Increasing cervical cancer screening in Iran: effectiveness of a theory-based educational intervention.

PURPOSE OF STUDY: The high mortality rate of cervical cancer in developing countries is mainly related to inefficient screening programs. The aim of the present study was, thus, to determine the effect of an educational intervention based on BASNEF (Belief, Attitudes, Subjective Norms, and Enabling Factors) model on increasing the rate of cervical cancer screening (CCS) in Bandar Deir in the south of Iran. METHODS: A quasi-experimental educational intervention was made with 202 women participants (101 in the intervention group (IG) and 101 in the control group (CG)) in 2019-20. The sampling was convenience in type. The data were collected using a reliable and valid tripartite questionnaire (demographic information, knowledge, BASNEF constructs). A total number of 14 training sessions were held each taking 60 min, at two levels, personal and interpersonal (for family members, health workers and healthcare givers). Finally, there was a three-month follow-up held in December 2021. RESULTS: After the training, a statistically significant difference was found between the IG and CG in all model constructs (p < 0.001). Before the intervention, in the IG, the personal health score was 4.35 ± 2.52, which was increased to 5.25 ± 0.753 after the training (p < 0.001). However, in the CG, the difference was not statistically significant (p < 0.030). 63.4% of women in the IG and 32.7% in the CG performed the CCS and the between-group difference was statistically significant (p < 0.001). Attitude, enabling factors and behavioral intention were the main predictors of CCS. CONCLUSION: The present findings showed though the training intervention based on the BASNEF model had limited resources and was run in a short time, it managed to motivate women to perform the CCS. It could maximally remove barriers at both personal and interpersonal levels and suggest strategies in the light of these barriers to achieve a successful screening program.

Cervical cancer is the fourth most prevalent fatal cancer among women on a global scale, and is one of the few cancers that can be prevented through screening. The high mortality rate of cervical cancer in developing countries, including Iran, has been largely attributed to inefficient screening programs. In developing countries cervical cancer screening programs are far from qualified. Yet, theory-based educational interventions can play an important role in promoting CCS behavior. Therefore, the present study was designed to determine the effect of an educational intervention based on the Beliefs, Attitudes, Subjective Norms and Enabling Factors (BASNEF model on increasing CCS in women in the south of Iran. BASNEF model includes beliefs about behavioral outcomes, attitudes toward behavior, subjective norms and enabling factors. The most significant construct in BASNEF model is the behavior change. Beliefs and attitudes are influenced by culture, values, traditions, education, media, and personal experiences. Subjective norms include family, society, social media, and peer pressure. Enabling factors include income, women's status, time, and skills. This model can be proposed as a new educational method. A quasi-experimental two-group (pretest­posttest) study was conducted in 2019­2020 on 202 women (101 in the intervention group, and 101 in the control group). In the intervention group, 14 training sessions (10 at the personal level and 4 at the interpersonal level) were held between 40 and 60 min' long. In the control group, 1 training session was held in 6 groups of 15­20. It was 60 min' long. The follow-up was held three months after the intervention. The results showed that the educational intervention, by affecting the BASNEF constructs, significantly affected women's CCS behavior. Maximizing barriers at both personal and interpersonal levels and suggesting strategies based on these barriers can help achieve a successful screening program. In particular, we call for the implementation of goal-oriented training programs according to health education and health promotion models to increase the rate of CCS behavior.

Determinants factors to Pap smear screening among married women in a city of South Iran: applying the BASNEF model.

BACKGROUND: Cervical cancer is known to be preventable because of the long pre-invasion period and the availability of appropriate screening methods. Pap smear is a selective screening approach, which is not taken seriously enough by many women. METHODS: This cross-sectional, descriptive, analytical study was performed using electronic health records of 202 women visiting the health centers chosen through the systematic sampling method. The data collection tool contained items on demographic information, awareness regarding cervical cancer, and the beliefs, attitudes, subjective norms, and enabling factors (BASNEF) model constructs. Data were analyzed using the linear regression analysis, logistic regression, and multivariate regression analysis with backward selection in SPSS, version 18. RESULTS: Based on the results, more than half of the women had never had a Pap smear test. Of the 202 women, only 14.8% had repeated the Pap smear test at the standard interval. Attitudes and subjective norms predicted the intention to have a Pap smear test among the eligible women. Overall, 10% of the changes in behavioral intention were explained by attitudes and subjective norms. In the BASNEF model, the behavioral intention was one of the most important factors that affected compliance with the Pap smear test among the eligible women. CONCLUSION: Based on the results of this study, it is possible to improve screening behaviors among women through proper planning to increase awareness and improve attitudes, subjective norms, enabling factors, and behavioral intention. Pap smear plays an important role in controlling cervical cancer.