Knowledge, Attitudes and Practice about Pap Smear Test among Women Living in Bojnourd, North East of Iran: a Population-Based Study

  • Bahri, Narjes (Department of Midwifery, School of Nursing and Midwifery, Gonabad University of Medical Sciences) ;
  • Jajvandian, Roya (Department of Midwifery, Islamic Azad University) ;
  • Bolandhemmat, Maryam (Department of Midwifery, Islamic Azad University) ;
  • Najmabadi, Khadigeh Mirzaii (Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences)
  • Published : 2015.03.18


Background: The aim of the study was to assess the extent of knowledge, attitudes and practical behavior of women in Bojnourd conerning the Pap smear test. Materials and Methods: This cross-sectional and population-based study was conducted with 1000 Iranian women aged 15-60 years old in Bojnourd city. In order to collect the data, a validated questionnaire was provided in four sections covering demographic information and questions about knowledge, attitude and practice about the Pap smear. Statistical analysis was performed with the Statistical Package for Social Sciences (version 17.0) applying a 0.05 significance level. Results: Evaluation of knowledge showed that 146 women (14.6%) had very weak, and 594 women (59.4%) had weak knowledge. In contrast, most of the women studied, 873 (87.3%), had a positive attitude toward the Pap smear test. According to the findings, 375 women (37.6%) had done this test so far. Findings indicated that the extent of knowledge had a meaningful relationship with the attitude status (p<0.0001). Also, there was a meaningful relationship between knowledge and practice, so that the weakest practice was seen in women who had weak knowledge (61.1%), (p<0.0001). Conclusions: According to findings of this research, most women do not have an appropriate knowledge about the necessity of having the Pap smear test, so that only a low percentage of women had undergone this test.


Pap smear test;cervical cancer;knowledge;attitude;practice;North-east Iran


  1. Akujobi CN, Ikechebelu JI, Onunkwo I, Onyiaorah IV (2008). Knowledge, attitude and practice of screening for cervical cancer among female students of a tertiary institution in South Eastern Nigeria. Niger J Clin Pract, 11, 216-9.
  2. Amarian ZO, Badria LF, Obeidat BR (2008). Attitudes and beliefs about cervical smear testing in ever-married Jordanian women. Eastern Mediterranean Health J, 14, 389-97.
  3. Anaya-Ruiz M, Vincent AK, Perez-Santos M (2014). Cervical cancer trends in Mexico: incidence, mortality and research output. Asian Pac J Cancer Prev, 15, 8689-92.
  4. Awodele O, Adeyomoye AA, Awodele DF, et al (2011). A Study on Cervical Cancer Screening Amongst Nursesin Lagos University Teaching Hospital, Lagos, Nigeria. J Canc Educ, 26, 497-504.
  5. Basu P, Sarkar S, Mukherjee S, et al (2006). Women's perceptions and social barriers determine compliance to cervical screening: Results from a population based study in India. Cancer Detect Prev, 30, 369-74.
  6. Chaudhry S, Fink A, Gelberg L, Brook R (2003). Utilization of papanicolaue smear by south Asian women living in the united states. J Gen Intern Med, 18, 377-84.
  7. Chee H, Rashidah S, Shamsuddin K, Intan O (2003). Factors related to the practice of breast self-examination (BSE) and Pap smear screening among Malaysian women workers in selected electronics factories. BMC Women's Health, 3, 3-10.
  8. Do HH, Taylor VM, Burke N, et al (2007). Knowledge about cervical cancer risk factors, traditional health beliefs, and Pap testing among Vietnamese American women. J Immigr Minor Health, 9, 109-14.
  9. Fernandes JV, Rodrigues SH, Costa YG, et al (2009). Knowledge, attitudes, and practices related to Pap test by women, Northeastern Mexico. Rev Saude Publica, 43, 851-8.
  10. Gakidou E, Nordhagen S, Obermeyer Z (2008). Coverage of cervical cancer screening in 57 countries: low average levels and large inequalities. PLoS Med, 5, 132.
  11. Gamarra CJ, Paz EP, Griep RH (2005). Knowledge, attitude and practice related to papaniculaou smear test among argentines' women. Rev saude publica, 39, 270-6.
  12. Gichangi P, Estamble B, Bwayo J (2003). Knowledge and practice about cervical cancer and pap smear testing among patients at kenyatta national hospital, Nairobi,Kenya. Int J Gynecol Cancer, 13, 827-33.
  13. Gregg J, CenturionT, Aguillon R, et al (2011). Beliefs about the pap smear among Mexican immigrants. J Immigr Minor Health, 13, 899-905.
  14. Ho IK, DinhKT (2011). Cervical Cancer Screening Among Southeast Asian American Women. J Immigr Minor Health, 13, 49-60.
  15. Ilter E, Celik A, Haliloglu B, et al (2010). Women's knowledge of Pap smear test and human papillomavirus: acceptance of HPV vaccination to themselves and their daughters in an Islamic society. Int J Gynecol Cancer, 20, 1058-62.
  16. Juon HS, Seung-Lee C, Klassen AC (2003). Predictors of regular Pap smears among Korean-American women. Prev Med, 37, 585-592.
  17. Khan HM, Gabbidon K, Abdool-Ghany F, et al (2014). Health disparities between Black Hispanic and Black Non- Hispanic Cervical Cancer Cases in the USA. Asian Pac J Cancer Prev, 15, 9719-23.
  18. Kidanto HL, Kilewo CD, Moshiro C (2002). Cancer of the cervix: knowledge and attitudes of female patients admitted at Muhimbili National Hospital, Dar es Salaam. East Afr Med journal, 79, 467-75.
  19. Monsonego J (2007). Prevention of cervical cancer: screening, progress and perspectives. Press Med, 36, 92-111.
  20. Onsuz MF, Hidiroglu S, Sarioz A, et al (2014). Knowledge, attitudes and behaviors of women over 20 years old on cervix cancer in Istanbul, Turkey. Asian Pac J Cancer Prev, 15, 8801-7.
  21. Othman NH, Mohamad Zaki FH (2014). Self-collection tools for routine cervical cancer screening: a review. Asian Pac J Cancer Prev, 15, 8563-9.
  22. Ranabhat S, Tiwari M, Dhungana G, Shrestha R (2014). Association of knowledge, attitude and demographic variables with cervical Pap smear practice in Nepal. Asian Pac J Cancer Prev, 15, 8905-10.
  23. Serrano-Olvera A, Cetina L, Coronel J, Duenas-Gonzalez A (2014). Follow-up consultations for cervical cancer patients in a Mexican cancer center. Comparison with NCCN guidelines. Asian Pac J Cancer Prev, 15, 8749-52.
  24. Seth T, Kotwal A, Thakur R, et al (2005). Common cancers in India: knowledge, attitudesandbehaviours of urban slum dwellers in New Delhi. Public Health, 119, 87-96.
  25. Tabatabaee Kave M (2009). Surveying of knowledge, attitude and practice of staffs in health centrals of Iran - Gonabad about papsmear and cervical cancer screening. J Gonabad University, 12, 47-54.
  26. Tung WC, Lu M, Cook D (2010). Papanicolaou screening in Taiwan: perceived barriers and self-efficacy. Health Care Women Int, 31, 421-34.
  27. WHO (2013). WHO fact sheet: Human papillomavirus (HPV) and cervical cancer. Retrieved from, August 2014.
  28. Wright KO, Kuyinu YA, Faduyile FA (2010). Community education on cervical cancer amongst market women in an urban area of Lagos, Nigeria. Asian Pac J Cancer Prev, 11, 137-40.