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Original Research

Effects of a Peer Cervical Cancer Prevention Education Program on Korean Female College Students' Knowledge, Attitude, Self-efficacy, and Intention

Korean Journal of Adult Nursing 2013;25(6):736-746.
Published online: December 18, 2013

1Chosun Nursing College, Gwangju

2Department of Nursing, Chosun University, Gwangju, Korea

Corresponding author: Kim, Jin Sun Department of Nursing, Chosun University, 375 Seosuk-dong, Dong-gu, Gwangju 501-759, Korea. Tel: +82-62-230-6327, Fax: +82-62-230-6329, E-mail: jinsun@chosun.ac.kr
• Received: July 3, 2013   • Accepted: December 19, 2013

© 2013 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to evaluate the effectiveness of a peer cervical cancer prevention education program on Korean female college students’ knowledge, attitude, self-efficacy, and intention.
  • Methods
    A quasi-experimental pretest-posttest design with a non-equivalent control group was used. The participants were 58 female college students in a metropolitan city in Korea. The sample consisted of an intervention group (n=28) that participated in a peer education program and a control group (n=30). Data were measured using self-administered questionnaires at two time points: prior to the intervention and after the intervention.
  • Results
    Compared to the control group, the experimental group reported significantly positive changes for knowledge, attitude, self-efficacy, and intent to practice cervical cancer prevention behaviors.
  • Conclusion
    The findings of this study indicated that a peer education program developed for Korean female college students was a useful and effective intervention strategy to promote cervical cancer prevention behaviors in Korean sociocultural contexts.
Table 1.
Peer Education Program to Promote Cervical Cancer Preventive Behaviors
Session Topic Contents Activity/method
1 Introduction ․ Explain educational objectives ․ Pretest
․ Build rapport between the peer educators and participants ․ Ice-breaking
Growth and development ․ Raise issues of cervical cancer ․ Activity 1: 6 Questions
․ Changes of body and mind ․ Activity 2: Sexual slang
․ Protect our bodies: gynecological examinations ․ Activity 3: We are changing/discussion, group contest
Sexual rights and responsibilities ․ Sexual morals and values ․ Activity 4: Pros and cons
․ Respect different values in others
Condom use ․ How to use condoms ․ Activity 5: Condom bomb
․ The effects of alcohol on our bodies ․ Activity 6: Condom wrapping
․ Negotiation strategies for condom use at refusal ․ Activity 7: Role-playing/PPT, Q&A, discussion
․ Importance of standing by sexual decisions
Sexual culture ․ Keep yourself safe in sexual culture ․ Activity 8: Stop motion-play
HPV infection ․ HPV/STD ․ Activity 9: STD mission
․ HPV infection ․ PPT
Finish ․ Summary & evaluation ․ Quiz, Q & A
2 Introduction ․ Review ․ Ice-breaking, Q & A
․ Build rapport
Cervical cancer ․ Cervical cancer facts ․ Activity 10: Speed quiz
․ STD examination and treatment ․ Activity 11: Telling examples activity/PPT, video, discussion
․ Preventive behaviors for cervical cancer: condom use, pap tests, HPV vaccine
Safe/unsafe sexual behaviors ․ Strategies to decrease unsafe sexual behaviors ․ Activity 12: HPV/Infection of STD
Role of peers ․ Importance of preventive behaviors of cervical cancer ․ Activity 13: Keeping on story
․ Help and support each other to practice cervical cancer preventive behaviors ․ Activity 14: Our role
Finish ․ Summary & evaluation ․ Q & A
․ Post-test
Table 2.
Homogeneity Test for Characteristics between Groups (N=58)
Characteristics Categories Exp. (n=28) Cont. (n=30) x2 or t p
n (%) or M±SD n (%) or M±SD
Age (year)   19.3±0.66 19.3±0.66 -0.28 .785
Economic status <Middle school 3 (10.7) 10 (33.3) 4.80 .091
Middle school 22 (78.6) 16 (53.3)
≥Middle school 3 (10.7) 4 (13.3)
Smoking Yes 2 (7.1) 3 (10.0)   .999
No 26 (92.9) 27 (90.0)
Alcohol Yes 26 (92.9) 27 (90.0)   .999
No 2 (7.1) 3 (10.0)
Sexual experience Yes 3 (3.6) 4 (13.3)   .999
No 25 (96.4) 26 (86.7)
Suggested HPV vaccination? Yes 17 (60.7) 14 (46.7) 1.15 .284
No 11 (39.3) 16 (53.3)
Educational need Yes 27 (96.4) 27 (90.0)   .612
No 1 (3.6) 3 (10.0)

Exp.=experimental group; Cont.=control group.

Fisher's exact probability test.

Table 3.
Homogeneity Test for Outcome Variables between Groups at Baseline (N=58)
Variables Exp. (n=28) Cont. (n=30) t p
M±SD M±SD
Knowledge 12.25±5.18 12.30±5.73 -0.04 .972
Attitude 55.07±7.38 53.76±7.16 0.68 .497
Self-efficacy 26.46±4.20 26.80±4.78 -0.28 .778
Intent to practice prevention behaviors 218.92±44.83 216.00±46.65 0.24 .809

Exp.=experimental group; Cont.=control group.

Table 4.
Effects of a Peer Education Program (N=58)
Variables Groups Pretest Posttest MD of post-pre t p
M±SD M±SD M±SD
Knowledge Exp. 12.25±5.18 19.79±14.33 7.54±4.89 4.32 <.001
Cont. 12.30±5.74 14.33±4.21 2.03±4.81
Attitude Exp. 55.07±7.38 62.71±5.37 7.64±7.29 4.01 <.001
Cont. 53.76±7.16 52.57±7.38 -1.20±9.42
Susceptibility Exp. 2.80±0.90 3.99±0.81 1.19±0.80 5.26 <.001
Cont. 2.60±0.75 2.73±0.85 0.13±0.72
Severity Exp. 3.86±0.65 4.59±0.50 0.73±0.64 3.11 .003
Cont. 3.64±0.72 3.63±0.76 -0.01±1.10
Benefit Exp. 3.20±0.66 4.64±0.59 1.44±0.85 7.68 <.011
Cont. 3.32±0.72 3.18±0.47 -0.14±0.72
Barrier Exp. 3.42±0.76 2.82±0.71 -0.60±0.96 -2.27 .027
Cont. 3.52±0.81 3.43±0.67 -0.09±0.74
Cues to action Exp. 3.65±0.83 3.95±0.70 0.30±0.98 1.72 .090
Cont. 3.40±0.74 3.24±0.74 -0.16±1.12
Self-efficacy Exp. 26.46±4.20 34.65±4.12 8.19±4.21 7.24 <.001
Cont. 26.80±4.78 25.70±4.65 -1.10±5.42
Intention Exp. 218.93±44.80 277.32±20.48 58.39±40.34 7.06 <.001
Cont. 216.00±46.65 210.33±51.09 -5.66±27.00
Condom use Exp. 93.21±12.78 99.29±3.78 6.07±11.97 3.67 .001
Cont. 92.00±12.14 88.67±13.32 -3.33±7.11
Pap test Exp. 59.28±20.17 85.72±12.60 26.43±16.82 5.89 <.001
Cont. 62.33±20.28 60.67±24.77 -1.67±19.31
HPV vaccine Exp. 66.42±23.12 92.32±11.18 25.90±22.90 5.60 <.001
Cont. 61.66±24.64 61.00±25.78 -0.66±12.01

Exp.=experimental group; Cont.=control group; MD of post-pre=mean difference of posttest-pretest.

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      Effects of a Peer Cervical Cancer Prevention Education Program on Korean Female College Students' Knowledge, Attitude, Self-efficacy, and Intention
      Korean J Adult Nurs. 2013;25(6):736-746.   Published online December 31, 2013
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      Effects of a Peer Cervical Cancer Prevention Education Program on Korean Female College Students' Knowledge, Attitude, Self-efficacy, and Intention
      Effects of a Peer Cervical Cancer Prevention Education Program on Korean Female College Students' Knowledge, Attitude, Self-efficacy, and Intention

      Peer Education Program to Promote Cervical Cancer Preventive Behaviors

      Session Topic Contents Activity/method
      1 Introduction ․ Explain educational objectives ․ Pretest
      ․ Build rapport between the peer educators and participants ․ Ice-breaking
      Growth and development ․ Raise issues of cervical cancer ․ Activity 1: 6 Questions
      ․ Changes of body and mind ․ Activity 2: Sexual slang
      ․ Protect our bodies: gynecological examinations ․ Activity 3: We are changing/discussion, group contest
      Sexual rights and responsibilities ․ Sexual morals and values ․ Activity 4: Pros and cons
      ․ Respect different values in others
      Condom use ․ How to use condoms ․ Activity 5: Condom bomb
      ․ The effects of alcohol on our bodies ․ Activity 6: Condom wrapping
      ․ Negotiation strategies for condom use at refusal ․ Activity 7: Role-playing/PPT, Q&A, discussion
      ․ Importance of standing by sexual decisions
      Sexual culture ․ Keep yourself safe in sexual culture ․ Activity 8: Stop motion-play
      HPV infection ․ HPV/STD ․ Activity 9: STD mission
      ․ HPV infection ․ PPT
      Finish ․ Summary & evaluation ․ Quiz, Q & A
      2 Introduction ․ Review ․ Ice-breaking, Q & A
      ․ Build rapport
      Cervical cancer ․ Cervical cancer facts ․ Activity 10: Speed quiz
      ․ STD examination and treatment ․ Activity 11: Telling examples activity/PPT, video, discussion
      ․ Preventive behaviors for cervical cancer: condom use, pap tests, HPV vaccine
      Safe/unsafe sexual behaviors ․ Strategies to decrease unsafe sexual behaviors ․ Activity 12: HPV/Infection of STD
      Role of peers ․ Importance of preventive behaviors of cervical cancer ․ Activity 13: Keeping on story
      ․ Help and support each other to practice cervical cancer preventive behaviors ․ Activity 14: Our role
      Finish ․ Summary & evaluation ․ Q & A
      ․ Post-test

      Homogeneity Test for Characteristics between Groups (N=58)

      Characteristics Categories Exp. (n=28) Cont. (n=30) x2 or t p
      n (%) or M±SD n (%) or M±SD
      Age (year)   19.3±0.66 19.3±0.66 -0.28 .785
      Economic status <Middle school 3 (10.7) 10 (33.3) 4.80 .091
      Middle school 22 (78.6) 16 (53.3)
      ≥Middle school 3 (10.7) 4 (13.3)
      Smoking Yes 2 (7.1) 3 (10.0)   .999
      No 26 (92.9) 27 (90.0)
      Alcohol Yes 26 (92.9) 27 (90.0)   .999
      No 2 (7.1) 3 (10.0)
      Sexual experience Yes 3 (3.6) 4 (13.3)   .999
      No 25 (96.4) 26 (86.7)
      Suggested HPV vaccination? Yes 17 (60.7) 14 (46.7) 1.15 .284
      No 11 (39.3) 16 (53.3)
      Educational need Yes 27 (96.4) 27 (90.0)   .612
      No 1 (3.6) 3 (10.0)

      Exp.=experimental group; Cont.=control group.

      Fisher's exact probability test.

      Homogeneity Test for Outcome Variables between Groups at Baseline (N=58)

      Variables Exp. (n=28) Cont. (n=30) t p
      M±SD M±SD
      Knowledge 12.25±5.18 12.30±5.73 -0.04 .972
      Attitude 55.07±7.38 53.76±7.16 0.68 .497
      Self-efficacy 26.46±4.20 26.80±4.78 -0.28 .778
      Intent to practice prevention behaviors 218.92±44.83 216.00±46.65 0.24 .809

      Exp.=experimental group; Cont.=control group.

      Effects of a Peer Education Program (N=58)

      Variables Groups Pretest Posttest MD of post-pre t p
      M±SD M±SD M±SD
      Knowledge Exp. 12.25±5.18 19.79±14.33 7.54±4.89 4.32 <.001
      Cont. 12.30±5.74 14.33±4.21 2.03±4.81
      Attitude Exp. 55.07±7.38 62.71±5.37 7.64±7.29 4.01 <.001
      Cont. 53.76±7.16 52.57±7.38 -1.20±9.42
      Susceptibility Exp. 2.80±0.90 3.99±0.81 1.19±0.80 5.26 <.001
      Cont. 2.60±0.75 2.73±0.85 0.13±0.72
      Severity Exp. 3.86±0.65 4.59±0.50 0.73±0.64 3.11 .003
      Cont. 3.64±0.72 3.63±0.76 -0.01±1.10
      Benefit Exp. 3.20±0.66 4.64±0.59 1.44±0.85 7.68 <.011
      Cont. 3.32±0.72 3.18±0.47 -0.14±0.72
      Barrier Exp. 3.42±0.76 2.82±0.71 -0.60±0.96 -2.27 .027
      Cont. 3.52±0.81 3.43±0.67 -0.09±0.74
      Cues to action Exp. 3.65±0.83 3.95±0.70 0.30±0.98 1.72 .090
      Cont. 3.40±0.74 3.24±0.74 -0.16±1.12
      Self-efficacy Exp. 26.46±4.20 34.65±4.12 8.19±4.21 7.24 <.001
      Cont. 26.80±4.78 25.70±4.65 -1.10±5.42
      Intention Exp. 218.93±44.80 277.32±20.48 58.39±40.34 7.06 <.001
      Cont. 216.00±46.65 210.33±51.09 -5.66±27.00
      Condom use Exp. 93.21±12.78 99.29±3.78 6.07±11.97 3.67 .001
      Cont. 92.00±12.14 88.67±13.32 -3.33±7.11
      Pap test Exp. 59.28±20.17 85.72±12.60 26.43±16.82 5.89 <.001
      Cont. 62.33±20.28 60.67±24.77 -1.67±19.31
      HPV vaccine Exp. 66.42±23.12 92.32±11.18 25.90±22.90 5.60 <.001
      Cont. 61.66±24.64 61.00±25.78 -0.66±12.01

      Exp.=experimental group; Cont.=control group; MD of post-pre=mean difference of posttest-pretest.

      Table 1. Peer Education Program to Promote Cervical Cancer Preventive Behaviors

      Table 2. Homogeneity Test for Characteristics between Groups (N=58)

      Exp.=experimental group; Cont.=control group.

      Fisher's exact probability test.

      Table 3. Homogeneity Test for Outcome Variables between Groups at Baseline (N=58)

      Exp.=experimental group; Cont.=control group.

      Table 4. Effects of a Peer Education Program (N=58)

      Exp.=experimental group; Cont.=control group; MD of post-pre=mean difference of posttest-pretest.

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