Promoting Attendance at Cervical Cancer Screening: Understanding the Relationship with Turkish Womens' Health Beliefs

  • Demirtas, Basak (Nursing Department, Faculty of Health Sciences, Ankara University) ;
  • Acikgoz, Inci (Nursing Department, Faculty of Health Sciences, Ankara University)
  • Published : 2013.01.31


Background: The aim of the study was to identify the relationship between 'Health Belief Model Scale for Cervical Cancer and the Pap Smear Test' subscale scores and demographic/gyneco-obstetric characteristics. Materials and Methods: This cross-sectional study was conducted with 256 women. Data were obtained using the 'Demographic and Gyneco-Obstetric Identification Form' and the 'Health Belief Model Scale for Cervical Cancer and the Pap Smear Test. Results: The percentage of women who had heard about the Pap test was 77.7 whereas only 32.4% had actually undergone the test. Some 45.7% of the women stated that they did not know the reason for having a Pap test. Women who had obtained a Pap smear test had statistically significantly fewer perceived barriers than those who had never had (p<0.05). Scores with regard to the subscales including 'Benefits of Pap Smear Tests and Health Motivation', 'Perceived Seriousness of Cervical Cancer', 'Susceptibility to Cervical Cancer' and 'Cervical Cancer Health Motivation' did not differ with demographic/gyneco-obstetric characteristics such as womens' educational level, whether or not young age at first marriage, whether or not having family history of female cancer, and whether or not having had a Pap test (p>0.05). Conclusions: Increasing knowledge about benefits of Pap smear tests, increasing motivation to obtain Pap Smear Test and increasing perceived seriousness of cervical cancer could promote attendance at cervical cancer screening. Different strategies are needed for behavioural change. Implementation of educational programmes by nurses in a busy environment could result in a major clinical change, based on the findings of this study.


  1. Abercrombie PD (2001). Improving adherence to abnormal pap smear follow-up. J Obstetric Gynecol Neonatal Nursing, 30, 80-8.
  2. Ackerson K, Pohl J, Low LK (2008). Personal influencing factors associated with Pap smear testing and cervical cancer. Policy, Politics Nurs Pract, 9, 50-60.
  3. Ak M, Canbal M, Turan S, et al (2010). Aile hekimligi poliklinigine basvuran kadınlarda pap smear testinin farkındalıgının degerlendirilmesi. Konuralp Tip Dergisi, 2, 1-4.
  4. Akyuz A, Guvenc G, Yavan T, Cetinturk A, Kok G (2006). Evaluation of the Pap smear test status of women and of the factors affecting this status. Gulhane Med J, 48, 25-9.
  5. Cooper M (2011). Reasons for non-attendance at cervical screening. Nursing Standard, 25, 41-6.
  6. Damiani G, Federico B, Basso D, et al (2012). Socioeconomic disparities in the uptake of breast and cervical cancer screening in Italy: a cross sectional study. BMC Public Health, 12, 99.
  7. Duran ET (2011). Examination with the Health Belief Model of women's attitudes to cervical cancer and early diagnosis in Turkey: A qualitative study. Asian Pac J Cancer Prev, 12, 1179-84.
  8. Forouzanfar MH, Foreman KJ, Delossantos AM, et al (2011). Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. Lancet, 378, 1461-84.
  9. Fylan F (1998). Screening for cervical cancer: a review of women's attitudes, knowledge, and behaviour. Br J Gen Pract, 48, 1509-14.
  10. Gollwitzer PM, Sheeran P (2006). Implementation intentions and goal achievement: a meta-analysis of effect and processes. Adv Exp Social Psychol, 38, 69-119.
  11. Gu C, Chan CWH, He GP, Choi KC, Yang SB (2012). Chinese women's motivation to receive future screening: The role of social-demographic factors, knowledge and risk perception of cervical cancer. Eur J Oncol Nurs, 10, 1016.
  12. Guner H, Taskıran C (2007). Epidemiology of cervical cancer and the role of human papiloma virus. J Turkish Obstetric Gynecol Soc, 4, 11-9 (in Turkish).
  13. Guvenc G, Akyuz A, Acıkel CH (2011). Health belief model scale for cervical cancer and Pap smear test: psychometric testing. J Adv Nurs, 67, 428-37.
  14. Harlan LC, Bernstein AB, Kessler LG (1991). Cervical cancer screening: who is not screened and why? Am J Public Hlth, 81, 885-90.
  15. Holroyd E, Twinn S, Adab P (2004). Socio-cultural influences on Chinese women's attendance for cervical screening. J Adv Nurs, 46, 42-52.
  16. Issah F, Maree JE, Mwinituo PP (2011). Expressions of cervical cancer-related signs and symptoms. Eur J Oncology Nur, 15, 67-72.
  17. Larsen LPS, Olesen F (1998). Women's knowledge of and attitude towards organized cervical smear screening. Acta Obstet Gynecol Scand, 77, 988-96.
  18. Lee J, Seow A, Ling SL, Peng LH (2002). Improving adherence to regular pap smear screening among Asian women: A population-based study in Singapore. Health Educ Behavior, 29, 207-18.
  19. Marcus AC, Crane LA, Kaplan CP, et al (1992). Improving adherence to screening follow-up among women with abnormal Pap smears: Results from a large clinic-based trial of three intervention strategies. Medical Care, 30, 216-30.
  20. Maree JE, Wright SCD (2011). Cervical cancer: does our message promote screening? A pilot study in a South African context. Eur J Oncol Nurs, 15, 118-23.
  21. McKiernan M, Campbell H, McDonald S, Douglas F (1996). Promoting attendance for cervical screening: the health visitor's role. Health Visitor, 69, 454-6.
  22. Ministry of Health (2008). Republic of Turkey Cancer Statistics. Retrieved from 1209/h/healthstatisticsyearbook2008.pdf on 10 Oct 2012.
  23. Ministry of Health Cancer Research Department (2009). National cervical cancer screening Standards. Retrieved from serviks_kanser_gen.pdf on 27 Nov 2012.
  24. Ozmen D (2004). Developing a scale to examine attitudes toward early diagnosis of cervical cancer by using Health Belief Model as a theoretical framework. Doctorate Dissertation, Ege University Health Science Institution, lzmir, Turkey.
  25. Park S, Chang S, Chung C (2005). Effects of a cognitionemotion focused program to increase public participation in Papanicolaou smear screening. Public Health Nursing, 22, 289-98.
  26. Perry MA (2001). How can the uptake of cervical cytology screening be improved? Nursing Standard, 16, 33-6.
  27. Seow A, Wong ML, Smith WCS, Lee HP (1995). Beliefs and attitudes as determinants of cervical cancer screening: a community-based study in Singapore. Prev Med, 24, 134-41.
  28. Shiu ATY, Twinn SF, Lee GCT, Chan CWH, Kwong KKF (2010). Strategies to maximise cervical cancer screening rates among older Hong Kong Chinese women- a cultural consensus analysis study. J Clinical Nur, 19, 3244-6.
  29. Sirin A, Atan S, Tascı E (2006). Protection from cancer and early diagnosis applications in lzmir, Turkey. Cancer Nursing, 29, 207-13.
  30. Twinn S (2006). Balancing uncertainty and acceptance: understanding Chinese women's responses to an abnormal cervical smear result. J Clinical Nursing, 15, 1140-8.
  31. Twin S, Cheng F (2000). Increasing uptake rates of cervical cancer screening amongst Hong Kong Chinese women: the role of the practitioner. J Advanced Nur, 32, 335-42.
  32. Welch C, Miller CW, James NT (2008). Sociodemographic and health-related determinants of breast and cervical cancer screening behavior, 2005. J Obstetric Gynecologic and Neonatal Nursing, 37, 51-7.
  33. World Health Organization (2012). Human papillomavirus infection and cervical cancer. publications/world_health_statistics/EN_WHS2012_Full. pdf (accessed 10 oct 2012)
  34. World Health Organization Regional Office for Europe (2007) Strengthening cervical cancer prevention in Europe. World Health Organization Regional Office for Europe (Kopenhages).

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