Understanding Cervical Cancer Screening Attendance: Barriers and Facilitators in a Representative Population Survey

Background/Objectives: Cervical cancer causes high mortality rates globally despite the existence of cervical cancer screening. The purpose of this study is to investigate the factors limiting Romanian women's participation in cervical cancer screening, focusing on socio-demographic characteristics, health practices, sexual history, and personal health views. Methods: A cross-sectional study was conducted with a representative sample of 1605 women aged 25 to 64 from all regions of Romania. Computer-Assisted Telephone Interviewing was performed in February and March 2020. Logistic regression models assessed the impact of socio-demographic characteristics, psychosocial factors, sexual health history, and personal beliefs on non-participation, which were quantified using the odds ratio. Results: A percentage of 25.1% of women had never been screened for cervical cancer. Higher education and income levels were linked to higher screening rates. The adjusted odds for a lack of HPV awareness were significantly high (aOR: 2.45, 95% CI: 1.85-3.25), highlighting a gap in health knowledge affecting screening behavior. Not receiving a referral to a specialist from the primary care physician (aOR: 2.96, 95% CI: 2.09-4.19) was strongly associated with increased odds of non-participation. Personal beliefs about cancer prevention, health misconceptions, perceived costs, and stigma emerged as significant contributors to cervical cancer screening participation. Conclusions: Analyzing predictors influencing participation in cervical screening is crucial for public health in Romania, which has high cervical cancer mortality and low participation rates in cervical cancer screening. To improve participation, we recommend enhanced physician referrals, HPV awareness campaigns, addressing social stigma, and widespread communication about screening availability.