Emotional, Cognitive, and Social Factors Influencing Romanian Women's Intention to Undergo Cervical Cancer Screening: A Mixed-Method Study

Abstract

Objective: To identify emotional, cognitive, and social factors associated with Romanian women's intention to undergo cervical cancer screening (CCS). Methods: An online, cross-sectional, mixed-method survey was conducted among Romanian women. Quantitative statistics were performed to uncover associations, while inductive content thematic analysis was used to refine results. Results: 317 women responded. Previous history of CCS (OR = 7.564, CI = 3.523-16.241, p < 0.001), testing positive for HPV strains (OR = 30.176, CI = 1.828-498.049, p < 0.001), knowing that the infection can cause CC (OR = 4.398, CI = 1.117-14.994, p < 0.017), believing the infection is asymptomatic (OR = 2.919, CI = 0.883-8.411, p = 0.04 and being aware of the HPV vaccine (OR = 5.56, CI = 1.722-16.649, p = 0.002 were associated with the intention to undergo screening. Fear of receiving a cancer diagnosis (OR = 2.727, CI = 1.291-5.764, p = 0.009) was associated with higher intention to undergo screening, while shame and feelings of violated privacy negatively impacted the intention. High perceived chances of being infected (OR = 3.38, p = 0.002) and perceiving CCC as beneficial (OR = 7.634, p < 0.001) drove respondents to pursue CCS. Doctor's recommendation (OR = 15.357) and partner's support were associated with the intention to pursue CCS when anticipating an HPV infection (OR = 6.016, CI = 2.808-12.888, p < 0.001) or a diagnosis of CC (OR = 4.794, CI = 2.267-10.139, p < 0.001). When anticipating a diagnosis of CC, guilt (OR = 2.557) and fear of dying (OR = 2.253) were significant factors impacting women's intention to screen. Qualitative analyses uncovered limited knowledge regarding HPV, a lack of awareness about the CCS's advantages, low perceived susceptibility, and financial burden as factors deterring women from screening. Fear, responsibility, and previous personal or family history of cancer or symptoms were the main drivers motivating participants to engage in CCS. Conclusions: Findings highlighted key emotional, cognitive, and social factors that influence Romanian women's intention to undergo CCS. This analysis can serve as a foundational support for developing future tailored interventions designed to address low addressability within the targeted population, especially as Romania is in a nascent state of creating population-based screening programs.

Keywords: HPV infection; cervical cancer; cervical cancer screening; intention.

Figure 1

Barriers and Facilitators of Cervical Cancer Screening (numbers represent unstandardized frequencies).