Beliefs and perceptions regarding cervical cancer and screening associated with pap smear uptake in Johannesburg

Abstract

Cervical cancer is a major global public health concern, with 85% of cases occurring in low- and middle-income countries. In South Africa, it is the second most common cancer amongst women. Screening and treatment of cervical cancer precursor lesions is associated with a lower incidence and mortality. This research determines the associations between women’s beliefs about cervical cancer and screening and the uptake of Papanicolaou (Pap) smears in Johannesburg, where cervical screening uptake is suboptimal. Methods: This cross-sectional analytical study applied a validated measurement scale based on the Health Belief Model (HBM), to describe health beliefs regarding cervical cancer and screening uptake using an interviewer-administered questionnaire among 280 women aged 30 years and older attending Johannesburg primary healthcare facilities in 2017. Logistic regression models with robust estimation of variance were fitted to identify health beliefs associated with ever having had a Pap smear (screening uptake), while controlling for potential confounders. Results: Of the 280 women, 177 (63.2%) had ever been screened, 180 (64.3%) were never married, 199 (71.1%) attained secondary education and 133 (47.5%) were employed full time. The multivariable logistic regression showed that the health beliefs associated with Pap smear uptake were perceived severity and perceived barriers. Women of older age (AOR=1.6 for a 5-year increase in age; CI: 1.3-1.9, P<0.001), with higher knowledge scores (AOR=2.5 for a 5-point increase in knowledge score; 95% CI:1.0-6.3 ;P=0.051 ), with lower perceived barriers scores (AOR =0.4 for a 5-point increase in barriers score; 95% CI:0.3-0.5; P<0.001) and higher perceived severity scores (AOR=1.3 for a 5-point increase in severity score; 95% CI:1.0-1.6; P=0.017) were more likely to have had a Pap smear. Conclusions: This study shows that women who take up screening are older, knowledgeable regarding cervical cancer and screening, less likely to perceive screening barriers, and more likely to perceive cervical cancer as a severe disease. This highlights that for public health interventions to increase screening uptake, the focus should include tailored behaviour change communication strategies that addresses women’s beliefs regarding screening barriers and emphasize the severity of cervical cancer.