Cervical cancer screening uptake questionnaire (CCSTQ) for women: instrument development and validation

Cervical cancer is a serious threat to women's health and is currently showing a trend of increasing incidence in young women. The screening rate for cervical cancer is lower than the WHO's target, and a scientific, comprehensive, and quantifiable evaluation is crucial to determine the factors that may affect the acceptance of cervical cancer screening. In this context, we developed a cervical cancer screening uptake questionnaire (CCSTQ), which was validated among urban and rural Chinese women.

We conducted a questionnaire development and cross-sectional validation study from April to June 2025. The CCSTQ was developed based on the Determinants of Screening UpTake model and a literature review. Content validity of the CCSTQ was established by a two-round Delphi expert consultation (n = 15). A pilot study (n = 10) was conducted to test the feasibility of the questionnaire. An online survey was administered to 560 Chinese women to assess the psychometric properties of the CCSTQ. Construct validity was evaluated by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The Kaiser-Meyer-Olkin value and factor loadings were > 0.8 and > 0.4, respectively. Internal consistency was assessed using Cronbach's α value, and the test-retest reliability was determined using the intraclass correlation coefficient (ICC).

Among the 520 participants (mean age: 49.15 ± 18.25 years), the final 43-item CCSTQ showed high internal consistency (Cronbach's α = 0.985) and good test-retest reliability (ICC = 0.879; 95% CI = 0.787-0.932). EFA (n = 260) showed that the six-factor model explained 80.99% of the variance. CFA (n = 260) indicated good model fit (χ²/df = 1.465, comparative fit index = 0.975, Tucker-Lewis index = 0.973, standardized root mean square residual = 0.047, and root-mean-square error of approximation = 0.042). The final scale comprised 43 items categorized into six dimensions: social norms, knowledge and awareness, perceived threat, perceived benefits, perceived barriers, and self-efficacy.

The CCSTQ was specifically developed to assess cervical cancer screening uptake in rural and urban women through a scientifically rigorous and systematic process. The CCSTQ shows good psychometric properties and can serve as a useful empirical tool for health professionals to design personalized intervention policies and enhance health service delivery.