Explanation of Pap Smear Preventive Behavior among Women Based on Health Belief Model: A Qualitative Study

Abstract

Background and objective: Cervical cancer is one of the most prevalent cancers among women. Although Pap smear test is an effective screening program, it is not conducted very frequently. This study aimed to recognize the determinants affecting women's participation in Pap smear test screening, with a qualitative approach, based on the health belief model (HBM). Materials and methods:This was a qualitative research, based on thematic analysis, conducted in 2015. Participants were 30 rural women who participated in this study voluntarily in Sarvabad County in Kurdestan Province in Iran. Purposive sampling was used to recruit participants and sampling continued until data saturation. Semi-structured interviews were used to collect the data. Data were analyzed using thematic analysis. Results: Based on participants' perception, more of the women believed that they were not at risk for cervical cancer; however, they perceived the severity of the disease. Some of them did not have an adequate understanding of the test benefits. They pointed to financial difficulties, fear of test result and lack of awareness are the main barriers in taking Pap smear test. Conclusion: Several factors affect women's participation in screening and Pap smear test. These factors include the components of social, economic, cultural, attitudes, individual beliefs, lack of awareness, fear, etc. Findings of this study could help health administers and planners in designing and implementing interventional programs such as theory-based educational programs, face-toface educational classes, expert advice and speech of clergy people and influential community people to increase women's participation in Pap smear test screening program.

Exploring the barriers to Pap smear test in Iranian women: a qualitative study

“…The high cost of the test reduces individuals' willingness to do it. Consistent with our findings, women participating in the Bahmani et al (2017) and Nazari (2019) studies have identified financial problems as one of the main barriers to doing the test [ 54 , 55 ]. Financial constraints and economic issues related to PS screening reported in other studies have also been a barrier to performing the screening [ 56 , 57 ].…”

“…The fatalism was the last finding of the present study and women were not afraid of being at risk of the disease and subsequent death. The results of several studies have been consistent with those of the present study, and religious beliefs, such as that disease and healing are God's will, have been identified as a barrier to preventive interventions for cervical cancer [ 54 , 69 , 75 ]. In appreciative fatalists, the belief that cancer is a person's fate and nothing can be done to prevent it, delays and challenges the process of diagnosing and treating cervical cancer, and proper planning and interventions must be designed and implemented to correct this belief.…”

“…Incomplete knowledge of PS, its functions, performance, and implications were major barriers to performing the test. Numerous domestic and foreign studies have referred to low level of awareness and knowledge as one of the most important barriers to performing PS screening [ 49 , 54 , 62 – 66 ]. In the review studies of Chorley et al (2017) and Islam et al (2017), lack of knowledge and poor understanding of screening function and role were identified as the main barriers to screening [ 58 , 67 ].…”

“…Fear of being diagnosed with the disease prevents women from attending for a PS. The results of many studies have highlighted the fear of cancer as a deterrent to PS screening [ 25 , 54 , 66 ]. By informing about the benefits of Pap smears in the early detection of cervical cancer, women can be both encouraged to undertake the test and reduce their fear.…”

“…The findings of the Chorley et al (2017)’s study show that embarrassment is a barrier to screening among Spanish women [ 67 ]. Other studies have cited embarrassment as a barrier to doing PS [ 45 , 49 , 54 , 71 ]. It seems that the most important thing in this regard is the presence of female doctors for examination and testing.…”