Ovarian cancer and healthy lifestyle awareness among women of reproductive age.

This study was conducted using a cross-sectional design. The study population consisted of women aged 18–49 living in Turkey. The sample size was calculated based on the chi-square test results from the ovarian cancer (OC) awareness study by Elmahdi et al. (2017) [ 15 ]. The Type I error rate (α) was set at 0.05, and the power of the study (1-β) at 0.95. Analyses indicated that, to achieve 95% power at a 95% confidence interval, at least 244 women were required. Anticipating potential data loss, we set a practical recruitment target of 366, approximately 50% above the minimum required sample, and disseminated the online survey broadly. A total of 342 participants completed the study and met al.l inclusion criteria. Thus, we approached the targeted sample size closely, and analyses were conducted on 342 eligible participants, preserving the planned statistical rigor and the reliability of the findings. Inclusion criteria were: being 18 years or older, being able to read and write in Turkish, having no communication problems, volunteering to participate in the study, not having received any education about ovarian cancer, not having been diagnosed with ovarian cancer, and not having undergone oophorectomy. In this study, the snowball sampling method was used to evaluate the relationship between ovarian cancer and healthy lifestyle awareness levels among women of reproductive age (18–49 years). Data collection was conducted digitally, and social media platforms (Instagram, Facebook, Twitter) were actively used to facilitate participant access. Informative announcements and invitation texts regarding the study were shared on these platforms, and participants were recruited on a voluntary basis. Additionally, participants were asked to invite other women of reproductive age in their social circles who met the study criteria, thereby aiming to expand and diversify the sample. To enhance the inclusiveness of the study and strengthen the generalizability of the findings, efforts were made to include participants from all seven geographical regions of Turkey. Thus, women with different sociodemographic characteristics were encouraged to participate, ensuring regional diversity. The sample was also designed to represent the general population by considering key demographic characteristics such as age, education level, marital status, and employment status. During the data collection process, participants’ confidentiality and anonymity were maintained, and participation was entirely voluntary. The data obtained were collected solely for scientific purposes. Data were collected online via social media platforms (Facebook, Instagram, WhatsApp) using a Descriptive Information Form, the Healthy Lifestyle Awareness Scale, and the Ovarian Cancer Awareness Scale, all prepared based on the literature and administered through Google Forms. The data collection took place between September 2024 and April 2025. To ensure diversity in the sample, the form was shared through various online platforms. Additionally, efforts were made to reach individuals from different cities and professions across Turkey, thereby increasing the reach to different groups. The form was made accessible on different devices (mobile/desktop) to facilitate participation from all groups. In this study, the primary dependent variables were ovarian cancer awareness and healthy lifestyle awareness, assessed using the respective scales. The independent variables consisted of sociodemographic characteristics collected via the Descriptive Information Form. Developed by the researchers based on the literature, this form consists of 17 questions designed to obtain information about participants’ sociodemographic characteristics, breastfeeding status, use of cosmetic products, and similar variables [ 3 , 6 , 16 , 17 ]. This scale was used to determine participants’ awareness levels regarding healthy living. Developed by Özer and Yılmaz in 2020 [ 18 ], its validity and reliability have been established. The scale consists of four subdimensions—change, socialization, responsibility, and nutrition—and includes 15 items. It is a 5-point Likert-type scale (1: Strongly disagree, 2: Disagree, 3: Neutral, 4: Agree, 5: Strongly agree). The minimum and maximum possible scores are 15 and 75, respectively. Higher scores indicate higher levels of healthy lifestyle awareness. The Cronbach’s alpha coefficient for the entire scale was 0.813 in the original study and calculated as 0.918 in our study. Cronbach’s alpha values above 0.80 indicate that the scales used in our study are reliable and that the data obtained are statistically meaningful and consistent. The Ovarian Cancer Awareness Scale was used to assess public awareness of ovarian cancer. The scale was developed in 2011, validated by Simon et al. in 2012 [ 19 ], and adapted to Turkish by Evgin and Hotun Ş. in 2020 [ 20 ]. The scale includes questions on ovarian cancer symptoms and risk factors, the timing of seeking medical appointments in case of symptoms, and self-confidence in recognizing the most common age for ovarian cancer. The scale consists of eight questions. The first, third, and fifth questions are open-ended, requiring participants to write their responses. The second question, which includes 10 sub-items, asks about ovarian cancer symptoms, with response options of ‘yes’, ‘no’, or ‘don’t know’. Participants who select ‘yes’ receive one point, while those who select ‘no’ or ‘don’t know’ receive zero points. For the first and second questions, the maximum score is 10 for each. The third question asks participants to write when they would seek an appointment if they noticed any symptoms. The fourth question asks about the most common age range for ovarian cancer, with four options provided; responses ‘b’ and ‘c’ are considered correct. The fifth question is an open-ended question about ovarian cancer risk factors. In the sixth question, participants who list risk factors receive one point for each, with a maximum score of 12. The sixth question also includes a 12-item risk factor section, rated on a 5-point Likert scale (1: Strongly disagree to 5: Strongly agree). Participants who select ‘strongly disagree’ receive one point, while those who select ‘strongly agree’ receive five points. The maximum and minimum scores for this section are 60 and 12, respectively. The seventh question asks participants about their confidence in recognizing ovarian cancer symptoms. There are no reverse-coded items in the scale. Higher total scores indicate higher levels of ovarian cancer awareness. In the reliability analysis of the Ovarian Cancer Awareness Scale, the Cronbach’s alpha coefficient was calculated as 0.768 for the symptoms section and 0.837 for the risk factors section in previous studies. In our study, these values were 0.838 and 0.924, respectively. Cronbach’s alpha values above 0.80 indicate that the scales used in our study are reliable and that the data obtained are statistically meaningful and consistent. All statistical analyses were performed using IBM SPSS Statistics version 27. Descriptive statistics (means, standard deviations, frequencies, and percentages) were used to summarize the participants’ sociodemographic characteristics. Normality of data distribution was assessed using skewness and kurtosis values. Pearson correlation analysis was conducted to examine the relationships among healthy life awareness, education status, cigarette use, and ovarian cancer (OC) risk factor and symptom awareness scores. Independent samples t-test and one-way ANOVA were applied to compare group differences. In addition, hierarchical multiple regression analyses were performed to investigate the predictive role of healthy life awareness on OC risk factor and symptom awareness, controlling for sociodemographic variables including age, education status, and cigarette use. The internal consistency of the scales was evaluated using Cronbach’s alpha coefficients. Statistical significance was set at p  <.05. Ethical approval was obtained from the Sakarya University Scientific Research Ethics Committee (Date: 22.08.2024, No: E-61923333-050.99-390962). Informed consent was obtained online from all participants, and the study was conducted in accordance with the Declaration of Helsinki.

Table  1 presents the demographic characteristics of the participants. The sample consisted of 342 women of reproductive age, with a mean age of 29.54 (SD = 6.48). Table 1 Distribution of demographic characteristics of women ( n  = 342) Demographic Characteristics Category n Percentage (%) Age 19–25 94 27.5 26–35 182 53.2 36 and over 66 19.3 Body Mass Index (BMI) 18.5 and under 16 4.7 18.6–24.9 199 58.2 25–29.9 77 22.5 30 and over 46 13.5 Marital Status Single 134 39.2 Married 208 60.8 Up to high school education 45 13.2 Bachelor’s degree 206 60.2 Postgraduate education 91 26.6 Cigarette Use/Smoking Status No 250 73.1 Yes 92 26.9 Family History of Cancer No 176 51.5 Yes 166 48.5 Presence of Chronic Disease/Chronic Illness No 295 86.3 Yes 47 13.7 Use of Family Planning Methods/Contraceptive Use No 207 60.5 Yes 135 39.5 Use of Cosmetic Products/Cosmetic Product Use No 19 5.6 Yes 323 94.4 Number of Births/Parity No birth 191 55.8 Single birth 99 28.9 Two births 46 13.5 Three or more births 6 1.8 Distribution of demographic characteristics of women ( n  = 342) Table  2 displays the Pearson correlation coefficients among the study variables. The Healthy Life Awareness Scale (HLAS) was positively correlated with education status ( r  =.14, p  =.010), OC risk factors ( r  =.27, p  <.001), and OC symptoms ( r  =.15, p  =.007). Education status was significantly correlated with both OC risk factors ( r  =.28, p  <.001) and OC symptoms ( r  =.15, p  =.005). Cigarette use showed a significant negative correlation with OC risk factors ( r  = −.17, p  =.002), but no significant correlation with OC symptoms. Age was not significantly associated with HLAS, OC risk factors or symptoms. Table 2 Means, standard Deviations, and intercorrelations among study variables ( n  = 342) Variable Mean SD 1 2 3 4 5 6 1. HLAS 57.51 10.13 - 2. Age 29.54 6.49 0.036 - 3. Education status 2.13 0.62 0.140* 0.280** - 4. Use cigarette 1.27 0.44 − 0.093 − 0.004 − 0.100 - 5. OC Risk Factors 41.54 8.98 0.268** 0.105 0.275** − 0.169** - 6. OC Symptoms 3.80 2.96 0.145** 0.071 0.150** − 0.014 0.264** - Note: Education status was measured as an ordinal variable coded as 1 “Up to high school education”, 2 “Bachelor’s degree” and 3 for “Postgraduate education”. Use cigarette variable was coded as 0 = “No” and 1 = “Yes” * p  <.05, ** p  <.01 Means, standard Deviations, and intercorrelations among study variables ( n  = 342) Note: Education status was measured as an ordinal variable coded as 1 “Up to high school education”, 2 “Bachelor’s degree” and 3 for “Postgraduate education”. Use cigarette variable was coded as 0 = “No” and 1 = “Yes” * p  <.05, ** p  <.01 Hierarchical multiple regression analyses were conducted to examine the predictors of OC risk factors and symptoms (Table  3 ). In Model 1, HLAS significantly predicted both OC risk factors (β = 0.27, p  <.001) and OC symptoms (β = 0.15, p  =.007), explaining 7.2% and 2.1% of the variance, respectively. In Model 2, after controlling for age, education status, and cigarette use, HLAS remained a significant predictor of OC risk factors (β = 0.22, p  <.001) and OC symptoms (β = 0.13, p  =.019). Additionally, education status significantly predicted both OC risk factors (β = 0.22, p  <.001) and symptoms (β = 0.12, p  =.028), while cigarette use was negatively associated with OC risk factors (β = − 0.13, p  =.014) but not with symptoms. The inclusion of sociodemographic variables in Model 2 resulted in a significant increase in explained variance for both OC risk factors (ΔR² = 0.075, ΔF = 9.82, p  <.001) and OC symptoms (ΔR² = 0.018, ΔF = 2.13, p  =.096). Table 3 Hierarchical multiple regression analysis predicting OC risk factors and symptoms ( n  = 342) Predictor Variables B SE β t Sig. 95% CI for B VIF Adj. R 2 ΔR 2 F p LLCI ULCI  OC Risk Factors Model 1 Constant 27.88 2.71 - 10.32 < 0.001 22.57 33.19 - 0.069 0.072 26.32 < 0.001 HLAS 0.24 0.05 0.27 5.13 < 0.001 0.15 0.33 1.000 Model 2 Constant 21.79 3.95 - 5.51 < 0.001 14.02 29.57 - 0.136 0.075 14.46 < 0.001 HLAS 0.19 0.05 0.22 4.39 < 0.001 0.11 0.29 1.027 Age 0.05 0.07 0.03 0.65 0.516 −0.10 0.19 1.086 Education status 3.24 0.77 0.22 4.19 < 0.001 1.72 4.77 1.115 Use cigarette −2.54 1.03 −0.13 −2.48 0.014 −4.56 −0.52 1.017 OC Symptoms Model 1 Constant 1.37 0.92 - 1.49 0.137 −0.44 3.17 - 0.018 0.021 7.27 0.007 HLAS 0.04 0.02 0.15 2.69 0.007 0.01 0.07 1.000 Model 2 Constant −0.73 1.38 - −0.53 0.600 −3.45 1.99 - 0.028 0.018 3.43 0.009 HLAS 0.04 0.02 0.13 2.35 0.019 0.01 0.07 1.027 Age 0.01 0.03 0.03 0.57 0.573 −0.04 0.06 1.086 Education status 0.59 0.27 0.12 2.21 0.028 0.07 1.13 1.115 Use cigarette 0.07 0.36 0.01 0.19 0.843 −0.64 0.78 1.017 OC Ovarian Cancer, HLAS Healthy Life Awareness Scale β Standardized coefficient, t  Validity coefficient of the regression, VIF Variance inflation factor, CI Confidence interval, LLCI  Lower limit confidence interval, ULCI  Upper limit confidence interval. Bold values indicate statistical significance at p < .05 Hierarchical multiple regression analysis predicting OC risk factors and symptoms ( n  = 342) OC Ovarian Cancer, HLAS Healthy Life Awareness Scale β Standardized coefficient, t  Validity coefficient of the regression, VIF Variance inflation factor, CI Confidence interval, LLCI  Lower limit confidence interval, ULCI  Upper limit confidence interval. Bold values indicate statistical significance at p < .05

The findings of this study demonstrate that healthy lifestyle awareness and education level are key determinants in increasing awareness of ovarian cancer risk factors and symptoms among women of reproductive age. In particular, women with high healthy lifestyle awareness and higher education levels have significantly greater knowledge of both risk factors and symptoms. Cigarette use, on the other hand, negatively affects awareness of risk factors. These results highlight the importance of health education and awareness programs in promoting early diagnosis and preventive behaviors related to ovarian cancer in the community. The main limitation of this study is its cross-sectional design. Therefore, causality cannot be established between the variables, and the findings only reflect the situation at a specific point in time. Additionally, the online, self-administered (non-face-to-face) format may have allowed some participants to consult external resources while completing the questionnaire, potentially inflating awareness scores and introducing information bias. Sample diversity was increased by including women from all seven geographical regions of Turkey and from different socioeconomic groups. Being the first national study to examine the relationship between ovarian cancer awareness and healthy lifestyle awareness makes a significant contribution to the literature. Health professionals, especially nurses, should develop education and counseling programs aimed at increasing ovarian cancer and healthy lifestyle awareness among women. Targeted awareness programs should be planned for women who smoke. Future research should use longitudinal designs, include more diverse samples, and investigate the effectiveness of specific educational interventions aimed at increasing OC awareness and early diagnosis.

In this study, the relationship between healthy lifestyle awareness and awareness of ovarian cancer risk factors and symptoms among women of reproductive age was examined. Our findings indicate that healthy lifestyle awareness is positively associated with awareness of both ovarian cancer risk factors and symptoms. Additionally, education level was found to have a significant effect on this awareness, while cigarette use was negatively associated with awareness of ovarian cancer risk factors, and age was not found to have a significant effect. Awareness and adoption of healthy lifestyle habits are important factors that influence individuals’ understanding of cancer and their engagement in preventive health practices [ 21 – 23 ]. Especially in gynecological cancers, high awareness among women regarding these cancer types and their risk factors promotes early recognition of symptoms, participation in regular screening tests, and adoption of healthy lifestyles, thereby increasing early diagnosis and prevention behaviors [ 24 – 26 ]. The literature emphasizes that gynecological cancer awareness positively affects cancer-related knowledge and preventive behaviors [ 27 ]. Recent research indicates a marked rise in ovarian cancer cases among younger women, which has been linked to higher rates of obesity, metabolic syndrome, increased estrogen exposure, and nulliparity. These trends are anticipated to persist, particularly in low-income countries, as a result of economic growth and associated lifestyle changes. The study highlights the importance of implementing comprehensive lifestyle interventions, particularly among individuals with an increased risk of ovarian cancer. For these high-risk groups, prioritizing actions such as quitting smoking, reducing alcohol consumption, engaging in regular physical activity, maintaining a healthy body weight, and effectively managing metabolic health conditions is regarded as essential for lowering cancer risk [ 28 ]. In line with this, our findings are consistent with the literature, demonstrating that healthy lifestyle awareness (HLAS) is a significant predictor of both ovarian cancer risk factors and symptom knowledge. These results suggest that healthy lifestyle awareness may play an important role in the diagnosis and treatment processes of ovarian cancer. This finding indicates that increasing awareness in the community may be effective in reducing the disease burden associated with ovarian cancer by facilitating early diagnosis and access to treatment. The literature frequently emphasizes the decisive effect of education level on awareness of ovarian cancer risk factors and symptoms. Higher education levels make women more conscious about their environment and health, increasing their chances of accessing health information and adopting healthier lifestyles [ 29 ]. A study among Palestinian women reported that individuals with post-secondary education had higher awareness of ovarian cancer risks and protective factors compared to those with lower education levels [ 8 ]. A study conducted in Turkey found that women with higher education levels had greater awareness of ovarian cancer [ 12 ]. Similarly, a study in Iran found that participants with higher education levels had higher knowledge about ovarian cancer [ 30 ]. Al-Azri et al. (2018) also showed that university graduate women had higher awareness of ovarian cancer symptoms and risk factors compared to illiterate women [ 31 ]. Another study in Nigeria found that women with higher education levels were more knowledgeable about ovarian cancer risk factors and symptoms [ 32 ]. In a large-scale study by Fallowfield et al. (2010), education level was found to significantly affect ovarian cancer knowledge [ 33 ]. Similarly, in this study, education level was found to be significantly associated with both ovarian cancer risk factors and symptom knowledge. All these findings indicate that education level positively affects women’s access to cancer-related information, health literacy, and health-related decision-making processes. As education level increases, individuals become more capable of accessing health resources, evaluating scientific information, and developing risk perception, as well as becoming more conscious, particularly regarding ovarian cancer risk factors and symptoms. Additionally, the positive correlation found between education status and HLAS in our study supports this. This situation provides a significant advantage in terms of early recognition and prevention of cancer. One of the determinants of cancer awareness is cigarette use. Cigarette use triggers the development of many types of cancer by disrupting cellular structure [ 16 ]. Therefore, it might be expected that individuals who smoke would have higher awareness of cancer risk factors. However, in our study, cigarette use was found to be significantly and negatively correlated with awareness of ovarian cancer risk factors, and not significantly associated with awareness of ovarian cancer symptoms. This finding suggests that women who smoke may have lower awareness of ovarian cancer risk factors. In the literature, it has been reported that smoking does not have a significant effect on ovarian cancer awareness [ 12 ]; that women who smoke tend to have less knowledge about breast cancer risk compared to non-smokers [ 34 ]; and that non-smokers exhibit higher levels of cancer awareness [ 35 ]. These conflicting findings suggest that the impact of smoking on individuals’ health behaviors and risk perception is complex. It can be proposed that preventive health behaviors may be lower among smokers, and consequently, their awareness of cancer risk factors may also be reduced. Furthermore, the social and psychological dimensions of smoking may influence levels of awareness. Therefore, developing targeted education and awareness programs for women who smoke could contribute to increasing knowledge about ovarian cancer risk factors and symptoms. The association between age and awareness of gynecological cancers has been examined in multiple studies, but the results are not consistent. While some research has found no significant link between age and ovarian cancer awareness [ 17 ], other studies have reported that older women tend to be more knowledgeable about ovarian cancer [ 12 ]. Furthermore, several investigations have indicated that age may influence awareness levels regarding ovarian cancer [ 10 , 11 , 29 ]. These varying findings suggest that the impact of age on cancer awareness may differ depending on the population and context studied. These findings suggest that the effect of age on cancer awareness may vary across societies and according to cultural and educational differences. The inconsistency in the effect of age on gynecological cancer awareness in different countries and samples indicates the need for more multicenter and culturally diverse studies on this topic. Furthermore, age alone may not be a decisive factor, and it may be more meaningful to evaluate it together with other variables such as health literacy, education level, and access to health services.

Women’s health is one of the fundamental determinants of individual and societal well-being, and the prevention of reproductive system diseases in women of reproductive age holds particular importance [ 1 ]. Among these diseases, gynecological cancers occupy a significant place. Of all gynecological cancers, ovarian cancer (OC) is the most notable in terms of prognosis. Due to the late onset of symptoms and frequent diagnosis at advanced stages, it poses a serious health threat [ 2 , 3 ]. According to the World Health Organization, ovarian cancer is the seventh most common cancer among women and ranks second among gynecological cancers after endometrial cancer. Globally, approximately 325,000 new cases and 207,000 deaths are reported annually. These figures indicate that, although the incidence of ovarian cancer is relatively low, its mortality rate is high [ 4 ]. In Turkey, according to the Ministry of Health data from 2020, ovarian cancer accounts for approximately 4.4% of cases, and the risk increases significantly, especially in women over the age of 40 [ 5 ]. Ovarian cancer presents with symptoms such as abdominal bloating, indigestion, pelvic pain, and fatigue, making early diagnosis challenging. The etiology of the disease includes several factors such as genetic predisposition (BRCA1 and BRCA2 mutations), advanced age, nulliparity, smoking, history of hormone replacement therapy, endometriosis, and the use of talc in the genital area. However, some of these risk factors can be managed by modifying lifestyle behaviors [ 3 , 6 ]. Practices such as eating nutritiously, staying physically active, and not smoking are important in decreasing the likelihood of ovarian cancer [ 6 ]. However, the prevalence of these protective behaviors largely depends on individuals’ level of awareness regarding the disease. Insufficient awareness can lead to delayed recognition of risk factors, low participation in screening programs, and limited access to healthcare services, all of which may contribute to increased cancer-related mortality [ 7 ]. The literature indicates that women’s knowledge about ovarian cancer is insufficient, and they often ignore or misinterpret the symptoms [ 8 – 11 ]. Studies conducted in Turkey also show that most women have limited knowledge about ovarian cancer and that participation in regular health check-ups is low [ 12 , 13 ]. This lack of awareness makes the role of nurses in preventive healthcare services even more critical. Women’s health nurses play a significant role in preventive healthcare through functions such as providing education, counseling, referral to gynecological screening services, and risk assessment [ 14 ]. These functions enable nurses to interact closely with the community and strengthen awareness-raising efforts. Reaching women through community-based practices, conducting health seminars and awareness activities, and promoting healthy lifestyle behaviors are among the professional responsibilities of nurses. This study aims to contribute to the development of nursing-based preventive health services by evaluating the relationship between ovarian cancer awareness and healthy lifestyle awareness among women of reproductive age. Previous studies conducted in Türkiye have been limited to single-center, face-to-face surveys and have focused on women from specific regions, thus restricting sample diversity. To overcome this limitation and obtain more inclusive data, we reached women from different regions and socioeconomic groups in Türkiye via an online survey platform (Google Forms). A review of national and international literature indicates that this is the first study to examine the relationship between ovarian cancer awareness and healthy lifestyle awareness, underscoring its significance. The findings are expected to inform the identification of risk groups, the planning of nursing interventions, and the development of health policies. Accordingly, the research question guiding this study is: Is there a significant association between ovarian cancer awareness and healthy lifestyle awareness among women of reproductive age?