Knowledge, attitude, practice, and self-efficacy in pap smear adherence intent: a cross-sectional study

Although knowledge, attitude, practice, and self-efficacy are recognized as important determinants of cervical cancer screening behavior, evidence examining their combined influence on Pap smear testing adherence remains limited. This cross-sectional study of 985 women aged 30-59 years in Saveh, Iran, used two-stage sampling. Validated questionnaires assessed KAPSE and PST adherence intent. Mann-Whitney U, Kruskal-Wallis, and Spearman correlation tests were used. Linear regression evaluated a composite KAPSE variable's impact on screening adherence. Participants had a median age of 40 years (IQR: 34-47). Most were housewives (79.3%) and reported below-average economic status (51.7%). Median (IQR) scores were 6 (4-8) for knowledge, 39 (36-42) for attitude, 4 (3-4) for practice, 31 (25-34) for self-efficacy, and 66 (56-74) for PST adherence intent. Self-efficacy demonstrated the strongest positive correlation with adherence (r = 0.597, p < 0.001). Regression analysis showed that the composite KAPSE score was a significant predictor of adherence; a one-unit increase in the KAPSE index was associated with a 7.2-unit increase in PST adherence (B = 7.20, t = 27.69, p < 0.001). Education level and previous screening history were the strongest demographic determinants (p < 0.001). Self-efficacy and prior practice are critical drivers of screening adherence. Health promotion programs should move beyond simple knowledge transfer to build women's confidence and address socioeconomic barriers. Culturally tailored interventions that strengthen KAPSE synergy can significantly improve cervical cancer prevention outcomes in Iran.Clinical trial number: IRCT20231130060228N1.Registration date: 2024-02-19, 1402/11/30. URL: https://irct.behdasht.gov.ir/trial/74165.