Path Analysis on the Determinants of Pap Smear Uptake in Women of Reproductive Age in Tegal, Central Java
Background: Cervical cancer is a leading cause of cancer-related deaths in women in developing countries. Although Pap smear is known as an effective strategy to reduce the burden of cervical cancer, it is underused in developing countries at around 19%. This study aimed to examine the determinants of Pap smear uptake in women of reproductive age using Health Belief Model (HBM).
Subjects and Method: This was a case-control study conducted in Tegal, Central Java, from October 4 to November 2, 2018. A sample of 200 women of reproductive age was selected by fixed disease sampling. The dependent variable was Pap smear uptake. The independent variables were perceived benefit, susceptibility, seriousness, and threat, cues to action, education, knowledge, and peer support. The data were collected by questionnaire and analyzed by path analysis run on Stata 13.
Results: Pap smear uptake directly increased with stronger perceived threat (b= 1.18; 95% CI= 0.44 to 1.92; p=0.002), stronger perceived benefit (b= 1.40; 95% CI= 0.63 to 2.16; p<0.001), and higher self-efficacy (b= 1.48; 95% CI= 0.73 to 2.24; p<0.001). Pap smear uptake was indirectly affected by perceived susceptibility, perceived seriousness, cues to action, education, knowledge, and peer support.
Conclusion: Pap smear uptake is directly affected by perceived threat, perceived benefit, and self-efficacy. It is indirectly affected by perceived susceptibility, perceived seriousness, cues to action, education, knowledge, and peer support.
Keywords: Pap smear, Health Belief Model, path analysis
Asthana S, Bhambani S, Sodhani P, Gupta S, Satyanarayana L (2014). A comparative study of cervical cancer screening methods in a rural community setting of North India. Indian Journal of Cancer, 51(2), 124. https://doi.org/10.4103/0019509X.138172.
Bayu H, Berhe Y, Mulat A, Alemu A (2016). Cervical cancer screening service uptake and associated factors among age eligible women in Mekelle zone, Northern Ethiopia, 2015: A community based study using health belief model. PLoS ONE, 11(3), 1
Dinkes Kota Tegal (2017). Profil Kesehatan Kota Tegal Tahun 2016. Tegal: Dinas Kesehatan Kota Tegal.
Farooqui M, Hassali MA, Knight A, Shafie AA, Farooqui MA, Saleem F, Haq NU, Aljadhey H (2013). A Qualitative Exploration Of Malaysian Cancer Patients
Glanz K, Rimer BK, Viswanath K (2015). Health behavior and health education: theory, research, and practice. John Wiley & Sons. http://riskybusiness.web.unc.edu/files/2015/01/HealthBehaviorandHealthEducation.pdf.
Idowu A, Olowookere SA, Fagbemi AT, Ogunlaja OA (2016). Determinants of Cervical Cancer Screening Uptake among Women in Ilorin, North Central Nigeria: A CommunityBased Study. Journal of Cancer Epidemiology. https://doi.org/10.1155/2016/6469240.
Jia Y, Li S, Yang R, Zhou H, Xiang Q, Hu T, Feng L (2013). Knowledge about Cervical Cancer and Barriers of Screening Program among Women in Wufeng County, a HighIncidence Region of Cervical Cancer in China. PLoS ONE, 8(7), 2
Karimy M, Azarpira H, Araban M (2017). Using health belief model constructs to examine differences in adherence to pap test recommendations among Iranian Women. Asian Pacific Journal of Cancer Prevention: APJCP, 18(5), 1389
Kasting ML, Wilson S, Zollinger TW, Dixon BE, Stupiansky NW, Zimet GD (2017). Differences in cervical cancer screening knowledge, practices, and beliefs: An examination of survey responses. Preventive Medicine Reports: 169
Komite Penanggulangan Kanker Nasional (2017). Kanker serviks: pedoman nasional pelayanan kedokteran. Jakarta: Kemenkes RI. http://kanker.kemkes.go.id/guidelines/PNPKServiks.pdf
Ma GX, Gao W, Fang CY, Tan Y, Feng Z, Ge S, Nguyen JA (2013). Health Beliefs Associated with Cervical Cancer Screening among Vietnamese Americans. Journal of Women's Health, 22(3): 276-288. https://doi.org/10.1089/jwh.2012.3587
Marlow L, Waller J, Wardle J (2015). Barriers to cervical cancer screening among ethnic minority women: a qualitative study. The Journal of Family Planning and Reproductive Health Care/Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists, 41(4): 248
Ncube B, Bey A, Knight J, Bessler P, Jolly PE (2015). Factors associated with the uptake of cervical cancer screening among women in Portland, Jamaica. North American Journal of Medical Sciences, 7(3), 104
Ndejjo R, Mukama T, Musabyimana A, Musoke D (2016). Uptake of cervical cancer screening and associated factors among women in rural Uganda: A cross sectional study. PLoS ONE, 11(2): 1
Ebu NI, Mupepi SC, Siakwa MP, Sampselle CM (2016). Knowledge, practice, and barriers toward cervical cancer screening in Elmina, Southern Ghana. Int J Womens Health. 24(7):31-9. doi: 10.2147/IJWH.S71797.
Nwobodo H, Ba Break M (2016). Analysis of the determinants of low cervical cancer screening uptake among Nigerian women. Journal of Public Health in Africa, 6(2), 12
Samadi P (2011). Yes, i know everything about kanker serviks!. Jakarta: Tiga Kelana.
Sidabutar S, Martini S, Wahyuni CU (2017). Analysis of factors affecting women of childbearing age to screen using visual inspection with acetic acid. Osong Public Health and Research Perspectives, 8(1): 61
Sulaeman SE (2016). Pembelajaran model dan teori perilaku kesehatan, konsep dan aplikasi. Surakarta: UNS Press.
Wakhidah MS, Hastuti URB, Dewi YLR (2017). The influence of personal factor, husband
Wardhani GK, Mudigdo A, Qadrijati I (2015). Path analysis on the determinants of Pap smear utilization for cervical cancer early detection in women of reproductive age. Journal of Health Promotion and Behavior. 2(4): 359
WHO (2015). Human Papillomavirus (HPV) and cervical cancer fact sheet. Available from: http://www.who.int/mediacentre/factsheets/fs380/en/.