Assessing the Relationship Between Motherhood and Cervical Cancer Screening and Prevention Behaviors.

Abstract

Background: National guidelines recommend Papanicolaou (Pap) testing and human papillomavirus (HPV) vaccination for cervical cancer prevention; however, certain subgroups may be at risk for underutilization. Prior studies have identified motherhood as a predictor of health outcomes, but this research has not been extended to cervical cancer prevention. Informed by the Health Belief Model, we explored the relationship between motherhood, health beliefs, and Pap testing and HPV vaccination. Methods: This study used an observational, cross-sectional design. Participants assigned female at birth (N = 417) completed an online survey assessing motherhood, health beliefs (perceived risk, perceived benefits, perceived barriers, and self-efficacy), and prior Pap testing and HPV vaccination. Bootstrapped mediation analyses determined whether motherhood was associated with prior Pap testing and HPV vaccination and whether health beliefs mediated these relationships. Results: Of mothers (25%), 75% were up-to-date with Pap testing and 36% had previously received ≥1 dose of the HPV vaccine. There was no direct effect of motherhood on Pap testing (p = 0.873) or HPV vaccination (p = 0.921) and no significant indirect effects via health beliefs (ps ≥ 0.096). However, perceived benefits and self-efficacy were significantly related to both Pap testing (ps ≤ 0.003) and HPV vaccination (ps ≤ 0.010). Mothers reported lower self-efficacy for HPV vaccination than nonmothers (p = 0.035). Discussion: Consistent with nationwide statistics, most eligible participants were up-to-date with Pap testing and HPV vaccination. Although motherhood was not significantly associated with either behavior, mothers reported lower self-efficacy for HPV vaccination. Perceived benefits and self-efficacy may be important targets for future interventions aiming to increase cervical cancer prevention and screening behaviors.