Cognitive Factors and Health Literacy as Determinants of Pap smear Screening among Married Women: A Cross-sectional Study

Articles in Press

Document Type : Original Article

Authors

1 Department of Health and Basic Sciences, Sarab Faculty of Medical Sciences, Sarab, East Azerbaijan, Iran.

2 Student Research Committee, Department of Health and Basic Sciences, Sarab Faculty of Medical Sciences, Sarab, East Azerbaijan, Iran.

3 Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

4 Department of Health and Basic Sciences, Sarab Faculty of Medical Sciences, Sarab, East Azerbaijan, Iran

Abstract

Background and Objectives: Pap smear screening is one of the most effective methods for the early diagnosis of cervical cancer in women, thereby preventing complications. Hence, this research aimed to investigate cognitive factors and health literacy as determinants of Pap smear screening among married women.

Materials and Methods: This cross-sectional research was conducted between June to October 2023 in Sarab, Iran. Multistage cluster sampling was used to recruitment of 259 participants. The inclusion criteria were women who were not pregnant, had been married for at least three years and had given their consent to participate in this study. The city of Sarab includes four health centers, each of which was considered as a cluster. To measure the data, valid and reliable instruments of Health Literacy (HL) for Iranian Adults (HELIA), Perceived barriers and Self-efficacy as cognitive factors were used. P-value less than 0.05 was considered significant.

Results: According to the results, significant differences in the Pap smear screening behavior by age groups (p-value < 0.001), history of urinary infection (p-value < 0.001) and number of children (p-value = 0.020). The differences in Pap smear screening by perceived barriers as cognitive factor was statistically significant (p-value < 0.001). Logistic regression analysis showed two variables with significant odds ratios. The participants who perceived fewer barriers (OR= 0.867; 95% CI = 0.819, 0.917), and higher level of self-efficacy (OR= 0.941; 95% CI= 890, 0.995) to perform the test were more likely to have a Pap smear screening in the previous three years. 

Conclusion: According to the results, it is suggested to health care providers focus on these factors to design the intervention programs in health centers in order to Pap smear screening behavior for married women based on cognitive factors including perceived barriers, self-efficacy and HL

Keywords

Acknowledgments: The authors acknowledge the support of Sarab Faculty of Medical Sciences and thank all women and staff of the healthcare service centers (HSCs) for providing valuable data.


Availability of data and materials: The datasets used or analyzed during the current study available from the corresponding author on reasonable request.


Conflict of interest: The authors declare no competing interests.


Consent for publication: Not applicable.


Ethics approval and consent to participate: The present study was conducted in terms of the principles of the revised Declaration of Helsinki, which is a statement of ethical principles that directs physicians and other participants in medical research involving human subjects. The participants were assured about their anonymity and confidentiality of their information. Moreover, the Ethics Committee of the Sarab Faculty of Medical Sciences (Ethics Code: IR.SARAB.REC.1402.003) approved this research. Written consent was obtained from the participants. All methods were performed in accordance with the relevant guidelines and regulations, and all the research methods met the ethical guidelines described in the Declaration of Helsinki.


Funding: No founding.


Author’ contributions: Substantial contributions to the conception or design of the work or the acquisition, analysis, or interpretation of data for the work: Towhid Babazadeh. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Madineh Abbasi. Drafting the work or reviewing it critically for important intellectual content and final approval of the version to be published: Soheila Ranjbaran. 

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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Available Online from 07 October 2025

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