Papanicolaou test behaviors among Taiwanese women: A transtheoretical approach

Background: Despite the reported health benefits and the availability of free or low-cost Papanicolaou (Pap) tests, 30-50% of adult Taiwanese women have never had a Pap test. The transtheoretical model (TTM) suggests that individuals in later stages of the TTM (action, maintenance) exhibit higher levels of self-efficacy and report more perceived benefits and fewer perceived barriers than people in earlier stages (precontemplation, contemplation). The objectives of this study were to assess Pap test behaviors of Taiwanese women, explore factors affecting the stages of change with regard to regular Pap tests, and determine whether constructs from the TTM are applicable to Taiwanese women with regard to Pap tests.

Methods: A descriptive, cross-sectional design was used to collect data from a convenience sample of 222 women in Taiwan. A self-administered questionnaire included a demographic survey, a Pap test stage questionnaire, a self-efficacy scale, and a benefits/barriers scale. Data were analyzed descriptively and with multiple linear regression.

Results: Only 56.3% of the respondents practiced regular Pap smear screening and 16.7% were relapsers. A sizeable percentage, 27%, had never had a Pap test. The stage of respondents' Pap tests was significantly associated with age, marital status, and history of HPV positive and abnormal smears. Self-efficacy scores were significantly higher for participants in action/maintenance than those in precontemplation or relapse (p < .0001). Relapsers reported significantly more perceived barriers than those in action/maintenance (p = .005). There were no significant differences in the level of perceived benefits (p = .70) to regular Pap tests between women in the various stages.

Conclusions: Pap screening among the sample was low, and nonexistent among those under age 30. Strategies for younger unmarried women might include education programs emphasizing the importance of routine screening and enhancing women's understanding of the relationship between Pap tests and cervical cancer. Since Pap test behaviors are influenced by spousal support in Taiwanese society, education messages should target not only women but also their family members. The results suggest that reinforcement of self-efficacy was more important for these women than emphasizing the benefits or decreasing the barriers to regular Pap tests.