Low Level of Awareness among Iranian Women Concerning Cervical Cancer and Screening: the Role of Knowledge, Risk Perceptions and Cues to Action

BackgroundIran has a low incidence of, but a higher rate of death from, cervical cancer (CC). The country is in the process of implementing an organized screening program including HPV testing and cytology. Studies show high drop-out in continued testing among eligible women. This qualitative study aimed to explore women’s awareness regarding CC and CC testing, and the role of knowledge, perceived risk and cues to action in this process.MethodsWe recruited 81 women aged between 25-65 years, who participated in 15 focus group discussions (FGDs) and two in-depth interviews in Tehran, the capital of Iran. Data were acquired through 11 open-ended questions and 32 related probe questions. All interviews were transcribed and independently analyzed by two researchers (Kappa and agreement testing respectively: 0.77, 97.11%).ResultsCoded texts were categorized under three themes and 13 subthemes. The three thematic areas referred to knowledge, cues to action and perceived risks regarding cervical cancer and screening. Results showed that women had inadequate and unspecified knowledge about cervical cancer and screening, compounded by misconceptions regarding infection and cancer prevention measures. Social and cultural barriers hindered proper communication between health system/providers and clients, and within communities on subjects related to cervical cancer and screening. Perceived risk of getting CC was low due to insufficient knowledge regarding the causes of cancer, difficulty in differentiating between cancer and sexually transmitted infections, and the absence of visible symptoms.ConclusionsThe results indicate a strong need to invest more efforts to improve health education and communication in the current national health program to promote awareness of the need to screen for CC, through, for example, establishing correct knowledge and risk perceptions among women. In addition, this intervention should address women’s social environment in order to prevent misconceptions being communicated to women.