||Intention and Health Beliefs to Undergo Cervical Cancer Screening among Indonesian Women
||Department of Nursing
intention of cervical cancer screening
Background: Cervical cancer is not only the highest prevalence cancer in women, but also a leading mortality in women around the world including Indonesia. Pap smear test is one of the effective screening in reducing the incidence and mortality of cervical cancer cases. Pap smear test has been freely provided to Indonesian women since 2014. It is needed to understand the intention and health beliefs regarding cervical cancer screening among Indonesian women.
Purposes: The purpose of this study was to identify the relationships among demographic factors, health characteristics, health beliefs and the intention to undergo cervical cancer screening among Indonesian women.
Methods: This study was a cross-sectional design. The participants were married women and able to communicate using Indonesian language, regardless their literacy. Health Belief Model Scale for Cervical Cancer and Pap Smear Test (CCPST) was used to measure the health beliefs among Indonesian women. This instrument contained five domains: susceptibility to cervical cancer, perceived severity of cervical cancer, benefits of Pap smear tests, barriers to Pap smear test and health motivation. The intention of cervical cancer screening was measured using one 11-point Likert scale. A median score was used to be a cut-off point to discriminate low and high intention.
Results: A total of 850 women participated in this study. The mean age of the women were 38.8 years (SD = 10.4). Ninety-two percent of the women were married, 27.8% never heard about cervical cancer, and 33.4% never heard about Pap smear test. There were still 82.7% women who have never gotten Pap smear test. The median of 7 was regarded as a cut-off point for discriminating high and low intention, 61.2% (n=520) of the women reported to have a high intention and 38.8% reported to have a low intention of cervical cancer screening. The mean score of the overall health beliefs was 3.16 (SD = 0.44), with the lowest score in perceived susceptibility (mean = 2.23; SD = 0.87), and the highest score in health motivation (mean = 4.23; SD = 0.60). Forward stepwise logistic regression was used to identify the predictive factors of intention to undergo cervical cancer screening. Final logistic regression model of the intention to undergo cervical cancer screening included nine variables: high level of education (OR: 1.86, 95% CI: 1.31 – 2.62), low level of income (OR: 0.43, 95% CI: 0.30 – 0.61), heard about cervical cancer (OR: 2.24, 95% CI: 1.55 – 3.25), never doing Pap smear test (OR: 0.45, 95% CI: 0.28 – 0.72), family history of cervical cancer (OR: 4.34, 95% CI: 1.50 – 12.55), perceived severity (OR: 1.06, 95% CI: 1.03 – 1.10), perceived benefits (OR: 1.03, 95% CI: 1.00 – 1.06), perceived barriers (OR: 0.98, 95% CI: 0.96 – 1.00) and health motivation (OR: 1.02, 95% CI: 1.02 – 1.23). The model explained 24.9% (Nagelkerke R2) of the variance of intention to undergo cervical cancer screening.
Conclusions: The findings of this study indicate that a high intention of cervical cancer screening exists among Indonesian women. Strategies to increase the intention to undergo cervical cancer screening should be introduced to those women who are in low income, who are divorced and widowed, less experience of the Pap smear, deficit awareness of cervical cancer and Pap smear. Health professionals in Indonesia should be responsible for the provision of education about Pap smear test and cervical cancer to improve women’s motivation and benefits regarding Pap smear.
TABLE OF CONTENTS
TABLE OF CONTENTS I
LIST OF TABLES IV
LIST OF FIGURES V
CHAPTER ONE INTRODUCTION 1
1.1 Research Background. 1
1.2 Research Purpose 3
CHAPTER TWO LITERATURE REVIEW 4
2.1 Women’s health and cervical cancer 4
2.2 Cervical cancer screening 7
2.3 Health Belief Model` 10
CHAPTER THREE RESEARCH DESIGN AND METHODOLOGY 15
3.1 Research design and sampling 15
3.2 Research Framework 16
3.3 Instruments 18
3.3.1 Demographic Factors and Health Characteristics 19
3.3.2 Health Belief Model Scale for Cervical Cancer and Pap Smear Test. 19
3.3.3 Intention of Cervical Cancer Screening 20
3.4 Ethical Consideration 21
3.5 Data Collection Procedures 21
3.6 Data Analysis 22
CHAPTER FOUR RESEARCH RESULTS 24
4.1 Demographic Factors and Health Characteristics 24
4.2 Health Beliefs 25
4.3 Intention to Undergo Cervical Cancer Screening 26
4.4 Relationships among Demographic Factors, Health Characteristics and the Health Beliefs 27
Table 4.4 Relationships among Demographic Factors, Health Characteristics and Health Beliefs of the Study Sample (n=850) 27
4.5 Relationships among Demographic Factors, Health Characteristics and the Intention to Undergo Cervical Cancer Screening 32
4.6 Relationships between Health Beliefs and the Intention to Undergo Cervical Cancer Screening 35
4.7 Independent Predictors on the Intention to Undergo Cervical Cancer Screening 36
4.8 Final Logistic Regression Model of the Intention to Undergo Cervical Cancer Screening 38
CHAPTER FIVE DISCUSSION 39
5.1 Discussion 39
5.1.1 Demographic Factors and Health Characteristics 39
5.1.2 Independent Predictors of Intention to Undergo Cervical Cancer Screening 39
5.1.3 Multiple Logistic Regression of Intention to Undergo Cervical Cancer Screening 43
5.2 Limitations 44
5.3 Research Implications 44
5.4 Conclusion 45
Appendix 1: Demographic Questionnaire 56
Appendix 2: Health Belief Model Scale for Cervical Cancer and Pap Smear Test 58
Appendix 3: Intention of Cervical Cancer Screening Outcome 61
Intention of Cervical Cancer Screening 61
Appendix 4: Health Belief Model Scale for Cervical Cancer and Pap Smear Test Permission 62
Appendix 5: Health Belief Model Scale for Cervical Cancer and Pap Smear Test (Forward Translation) 64
Appendix 6: Informed Consent 68
Appendix 7: Ethical Clearance Approval 70
Appendix 8: Research Permission Approval Document 71
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