Factors affecting women's participation in cervical cancer screening through the theory of planned behavior: a cross-...

This study aimed to determine, within the framework of the theory of planned behavior (TPB), the psychosocial factors, such as attitude, subjective norms, perceived behavioral control, and intention, that affect participation in cervical cancer screening among women aged 30-65, as well as the mediating relationships among these factors.

This descriptive cross-sectional study was conducted with 511 women aged 30-65 who applied to four Healthy Life Centers in Amasya, Türkiye between 1 April and 30 September 2025. Data were collected through face-to-face interviews using a 30-item five-point Likert-type scale based on the dimensions of TPB, along with sociodemographic questions. Descriptive statistics, t-tests, Pearson correlation, binary logistic regression, confirmatory factor analysis, and bootstrap mediation analysis using Hayes PROCESS were employed in the statistical analyses.

Among the participants, 61.3% had undergone cervical cancer screening at least once during their lifetime. The TPB subdimensions generally demonstrated good internal consistency (attitude α = 0.858; perceived behavioral control α = 0.845; intention α = 0.700; revised subjective norms α = 0.791), and four-factor model demonstrated a good fit (comparative fit index = 0.993; Tucker-Lewis index = 0.992; root mean square error of approximation = 0.086). In the logistic regression analysis, age [odds ratio (OR) = 1.10], cancer diagnosis in close surroundings (OR = 2.23), and intention score (OR = 1.55) were identified as independent determinants of screening behavior. Mediation analyses revealed that the effects of attitude, subjective norms, and perceived behavioral control on screening behavior occurred entirely through intention, with direct effects being non-significant and indirect effects being significant.

Within the context of TPB, participation in cervical cancer screening is explained not directly by attitudes and perceptions but through the intention shaped by these constructs. Intention emerges as the main determinant of screening behavior, along with age and a history of cancer in close surroundings. These findings suggest that beyond providing information, national intervention programs should be designed to focus on strengthening women's intention to participate in screening.