Papanicolaou Screening: Perceived Barriers and Self-Efficacy in Taiwan

Background: Cervical cancer remains a leading cause of death in Taiwan, and 30-50% of Taiwanese women have never had a Papanicolaou test. The transtheoretical model (TTM) suggests that individuals in earlier stages of the TTM (precontemplation, relapse) report greater perceived barriers and lower levels of self-efficacy than people in later stages (action, maintenance). This study explored differences in specific items of perceived barriers and self-efficacy to obtaining Papanicolaou smears within the framework of the TTM stages among Taiwanese women.

Methods: A descriptive, cross-sectional survey design was used to collect data from a convenience sample of 222 women in Taiwan. The survey measured demographics, 12 perceived barriers, and seven self-efficacy items. Data were analyzed descriptively and with multiple linear regression.

Results: Relapsers perceived more barriers related to worry (p = .0002), embarrassment (p = .002), stigma (p = .002), and the lack of female physicians (p = .005) than those in action/maintenance. Relapsers reported significantly lower self-efficacy scores than those in action/maintenance, including less confidence in obtaining the test if it: requires long travel (p < .0001); is anticipated to be painful (p = .002), stressful (p < .0001), time-inconvenient (p = .0002) or expensive (p = .0004); has no family support (p = .005).

Conclusions: Specific perceived barriers and self-efficacy may play important roles in moving Taiwanese women through the TTM stages for Pap screening practice. This has important implications for public health nurses in the development of educational programs. Interventions for relapsers should teach overcoming identified barrier skills (e.g., asking for female physicians), and how to increase self-efficacy to carry out those skills. The barriers themselves (e.g., cost) may also be a target.