Online Exclusive Article

Cervical Cancer Screening Among Taiwanese Women: A Transtheoretical Approach

Wei-Chen Tung

Minggen Lu

Daniel Cook

cervix neoplasms
ONF 2010, 37(4), E288-E294. DOI: 10.1188/10.ONF.E288-E294

Purpose/Objectives: To assess Papanicolaou (Pap) test screening behaviors of Taiwanese women, to explore factors affecting stages of change, and to determine whether constructs from the transtheoretical model are applicable to Taiwanese women with regard to Pap screening.

Design: Descriptive, cross-sectional.

Setting: A hospital in Taiwan.

Sample: 222 female hospital workers.

Methods: Data were collected with a questionnaire.

Main Research Variables: Cervical screening behavior, perceived barriers and benefits, self-efficacy, and stages of change.

Findings: Fifty-six percent of participants reported engaging in regular screening practice. The stage of respondents' cervical cancer screening was significantly associated with age, marital status, and history of human papilloma virus-positive and abnormal tests. Self-efficacy scores were significantly higher for women who were in action or maintenance than those in precontemplation or relapse (p < 0.0001). Women in relapse reported significantly more perceived barriers than those in action-maintenance (p = 0.005). No significant differences were found in the level of perceived benefits (p = 0.702) to regular Pap screening among women in the various stages.

Conclusions: Pap screening was low among the entire sample and nonexistent among women younger than age 30. The transtheoretical model only was partially applicable to the Taiwanese women in this study.

Implications for Nursing: Reinforcement of self-efficacy was more important for women in the sample than emphasizing the benefits of or decreasing the barriers to regular Pap screening. Strategies for younger unmarried women might include education programs emphasizing the importance of routine annual screening and enhancing women's understanding of the relationship between Pap tests and cervical cancer.

Jump to a section

    References

    American Cancer Society. (2008). ACS cancer detection guidelines. Retrieved from http://www.cancer.org/docroot/ped/content/ped_2_3x_acs_cancer_detection_guidelines_36.asp
    Bandura, A. (1997). Self-efficacy: The exercise of control. New York, NY: Freeman.
    Breitkopf, C. R., Catero, J., Jaccard, J., & Berenson, A. B. (2004). Psychological and sociocultural perspectives on follow-up of abnormal papanicolaou results. Obstetrics and Gynecology, 104, 1347-1354.
    Bureau of National Health Insurance of Taiwan. (2006). Introduction to National Health Insurance. Retrieved from http://www.nhi.gov.tw
    Byrd, T. L., Peterson, S. K., Chavez, R., & Heckert, A. (2004). Cervical cancer screening beliefs among young Hispanic women. Preventive Medicine, 38, 192-197. doi: 10.1016/j.ypmed.2003.09.017
    Cancer Registry of Taiwan. (2007). Cancer statistics. Retrieved from http://crs.cph.ntu.edu.tw/main.php?Page=A5
    Chen, L. S., Huang, N., Tsay, J. H., Wang, P. J., Chou, Y. J., Chou, P., … Lee, C. H. (2007). Screening for cervical cancer among female physicians and their relatives in Taiwan: A population-based comparative study. Preventive Medicine, 44, 531-535. doi: 10.1016/j.ypmed.2007.02.001
    Cohen, J. (1977). Statistical power analysis for the behavioral sciences (rev. ed.). New York, NY: Academic Press.
    Eiser, J. R., & Cole, N. (2002). Participation in cervical screening as a function of perceived risk, barriers and need for cognitive closure. Journal of Health Psychology, 7, 99-105. doi: 10.1177/1359105302007001657
    Hogenmiller, J. R., Atwood, J. R., Lindsey, A. M., Johnson, D. R., Hertzog, M., & Scott, J. C., Jr. (2007). Self-efficacy scale for Pap smear screening participation in sheltered women. Nursing Research, 56, 369-377. doi: 10.1097/01.NNR.0000299848.21935.8d
    Hou, S. I. (2005). Stage of adoption and impact of direct-mail communications with and without phone intervention on Chinese women's cervical smear screening behavior. Preventive Medicine, 41, 749-756. doi: 10.1016/j.ypmed.2005.07.011
    Hou, S. I. (2006). Perceived spousal support and beliefs toward cervical smear screening among Chinese women. Californian Journal of Health Promotion, 4, 157-164.
    Hou, S. I., Fernandez, M. E., Baumler, E., Parcel, G. S., & Chen, P. H. (2003). Correlates of cervical cancer screening among women in Taiwan. Health Care for Women International, 24, 384-398.
    Jeng, C. J., Ko, M. L., Ling, Q. D., Shen, J., Lin, H. W., Tzeng, C. R., … Chen, S. C. (2005). Prevalence of cervical human papillomavirus in Taiwanese women. Clinical Investigative Medicine, 28, 261-266.
    Kelaher, M., Gillespie, A. G., Allotey, P., Manderson, L., Potts, H., Sheldrake, M., … Young, M. (1999). The transtheoretical model and cervical screening: Its application among culturally diverse communities in Queensland, Australia. Ethnicity and Health, 4, 259-276. doi: 10.1080/13557859998047
    Koong, S. L., Yen, A. M., & Chen, T. H. (2006). Efficacy and cost-effectiveness of nationwide cervical cancer screening in Taiwan. Journal of Medical Screening, 13(1, Suppl.), S44-S47.
    Lechner, L., de Vries, H., & Offermans, N. (1997). Participation in a breast cancer screening program: Influence of past behavior and determinants on future screening participation. Preventive Medicine, 26, 473-482. doi: 10.1006/pmed.1997.0161
    Liao, C. C., Wang, H. Y., Lin, R. S., Hsieh, C. Y., & Sung, F. C. (2006). Addressing Taiwan's high incidence of cervical cancer: Factors associated with the nation's low compliance with Papanicolaou screening in Taiwan. Public Health, 120, 1170-1176. doi: 10.1016/j.puhe.2006.07.028
    Lin, Y. J., Chen, C. S., Liu, T. C., & Lin, H. C. (2008). Taiwan's national health insurance system and the application of preventive care: The case of Pap smear testing. Public Health, 122, 857-861. doi: 10.1016/j.puhe.2007.12.002
    Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Counseling and Clinical Psychology, 51, 390-395. doi: 10.1037/0022-006X.51.3.390
    Prochaska, J. O., Redding, C. A., & Evers, K. E. (2002). The transtheoretical model and stages of change. In K. Glanz, B. K. Rimer, & F. M. Lewis (Eds.), Health behaviour and health education: Theory, research, and practice (pp. 99-120). San Francisco, CA: Jossy-Bass.
    Rimer, B. K., Conaway, M. R., Lyna, P. R., Rakowski, W., Woods-Powell, C. T., Tessaro, I., & Barber, L. T. (1996). Cancer screening practices among women in a community health center population. American Journal of Preventive Medicine, 12, 351-357.
    Tung, W. C., Nguyen, D. H., & Tran, D. N. (2008). Applying the transtheoretical model to cervical cancer screening in Vietnamese-American women. International Nursing Review, 55, 73-80. doi: 10.1111/j.1466-7657.2007.00602.x
    Wang, P. D., & Lin, R. S. (1996). Sociodemographic factors of Pap smear screening in Taiwan. Public Health, 110, 123-127. doi: 10.1016/S0033-3506(96)80059-X
    Wang, P. J., Huang, N., Chou, Y. J., & Chang, H. J. (2006). Utilization analysis of cervical Pap smear screening. Retrieved from http://www.nhi.gov.tw/webdata/webdata.asp?menu=1&menu_id=&webdata_ID=1921