The application of health behavior theories to promote cervical cancer screening uptake
Open accessAbstract
Background: While cervical cancer is a major cause of mortality, its progress and survival rate can be improved through screening. Yet despite their wide availability, women's participation in cervical cancer screening (CCS) programs is often suboptimal, especially in low‐ and middle‐income countries. Besides demographic and organizational characteristics, screening uptake is influenced by psychological factors, most of which are included in health behavior theories. This systematic review compared different health behavior theories in terms of their capacity to explain CCS uptake and inform CCS promotion campaigns. Methods: A comprehensive search and analysis of published intervention and non‐intervention (observational) studies that applied at least one health behavior theory to CCS participation. Results: After quality screening, 48 observational and 21 intervention studies were identified that applied the Health Belief Model (HBM), Theory of Reasoned Action (TRA), Theory of Planned Behaviour (TPB), Transtheoretical model (TTM), Social‐ecological Model (SEM), and/or Theory of Triadic Influence (TTI) to CCS. The HBM was most frequently used to explain behavior, whereas the TPB was better at explaining screening intentions. Tailored intervention studies focusing on all theoretical constructs were most effective in modifying perceptions and increasing CCS uptake. Conclusions: Despite their inconsistent use, health behavior theories can explain CCS intentions and behavior and contribute to the development of targeted interventions to promote screening uptake.
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Not all studies have found differences in self-efficacy between screened and unscreened groups for CC.
“However, not all studies have found differences in self-efficacy between screened and unscreened groups for CC [11].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [11]
In systematic reviews, perceived control in personal health choices and high self-efficacy to attend screening are positively associated with screening.
“In systematic reviews, perceived control in personal health choices and high self-efficacy to attend screening have been positively associated with screening [7,10,11,14].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [11]
In a systematic review comparing different health behaviour models, knowledge was not associated with screening for cervical cancer.
“in a systematic review comparing different health behaviour models, knowledge was not associated with screening for CC [11].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [11]
Higher perceived susceptibility is associated with screening attendance.
“Higher perceived susceptibility and seriousness of the disease, and personal vulnerability have been associated with screening attendance [11,17,20,21].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [11]
Higher perceived seriousness of the disease is associated with screening attendance.
“Higher perceived susceptibility and seriousness of the disease, and personal vulnerability have been associated with screening attendance [11,17,20,21].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [11]
Perceived benefits such as reassurance of not having cancer or detecting cancer at a treatable stage are positively related to cancer screening.
“Perceived benefits such as reassurance of not having cancer or detecting cancer at a treatable stage have been positively related to cancer screening [8,11,14,17,20].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [11]
Positive attitudes towards cancer screening are associated with increased BC and CC screening.
“In systematic reviews comparing different health behaviour theory constructs, positive attitudes towards cancer screening have been associated with increased BC and CC screening [11,14].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [11]
The odds of getting screened for CC were OR 1.8 compared to those with no intention.
“The odds of getting screened for CC were OR 1.8 [11] and OR 1.72 for BC [14] compared to those with no intention.”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [11]
Personal vulnerability is associated with screening attendance.
“Higher perceived susceptibility and seriousness of the disease, and personal vulnerability have been associated with screening attendance [11,17,20,21].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [11]
In a systematic review of behavioural theory-based interventions to increase CC screening, involving women in discussions, using films and multiple audio-visual aids, and using self-learning materials were effective.
“According to a systematic review of behavioural theory-based interventions to increase CC screening, involving women in discussions, using films and multiple audio-visual aids and using self-learning materials were effective [11].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [11]
Using culturally sensitive imagery has increased effectiveness.
“Also, using culturally sensitive imagery has increased effectiveness [11].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [11]
These prompts also increased CC and BC screening.
“These prompts also increased CC [11] and BC screening [57].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [11]
Social supports facilitate self-efficacy, which in turn is associated with screening attendance.
“Such supports are important because they facilitate self-efficacy, which in turn is associated with screening attendance [7,10,11,14].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [11]
Giving information on the nearest screening facility and providing assistance to reach the screening location has increased CC screening rates.
“Giving information on the nearest screening facility and providing assistance to reach the screening location has increased CC screening rates [11].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [11]
Interventions can enhance the perceived susceptibility and severity of CC through providing detailed information about anatomy of the cervix and the cause, symptoms and risk factors of CC.
“Interventions can enhance the perceived susceptibility and severity of CC through providing detailed information about anatomy of the cervix and the cause, symptoms and risk factors of CC [11].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [11]
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- Authors
- Dsouza, J. P., Van den Broucke, S., Pattanshetty, S., & Dhoore, W.
- Affiliations
- UCLouvain (BE)
- Faculty of Psychology and Educational Sciences Université Catholique de Louvain Louvain Belgium
- Manipal Academy of Higher Education (IN)
- Faculty of Public Health Université Catholique de Louvain Louvain Belgium
- Corresponding author
- Dsouza, Jyoshma Preema
- Venue
- Public Health Nursing
- Publisher
- Wiley
- Published
- 2021-07-07
- Volume
- 38
- Issue
- 6
- Pages
- 1039-1079
- ISSN
- 0737-1209 (ISSN-L)
- 1525-1446
- OpenAlex
- W3181815887
- Cited by
- 27
- References
- 102
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 8 · 2023: 1 · 2022: 3
- FWCI
- 0.53
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Public Health Nursing (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Libraries (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Keywords
- cervical cancer screening, screening uptake, health behavior theory, Health Belief Model, theory of reasoned action, theory of planned behavior, transtheoretical model, socio-ecological model, Theory of Triadic Influence, personalized interventions, screening intention, low- and middle-income countries
- MeSH terms
- Uterine Cervical Neoplasms, Female, Humans, Mass Screening, Health Behavior, Intention, Early Detection of Cancer
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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