Background In line with the World Health Organization’s elimination targets, HPV‑DNA-based cervical cancer screening is the standard; however, screening uptake remains suboptimal in many settings. To assess, in a centre implementing Türkiye’s national cancer screening standards, the relationship between women’s screening status and a Health Belief Model (HBM)-based, 19‑item attitude scale; and to provide clear, practice‑oriented findings on screening behaviour. Methods In a case-control design, women aged 30-65 years were studied (November-December 2024). A total of 210 participants (1:1 screened vs. not screened) were included. The HBM‑based scale and sociodemographic variables were administered. Chi‑square tests were used for categorical variables and Mann-Whitney U tests for continuous variables. Scale scores were dichotomised at the median (low/high), and unadjusted odds ratios (ORs) were calculated from 2 × 2 tables; multivariable logistic regression was additionally used to estimate adjusted odds ratios (aORs) controlling for age, education, marital status, employment, and perceived income (two-sided p < 0.05). Results Scale scores were significantly higher among women who had undergone screening [median (IQR)]: perceived severity 22(4) (p < 0.001, r = 0.339), perceived susceptibility 12(7) (p < 0.001, r = 0.314), perceived barriers/self-efficacy 17(3) (p < 0.001, r = 0.355), perceived benefits 19(4) (p = 0.03, r = 0.176), and total score 71(9) (p < 0.001, r = 0.483). Women with low scores had higher odds of not being screened: severity OR = 3.04, susceptibility OR = 3.33, barriers/self‑efficacy OR = 2.86, total score OR = 4.41 (all p < 0.001); benefits OR = 1.17 (not significant, p = 0.68). Associations remained significant after adjustment for sociodemographic characteristics: low total HBM score aOR = 4.50 (2.46-8.26, p < 0.001); low perceived severity aOR = 3.73, low perceived susceptibility aOR = 4.92, low perceived barriers/self-efficacy aOR = 3.10 (all p < 0.01). Conclusion The HBM‑based attitude scale indicates that perceived threat (severity, susceptibility) and barriers/self‑efficacy are strongly associated with women’s screening behaviour; the total belief score discriminates better than individual subscales. Findings support culturally sensitive communication and service arrangements focused on reducing barriers and enhancing self‑efficacy to improve screening participation.

Health belief model-based determinants of women’s participation in cervical cancer screening: a case-control study from Southeastern Turkey

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2026年5月30日

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Ufuk Acar,
Feyyaz Barlas,
Burcu Beyazgul,
Ibrahim Koruk

摘要

Background

In line with the World Health Organization’s elimination targets, HPV‑DNA-based cervical cancer screening is the standard; however, screening uptake remains suboptimal in many settings. To assess, in a centre implementing Türkiye’s national cancer screening standards, the relationship between women’s screening status and a Health Belief Model (HBM)-based, 19‑item attitude scale; and to provide clear, practice‑oriented findings on screening behaviour.

Methods

In a case-control design, women aged 30-65 years were studied (November-December 2024). A total of 210 participants (1:1 screened vs. not screened) were included. The HBM‑based scale and sociodemographic variables were administered. Chi‑square tests were used for categorical variables and Mann-Whitney U tests for continuous variables. Scale scores were dichotomised at the median (low/high), and unadjusted odds ratios (ORs) were calculated from 2 × 2 tables; multivariable logistic regression was additionally used to estimate adjusted odds ratios (aORs) controlling for age, education, marital status, employment, and perceived income (two-sided p < 0.05).

Results

Scale scores were significantly higher among women who had undergone screening [median (IQR)]: perceived severity 22(4) (p < 0.001, r = 0.339), perceived susceptibility 12(7) (p < 0.001, r = 0.314), perceived barriers/self-efficacy 17(3) (p < 0.001, r = 0.355), perceived benefits 19(4) (p = 0.03, r = 0.176), and total score 71(9) (p < 0.001, r = 0.483). Women with low scores had higher odds of not being screened: severity OR = 3.04, susceptibility OR = 3.33, barriers/self‑efficacy OR = 2.86, total score OR = 4.41 (all p < 0.001); benefits OR = 1.17 (not significant, p = 0.68). Associations remained significant after adjustment for sociodemographic characteristics: low total HBM score aOR = 4.50 (2.46-8.26, p < 0.001); low perceived severity aOR = 3.73, low perceived susceptibility aOR = 4.92, low perceived barriers/self-efficacy aOR = 3.10 (all p < 0.01).

Conclusion

The HBM‑based attitude scale indicates that perceived threat (severity, susceptibility) and barriers/self‑efficacy are strongly associated with women’s screening behaviour; the total belief score discriminates better than individual subscales. Findings support culturally sensitive communication and service arrangements focused on reducing barriers and enhancing self‑efficacy to improve screening participation.