| Objective:Cervical cancer is one of the most common reproductive malignant tumor,and cervical cancer screening is proved to be an effective method for reducing the incidence and mortality of cervical cancer.Despite the significance of cervical cancer screening,motivating more rural women to participate remains a challenge in resource-limited settings.In this study,we tested the protection motivation theory(PMT)in investigating the cognition situation about cervical cancer and predicting screening intentions.For do this we can provide references for further cervical cancer prevention in the countryside of China.Methods:Participants were women from Wufeng,a typical rural county in China.Participants(n=3000)with no cervical cancer history were recruited from 10 randomly selected villages via cluster random sampling method.The questionnaire included the demographic factors,cognition of cervical cancer,requirements and barriers about screening.Also,as mediating variables,six PMT constructs(Perceived Risk,Fear Arousal,Perceived Severity,Response Efficacy,Response Cost and Self-Efficacy)were measured using the standardized questionnaire.Structural equation modeling(SEM)method was employed to test PMT-based prediction models.Results:(1)Totally 3000 people with 35-65 years old were completed the questionnaire survey and 2972(99.07%)were incorporated into the group with screening intention.2895 women(96.50%)among respondents were married and primary school or below was 49.67%.2366 participants(78.86%)were farmers and 69.33%were less than 30,000 in annual income last year.Also,women with high annual income were more likely to have the positive intention of cervical cancer screening(P<0.05).(2)The cognition about cervical cancer with screening intention group was higher than no-screening intention group and the difference was significant(P<0.05).In 9 items about cervical cancer screening,the highest accuracy item was "attending cervical cancer screening regularly can reduce the risk of cervical cancer"(57.90%),the lowest accuracy item was "women with only one sex partner does not need to be screened for cervical cancer"(4.33%).In 11 items about cervical cancer risk factors,the highest accuracy item was menopause(30.17%),the lowest accuracy item was HPV infection(6.43%).(3)The respondents were mainly informed by village doctors or superior hospitals to obtain information of screening(87.43%).They will attend screening in maternal and child health care centers(47.90%)and comprehensive hospitals(31.60%)mainly.The top three most concerned questions were "whether the technology is effective(72.23%)","whether the technology is safe(32.17%)" and "whether the process is painful(20.80%)"."more health promotion education(73.90%)","superior organization requirements(37.00%)","some people attend first(17.00%)" were the top three prompt ways of screening."Do not know the benefits of cervical cancer screening"(37.30%),"Too far away from home or no time"(14.63%)and "No symptoms"(13.13%)were the top three barriers of cervical cancer screening.(4)There were 2202 respondents who had heard of cervical cancer screening(73.40%).And 2877 subjects had attended cervical cancer screening services in the past three years(95.90%).Women with screening intention had higher previous screening rate than women without screening intention(95.93%VS 92.86%).(5)Results from multivariate analysis showed that the age(OR=0.567),annual income(OR=6.793)and knowledge(OR=4.322)were associated with cervical cancer screening intention.Younger women who had higher annual incomes and higher levels of knowledge were more willing to participate in cervical cancer screening than women without these characteristics.(6)Our data fit the PMT model well(GFI=0.95,AGFI=0.93,CFI=0.90,NFI=0.88,RMSEA= 0.06,SRMR=0.04,Chi-square/df =4.87).Knowledge of screening was directly and positively associated with screening intention.Age,annual income and awareness of and prior experience with screening were significantly associated with screening intention by enhancing cervical cancer risk perception and by reducing response cost(P<0.05 for both).Conclusion:PMT can be used as guidance to investigate cervical cancer screening intentions among rural women in China with focus on cancer knowledge,some demographic factors and awareness of and previous experience with screening.These findings,if verified with longitudinal data,can be used for intervention program development.It is necessary to implement health education focusing on the women in rural areas with poor knowledge of cervical cancer in order to elevate women's perceptions of support for screening.We should provide free convenient screening services and health knowledge training for rural women.At the same time,we can improve skills of physician and equipment female screening physicians to build a good screening environment. |
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