Using the Health Belief Model to Assess Beliefs and Behaviors Regarding Cervical Cancer Screening among Saudi Women: A Cross-Sectional Observational Study

The Health Belief Model (HBM) focuses on a person's health-related behaviour for predicting future actions. It has been tested, translated, and used to study women, among other populations, in different cultures. However, to date, there have been no studies employing the HBM with regard to cervical cancer in Saudi Arabia. Therefore, this study uses the HBM to assess women's knowledge and beliefs regarding cervical cancer, the Pap smear test, and human papillomavirus (HPV) vaccination in relation to socio-demographic characteristics.

According to the HBM, the decision to participate in programmes designed to prevent or detect disease is determined by factors including: perceived susceptibility to the health condition, awareness of the impact of disease on their health (perceived severity), perceived benefits of undergoing screening, and perceived barriers and costs of the screening methods.

A cross-sectional study was conducted in all women who attended the gynaecology outpatient clinics in Riyadh's 4 main hospitals and 10 randomly selected primary care centres. The investigator collected the data from January 15 2018 to February 30 2018; 450 women participated.

Among the findings:

• Twelve percent of the participants considered themselves to be at risk of developing cervical cancer (perceived susceptibility). Women who had a positive family history of cervical cancer believed they were more susceptible to developing cervical cancer.
• Over 36% of the participants agreed to statements related to the seriousness of the disease.
• Almost half of the participants (48.7%) had knowledge about the Pap smear test. The most popular sources of relevant information were health professionals (59.8%), followed by the media (23.7%). Women who were socially interactive with health professionals, family, and friends were more aware of the Pap smear test than were women who obtained their information from the media.
• More than two-thirds (74%) of the participants had not undergone a Pap smear screening test. Twenty-seven percent of the participants had experienced barriers to obtaining a Pap smear test. For example, 79% of participants preferred a female doctor rather than a male doctor, 52% of the participants did not know where to go for a Pap smear test, and 42% believed that "if there is cervical cancer development in my destiny, having a Pap smear test cannot prevent it".
• Regarding perceived benefits of the Pap smear test, approximately 82% of the participants believed that undergoing regular Pap smear tests would help to find changes to the cervix before cancer develops, that regular Pap smear tests are the best way to diagnose cervical cancer at an early stage, and that cervical cancer treatment would be tolerable.
• The majority of participants (424; 94.2%) did not receive the HPV vaccine, and less than 1% had been vaccinated (the rest did not know their vaccination status). The most popular reason for not receiving the vaccination was lack of knowledge about the vaccine (91.1%), while less than one-tenth of the participants (6.4%) cited other reasons such as fear of infection and refusal from parents or husband due to high cost.
• Almost 70% of women were motivated to promote their health (health motivation measures).

In reflecting on the findings, the researchers note that lack of knowledge or incorrect information perceived by the participants could be the main reason for the low uptake rate of the Pap smear test, as has been shown in other studies. Hence, they recommend that efforts should be made to increase awareness of the importance of the Pap smear test, and that the media should be recruited to help in this regard. However, it is notable that, in the study, the media was less preferred by women as a source of information, and more women sought such information from health professionals.

Currently, some of Saudi Arabia's major hospitals offer the HPV vaccine based on a doctor's prescription. Thus, the researchers propose, primary healthcare physicians should provide more information about the HPV vaccine and should recommend timely vaccination to their patients. The present study showed a low uptake of HPV vaccine in Saudi Arabia among women (1%); this may be due to the lack of a national HPV vaccination programme in Saudi Arabia. Thus, there is a need to implement HPV awareness campaigns and to promote HPV vaccination programmes in Saudi Arabia.