Abstract
Purpose
The study was conducted to evaluate the effect of fear of COVID-19 on women's attitudes toward cancer screening and healthy lifestyle behaviors.
Method
The study is of descriptive and cross-sectional type. The sample of the study consisted of 221 women living in Turkey. Research data were collected using Introductory Information Form, Attitude Scale for Cancer Screening, The Fear of COVID-19 Scale and Healthy Lifestyle Behaviors Scale II (HLBS-II).
Results
It was found out that 92.3% of the women did not have cancer screening during the pandemic period, 33.0% of the women who did not have it because they were afraid of the contamination, 33.0% thought they were healthy, 13.1% did not have screening tests because they thought that screening tests were not easy and accessible during the pandemic period. While no significant relationship was found between women's attitudes toward cancer screenings and fear of COVID-19 (P > 0.05), a positive significant relationship was found between women's attitudes toward cancer screenings and spiritual growth, health responsibility and interpersonal relations scores, which are sub-dimensions of the HLBS-II scale (P > 0.05). In addition, it was found out that women's fear of COVID-19 affected interpersonal relations and stress management (P < 0.05).
Conclusion
In our study, it was concluded that most of the women did not have cancer screening during the pandemic, and that the fear of COVID-19 affected such healthy lifestyle behaviors as interpersonal relations and stress management.
Keywords: Fear of COVID-19, Cancer screening, Healthy lifestyle behaviors
Introduction
Coronavirus (COVID-19) first emerged in China's Hubei Province in December 2019 and rapidly affected the whole world [1, 2]. The rapid spread of COVID-19, its rapid mutation, the uncertainty of mutations, the lack of definitive treatment and effective prevention methods have affected many aspects of human life and activities [3].
As a disadvantaged gender, women are more affected by and afraid of epidemics. During the COVID-19 pandemic, there have been situations in which women could not meet their own age-related needs such as reproductive health, menopause and old age, as well as the risks they have been exposed to together with the general population, and in order to get those needs met, they have frequently had to apply to hospitals and to get in contact with the health professionals where and for whom the rate of contamination is high [4, 5]. The increasing fear among women about COVID-19 disease may adversely affect their ability to benefit from health care services, for the epidemic has had a tremendous impact on our health systems as much as it has affected our lives. It is possible that the fear of contracting COVID-19 will cause a large number of deaths such as those due to cancer due to diagnostic delays of life-threatening diseases. Studies report that cancer screenings have decreased compared to the pre-pandemic period, and that the number of individuals at high risk for cancer has increased [6, 7]. On the other hand, despite the introduction of various restrictions due to the epidemic, cancer screening continues in accordance with the national cancer screening standards of the countries even during the epidemic. However, the delay of cancer screening by women due to fear of coronavirus transmission raises concerns about the delay of cancer diagnosis [8].
Due to the fear of coronavirus as well as social isolation measures, it has not been possible for physicians, nurses and midwives to reach every woman. Cancer screenings have been suspended as many healthcare professionals have been directed to therapeutic services in the fight against coronavirus. For these reasons, the invitation method cannot be applied in screening, and family physicians have to devote more time to the follow-up of those with COVID and those in close contact with them [4, 5].
In the event of a crisis such as the current pandemic, it is necessary for health professionals to continue preventive health services such as cancer screening, to determine cancer risk factors and to screen women at risk for cancer by taking precautions to prevent infection. Necessary health care and counseling should be provided through applications such as tele-health, remote health monitoring and appointment health screenings [9]. It will thereby be of help in the early diagnosis of female cancers and in the development of healthy lifestyle behaviors.
It has been reported that the genetic risk factor, which plays an important role in the development of cancer, can be brought under control by some changes in the lifestyle. Studies show that individuals with genetic susceptibility can reduce their risk of developing cancer if they acquire healthy lifestyle behaviors [10, 11]. Therefore, healthy lifestyle behaviors gain importance in the prevention of cancers. However, given the enormous impact of COVID-19 on society, little is known about the healthy lifestyle behaviors of women under extremely limited circumstances [12]. On the other hand, it is thought that the pandemic may increase the sedentary lifestyle, have negative effects on health-related life quality and have negative effects on such healthy lifestyle behaviors as nutrition and sleep quality. However, in addition to being more comfortable than daily busy work schedules, staying at home with the family members can also have a positive effect on individuals' healthy lifestyle behaviors [13].
Few studies have been conducted to evaluate the effects of cancer screening and healthy lifestyle behaviors in women during the pandemic [6]. The early diagnosis of cancers and the necessary interventions are important in protecting and improving the health of women and therefore that of the society. Therefore, in this study, it was aimed to find out the attitudes toward cancer screening and healthy lifestyle behaviors of women during the coronavirus (COVID-19) pandemic.
Purpose and Questions of the Research
This research was conducted to evaluate the effect of fear of COVID-19 on the attitudes of women (30–65 years old) toward cancer screening and healthy lifestyle behaviors.
What are women's attitudes toward cancer screening during the COVID-19 pandemic?
What are women's healthy lifestyle behaviors during the COVID-19 pandemic?
What is the relationship between women's fear of COVID-19, healthy lifestyle behaviors and attitudes toward cancer screening?
Does the fear of COVID-19 affect women's attitudes toward cancer screening?
Does the fear of COVID-19 affect women's healthy lifestyle behaviors?
Methods
Study Design
This descriptive and cross-sectional research used the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.
Sample
The population of the study consisted of women aged 30 to 65 across the country. No sample selection was made, and the study was conducted with 221 women who volunteered to participate in the study and filled out the data collection tools completely. In the post-study power analysis (PostHoc) conducted to examine the power of the sample, it was discovered that the sample had a 99% power at a 95% confidence interval with a 0.349 effect size (G * Power 3.1.9.7).
Measures
Research data were collected using Introductory Information Form, Attitude Scale for Cancer Screening, The Fear of COVID-19 Scale (FCV-19S) and Healthy Lifestyle Behaviors Scale II (HLBS-II).
Introductory Information Form
This form, prepared by the researchers by scanning the literature [4, 7, 14–16], consists of 13 questions including socio-demographic and cancer screening features.
The Fear of COVID-19 Scale (FCV-19S)
The validity and reliability of the Fear of COVID-19 Scale developed by Ahorsu et al. [16] and its adaptation into Turkish were performed by Bakiroğlu et al. [18] The scale is a self-assessment, 5-point Likert scale and has seven items. The scale yields a score ranging from 7 to 35. Cronbach's alpha value was determined to be 0.88 in the study conducted in the Turkish sample [15]. Cronbach's alpha value of the scale was found to be 0.92 in our study.
Attitude Scale for Cancer Screening
It was developed by Öztürk-Yıldırım et al. [17] to evaluate individuals' attitudes toward cancer screening. The scale consists of 24 items and is one-dimensional. The scale is 5-point Likert type. The items making up the scale are answered in a range from 5 to 1 as "5: I totally agree, 4: I somewhat agree, 3: I neither agree nor disagree, 2: I somewhat disagree, 1: I strongly disagree." The lowest score that can be obtained from the scale is 24 and the highest is 120. It is interpreted that there is a negative attitude toward cancer screenings as the scores of the participants near to 24, and a positive attitude if near to 120. No specific cut-off point was set for the scale. Cronbach's alpha value of the scale was calculated as 0.95 [17]. In this study, the Cronbach alpha value of the scale was calculated as 0.87.
Healthy Lifestyle Behaviors Scale II (HLBS-II)
Based on Pender's Health Promotion Model and developed by Walker et al. it measures health-promoting behaviors associated with an individual's healthy lifestyle. The scale was revised in 1996 and named as HLBS-II [18]. The Turkish validity and reliability study of the scale was conducted by Bahar et al. in 2008 [17]. The scale consists of 52 items, which are all positive, in a 4-point Likert type (1 (Never), 2 (Sometimes), 3 (Often) and 4 (Regularly)). The lowest score is 52, and the highest is 208. An increase in the scores obtained from the scale indicates that the individual applies the stated health behaviors at a high level, and the scale does not have a cut-off value [14]. It consists of six sub-dimensions, which are Spiritual Growth, Nutrition, Physical Activity, Health Responsibility, Interpersonal Relations and Stress Management. The Cronbach's alpha value of the original scale is 0.94 [18]. In the study conducted for the Turkish sample, the Cronbach alpha values of the subscales were found to be 0.94 [14]. In our study, the Cronbach's alpha value of the scale was found to be 0.96.
Procedure
Before applying them to the women, data collection forms had been applied to 10 women —5 of whom in written and 5 via an online interface— who were not included in the sample group, thus giving the forms their final forms. The data of the research were collected through electronic surveys created through Google Forms between March and July 2021. During the pandemic, where direct contact was reduced as much as possible due to the social distance rules, the participants were invited to the research via social media groups (WhatsApp groups, public forums, Twitter and Facebook accounts). All participants were informed about the study at the beginning of the online survey, and their consent was obtained. No names, Internet Protocol (IP) addresses, or other identifying information were collected; thus, participants’ responses were anonymous, and no personal information was attached to the data. All questions had to be completed before submission. Additionally, survey responses from Google Forms are limited to only one response per person. Thus, people were prevented from filling out a questionnaire more than once.
Ethical Dimension of Research
Written approval (Date: 03.02.2021, Decision No: 2021.02.47) was obtained from the Ethics Committee of the relevant university before conducting the research. Written permission (Date: 06.02.2021; Decision No:2021-02-02T16_28_53) was obtained from the Ministry of Health in order to conduct the research. In addition, all participants were informed about the study at the beginning of the online survey, and their consent was obtained. The study was based on the principles of the Declaration of Helsinki.
Evaluation of the Data
Analysis of the data collected was performed using the Statistical Package for Social Science (SPSS) version 25 software program. Number and percentage were used for categorical measurements, and mean and standard deviation were used for numerical measurements. The conformity of the data to normal distribution was determined by the Kolmogorov–Smirnov and Shapiro–Wilk tests according to the sample size. Because all variables in all the scales were normally distributed, Pearson correlation test was used for the correlation analysis. Multiple linear regression analyses were used to define the predictor variables. A P value of < 0.05 was considered statistically significant in all analyses.
Results
The distribution of some descriptive characteristics of the women is given in Table 1. It was found out that 61.5% of the women were between the ages of 30–40, 67.4% had a university degree or higher, 60.6% had a job, 76.9% lived in the metropolis/city and 61.1% had an income level equal to their income and expenses. It was found out that 90.5% of the women did not use alcohol, 76.5% did not smoke, and 72.9% did not have any chronic disease. It was found out that 26.7% of the women had cancer in their first-degree relatives, 53.4% had cancer in their second-degree relatives, 81.4% had knowledge about cancer, 75.1% feared cancer, 45.2% regarded cancer as fatal, 44.8% thought that the treatment is possible.
Table 1.
The distribution of some descriptive characteristics of women (n = 221)
| Descriptive characteristics | n | % |
|---|---|---|
| Age (years) | ||
| 30–40 | 136 | 61.5 |
| 41–50 | 61 | 27.6 |
| 51–65 | 24 | 10.9 |
| Age (Mean ± SD) | 39.48 ± 8.17 | |
| Educational status | ||
| Elementary | 33 | 14.9 |
| High school | 39 | 17.6 |
| University and higher | 149 | 67.4 |
| Employment | ||
| Employed | 134 | 60.6 |
| Not employed (Housewife) | 87 | 39.4 |
| Location | ||
| Metropolis/City | 170 | 76.9 |
| District/Village | 51 | 23.1 |
| Income level | ||
| Income is less than expenses | 50 | 22.6 |
| Income is equal | 135 | 61.1 |
| Income is more than expenses | 36 | 16.3 |
| Alcohol use | ||
| Yes | 21 | 9.5 |
| No | 200 | 90.5 |
| Smoking | ||
| Yes | 52 | 23.5 |
| No | 169 | 76.5 |
| Chronic disease status | ||
| Yes | 60 | 27.1 |
| No | 161 | 72.9 |
| Presence of cancer in first degree relatives | ||
| Yes | 59 | 26.7 |
| No | 162 | 73.3 |
| Presence of cancer in second degree relatives | ||
| Yes | 118 | 53.4 |
| No | 103 | 46.6 |
| Status of knowledge about cancer | ||
| Yes | 180 | 81.4 |
| No | 41 | 18.6 |
| Fear of cancer | ||
| Yes | 166 | 75.1 |
| No | 55 | 24.9 |
| Thoughts about cancer | ||
| Fatal | 100 | 45.2 |
| Not deadly | 3 | 1.4 |
| Not contagious | 4 | 1.8 |
| Possible to treat | 99 | 44.8 |
| Cannot be cured | 15 | 6.8 |
Table 2 shows the distribution of the characteristics of the women regarding cancer screening. It was found out that 49.3% of the women had never been screened for cancer before, 31.2% of those who had cancer screening had mammography and 18.6% had Pap-smear. It was found out that 92.3% of the women did not have cancer screening during the pandemic period, 33.0% of the women who did not have it because they were afraid of the contamination, 33.0% thought they were healthy, 13.1% did not have screening tests because they thought that screening tests were not easy and accessible during the pandemic.
Table 2.
Distribution of women's characteristics regarding cancer screening (n = 221)
| Characteristics | n | % |
|---|---|---|
| Previous cancer screening | ||
| Never done | 109 | 49.3 |
| Have done at least once | 112 | 50.7 |
| Cancer screening (n = 112) | ||
| Mammography | 69 | 31.2 |
| Pap-Smear | 41 | 18.6 |
| Colonoscopy | 1 | 0.5 |
| Occult blood in stool | 1 | 0.5 |
| Status of cancer screening in the pandemic period | ||
| Yes | 17 | 7.7 |
| No | 204 | 92.3 |
| Reason for not screening for cancer in the pandemic period * (n = 204) | ||
| I was afraid of the contamination coronavirus | 73 | 33.0 |
| I thought I was healthy | 73 | 33.0 |
| I didn't know about cancer screenings | 27 | 12.2 |
| Screening tests were not easy and accessible during the pandemic period | 29 | 13.1 |
| I couldn't find the time | 24 | 10.9 |
| I couldn't leave the house due to curfews | 21 | 9.5 |
| I was afraid of getting bad news | 9 | 4.1 |
| I was ashamed of the healthcare worker / having an examination | 3 | 1.4 |
| I thought cancer screening wouldn't help | 3 | 1.4 |
*More than one option is marked
The mean score of the women’s fear of COVID-19 was 17.99 ± 7.33, the total mean score of the Healthy Lifestyle Behaviors Scale II was 130.46 ± 29.16, the sub-dimension mean scores of HLBS-II was 25.73 ± 5.73 for Spiritual Growth, 21.51 ± 5.06 for Nutrition, 16.56 ± 5.71 for Physical Activity, 22.34 ± 5.88 for Health Responsibility, 25.38 ± 5.81 for Interpersonal Relations and 18.94 ± 5.13 for Stress Management. The mean score of the Attitude Scale for Cancer Screening was calculated as 66.10 ± 15.71.
No significant relationship was found between women's attitudes toward cancer screening and fear of COVID-19 (P > 0.05) (Table 3). A positive significant relationship was found between women's attitudes toward cancer screenings and spiritual growth, health responsibility and interpersonal relations scores, which are sub-dimensions of the HLBS-II scale (P > 0.05) (Table 4).
Table 3.
Distribution of total mean scores of women's Fear of COVID-19 Scale (FCV-19S), Healthy Lifestyle Behaviors Scale II (HLBS-II) and its sub-dimensions, and Attitude Scale for Cancer Screening (ASCS)
| Scales | Mean ± SD | Min | Max |
|---|---|---|---|
| Fear of COVID-19 Scale (FCV-19S) | |||
| FCV-19S | 17.99 ± 7.33 | 7 | 35 |
| Healthy Lifestyle Behaviors Scale II (HLBS-II) | |||
| Spiritual growth | 25.73 ± 5.73 | 9 | 36 |
| Nutrition | 21.51 ± 5.06 | 9 | 36 |
| Physical activity | 16.56 ± 5.71 | 8 | 32 |
| Health responsibility | 22.34 ± 5.88 | 9 | 36 |
| Interpersonal relations | 25.38 ± 5.81 | 9 | 36 |
| Stress management | 18.94 ± 5.13 | 8 | 32 |
| HLBS-II (Total) | 130.46 ± 29.16 | 52 | 208 |
| Attitude Scale for Cancer Screening (ASCS) | |||
| ASCS (Total) | 66.10 ± 15.71 | 24 | 107 |
Table 4.
The relationship between women's fear of COVID-19, healthy lifestyle behaviors, and attitudes toward cancer screening
| Attitude Scale for Cancer Screening (ASCS) | ||
|---|---|---|
| r | P | |
| Fear of COVID-19 Scale (FCV-19S) | 0.122 | 0.071 |
| Healthy Lifestyle Behaviors Scale II (HLBS-II) | ||
| Spiritual growth | 0.238 | < 0.001* |
| Nutrition | 0.058 | 0.393 |
| Physical activity | − 0.074 | 0.272 |
| Health responsibility | 0.134 | 0.047* |
| Interpersonal relations | 0.228 | 0.001* |
| Stress management | 0.061 | 0.366 |
| HLBS-II (Total) | 0.125 | 0.063 |
* P < 0.05, r = Pearson correlation coefficient
Multiple linear regression results to examine the effect of fear of COVID-19 on women's attitudes toward cancer screening and healthy lifestyle behaviors are given in Table 5. The established model was found to be statistically significant (P < 0.05). According to the results of the research, it was determined that the fear of COVID-19 did not have an effect on the attitude toward cancer screening, but it affected the interpersonal relationships and stress management of the women (P < 0.05).
Table 5.
The effect of women's fear of COVID-19 on their attitudes toward cancer screening and healthy lifestyle behaviors
| Independent variable | β | SE | t | P value | F model | P model | R2 |
|---|---|---|---|---|---|---|---|
| ASCS | 0.087 | 0.032 | 1.253 | 0.212 | |||
| HLBS-II sub-dimensions | |||||||
| Spiritual growth | − 0.248 | 0.198 | − 1.597 | 0.112 | |||
| Nutrition | 0.179 | 0.160 | 1.619 | 0.107 | 3.889 | 0.001* | 0.113 |
| Physical activity | − 0.134 | 0.144 | − 1.194 | 0.234 | |||
| Health responsibility | 0.149 | 0.168 | 1.105 | 0.270 | |||
| Interpersonal relations | 0.318 | 0.185 | 2.163 | 0.032* | |||
| Stress management | − 0.306 | 0.201 | − 2.180 | 0.030* | |||
ASCS Attitude Scale for Cancer Screening, HLBS-II Healthy Lifestyle Behaviors Scale II, *P < 0.05
Discussion
Cancer is an important public health problem today, and it maintains its current importance. Cancer, which ranks second after cardiovascular diseases in the list of known deaths, causes heavy losses in the workforce and the country's economy due to the disabilities it causes and the high costs of its treatment. Raising awareness about cancer, improving public awareness and cancer screening are among the most effective methods in the fight against cancer. Breast cancer, cervical cancer and colorectal cancer screenings are carried out free of charge by the Ministry of Health within the scope of the National Cancer Screening Program in Turkey. Within the scope of this screening program, breast cancer screening with mammography every two years on women aged 40–69, cervical cancer screening on women aged 30–65 with Papanicolaou smear and HPV test every five years, colorectal cancer screening with a stool occult blood test on women and men aged 50–70 every two years performed [19]. According to the results of the Turkey Household Health Survey conducted in 2017, it was found out that 46.4% of women are aware of the existence of cancer screening tests, two out of five women aged 40 to 69 have never had a mammogram, and nearly half of the women aged 30–65 have never had any cervical cancer screening [20]. COVID-19 pandemic, as in all health services, affected these numbers, which were not good at all, and all population-based screening programs around the world came to a standstill [21]. Many governments have suspended cancer screenings and called for not applying to health institutions except in emergencies. According to the World Health Organization (WHO) data, about half of the 155 countries have postponed their cancer screening programs and reported disruptions in cancer treatment services [22]. In our study, it was found out that 50.7% of women had cancer screening at least once in their lives, and 92.3% of women did not have cancer screening during the pandemic period. In the study of Erdoğan and Akkaya [23], it was found out that due to COVID-19 pandemic, HPV scanning decreased significantly in 2020 compared to previous years. The studies conducted by Peacock et al. [24] in Belgium, by Jacob et al. [25] in Germany and by Skovlund et al. [26] in Denmark all shown that cancer diagnosis in the pandemic has decreased significantly compared to the pre-pandemic period. The results of our study are similar to those around the world. Our study is important in terms of showing the dramatic and negative impact of the restrictions stemming from COVID-19 pandemic on cancer screening rates in the Turkish sample as well.
Factors causing the decrease in cancer screening rates have been reported as the need to direct health personnel and resources to the fight against the pandemic, reduced availability of public transport, the lack of personnel, medicine, diagnosis and technology [22]. In addition, many patients feared exposure to SARS-CoV-2 or overburdening their healthcare and therefore were less likely to seek healthcare for cancer screening and diagnosis. In our study, too, approximately one-third of the women stated that they did not have cancer screening because they were afraid of contracting the Coronavirus. Similar to the results of our study, De Pelsemaeker et al. [27] stated that histological and cytological examinations of colon biopsies, breast biopsies and cervical cytology decreased significantly due to fear of COVID-19, while Cheng et al. [28] stated that half of colonoscopy cancelations during the pandemic were due to fear of infection. Individuals with potential non-specific cancer symptoms faced barriers to consulting a specialist [29], largely due to fear and anxiety about getting infected with COVID-19 in a healthcare setting. Both patients and staff at the hospitals experience fear and anxiety [30]. This fear and anxiety affect women's participation in cancer screening programs and prevents early diagnosis of cancer [31]. Cancer screenings are an opportunity to detect precancerous lesions early and to initiate interventions that prevent or delay disease progression. Failure to detect early symptoms of cancer causes cancers to be diagnosed in later stages [32]. Yong et al. [33] predict that about 5300 additional deaths from breast cancer and 4500 from colorectal cancer will occur in Canada due to delays in cancer diagnosis. Sud et al. [34] stated that a 3- to 6-month delay in cancer screening and surgery in the UK has a significant impact on survival, and a delay in diagnosis and treatment will reduce individuals' life expectancy by 19 to 43%. On the other hand, suspension of cancer screening or cancer prevention programs is expected to aggravate patients' suffering, disease burden, 5-year mortality, economic burden and workload for surgeons and oncologists [35]. Although cancer screening programs in Turkey have not been halted during the pandemic, the result of our study shows that women were hesitant to participate in cancer screening programs. From this perspective, we are of the opinion that raising women's awareness of cancer prevention during the ongoing pandemic is critically important and that health care professionals should refer women to cancer screenings during the pandemic.
Attitudes, defined as a state of emotional and mental readiness that is formed as a result of experiences and has a directive effect on the behavior of the individual against all relevant situations [36], have an important place in cancer screenings [17]. In our study, the mean score of Attitude Scale for Cancer Screening was found to be 66.10 ± 15.71. According to this result, considering that the highest score on the scale is 120, we can say that the attitude of women toward cancer screening is moderate. Attitude has an important power directing the behavior of the individual, and strong attitudes are more reflected in behavior than the weak ones [36]. Therefore, strengthening women's attitudes toward cancer screenings can help women to go to screening regularly.
Mammography and PAP smear test, which are early diagnosis and screening methods in breast and cervical cancer, are among the healthy lifestyle behaviors. Healthy lifestyle behaviors of women affect the knowledge of early diagnosis and the practices in cancer [37]. In our study, the mean score of the Healthy Lifestyle Behaviors Scale II was found to be 130.46 ± 29.16. In a study conducted in a Turkish sample before the pandemic, it was found to be 142.73 ± 26.3 [38], and 126.8 ± 19.2 [39] in another study. According to these results, we can say that the healthy lifestyle behavior levels of women in the pre-pandemic and pandemic period are similar.
In our study, a positive and significant relationship was found between such healthy lifestyle behaviors as spiritual growth, health responsibility, interpersonal relationship and attitudes toward cancer screening. Gözüyeşil et al. [38] found a statistically significant difference between knowing about and performing Breast Self-Exam (BSE) and health responsibility and interpersonal relations, which are two sub-dimensions of the HLBS-II. In the study conducted by Gök-Uğur and Aydın-Avcı [37], a statistically significant difference was found between the status of performing BSE, mammography and smear test and spiritual growth and health responsibility. Im Kim et al. [40] reported that women who regularly practice breast cancer screening tend to exhibit better healthy lifestyle behaviors. It can be seen that our study results are compatible with the data obtained from other studies. These results show that healthy lifestyle behaviors affect early diagnosis practices in women.
The most important nationwide goal during COVID-19 pandemic has been to reduce the spread of the virus. For this purpose, serious restrictions were placed on individual freedom and people were called to stay at home. In this process, the unavoidable increases in the number of positive cases and loss of life led to fear, which is a psychological aspect of COVID-19 [41]. While fear of COVID-19 triggered psychological distress, it also helped to encourage a reduction in risky behaviors [42]. In our study, it was found out that while women's fear of COVID-19 did not affect their attitudes toward cancer screening, healthy lifestyle behaviors affected interpersonal relationships and stress management. Ayandele et al. [42] reported that high levels of fear of COVID-19 are more likely to trigger participation in frequent preventive health behaviors. Our results are consistent with the previous studies [42]. Fear can be effective in triggering certain problem-solving or problem-avoidance behaviors, which can prevent the feared event or situation from happening. In addition to increasing people's alertness to the seriousness of risks, fear may also have a feature that may prevent preventive behaviors [42]. Therefore, it may be wrong to assume that fear will lead individuals to healthy lifestyle behaviors in the pandemic. In this process, individuals should be encouraged to participate in cancer screening programs and healthy lifestyle behaviors by providing them with sufficient information.
Limitations
The current study has some limitations. An internet-based (online) questionnaire was used in the study. This can lead to selection bias and poor generalization. In addition, since the data obtained from the study are cross-sectional, they do not provide long-term results. Individuals may also respond differently to the questionnaire depending on the stage of COVID-19 pandemic. Therefore, in our study, data were collected in a short time to minimize differences and changes in restrictions due to COVID-19. Despite these limitations, it provides important information about the attitudes of women toward cancer screening during the pandemic.
Conclusion
In our study, it was found out that most of the women did not have cancer screening during the pandemic, and that there was a positive and significant relationship between women's attitudes toward cancer screening and spiritual growth, health responsibility, interpersonal relationships, and that fear of COVID-19 affected interpersonal relationships and stress management. According to the results of the research, in order to protect, maintain and improve women's health during the pandemic, it is important to increase the awareness of women about common cancers, especially in primary healthcare centers, to question health behaviors and the variables affecting health behaviors and to prepare, conduct and maintain health education programs regarding all these.
Acknowledgements
The authors wish to thank all the participants to participate in this study.
Authors’ contributions
CP was involved in data curation (equal), formal analysis (equal), investigation (equal), methodology (equal), resources (equal), software (equal), visualization (equal), writing—original draft (equal) and writing-review and editing (equal); ÖPU contributed to conceptualization (equal), methodology (equal), project administration (equal), resources (equal), software (equal), visualization (equal), writing-original draft (equal) and writing—review and editing (equal).
Funding
This study has not received financial support from any official or private institution.
Declarations
Conflict of interest
The authors declared no disclosures or potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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