Abstract
We used the Theory of Planned Behavior (TPB) to analyze the role of attitudes, subjective norms, and perceived behavioral control as predictors of intentions to obtain Human Papillomavirus (HPV) vaccinations or a Papanicolaou (Pap) smear in a sample of young Singaporean women. A further aim was to evaluate knowledge of cervical cancer and preventive measures as a possible additional predictor of intentions. A purpose-designed TPB and knowledge questionnaire was completed by 206 women aged 18 to 26 years living in Singapore. Descriptive analyses and structural equation modeling revealed subjective norm as the best predictor, while perceived behavioral control had moderate predictive power. Attitude and knowledge were not significant predictors of intentions. The findings suggest the importance of focusing on subjective norms, rather than factual knowledge, in educational and awareness campaigns that encourage HPV vaccination and Pap smear screening in Singapore.
Highlights
In Singapore, cervical cancer is the fourth most frequent cancer among young women (15-44 years) with annual incidence rates of 11.5 per 100,000 women (Bruni et al, 2014)
The aim of the current study was to assess the relative impact of the predictive factors of attitude, subjective norm, and perceived behavioral control under a single theoretical framework of Theory of Planned Behavior (TPB), as well as evaluating the impact of the addition of the knowledge construct to the TPB model
This study investigated the predictors of the intentions of young 18- to 26-year-old Singaporean women to utilize Human Papillomavirus (HPV) vaccination and Pap smear preventive measures
Summary
In Singapore, cervical cancer is the fourth most frequent cancer among young women (15-44 years) with annual incidence rates of 11.5 per 100,000 women (Bruni et al, 2014). A Pap smear test is recommended once every 3 years for Singaporean women who are above 25 years and sexually active (Health Promotions Board, 2014). Socio-cultural influences in Singapore, such as Chinese ethnicity and lower educational level, are believed to contribute to increased risk of cervical cancer development (Bruni et al, 2014). In response to this increased risk, ongoing public education and social marketing programs in Singapore have introduced initiatives such as vaccination subsidies and free Pap smears for females aged 25 to 69 years. In terms of self-efficacy, women reported lack of accessibility to a regular family doctor (Bish, Sutton, & Golombok, 2000), time constraints due to work (Markovic, Kesic, Topic, & Matejic, 2005), and affordability concerns that limit their belief in their own ability to access prevention services (Taylor et al, 2002)
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