Beliefs and attitudes as determinants of cervical cancer screening: a community-based study in Singapore

The investigation of cervical cancer screening acceptance in relation to health beliefs and attitudes presents a challenge in a multiethnic population such as Singapore's, where the uptake is currently suboptimal in high-risk groups. This study attempts to identify cognitive barriers to screening activity in order to suggest possible directions for cervical cancer prevention efforts.

A cross-sectional survey consisting of a household interview of 640 randomly selected women ages 21-65 years was performed. The screening history and future intention to have a Pap smear were elicited, and attitudes toward cancer and the Pap smear as expressed in 14 statements were measured on a five-point scale.

Of the respondents, 73.1% were aware of the Pap smear, and about half (49.7%) had obtained the information from a doctor or nurse. Overall, the belief in personal susceptibility to cancer was low (58.9%) and a substantial proportion (48.7%) of women were of the attitude that cancer could not be prevented. The effect on a future intention to have a smear varied between women who had had and women who had not had a smear. Among the former, perceived barriers such as discomfort and embarrassment had a significant influence, while a belief in personal susceptibility was an important determinant for the latter group.

The means of increasing the acceptance of the Pap smear, both for the first time and subsequently, are culture-specific and must address the appropriate health beliefs and attitudes. In Singapore, such efforts should include not only influencing awareness and perceptions through public education but also reducing barriers by creating an appropriate environment for the delivery of this important health service.