Cervical cancer screening in China: a mixed methods approach to understanding perception, practice, and prevention

Cervical cancer remains a significant global public health concern, particularly affecting younger women. Despite increasing awareness and national initiatives to encourage prevention, cervical cancer screening among Chinese women aged 18–45 remains suboptimal. This study used an explanatory sequential mixed methods approach to identify and contextualize barriers and facilitators influencing regular cervical cancer screening among Chinese women, guided by the Health Belief Model (HBM). In the quantitative phase, 746 women completed an online questionnaire assessing screening behaviors, attitudes, and barriers; multivariable logistic regression identified factors associated with screening. Subsequently, semi-structured qualitative interviews were conducted with 20 participants purposively selected based on quantitative findings and consent. We used a hybrid inductive/deductive thematic analysis approach to analyze qualitative data. Quantitative results indicated a high self-reported cervical cancer screening rate. However, qualitative data suggested this prevalence may be overestimated due to patients’ misunderstanding about screening procedures and lack of consistent follow-up for further screening. Marital status, age, sexual activity, and HPV vaccination status were highly correlated with screening receipt. Qualitative analysis contextualized these results, revealing barriers such as misconceptions about HPV vaccination, lower screening rates due to marital status coupled with screening eligibility, financial concerns, procedural discomfort, and negative provider-patient interactions. Improving cervical cancer screening requires interventions emphasizing sustained screening participation. Strategies should integrate screening education with HPV vaccination campaigns, shift eligibility criteria from marital status to age or risk-based guidelines, reduce structural barriers, enhance patient-centered provider interactions, and promote self-sampling options. • Self-reported cervical cancer screening in China may overestimate true screening coverage. • Marital status and HPV vaccination are strongly associated with screening history among young women. • Intention to screen far exceeds completed screening. • Misconceptions, financial, and health system barriers prevent screening uptake.