Individual, social, economic, and health system determinants of cervical cancer screening uptake among women in Rubanda District, Uganda

Cervical cancer screening uptake in Sub-Saharan Africa is shaped by individual, social, economic, and health system factors, yet few studies test all four domains simultaneously within a single rural district. This study examined individual, social, economic, and health system determinants of screening uptake among women aged 18 years and above in Rubanda District, Uganda, a district with critically low screening coverage. A community-based cross-sectional study was conducted among 418 women aged 18 years and above across four sub-counties of Rubanda District, selected through multi-stage sampling. Individual, social, economic, and health system characteristics were collected via structured questionnaire. Univariable logistic regression tested associations with uptake; variables meeting p < 0.05 were entered into a single multivariable model adjusting for all four domains. At the univariable level, education, parity, cost awareness, and waiting time were significantly associated with uptake. Seven variables retained independent significance in the multivariable model, spanning two of the four domains. Women with no children had lower odds of screening than those with 1–4 children (AOR = 0.20). Knowing payment was required for screening was associated with markedly higher odds than being unsure about cost (AOR = 12.34); believing screening was free was no longer significant after adjustment. Waiting time showed a threshold effect: one hour raised odds of screening (AOR = 6.96) while over two hours lowered them sharply (AOR = 0.08). Longer or unspecified procedure duration lowered odds (AOR = 0.23), and both fair (AOR = 7.64) and good (AOR = 10.78) provider attitudes raised odds relative to a bad attitude. No other factor retained significance after adjustment. Reproductive history, cost clarity, and health system factors, specifically waiting time, procedure duration, and provider attitude, are the dominant independent determinants of screening uptake in Rubanda District. Education and risk perception, though associated with uptake before adjustment, lose significance once economic and health system factors are accounted for; religious affiliation showed no association at any stage. Interventions should prioritise clear cost communication, shorter waiting times, simplified procedures, better provider-patient interactions, and outreach to women without children.