Community-Based Education on Cervical Cancer Screening Uptake in Rural Women
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Background: Cervical cancer is largely preventable through timely screening, yet screening participation remains limited in many rural communities because of inadequate awareness and sociocultural and healthcare-access barriers. Objective: To evaluate changes in cervical cancer knowledge and Pap-smear screening uptake following structured community-based health education among rural women in Quetta, Pakistan, and to identify barriers to screening. Methods: A single-group quasi-experimental pre-test and post-test study included 220 married women aged 21–60 years recruited through non-probability convenience sampling from selected rural communities. Participants completed a structured questionnaire before receiving small-group education delivered by trained female health workers and were reassessed after the intervention. Knowledge of symptoms, risk factors, prevention, and Pap-smear screening was assessed using dichotomously scored items, while screening behaviour and barriers were recorded descriptively. Results: The mean total knowledge score increased from 5.8 ± 2.4 before the intervention to 15.5 ± 2.9 after the intervention, an absolute increase of 9.7 points (p<0.001). Improvements were also observed in knowledge of symptoms, risk factors, prevention, and Pap-smear screening (all p<0.001). At baseline, 17 women (7.7%) reported previous Pap-smear screening, whereas 64 women (29.1%) reported undergoing screening following the educational intervention. Persistent barriers included fear or shyness, family permission, lack of female healthcare providers, transportation difficulties, distance, financial constraints, and uncertainty regarding where screening was available. Conclusion: Community-based education was followed by substantial improvement in cervical cancer knowledge and greater screening participation; however, persistent sociocultural and service-access barriers indicate that education should be integrated with accessible, culturally acceptable screening pathways
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1. Singh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, Lauby-Secretan B, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health. 2023;11(2):e197-e206. doi:10.1016/S2214-109X(22)00501-0.
2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.3322/caac.21660.
3. Arbyn M, Weiderpass E, Bruni L, de Sanjose S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):e191-e203. doi:10.1016/S2214-109X(19)30482-6.
4. Brisson M, Kim JJ, Canfell K, Drolet M, Gingras G, Burger EA, et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020;395(10224):575-590. doi:10.1016/S0140-6736(20)30068-4.
5. Canfell K, Kim JJ, Brisson M, Keane A, Simms KT, Caruana M, et al. Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020;395(10224):591-603. doi:10.1016/S0140-6736(20)30157-4.
6. Raza SA, Franceschi S, Pallardy S, Malik FR, Avan BI, Zafar A, et al. Human papillomavirus infection in women with and without cervical cancer in Karachi, Pakistan. Br J Cancer. 2010;102(11):1657-1660. doi:10.1038/sj.bjc.6605664.
7. Siddiqa A, Zainab M, Qadri I, Bhatti MF, Parish JL. Prevalence and genotyping of high risk human papillomavirus in cervical cancer samples from Punjab, Pakistan. Viruses. 2014;6(7):2762-2777. doi:10.3390/v6072762.
8. Denny L, Kuhn L, De Souza M, Pollack AE, Dupree W, Wright TC Jr. Screen-and-treat approaches for cervical cancer prevention in low-resource settings: a randomized controlled trial. JAMA. 2005;294(17):2173-2181. doi:10.1001/jama.294.17.2173.
9. Sankaranarayanan R, Nene BM, Shastri SS, Jayant K, Muwonge R, Budukh AM, et al. HPV screening for cervical cancer in rural India. N Engl J Med. 2009;360(14):1385-1394. doi:10.1056/NEJMoa0808516.
10. Shamaun S, Jaleel R, Gull Y, Shahid A, Iqbal M, Qazi TN. Knowledge and attitude of cervical cancer screening and vaccination in patients attending gynecology outpatient clinic at a tertiary care hospital in Pakistan. South Asian J Cancer. 2023;12(1):17-22. doi:10.1055/s-0042-1751093.
11. Shahnaz S, Fricovsky E, Anwar R, Arain MI. Cervical cancer awareness and attitude towards cervical cancer screening and human papillomavirus vaccines among urban women of Karachi, Pakistan. Cureus. 2023;15(8):e42970. doi:10.7759/cureus.42970.
12. Javaeed A, Shoukat S, Hina S, Hameed Z, Ghauri SK, Ahmed MM. Knowledge, attitude, and practices related to cervical cancer among adult women in Azad Kashmir: a hospital-based cross-sectional study. Cureus. 2019;11(3):e4234. doi:10.7759/cureus.4234.
13. Riaz L, Manazir S, Jawed F, Ali SA, Riaz R. Knowledge, perception, and prevention practices related to human papillomavirus-based cervical cancer and its socioeconomic correlates among women in Karachi, Pakistan. Cureus. 2020;12(3):e7183. doi:10.7759/cureus.7183.
14. Shamsi U, Zahid F, Jabbar ABA, Musharraf MD, Gauhar F, Akbar I, et al. Human papillomavirus vaccine awareness and acceptability for primary prevention of cervical cancer in Pakistan: a cross-sectional study. Asian Pac J Cancer Prev. 2024;25(3):813-820. doi:10.31557/APJCP.2024.25.3.813.
15. Zhang M, Sit JWH, Chan DNS, Akingbade O, Chan CWH. Educational interventions to promote cervical cancer screening among rural populations: a systematic review. Int J Environ Res Public Health. 2022;19(11):6874. doi:10.3390/ijerph19116874.
16. Naz MSG, Kariman N, Ebadi A, Ozgoli G, Ghasemi V, Rashidi Fakari F. Educational interventions for cervical cancer screening behavior of women: a systematic review. Asian Pac J Cancer Prev. 2018;19(4):875-884. doi:10.22034/APJCP.2018.19.4.875.
17. Shrestha AD, Gyawali B, Shrestha A, Shrestha S, Neupane D, Ghimire S, et al. Effect of a female community health volunteer-delivered intervention to increase cervical cancer screening uptake in Nepal: a cluster randomized controlled trial. Prev Med Rep. 2022;29:101948. doi:10.1016/j.pmedr.2022.101948.
18. Sapkota A, Shrestha AD, Gyawali B, et al. Effectiveness of health education interventions for cervical cancer screening: a quasi-experimental study in Pokhara Metropolitan Slum, Nepal. PLOS Glob Public Health. 2026;6:e0005853. doi:10.1371/journal.pgph.0005853.
19. Mili MA, Hossain MJ, Poli MA, Kumar SB, Bhowmick B, Kundu LR, et al. Impact of health education on knowledge and perception of cervical cancer and screening among rural women in Bangladesh. Sci Rep. 2025;15:36812. doi:10.1038/s41598-025-20676-5.
20. Ayanto SY, et al. Effectiveness of couple education and counseling on uptake of cervical cancer screening among women in Southern Ethiopia: a cluster randomized trial. Sci Rep. 2024;14:12498. doi:10.1038/s41598-024-61988-2.
21. Abiodun OA, Olu-Abiodun OO, Sotunsa JO, Oluwole FA. Impact of health education intervention on knowledge and perception of cervical cancer and cervical screening uptake among adult women in rural communities in Nigeria. BMC Public Health. 2014;14:814. doi:10.1186/1471-2458-14-814.
22. Huchko MJ, Ibrahim S, Blat C, Cohen CR, Smith JS, Hiatt RA, Bukusi E. Cervical cancer screening through human papillomavirus testing in community health campaigns versus health facilities in rural western Kenya. Int J Gynaecol Obstet. 2018;141(1):63-69. doi:10.1002/ijgo.12415.