:: Volume 10, Issue 1 (Spring 2022) ::
Iran J Health Educ Health Promot 2022, 10(1): 17-30 Back to browse issues page
Cervical cancer screening: The Investigation of the Effectiveness of a theory- based interventional study using expanded Protection Motivation Theory
Mona Khalednejad , Leili Salehi * , Sara Pashang, Abbas Moghimbeigi, Atefeh NezhadmohamadNameghi
Abstract:   (2102 Views)
Background: A Pap smear test is one of the most effective procedures utilized for cervical cancer (CC) screening purposes. Nevertheless, many women do not like to do such a test. The present study aimed to monitor the impact of an educational intervention developed based on the expanded Protection Motivation Theory (PMT) on CC screening behavior.
Methods: A quasi-experiment was conducted on 200 women referred to Karaj health centers, Iran. The participants were randomized into experimental and control groups. The data was collected by a Standardized questionnaire including demographic characteristics, the constructs of the PMT, and a self-administered Emotional Social- Support questionnaire (ESS). They filled the questionnaire before, after, and at 6-months follow-up. Eight educational sessions based on the model were held for the experimental group via lecture, group discussions and role play. The data were analyzed by SPSS (Ver. 24) and repeated measures ANOVA and Chi-square test.
Results: In the pre- intervention and post-intervention stages, the mean score of perceived susceptibility from 8/07±3/28 to 11/83±1/99, perceived severity from 12/64±3/46 to 15/19± 2/85,response efficacy from 12/66±5/37 to 16/06±3/6, self-efficacy from 25/94±5/38 to 29/68±4/68,emotional social support from 27/01±7/16 to 31/46±5/76 and intention from 11/01±2/14 to 13/42±1/65 increased and this difference was statistically significant (p<0/05). The mean score of fear from 10/37±2/29 to 5/54±2/76 and response cost from 6/62±2/13 to 3/97±1/69 decreased and that was statistically significant (p<0/05). No significant difference was observed in the control group. Besides, the Pap smear test was increased after the educational intervention in the post-test and follow-up in the experimental group (p<0/05).
Conclusion: Based on the findings, PMT and ESS can be used as a framework for designing educational programs to promote CC screening behavior. 
Keywords: Protection Motivation Theory, Screening, Cervical Cancer, Emotional Social Support
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Type of Study: Research | Subject: Health Promotion Interventions
Received: 2021/09/18 | Accepted: 2021/11/20
1. Sharifi M, Mohammadi Z, Makvandi Z, Rostami P, Moradi A. Assessment of cervical Cancer Screening and its Barriers in 18-50-Year-Old Women Referring to Asad Abad Comprehensive Health Centers. Pajouhan Scientific Journal. 2018; 16(2): 35-45. [DOI:10.21859/psj.16.2.35]
2. Cohen PA, Jhingran A, Oaknin A, Denny L. Cervical cancer. The Lancet. 2019;12;393(10167):169-182. https://doi.org/10.1016/S0140-6736(18)32470-X [DOI:10.1016/S0140-6736(18)32470-X.]
3. Roshandel G, Ghanbari-Motlagh A, Partovipour E, Salavati F, Hasanpour-Heidari S, Mohammadi G, et al. Cancer incidence in Iran in 2014: results of the Iranian National Population-based Cancer Registry. Cancer epidemiology. 2019;61:50-8. [DOI:10.1016/j.canep.2019.05.009] [PMID]
4. Hanifi M, Jalili PZ, Tavakoli R. The Effects of an Educational Intervention Based on the BASNEF model on Promoting Cervical Cancer Preventive Behaviors among women. Payesh. 2018;17(1):67-73
5. Mwaka AD, Orach CG, Were EM, Lyratzopoulos G, Wabinga H, Roland M. Awareness of cervical cancer risk factors and symptoms: cross‐sectional community survey in post‐conflict northern Uganda. Health Expectations. 2016;19(4):854-67. [DOI:10.1111/hex.12382] [PMID] [PMCID]
6. Sachan PL, Singh M, Patel ML, Sachan R. A study on cervical cancer screening using pap smear test and clinical correlation. Asia-Pacific journal of oncology nursing. 2018 Jul;5(3):337. [DOI:10.4103/apjon.apjon_15_18] [PMID] [PMCID]
7. Vafaeinezhad Z, Kazemi Z, Mirmoeini M, Piroti H, Sadeghian E, Mohammad Ali-Vajari M, Fattah N, Jafari M. Trends in cervical cancer incidence in Iran according to national cancer registry. J Mazandaran Univ Med Sci. 2018 Jun 10;28(161):108-14.
8. Namdar A, Bigizadeh S, Naghizadeh M M. Measuring Health Belief Model components in adopting preventive behaviors of cervical cancer. JABS. 2012; 2 (1) :34-44.
9. Mohebi S, Sharifirad G, Gharlipour Z, Kamran A. The Study of Pap Smear Conduction and its Related Factors Based on Health Belief Model in Women Referring to Health Care Centers in Qom During 2014. J Educ Community Health. 2016; 2 (4) :25-33. [DOI:10.21859/jech-02044]
10. Reisi M, Fazeli H, Mahmoodi M, Javadzadeh H. Application of the Social Cognitive Theory to Predict Self-Care Behavior among Type 2 Diabetes Patients with Limited Health Literacy. Journal of Health Literacy. 2021;6(2):21-32.
11. Ghahramani M, Alami A, Mohammad zade moghaddam H, Moodi M. Screening for Cervical Cancer: An Educational Intervention Based on Transtheoretical Models and Health Belief in Women of Gonabad, Iran. The Iranian Journal of Obstetrics, Gynecology and Infertility, 2018; 21(5): 22-32.
12. Alami A, Tavakoly Sany SB, Tehrani H, Lael-Monfared E, Hosseini Z, Jafari A. The effect of educational intervention on iron and vitamin D consumption based on the theory of planned behaviour in Iranian adolescent girls: a quasi-experimental study. International Journal of Health Promotion and Education. 2019;57(6):316-31. [DOI:10.1080/14635240.2019.1632732]
13. MorowatiSharifAbad M A, MohammadYousefi Vardanjani Z, Raiisi Z, AskariShahi M. Predictors of Pap Smear Test Based on Protection Motivation Theory among Women of Shahree-kord. TB. 2018; 17 (4) :43-55. [DOI:10.18502/tbj.v17i4.185]
14. Chen YL, Lin YJ, Chang YP, Chou WJ, Yen CF. Differences in the Protection Motivation Theory Constructs between People with Various Latent Classes of Motivation for Vaccination and Preventive Behaviors against COVID-19 in Taiwan. Int. J. Environ. Res. Public Health 2021, 18(13), p.7042. [DOI:10.3390/ijerph18137042] [PMID] [PMCID]
15. Ginja S, Coad J, Bailey E, Kendall S, Goodenough T, Nightingale S, Smiddy J, Day C, Deave T, Lingam R. Associations between social support, mental wellbeing, self-efficacy and technology use in first-time antenatal women: data from the BaBBLeS cohort study. BMC pregnancy and childbirth. 2018 Dec;18(1):1-1. [DOI:10.1186/s12884-018-2049-x] [PMID] [PMCID]
16. Izadi rad H, Nohtani V, Aliahmadi M, Pourhaji F, Niknami S. The effect of educational intervention based on the integrated model of health belief with the structure of social support on self-care behaviors during pregnancy. Iranian Journal of Health Education and Health Promotion. 2020;8(4):324-35. [DOI:10.29252/ijhehp.8.4.324]
17. Broadhead WE, Gehlbach SH, De Gruy FV, Kaplan BH. The Duke-UNC Functional Social Support Questionnaire: Measurement of social support in family medicine patients. Medical care. 1988 Jul 1:709-23. [DOI:10.1097/00005650-198807000-00006] [PMID]
18. Gamarra CJ, Paz EP, Griep RH. Social support and cervical and breast cancer screening in Argentinean women from a rural population. Public Health Nursing. 2009 May;26(3):269-76. [DOI:10.1111/j.1525-1446.2009.00779.x] [PMID]
19. Silva IT, Griep RH, Rotenberg L. Social support and cervical and breast cancer screening practices among nurses. Revista latino-americana de enfermagem. 2009;17:514-21. [DOI:10.1590/S0104-11692009000400013] [PMID]
20. Malmir S, Barati M, Khani Jeihooni A, Bashirian S, Hazavehei SMM. Effect of an Educational Intervention Based on Protection Motivation Theory on Preventing Cervical Cancer among Marginalized Women in West Iran. Asian Pac J Cancer Prev. 2018 Mar 27;19(3):755-761.
21. Hassani L, Dehdari T, Hajizadeh E, Shojaeizadeh D, Abedini M, Nedjat S. Development of an Instrument based on the protection motivation theory to measure factors influencing women's intention to first pap test practice. Asian Pac J Cancer Prev. 2014;15(3):1227-32. [DOI:10.7314/APJCP.2014.15.3.1227] [PMID]
22. Shobeiri F, Javad MT, Parsa P, Roshanaei G. Effects of group training based on the health belief model on knowledge and behavior regarding the pap smear test in Iranian women: a quasi-experimental study. Asian Pac J Cancer Prev. 2016;17(6):2871-6.
23. Rakhshani F, Jalilian F, Mirzaei Alavijeh M, Zinat Motlagh F, Aghaei A, Ahmadi-Jouibari T. Pap smear test among women: an educational intervention based on health belief model. J Birjand Univ Med Sci 2013; 20(2):136-43.
24. Baghianimoghadam M, Khajedehi Z, Rahimi T, Jowzi F. The Effect of Educational Intervention Based on Health Belief Model Constructs on Performing Pap smear in Yazd. JHC. 2018; 20 (1) :72-81. URL: http://hcjournal.arums.ac.ir/article-1-943-en.html [DOI:10.29252/jhc.20.1.72]
25. Demirtas B, Acikgoz I. Promoting attendance at cervical cancer screening: understanding the relationship with Turkish womens' health beliefs. Asian Pac J Cancer Prev. 2013;14(1):333-40. [DOI:10.7314/APJCP.2013.14.1.333] [PMID]
26. Khiyali Z, Ghahremani L, Kaveh MH, Keshavarzi S. The Effect of an Educational Program Based on Protection Motivation Theory on Pap Smear Screening Behavior among Women Referring to Health Centers in Fasa. J Educ Community Health. 2016;3(4): 31-37. [DOI:10.21859/jech.3.4.31]
27. Tahmasebi R, Hosseini F, Noroozi A. The effect of education based on the health belief model on women's practice about Pap smear test. Hayat. 2016; 21 (4) :80-92
28. Chisale Mabotja M, Levin J, Kawonga M. Beliefs and perceptions regarding cervical cancer and screening associated with Pap smear uptake in Johannesburg: A cross-sectional study. PloS one. 2021 Feb 10;16(2):e0246574. [DOI:10.1371/journal.pone.0246574] [PMID] [PMCID]
29. Khosravi V, Barati M, Moeini B, Mohammadi Y. Prostate Cancer Screening Behaviors and the Related Beliefs among 50- to 70-year-old Men in Hamadan: Appraisal of Threats and Coping. J Educ Community Health. 2018; 4 (4) :20-31 [DOI:10.21859/jech.4.4.20]
30. Dehdari T, Hassani L, Hajizadeh E, Shojaeizadeh D, Nedjat S, Abedini M. Effects of an Educational Intervention Based on the Protection Motivation Theory and Implementation Intentions on First and Second Pap Test Practice in Iran. APJCP , 2014, 15(17), 7257-7261. [DOI:10.7314/APJCP.2014.15.17.7257] [PMID]
31. Reisi M, Mostafavi F, Javadzade H, Mahaki B, Tavassoli E, Sharifirad G. Impact of health literacy, self-efficacy, and outcome expectations on adherence to self-care behaviors in iranians with type 2 diabetes. Oman medical journal. 2016;31(1):52. [DOI:10.5001/omj.2016.10] [PMID] [PMCID]
32. Del Mistro A, Frayle H, Ferro A, Fantin G, Altobelli E, Rossi PG. Efficacy of self-sampling in promoting participation to cervical cancer screening also in subsequent round. Preventive medicine reports. 2017 Mar 1;5:166-8. [DOI:10.1016/j.pmedr.2016.12.017] [PMID] [PMCID]
33. Eghbal SB, Karimy M, Kasmaei P, Roshan ZA, Valipour R, Attari SM. Evaluating the effect of an educational program on increasing cervical cancer screening behavior among rural women in Guilan, Iran. BMC Women's Health. 2020;20(1):1-9. [DOI:10.1186/s12905-020-01020-7] [PMID] [PMCID]
34. Soleimanpour Hossein Abadi S, Mehri A, Rastaghi S, Hashemian M, Joveini H, Rakhshani M.H, Shahrabadi R. Effectiveness of Educational Intervention based on Protection Motivation Theory to Promotion of Preventive Behaviors from Brucellosis among Ranchers of Farmer. Journal of Education and CommunityHealth. 2021;8(1):11-19. [DOI:10.52547/jech.8.1.11]
35. Kye SY, Moon IO. Development of analytic model for determinants on the stages of change in colorectal cancer screening. Korean Journal of Health Education and Promotion. 2010;27(2):79-93.
36. Rahaei Z, Mohammadi E, Morowatisharifabad M, Ghofranipour F, Gholami Naserabadi A, Aghaei M et al. Evaluation of a Protection Motivation Theory-Based Media Program regarding Cancer Early Detection: A Mixed-Methods Study. J Mil Med. 2017; 19 (3) :263-273
37. Baghianimoghadam MH, Mohammadi S, Mazloomi Mahmoudabad SS, Norbala MT. The effect of education based on protection motivation theory on skin cancer preventive practices among female high school students in Yazd. Horizon Med Sci. 2011;17(1):27-34. [Persian].
38. Bozorgi N, Khani S, Elyasi F, Moosazadeh M, Janbabaei G, Shojaee L. A Review of Strategies to Promote Breast Cancer Screening Behaviors in Women. J Mazandaran Univ Med Sci. 2018; 28 (165) :243-255.
39. Karimi M, Shamsi M, Araban M, Gholamnia Z, Kasmai P. Health beliefs and performance regarding Pap Smear test in Zarandieh City women's. Journal of Guilan University of Medical Sciences. 2012 ;20(80):42-8.
40. Hoque ME, Coopoosmay R, Van Hal G. Cervical cancer screening among university students in South Africa: a theory-based study. PloS one. 2014; 9(11). [DOI:10.1371/journal.pone.0111557] [PMID] [PMCID]

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