influence preventive health actions. The present study suggests that Indian women may be receptive to cervical cancer prevention programs if effective awareness strategies are implemented. A significant association was found between educational status and awareness regarding cervical cancer screening and HPV vaccination (χ² = 24.68, p < 0.05). Women with higher education demonstrated better awareness compared to those with lower educational levels. This finding is supported by Bansal et al. (2015), who reported that education significantly influences awareness and screening behavior among women. Similarly, Nene et al. (2007) found that educated women were more likely to participate in cervical cancer screening programs. Education enhances access to information, improves understanding of health messages, and promotes positive health-seeking behavior. Therefore, improving female education and integrating cervical cancer awareness into school and college health programs may significantly improve preventive practices. The findings of the present study highlight important implications for public health practice in India. Despite national efforts, awareness regarding cervical cancer screening and HPV vaccination remains low. However, the presence of a positive attitude among women suggests strong potential for behavioral change if appropriate interventions are implemented. India bears a significant burden of cervical cancer, contributing nearly one-fifth of global cases (IARC, 2022). Therefore, strengthening awareness through mass media campaigns, community outreach, school-based education, and involvement of frontline health workers such as ASHAs and ANMs is essential. Integration of cervical cancer education into existing reproductive and maternal health programs under NHM (National Health Mission) can also improve awareness and uptake. Additionally, government initiatives for HPV vaccination rollout should focus on reducing misconceptions and increasing public trust.

The study concludes that awareness regarding cervical cancer screening and HPV vaccination among women remains inadequate despite a generally positive attitude toward preventive measures. Educational status significantly influences awareness levels. Strengthening health education, community outreach programs, and integration of cervical cancer prevention services into primary healthcare can improve knowledge and promote uptake of screening and HPV vaccination. Early detection and prevention strategies are essential for reducing the burden of cervical cancer in India.

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