Sociodemographic characteristics
The characteristics of the participants are shown in Table 1. Of the 1483 women, the mean age was 32.86 years (SD 10.93, range 14 to 65), and 85.5% of the participants were aged 20 to 49 years. Nearly all of the interviewees were in the Muslim region (98.04%). The vast majority of the participants were married or cohabiting (74.58%), whereas 14.95% were identified as consanguineous mating. Nearly one quarter (23.40%) of the women had had sexual onset before 18 years of age, and the average parity of all respondents was 2.96, with a maximum of 14. Over half (62.04%) had obtained a secondary level of education, and approximately two-thirds (66.01%) lived lives of bare subsistence. Most women (80.38%) drank tap water; 16.5% drank well water, and 3.44% drank pure water. A considerable number of respondents drank local spice tea frequently (39.04%) or occasionally (27.78%). Approximately one-third (34.66%) of the participants had a previous disease history, including schistosomiasis history, which accounted for 7.28% of all women in the sur-vey. Genetic diseases affected 15.31% of women in our study, and 9.78% of participants had a family cancer history. A total of 1304 women (87.93%) were willing to attend a free screening pro-gram, while only 852 (57.45%) were willing to uptake a screening at their own expense. Only 4.38% of the respondents had previously received cervical cancer screening. The average TKS was 7.84±5.32 (range from 0 to 22).
Bivariate models for identifying the factors associated with screening and cervical cancer awareness
As presented in Table 2, women’s screening willingness was significantly associated with age group, marital status, parity, educational level, family income, personal history of disease, genetic disease and family cancer history. Participants between 20 and 49 years old showed higher acceptance of free screening (P=0.001) and non-free screening (P=0.042). The married/cohabiting group showed higher acceptance than the divorced/widowed group (60.58% vs 48.97%, P=0.000). Women who had delivered 1-3 children were more likely to uptake both types of screening than the highest parity group (90.74% vs 78.98%, P=0.000 and 60.55% vs 53.98%, P=0.000, respectively). There was no difference in the acceptance of free screening, but women without formal education were more likely to uptake non-free screening than those who obtained a tertiary level of education (64.8% vs 50%, P=0.000). Wealthy women were more willing to uptake non-free screening than needy women (62.5% vs 50.81%, P=0.000). Women with previous disease, especially those with a history of schistosomiasis, were more likely to accept both types of screening than healthy women (99.07% vs 85.99%, P=0.001; 93.52% vs 51.38%, P=0.000). Women who had genetic disease were more willing to uptake free screening (95.15% vs 86.35%, P=0.000); however, for self-paying screening, there was no difference between the two groups. Moreover, women who were unaware of any family tumor history were less likely to uptake any type of screening than other women (P=0.042 & P=0.005).
The knowledge scores were correlated with marital status, parity, educational level, age of sexual onset, family income, personal previous disease, family cancer history and previous screening. Women who were unmarried, were nulliparous, had obtained tertiary education, had sexual onset after 24 years of age and were wealthy scored higher compared to their counterparts (P<0.05). Women with previous schistosomiasis history were much less aware than those with other disease histories (3.21±6.30 vs 8.62±4.93, P=0.000). Higher awareness also appeared to be associated with family cancer history (9.05±5.00 vs 7.64±5.33, P=0.004) and previous screening (10.28±4.75 vs 7.72±5.32, P=0.000).
Multivariate models for identifying the factors associated with screening and cervical cancer awareness
In the multivariate logistic regression model, previous schistosomiasis history (OR = 24.14, 95% CI= 3.31-176.27) and family genetic disease history (OR = 3.14, 95% CI= 1.64-6.00) were strong predictors of free screening willingness. Women were less likely to uptake free screening if they had 7 or more deliveries (OR = 0.30, 95% CI= 0.15-0.60) and were unaware of any previous family tumor history (OR = 0.38, 95% CI= 0.22-0.67) (Table 3).
As shown in Table 4, age and educational level were negatively associated and family income was positively associated with willingness to pay for screening; being divorced/widowed or single and being unaware of any previous family tumor history were predictors of not up-taking self-paying screening, while previous disease history was a strong predictor of non-free screening willingness.
Table 5 present the factors that may be linearly dependent on the TKS using multiple linear regressions. Among these variables, educational level and family income were significant TKS predictors (Coef=1.08, 95% CI=0.69-1.46 and Coef=0.81, 95% CI=0.26-1.36, respectively). Single women scored more compared to married and cohabited women (Coef=2.15, 95% CI=0.72-3.58). Women who had 7 or more deliveries were more likely to have a higher score (Coef=1.37, 95% CI=0.21-2.53) compared to those who had never delivered. In addition, women with family tumor history and cervical screening history were associated with higher knowledge scores (Coef=1.07, 95% CI=0.20-1.94 and Coef=2.40, 95% CI=1.14-3.66, respectively). Women with previous schistosomiasis history and who were unaware of any previous disease history scored lower compared to healthy participants (Coef=-3.95, 95% CI=-4.99-2.90 and Coef=-4.05, 95% CI=-6.13-1.97, respectively).
TKS and Distribution by different attitudes towards free and non-free screening
As shown in Figure 1, women who were not going to receive either free or non-free screening scored higher than the other two groups; however, there was a generally low level among all participants. Of all the women sampled, 87.9% were willing to receive free screening, and slightly more than half (57.4%) were willing to receive non-free screening; however, of the women who scored 20 points or more, nearly all (96.4%) were going to uptake free screening, and the majority (82.1%) were willing to uptake screening even at their own expense.
Worries about cervical cancer screening among women of different age groups
Table 6 portrays the women’s worries about cervical cancer screening. Among the 1483 women who were interviewed, 548 instances of worry were expressed. Most of the worries were not significantly different between age groups; compared to the 20-49 age group, more women in the less than 20 and 50 or more age groups thought cervical cancer screening was not necessary.
Women’s awareness of cervical cancer warning signs and risk factors
As shown in Table 7, the highest rate of cognitive accuracy is only 37.76%, with approximately four in ten denying that they knew anything about cervical cancer warning signs and risk factors (40.46% and 39.04%, respectively). Many women thought that oral contraceptives, condom usage and even swimming in public pools were risk factors for cervical cancer, with proportions of 30.68%, 14.03% and 13.42%, respectively (Figure 2).