Attitudes rather than knowledge are associated with cervical cancer screening among ethnic minority and migrant women in Thailand

Although Thailand’s national cervical cancer screening (CCS) program offers HPV-based screening, access remains limited among ethnic minority and migrant women. This study aimed to examine the associations and pathways of knowledge, attitudes, and practices (KAP) with CCS uptake among ethnic minority and migrant women in Chiang Mai, Northern Thailand. A cross-sectional study was conducted from November to December 2023 among 250 women, including 125 migrant women and 125 women from ethnic minority groups. An interviewer-administered questionnaire was used to collect demographic characteristics and KAP data. Generalized structural equation modeling (GSEM) was performed to examine the direct and indirect associations between KAP and CCS uptake. Of the 250 participants, 81 (32.4%) reported having previously undergone cervical cancer screening, including 54 women from ethnic minority groups and 27 migrant women. Longer residence in Chiang Mai (> 10 years vs. <5 years), being married, previous health check-up experience, higher knowledge, and better reproductive health practices were positively associated with CCS uptake. In contrast, Shan ethnicity (vs. non-Shan) and migrant worker status (vs. non-migrant worker status) were negatively associated with CCS uptake. GSEM indicated that attitude was more strongly associated with CCS uptake than knowledge and also showed indirect associations through reproductive health practices. CCS uptake remains low among ethnic minority and migrant women in Northern Thailand. These findings highlight the potential importance of addressing knowledge, attitudes, and practices when developing strategies to improve screening uptake. Longitudinal and intervention studies are warranted to confirm these associations and inform effective strategies to improve CCS participation.