Cervical cancer is the fourth most common cancer in women worldwide1. Globally, more than 570000 women were diagnosed with cervical cancer and about 311000 women died from the disease, a number that is expected to grow as the population ages1. Cervical cancer is considered a major health problem in eastern, western, middle, and southern Africa2 (Torre et al., 2012). In Saudi Arabia, cervical cancer incidence is low. In 2018, the number of cervical cancer cases is 316 and 158 deaths among Saudi Arabian women3. According to statistics, cervical cancer is the 9th most frequent cancer among women in Saudi Arabia and the 9th most frequent cancer among women between 15 and 44 years of age3. Although the incidence of cervical cancer in Saudi Arabia is lower than that of many other countries, it has increased significantly over the last two decades4.
More than 40% of cervical cancer cases are diagnosed at advanced stages among Saudi Arabian women probably due to the lack of national screening programs in Saudi Arabia5. Cervical cancer is on the most preventable cancers1. Early screening and treatment of cervical cancer are important to decrease incidence and mortality. Early detection of cervical cancer can be obtained with Pap smear tests. Pap smear test is one of the effective methods to detect the cervical cancer6. The United States Preventive Services Task Force (USPSTF) recommends cervical cancer screening in women age 21 to 65 years with Pap smear every 3 years, or for women age 30 to 65 years with a combination of Pap smear and HPV testing every 5 years6. The USPSTF recommends against screening with HPV testing alone or with Pap smear in women younger than age 30 years. It also recommends against screening in women younger than age 21 years and in women older than age 65 years who had adequate prior screening and not at high risk for cervical cancer6. The mortality rates for cervical cancer in developed countries have decreased dramatically in the past 25 years, due largely to cervical cancer screening using Pap tests, which allows for detection and treatment of precancerous lesions7.
The knowledge of Pap smear and uptake of preventive behaviors to prevent cervical cancer are the most important contributors to the advanced stage of the disease. Knowledge is one of the most leading factors to predict the health behaviors and a helpful factor in performing screening procedures. However, knowledge alone is not sufficient since individual's intention to uptake the preventive measure is also an important element in adopting preventive behaviors. Thus, the knowledge of Pap smear and intentions to undergo screening for cervical cancer are critical to primary prevention. A previous study conducted pointed out that 80% United Arab Emirates women had no knowledge of precancerous lesions8. In a similar study9, examined the knowledge of Pap smear tests among Bahraini women in primary health care centers in Bahrain. The researchers found that of about 64% Bahraini women had never heard of a Pap smear procedure and only 40.7% had a Pap smear in their lifetime. Another study 10 found that Omani women knowledge about symptoms of cervical cancer and Pap smear was low at 38.7%, 35.3% and 7.6% among outpatients, staff and students, respectively. Approximately half of the married outpatients had adequate overall knowledge as compared to none of the single women. Educational level was found to be significantly associated with outpatient knowledge, with the highest awareness levels among postgraduates and medical university graduates10. A research study among female health college students in Princess Nora University in Riyadh City, Saudi Arabia indicated that 95.7% of the students had a poor level of knowledge of cervical cancer11. Also, the study found that Pap smear was poorly recognized as a screening tool by most of students and misconception regarding primary and secondary preventive measures11. Generally, the studies in gulf countries and Saudi Arabia revealed low knowledge about Pap smear test and there is a need for more education and promotion programs to increase the awareness of cervical cancer and Pap smear test in the population. Moreover, health education programs were recommended as an effective strategy in improving the level of knowledge on cervical cancer among the target population.
A research study examined the factors associated with the intention to undergo Pap testing, by level of sexual experience12. Findings of the study revealed that the subjective norm was the most important predictor of intention to undergo Pap testing12. However, there is no previous studies about the knowledge of Pap smear testing in relation to the intention to undergo Pap testing among Saudi Arabian women. This information would be will be crucial in developing interventions to educate Saudi Arabian women on cervical cancer prevention measures. This study aimed to investigate Saudi Arabian women knowledge of Pap testing in relation to their intention to undergo the test. The results of this study will support greater awareness and prevention of cervical cancer and create targeted areas for future health promotion and education efforts. Findings of the study will be helpful to use knowledge of Pap smear testing in the prediction of Saudi Arabian women prevent behavior in relation to undergo Pap testing. A better understanding of what Saudi Arabian women know about Pap testing in relation to their intentional behavior is essential to establish effective health promotion interventions.
The continuous rise in cervical cancer around the world necessitates health professionals to pay more attention to this prevented disease. Health care providers have the opportunity to be a great contributor in reducing cervical cancer rates by participating in research on this important issue and by providing effective preventive measures. Even though cervical cancer morbidity and mortality rates are increasing among Saudi Arabian women, understanding and awareness of the disease are low11. This lack of knowledge and awareness combined with the low uptake of preventive measures could puts the women of Saudi Arabia at risk of having cervical cancer. These disturbing facts and statistics regarding the cervical cancer among Saudi Arabian women justify the need for the implementation of effective initiatives to prevent the disease.
This study may have an important impact on the focus of cervical cancer research in Saudi Arabia. Specifically, this study would be beneficial to future researchers studying the cervical cancer in Saudi Arabian. Emphasis should be given to implementing interventions aimed at increasing awareness of cervical cancer in relation to undergo screening for cervical cancer to encourage healthy preventive behaviors among Saudi Arabian women, thereby reducing the risk of cervical cancer. It is the goal of this study to examine the knowledge of Pap testing in relation to the intentions to undergo the test and make recommendations for educational programs to increase the knowledge of cervical cancer preventive measure in relation to intentions to uptake Pap testing so as to decrease the incidence of cervical cancer among the target population.