Barriers and attitudes toward cervical cancer screening among eligible women
This study examined barriers and attitudes toward cervical cancer screening among eligible women in São Paulo, Brazil, and their associations with sociodemographic factors, screening behaviors, and knowledge. A survey was conducted with 384 women aged 25-64 attending primary healthcare units, selected through multistage random sampling across 50 primary health units from 17 regional health departments of São Paulo. Participants rated barriers and attitudes using 5-point Likert items, which were later condensed in a 3-point scale for analysis. Non-parametric tests assessed associations with sociodemographic factors, screening practices, and knowledge levels. The sample was predominantly low-income (40% in the lowest income bracket; 82% without private health insurance), with 87% reporting a Pap smear within the past five years. Key personal and structural barriers included fear of bad news (41%), test results delays (30%), long wait times (30%), and shame (29%). Significant associations were found between lower income and reporting delays in test results (p = 0,020) and long wait times (p = 0,012), as well as between lower education and experiencing delays (p = 0,030) and shame (p = 0,007). Positive attitudes toward screening exceeded 95% overall and were stronger among women who understood the Pap smear's role in early detection (p = 0,026) and improving survival (p = 0,006). While screening participation was high, persistent socioeconomic disparities in access and personal barriers require targeted interventions. Strengthening primary healthcare systems with patient-centered approaches could improve screening adherence and reduce inequities.