Health belief model-based determinants of women’s participation in cervical cancer screening: a case-control study from Southeastern Turkey

BACKGROUND: In line with the World Health Organization's elimination targets, HPV‑DNA-based cervical cancer screening is the standard; however, screening uptake remains suboptimal in many settings. To assess, in a centre implementing Türkiye's national cancer screening standards, the relationship between women's screening status and a Health Belief Model (HBM)-based, 19‑item attitude scale; and to provide clear, practice‑oriented findings on screening behaviour. METHODS: In a case-control design, women aged 30-65 years were studied (November-December 2024). A total of 210 participants (1:1 screened vs. not screened) were included. The HBM‑based scale and sociodemographic variables were administered. Chi‑square tests were used for categorical variables and Mann-Whitney U tests for continuous variables. Scale scores were dichotomised at the median (low/high), and unadjusted odds ratios (ORs) were calculated from 2 × 2 tables; multivariable logistic regression was additionally used to estimate adjusted odds ratios (aORs) controlling for age, education, marital status, employment, and perceived income (two-sided p < 0.05). RESULTS: Scale scores were significantly higher among women who had undergone screening [median (IQR)]: perceived severity 22(4) (p < 0.001, r = 0.339), perceived susceptibility 12(7) (p < 0.001, r = 0.314), perceived barriers/self-efficacy 17(3) (p < 0.001, r = 0.355), perceived benefits 19(4) (p = 0.03, r = 0.176), and total score 71(9) (p < 0.001, r = 0.483). Women with low scores had higher odds of not being screened: severity OR = 3.04, susceptibility OR = 3.33, barriers/self‑efficacy OR = 2.86, total score OR = 4.41 (all p < 0.001); benefits OR = 1.17 (not significant, p = 0.68). Associations remained significant after adjustment for sociodemographic characteristics: low total HBM score aOR = 4.50 (2.46-8.26, p < 0.001); low perceived severity aOR = 3.73, low perceived susceptibility aOR = 4.92, low perceived barriers/self-efficacy aOR = 3.10 (all p < 0.01). CONCLUSION: The HBM‑based attitude scale indicates that perceived threat (severity, susceptibility) and barriers/self‑efficacy are strongly associated with women's screening behaviour; the total belief score discriminates better than individual subscales. Findings support culturally sensitive communication and service arrangements focused on reducing barriers and enhancing self‑efficacy to improve screening participation.