Abstract
Globally, cervical cancer is the fourth leading cause of death among women. While overall cervical cancer rates have decreased over the last few decades, minority women continue to be disproportionately affected compared to White women. Given the paucity of theory-based interventions to promote Pap smear tests among minority women, this cross-sectional study attempts to examine the correlates of cervical cancer screening by Pap test using the Multi-theory Model (MTM) as a theoretical paradigm among minority women in the United States (U.S.). Structural Equation Modelling (SEM) was done for testing the construct validity of the survey instrument. Data were analyzed through bivariate and multivariate tests. In a sample of 364 minority women, nearly 31% (n = 112) of women reported not having received a Pap test within the past three years compared to the national rate (20.8%) for all women. The MTM constructs of participatory dialogue, behavioral confidence, and changes in the physical environment explained a substantial proportion of variance (49.5%) in starting the behavior of getting Pap tests, while the constructs of emotional transformation, practice for change, and changes in the social environment, along with lack of health insurance and annual household income of less than $25,000, significantly explained the variance (73.6%) of the likelihood to sustain the Pap test behavior of getting it every three years. Among those who have had a Pap smear (n = 252), healthcare insurance, emotional transformation, practice for change, and changes in the social environment predicted nearly 83.3% of the variance in sustaining Pap smear test uptake behavior (adjusted R2 = 0.833, F = 45.254, p < 0.001). This study validates the need for health promotion interventions based on MTM to be implemented to address the disparities of lower cervical cancer screenings among minority women.
Highlights
Cervical cancer is the fourth leading cause of death in the world among women [1].It was estimated that, worldwide, 570,000 women were diagnosed with cervical cancer and approximately 311,000 women died due to cervical cancer in 2018 [1]
All three constructs of Multi-theory Model (MTM), namely participatory dialogue, behavioral confidence, and changes in the physical environment, were significantly associated with the intent to initiate cervical cancer screening among women who had not received a Pap test over the past three years and together they accounted for 49.5% of the variance in explaining the dependent variable
Our study found that educational tools, such as motivation through participatory dialogue, in which advantages of getting a Pap test and building the behavioral confidence of minority women are attributed, when coupled with changes in the physical environment, such as availability and accessibility of Pap test, can contribute substantially to women’s ability to start getting the Pap test at regularly prescribed intervals
Summary
Cervical cancer is the fourth leading cause of death in the world among women [1].It was estimated that, worldwide, 570,000 women were diagnosed with cervical cancer and approximately 311,000 women died due to cervical cancer in 2018 [1]. While there has been a decrease in cervical cancer mortality in the United States (U.S.), approximately 13,800 women are diagnosed and approximately 4290 women die per year [2,3]. These rates have decreased over the past few decades, yet cervical cancer disparities in the U.S continue to affect minority women, (i.e., women who are not of White/European heritage such as African American, Hispanic/Latino, Asian American, Pacific Islander, American Indian, etc.) [4]. The Papanicolaou (Pap) test is an effective cervical cancer screening tool to decrease the rates of cervical cancer [5]. Rates of cervical cancer screening (Pap testing) in the U.S were
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