Screening for Cervical Cancer: An Educational Intervention Based on Transtheoretical Models and Health Belief in Women of Gonabad, Iran

Document Type : Original Article


1 M.Sc. in Health Education and Health Promotion, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.

2 Associate Professor, Department of Public Health and Health Promotion, Social Determinants of Health Research Center, School of Public Health, Gonabad University of Medical Sciences, Gonabad, Iran.

3 Assistant Professor, Department of Social Medicine, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran.

4 Associate Professor, Department of Public Health and Health Promotion, Social Determinants of Health Research Center, School of Public Health, Birjand University of Medical Sciences, Birjand, Iran.


Introduction: Screening for chronic diseases, such as cervical cancer is important in early diagnosis and prevention of the disease in women. Cervical cancer in Iran is the second leading cause of death due to sex-linked cancers. With this background in mind, this study conducted to improve the behavior of Pap smear screening.
Methods: This quasi-experimental study was performed in 2014 on 80 women aged 20-65 years old in Gonabad, Iran with active health records. The subjects were divided into the two groups of experiment and control, each containing 40 participants. The research units were the women at the stages of pre-contemplation, contemplation, preparation, and relapse of the transtheoretical model and did not have screening behavior. The test group received constructions based on health belief model toward improving the behavior of Pap smear screening. However, the control group received the regular trainings provided by the personnel in health centers about the behavior of Pap smear screening. A researcher-made questionnaire used to collect the data was completed pre- and three months post-intervention by the subjects. All the data were analyzed by independent t-test, paired t-test, Chi-square, and Fisher's exact test using SPSS version 20. P-value < 0.05 was considered as significant for all tests.
Results: Before the educational intervention in the stages of behavior change, there was no significant difference between the two groups (P > 0.05). However, three months post-intervention, the difference between the experiment and control groups was significant in the stages of change in the Pap smear behavior screening (P < 0.001). Moreover, According to the results of paired t-test, the mean scores of knowledge, motivation for health, severity, benefits, barriers, and perceived self-efficacy in the test group were significantly different pre- and post-intervention (P < 0.05). After the intervention, the performance of Pap smear screening behavior was significantly higher in the experiment group, compared to the control group (P < 0.001).
Conclusion: Findings of this study demonstrated that training the pap smear screening behavior based on the models of health belief and change stages can affect the promotion of Pap smear screening behavior in women.


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