Factors associated with cervical cancer stigma among women living in urban Nepal

Cervical cancer stigma can affect perceptions of cancer, interactions with affected people, and engagement in preventive behavior. Evidence on factors associated with cervical cancer stigma among women in urban Nepal is limited. This study examined sociodemographic, reproductive and knowledge-related factors associated with cervical cancer stigma. We analysed baseline data from 310 women aged 30 to 60 years enrolled in a community-based, two-arm cluster-randomized controlled trial in Budanilkantha Municipality, Kathmandu, Nepal, between 15 June and 15 December 2022. Cervical cancer stigma was assessed using the validated Nepali version of the Cancer Stigma Scale. Multivariable generalized estimating equations (GEE) with a Gaussian distribution and identity link were used to examine associations, adjusting for age, ethnicity, religion, education, occupation, and annual household income. Results are reported as beta coefficients (β) and 95% confidence intervals (CIs). The mean age was 41.5 years, and 54.2% of participants were Janjati. Overall, 82.3% had heard of cervical cancer, 31.8% knew its signs and symptoms, and 1.6% had heard of Human Papilloma Virus. Most knew cervical cancer could be prevented (75.6%) and treated (90.1%). After adjustment, Janjati women (β = 0.311, 95% CI: 0.099, 0.523) and women from other ethnic groups, including Dalit and Madhesi (β = 0.411, 95% CI: 0.054, 0.768), had higher cervical cancer stigma scores than Brahmin/Chettri women. Formal education was associated with lower cervical cancer stigma scores (β = -0.359, 95% CI: -0.554, -0.165). Homemakers (β = 0.263, 95% CI: 0.014, 0.513) and self-employed women (β = 0.309, 95% CI: 0.054, 0.564) had higher cervical cancer stigma scores than salaried women. Awareness of cervical cancer (β = -0.249, 95% CI: -0.437, -0.060), its signs and symptoms (β = -0.245, 95% CI: -0.465, -0.025), preventability (β = -0.285, 95% CI: -0.554, -0.016) and treatability (β = -0.362, 95% CI: -0.635, -0.089) was associated with lower cervical cancer stigma scores. Age, religion, income, risk-factor awareness, menopause history, number of pregnancies and use of Intra Uterine Contraceptive Devices (IUCD) use were not significantly associated with cervical cancer stigma. Cervical cancer stigma among women in urban Nepal was associated with educational status, ethnicity, employment, and specific aspects of cervical cancer knowledge. Longitudinal and intervention studies are needed to determine whether improving cancer knowledge can effectively reduce cervical cancer stigma.