A comparison of behavioural models explaining cervical cancer screening uptake

Abstract

Background Cervical cancer represents a very high burden of disease, especially in Low- and Middle-income economies. Screening is a recommended prevention method in resource-poor settings. Cervical cancer screening (CCS) uptake is influenced by various psycho-social factors, most of which are included in behavioural models. Unlike demographic characteristics, these factors are modifiable. While few studies have compared these models in terms of their capacity to predict health behaviour, this study considers three health behaviour theories to assess and compare the predictors of CCS behaviour and intention. Methods A survey was conducted among 607 sexually active women in the South Indian state of Karnataka. Data was collected regarding socio-demographic factors, health literacy, knowledge on CCS, and the socio-cognitive factors related to CCS that are represented in the Health Belief Model (HBM), Theory of Planned Behaviour (TPB) and Theory of Care-Seeking Behaviour (TCSB). Logistic regression analyses tested to what extent each of the theoretical models explained cervical cancer screening (CCS) intention and regular screening behaviour, comparing the variance explained by each of the models. Results CCS intention was best explained by the TPB, followed by the HBM. Of the constructs included in these models, positive attitude towards the screening procedure and perceived benefits contributed most significantly to screening intention, followed by fear, anxiety or embarrassment related to the disease or screening procedure, and context specific barriers. Conclusion Health behavioural models such as the TPB and HBM can help to identify the main socio-cognitive factors explaining the intention of women to participate in CCS. As such, they can inform interventions to target specific determinants of screening intention and behaviour, and enhance their effectiveness by addressing women’s screening attitude, perceived benefits, and emotions as well as reducing context specific barriers to screening.

Factors explaining men’s intentions to support their partner’s participation in cervical cancer screening

“…With regard to socio-cognitive factors, our findings confirmed those of previous studies [ 49 ], including those that had been performed in Low-middle income countries [ 46 , 50 ] that knowledge about the disease and awareness of the possibility to be screened are significant predictors of screening intention. This is similar to what has been found among females in this context [ 36 ]. In that regard, it is important to note that the overall knowledge about cervical cancer, its aetiology, risk factors, and early warning signs, was very low amongst the male participants in our study, which is consistent with the results of similar studies conducted earlier [ 15 , 18 , 22 – 24 , 44 , 51 ] and among women.…”

“…The modified version of the TPB that was used for this study [ 33 , 36 ] holds that the men’s intention to support their female partner’s cervical cancer screening (ISP) is influenced by attitude, subjective norms, and habitual screening behaviour, with attitudes and subjective norm in turn being influenced by knowledge, awareness of cervical cancer and routine screening participation (Fig. 1 ).…”

“…Studies have shown that adding additional constructs such as habit (i.e., one’s usual care-seeking behaviour, such as routinely participating in general screening) and ‘affect’ adds to the prediction of the behaviour [ 35 ]. A recent study that we conducted among females in India confirmed that although TPB is a better predictor of the intention to be screened, additional constructs like ‘structural barriers’ and ‘habit’ could enhance the prediction of screening intentions [ 36 ]. A model that includes the two most predictive TPB constructs (‘attitude’ and ‘subjective norm’) in combination with ‘structural barriers’ and ‘habits’ provided the best prediction of Indian women’s intentions to be screened for cervical cancer.…”

Factors affecting cervical screening using the health belief model during the last decade: A systematic review and meta‐analysis

“…13 This is particularly important for low-to-middle income countries where lack of access is the most prevalent barrier to cervical cancer screening. 8 It should be noted that proposed interventions should be culturally relevant to its recipients. 12,13,42 Moreover, they should be competent enough as to meet the expectations of susceptible females and clear the misconceptions of the general population with regard to screening services.…”

“…5 In addition, the high costs of the HPV vaccine, the inability of the vaccine to cover some high-risk HPV strains, and skepticism toward screening effectiveness are additional factors contributing to the low participation of women in cervical cancer prevention and screening, particularly in resource-scarce areas. 8 In addition to the well-documented sociodemographic and cultural factors that influence screening uptake by women, 9 it is of vital importance to examine the psychosocial factors such as beliefs, perceptions, and emotions as mediators of cervical cancer screening as they are easier to modify than their sociodemographic counterparts. Several European-and USA-based studies were conducted as means to improve cervical cancer screening uptake using theories of behavioral science, 4 of those, the health belief model (HBM) is the most prevalent.…”