Barriers and attitudes toward cervical cancer screening among eligible women.

PURPOSE: 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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.