Screening Behaviors Of Cervical Cancer Among Fertile Women:An Application Of The Protection Motivation Theory

Purpose:To investigate cervical cancer screening and its related cognitive factors with an application of the protection motivation theory among fertile women and further explore the factors associated with standard screening behavior,which can help make reasonable forecasts and estimation cervical cancer screening intention and screening behavior,guiding health management behavior in reality.Method:From December 1st.2016 to December 31st.2016,we enrolled 328 fertile women who participated in regular health examinations in a public tertiary hospital in Jinan.Data were selected on general information,cervical cancer screening knowledge,protectionmotivation factors,cervical cancer screening intention and behavior.SPSS 21.0 were used to conduct the quantitative analysis of sample data,including statistical description,single factor analysis,Pearson correlation analysis,multiple linear regression analysis,Logistic regression analysis,which can help identify the factors influencing on cervical cancerscreening intention and behavior level.Results1.The cervical cancer screening intention rate(85.97%)among fertile women was relatively high level,but the screening behavior rate(37.80%)was relatively low.Furthermore,the overall cervical cancer screening compliance rate(30.49%)among fertile women is also relatively low.2.The cervical cancer screening intention increased with increasing age.Compared to fertile women without spouse,those with spouse had stronger cervical cancer screening intention.Fertile women with 1 child had stronger cervical cancer screening intention than both those without child and those with 2 or more children.Fertile women had 1-2 pregnancies reported stronger cervical cancer screening intention than both those without pregnancy and those with more than 2 pregnancies.The screening intention level of fertile women with 2 or more sexual partners tend to decrease compared to those with 1 sexual partner.Fertile women with doctor’s advice on screening had stronger cervical cancer screening intention than those without doctor’s advice.3.An increasing age,higher income,late first sexual intercourse,having spouse were associated with more cervical cancer screening times.Fertile women with one child had more cervical cancer screening times than both those without child and those with 2 or more children.Fertile women had 1-2 pregnancies reported more cervical cancer screening times than both those had 0 pregnancy and those had 3 or more pregnancies.Fertile women with 2 or more sexual partners had less cervical cancer screening times than those with 1 sexual partner.Fertile women with doctor’s advice on screening had more cervical cancer screening times than those without doctor’s advice.4.There were moderate correlations between cervical cancer screening intention and self-efficacy(r=0.520,P<0.01),response efficacy(r=0.497,P<0.01),and vulnerability(r=0.411,P<0.01);there were weak correlations between cervical cancer screening intention and the cervical cancer screening knowledge level,perceived severity,internal rewards,extrinsic rewards,and response cost(r=-0.268-0.350,P<0.01).The correlation between cervical cancer screening behavior and self-efficacy(r=0.607,P<0.01)was high;the correlations between cervical cancer screening behavior and response cost,behavioral intention,extrinsic rewards,and perceived severity(r=-O.570-0.435,P<0.01)were moderate;the correlations between cervical cancer screening behavior and the cervical cancer screening knowledge level,vulnerability,response efficacy,as well as internal rewards(r=-0.251-0.295,P<0.01)were weak.5.Results from multiple regression analyses showed that self-efficacy(β=0.383,P<0.01),response efficacy(β=0.323,P<0.01),vulnerability(β=0.187,P<0.01),and perceived severity(β=0.168,P<0.01)were the main protection motivation factors of cervical cancer screening intention;self-efficacy(β=0.271,P<0.01),response cos(β=-0.252,P<0.01)t,behavioral intention(β=0.170,P<0.01),perceived severity(β=0.103,P<0.05),and extrinsic rewards(β=-0.101,P<0.05)were the main protection motivation factors of cervical cancer screening behavior;vulnerability(OR=1.207,P<0.01),self-efficacy(OR=1.144,P<0.01),and perceived severity(OR=1.131,P<0.05)were the main contributors of cervical cancer screening compliance rate,and response cost(OR=0.761,P<0.01)was the main barrier.Conclusions1.The cervical cancer screening intention level among fertile women was high,but the cervical cancer screening behavior level and the compliance rate were low.2.The cervical cancer screening intention was associated with age,marital status,number of children,pregnancies and sexual partners,and doctor’s advice on screening.Compared to the cervical cancer screening intention,the cervical cancer screening behavior was associated with more social demographic factors,including age,marital status,income,number of children,pregnancies and sexual partners,age at first sexual intercourse,and doctor’s advice on screening.3.Both cervical cancer screening intention and screening behavior were correlated with the cervical cancer screening knowledge level as well as the protection motivation factors.Thecorrelations between cervical cancer screening intention and self-efficacy,response efficacy,and vulnerability were relatively high;the correlation between cervical cancerscreening behavior and self-efficacy,response cost,behavioral intention,extrinsic rewards,and perceived severity were relatively high.4.The formation mechanism of cervical cancer screening intention and behavior was explained primely by using protection motivation theory:influenced by different protection motivation factors,individuals’ expression levels on cervical cancer screening intention and screening behavior vary greatly.During the behavior intention stage,individuals are mainly guided by positive protection motivation factors(self-efficacy,response efficacy,vulnerability,and perceived severity);during the behavior stage,individuals are mainly guided by both positive(self-efficacy,vulnerability,and perceived severity)and negative(response cost and extrinsic rewards)protection motivation factors.