Exploring Preventative Measures: The Role of Nurses in the Fight Against Cervical Cancer in Iraq
DOI:
https://doi.org/10.31674/mjn.2025.v17i01.006Abstract
Background: Cervical cancer remains a significant public health concern globally, especially in Low- and Middle-Income Countries (LMICs) such as Iraq, where healthcare challenges and cultural barriers impede prevention efforts. Nurses, as frontline healthcare providers, play a critical role in promoting awareness, education, and prevention of cervical cancer. However, their knowledge, cultural attitudes, and behavioural intentions remain underexamined. Objectives: To assess the knowledge, cultural attitudes, and intentions of nurses toward cervical cancer prevention in Iraq using the Theory of Reasoned Action (TRA) as a guiding framework. Methods: This cross-sectional study involved 105 registered nurses working in maternal hospitals across Mosul, Iraq. Data were collected through a structured questionnaire encompassing demographic information, knowledge of cervical cancer, cultural attitudes, and intentions toward prevention. Descriptive and inferential statistical analyses, including mean, standard deviation (SD) and Pearson’s correlation, were performed using SPSS version 25 to explore interrelationships among the variables. Results: While the majority of nurses demonstrated moderate knowledge of cervical cancer, significant gaps were identified, particularly regarding the role of HPV as a primary cause. Cultural attitudes, including stigma and traditional gender roles, influenced preventive practices. Nurses expressed generally positive intentions toward cervical cancer prevention, driven by workplace expectations and peer influence, though some lacked motivation and confidence. Barriers such as limited access to screening, financial constraints, and insufficient healthcare support were significant challenges. Conclusion: The study highlights critical gaps in nurses’ knowledge and cultural attitudes toward cervical cancer prevention, emphasising the need for targeted educational campaigns, policy reforms, and systemic support to empower nurses. Addressing these gaps can enhance preventive practices and contribute to reducing the cervical cancer burden in Iraq.
Keywords:
Cervical Cancer Prevention, Cultural Attitudes, Healthcare Barriers, HPV Awareness, Nurses’ Knowledge, Theory of Reasoned ActionDownloads
References
Abu-Rustum, N. R., Yashar, C. M., Bean, S., Bradley, K., Campos, S. M., Chon, H. S., ... & Motter, A. D. (2020). NCCN guidelines insights: cervical cancer, version 1.2020: featured updates to the NCCN guidelines. Journal of the National Comprehensive Cancer Network, 18(6), 660-666. https://doi.org/10.6004/jnccn.2023.0062
Adigun, M. O., Esan, D. T., Oyinloye, B. E., Adeyanju, B. T., Olowoyo, K. S., & Olawade, D. B. (2024). Knowledge and practice of health promotive lifestyle toward cervical cancer prevention among women in Africa: A scoping review. Cancer Treatment and Research Communications, 43. https://doi.org/10.1016/j.ctarc.2025.100877
Agha, O. A. M., & Mukhtar, S. H. A. (2025). Holistic Healing: CAM Use, Motivational factors, and impact among women diagnosed with breast cancer. Mosul Journal of Nursing, 13(1), 342-353. https://doi.org/10.33899/mjn.2025.186954
Ahmed, H. A. A., Abbas, M. H., Hussein, H. A., Nasr, R. S. F., Lashen, A. A., Khaled, H., & Azzam, A. (2024). Cervical cancer screening uptake in Arab countries: A systematic review with meta-analysis. BMC Cancer, 24(1). https://doi.org/10.1186/s12885-024-13204-7
Al-Darwish, A. A., Al-Naim, A. F., Al-Mulhim, K. S., & Al-Kuwari, M. G. (2014). Knowledge about cervical cancer early warning signs and vaccination among female students in universities in Eastern Province, Saudi Arabia. Asian Pacific Journal of Cancer Prevention, 15(6), 2529–2532. https://doi.org/10.7314/APJCP.2014.15.6.2529
Alghalyini, B., Zaidi, A. R. Z., Meo, S. A., Faroog, Z., Rashid, M., Alyousef, S. S., ... & Almuhanna, H. A. (2024). Awareness and knowledge of human papillomavirus, vaccine acceptability and cervical cancer among college students in Saudi Arabia. Human Vaccines & Immunotherapeutics, 20(1). https://doi.org/10.1080/21645515.2024.2403844
AL-Hussieny, S. H. A. K., & Al Mukhtar, S. H. (2025). A Theory-Based examination of nurses’ preventive intentions and attitudes toward cervical cancer in Mosul. Mosul Journal of Nursing, 13(1), 366-376. https://doi.org/10.33899/mjn.2025.186956
Alkhyatt, M. K., Abdullah, E. K., Ibraim, R. H., Al Anee, B., & Al Raho, J. (2012). Post-traumatic stress in women with breast cancer. Jordan Medical Journal, 46(4), 315-319. Retrieved from: https://archives.ju.edu.jo/index.php/jmj/article/view/3444. Accessed on 15th December 2024.
Bedell, S. L., Goldstein, L. S., Goldstein, A. R., & Goldstein, A. T. (2020). Cervical cancer screening: past, present, and future. Sexual Medicine Reviews, 8(1), 28-37. https://doi.org/10.1016/j.sxmr.2019.09.005
Berza, N., Zodzika, J., Kivite-Urtane, A., Baltzer, N., Curkste, A., Pole, I., ... & Uuskula, A. (2024). Understanding the high-risk human papillomavirus prevalence and associated factors in the European country with a high incidence of cervical cancer. European Journal of Public Health, 34(4), 826-832. https://doi.org/10.1093/eurpub/ckae075
Buskwofie, A., David-West, G., & Clare, C. A. (2020). A review of cervical cancer: Incidence and disparities. Journal of the National Medical Association, 112(2), 229-232. https://doi.org/10.1016/j.jnma.2020.03.002
Chargari, C., Peignaux, K., Escande, A., Renard, S., Lafond, C., Petit, A., ... & Haie-Méder, C. (2022). Radiotherapy of cervical cancer. Cancer/Radiothérapie, 26(1-2), 298-308. https://doi.org/10.1016/j.canrad.2021.11.009
Damani, M., Mhaske, A., Dighe, S., & Sawarkar, S. P. (2025). Immunotherapy in cervical cancer: An evolutionary paradigm in women's reproductive health. Critical Reviews™ in Therapeutic Drug Carrier Systems, 42(3), 55–88. https://doi.org/10.1615/CritRevTherDrugCarrierSyst.2025044498
Fishbein, M., & Ajzen, I. (1975). Belief, attitude, intention and behavior: An introduction to theory and research. Addison-Wesley. Retrieved from https://people.umass.edu/aizen/f&a1975.html. Accessed on 17th December 2024.
Francoeur, A. A., Monk, B. J., & Tewari, K. S. (2025). Treatment advances across the cervical cancer spectrum. Nature Reviews Clinical Oncology, 22(3), 182–199. https://doi.org/10.1038/s41571-024-00977-w
Gopu, P., Antony, F., Cyriac, S., Karakasis, K., & Oza, A. M. (2021). Updates on systemic therapy for cervical cancer. Indian Journal of Medical Research, 154(2), 293-302. https://doi.org/10.4103/ijmr.IJMR_4454_20
Hamarash, M. Q., Yaas, M. H., Almushhadany, O. I., & Ibrahim, R. H. (2023). Preceptoring of graduate nursing students in Iraq. Advances in Medical Education and Practice, 1025-1034. https://doi.org/10.2147/AMEP.S418824
Harder, M. T., Mokete, M., Chammartin, F., Lerotholi, M., Motaboli, L., Kopo, M., ... & Belus, J. M. (2024). Cervical cancer screening delay and associated factors among women with HIV in Lesotho: A mixed-methods study. BMC Women's Health, 24(1). https://doi.org/10.1186/s12905-024-03382-8
Ibrahim, R. H., Ghanim, A. K., & Alkhaderjameel, H. A. (2020). Impact of electronic games on the behavior of children and their academic achievement upon schools in Mosul city. Indian Journal of Forensic Medicine & Toxicology, 14(1), 374-379. https://doi.org/10.37506/v14/i1/2020/ijfmt/192926
Jecke, L., & Zepf, F. D. (2024). Delivering transgender-specific knowledge and skills into health and allied health studies and training: A systematic review. European Child & Adolescent Psychiatry, 33(5), 1327-1354. https://doi.org/10.1007/s00787-023-02195-8
Khumalo, P. G., Carey, M., Mackenzie, L., & Sanson-Fisher, R. (2024). Cervical cancer screening knowledge and associated factors among Eswatini women: A cross-sectional study. PLoS One, 19(4). https://doi.org/10.1371/journal.pone.0300763
Li, X., Yang, X., Lin, S., Cong, H., Liu, Y., Wang, Y., & Fu, J. (2025). Perineural Invasion in Cervical Cancer. Cancer Letters, 616. https://doi.org/10.1016/j.canlet.2025.217561
Lou, J., & Guo, F. (2024). The characteristics of high-risk HPV-negative cervical cancer: A systematic review and meta-analysis. Frontiers in Oncology, 14. https://doi.org/10.3389/fonc.2024.1452834
Luvián-Morales, J., Gutiérrez-Enríquez, S. O., Granados-García, V., & Torres-Poveda, K. (2024). Risk factors for the development of cervical cancer: Analysis of the evidence. Frontiers in Oncology, 14. https://doi.org/10.3389/fonc.2024.1378549
Mahmood, H. J., Murad, S. H., Abdullah, M. K., & Ibrahim, R. H. (2022). Quality of life in patients with coronary artery disease: A prospective study. Malaysian Journal of Public Health Medicine, 22(3), 259-267. https://doi.org/10.37268/MJPHM/VOL.22/NO.2/ART.1618
Mayadev, J. S., Ke, G., Mahantshetty, U., Pereira, M. D., Tarnawski, R., & Toita, T. (2022). Global challenges of radiotherapy for the treatment of locally advanced cervical cancer. International Journal of Gynecological Cancer, 32(3), 436-445. https://doi.org/10.1136/ijgc-2021-003001
Mutambara, J., Moyo, T., & Madziyire, M. G. (2021). Healthcare workers’ knowledge, attitude and practice towards cervical cancer prevention in Zimbabwe. BMC Women's Health, 21. https://doi.org/10.1186/s12905-021-01493-8
Naaman, R. M., Abdullah, W. S., & Sadeeq, H. A. (2025). Knowledge of the Public towards the symptoms and risk factors of colorectal cancer: A cross-sectional study. Mosul Journal of Nursing, 13(1), 164-182. https://doi.org/10.33899/mjn.2025.154614.1130
Nguyen, T., Nougaret, S., Castillo, P., Paspulati, R., & Bhosale, P. (2023). Cervical cancer in the pregnant population. Abdominal Radiology, 48(5), 1679-1693. https://doi.org/10.1007/s00261-023-03836-x
Obaid, I. M., AL-Ameri, H. D., Shubber, L. A., & Hussien, A. H. (2023). Barriers to early detection of cervical cancer among Iraqi Women in Baghdad. Advance Research Journal of Medical and Clinical Science, 9(04), 1147-1153. https://doi.org/10.52845/rrarjmcs/2023/9-4-2
Ogasawara, A., & Hasegawa, K. (2025). Recent advances in immunotherapy for cervical cancer. International Journal of Clinical Oncology, 30(3), 434-448. https://doi.org/10.1007/s10147-025-02699-0
Revathidevi, S., Murugan, A. K., Nakaoka, H., Inoue, I., & Munirajan, A. K. (2021). APOBEC: A molecular driver in cervical cancer pathogenesis. Cancer letters, 496, 104-116. https://doi.org/10.1016/j.canlet.2020.10.004
Sharma, S., Deep, A., & Sharma, A. K. (2020). Current treatment for cervical cancer: An update. Anti-Cancer Agents in Medicinal Chemistry, 20(15), 1768-1779. https://doi.org/10.2174/1871520620666200224093301
Shrestha, S., Dhakal, P., & Shrestha, S. (2018). Knowledge, attitude and practice regarding cervical cancer screening among nurses in a tertiary care hospital in Nepal. International Journal of Community Medicine and Public Health, 5(7), 2482–2487. https://doi.org/10.18203/2394-6040.ijcmph20182606
Smith, D. K., Slack, J., Shaw, R. W., & Marteau, T. M. (1994). Lack of knowledge in health professionals: a barrier to providing information to patients? BMJ Quality & Safety, 3(2), 75-78. https://doi.org/10.1136/qshc.3.2.75
Taher, M. I. M., & Ibrahim, R. H. (2023). Knowledge, attitudes, and practice of university's employees about complementary and alternative medicine (CAM). Informatics in Medicine Unlocked, 37. https://doi.org/10.1016/j.imu.2023.101184
Voelker, R. A. (2023). Cervical Cancer Screening. JAMA, 330(20). https://doi.org/10.1001/jama.2023.21987
World Health Organisation (WHO). (2024, March 4). Cervical Cancer. Retrieved from https://www.who.int/news-room/fact-sheets/detail/cervical-cancer?utm_source=chatgpt.com. Accessed on 18th December 2024.
Xu, M., Cao, C., Wu, P., Huang, X., & Ma, D. (2025). Advances in cervical cancer: current insights and future directions. Cancer Communications, 45(2), 77-109. https://doi.org/10.1002/cac2.12629
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 The Malaysian Journal of Nursing (MJN)

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.