Determinants of Cervical Cancer Screening Uptake Among Women in Aburaso, Ghana: A Cross-Sectional Study

Determinants of Cervical Cancer Screening Uptake Among Women in Aburaso, Ghana: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of Cervical Cancer Screening Uptake Among Women in Aburaso, Ghana: A Cross-Sectional Study Gertrude Nancy Annan-Aidoo, Clement Naayaara Zuuri, Ida Ohenewaa Duodu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8370044/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract Background: Cervical cancer remains a major health threat, especially in Ghana, due to low screening uptake. Despite the availability of prevention, participation is limited particularly in peri-urban areas with unique barriers; making it crucial to understand the reasons for non-utilization to reduce the disease burden. Methods: A descriptive cross-sectional study of 427 women of reproductive age at Aburaso Hospital used stratified random sampling and structured questionnaires. Data were analyzed with SPSS version 26, utilizing descriptive statistics, Chi-square tests, and logistic regression to identify key factors associated with cervical cancer screening uptake. Results: Screening uptake was low at 18.3% despite moderate awareness. Chi-square analysis showed that education level (p = 0.006), awareness (p < 0.001), marital status (p = 0.015), and stigma (p = 0.003) were significantly associated with screening uptake. Logistic regression revealed that tertiary education (aOR = 2.4, p = 0.012), awareness (aOR = 3.1, p < 0.001), willingness to undergo free screening (aOR = 2.8, p = 0.001), and perceived stigma (aOR = 0.5, p = 0.025) remained significant independent predictors. Conclusion: There is a considerable disconnect between awareness and actual screening for cervical cancer among women in Aburaso, driven by individual, institutional, and community barriers. Key factors influencing uptake include education, awareness, willingness, and absence of stigma. Improving screening rates will require culturally tailored education, enhanced provider engagement, financial support, and efforts to reduce community stigma. Cervical cancer screening Non-utilization Reproductive-age women Community factors Institutional factors individual factors Ghana Methodist Aburaso Figures Figure 1 1.0 Background Cervical cancer remains a significant global public health concern, with rising incidence and mortality rates, particularly in low- and middle-income countries. Over the past decade, this upward trend has been largely attributed to the low uptake of cervical cancer screening services, despite the availability of effective preventive measures [ 1 ] . Cervical cancer is the fourth most common cancer affecting women globally, after breast, colorectal, and lung cancers, with approximately 570,000 new cases and 311,000 deaths recorded annually [ 2 – 4 ] with a global incidence rate of 13.1 per 100,000 women and a mortality rate of 6.5 per 100,000 [ 5 ] . Evidence has consistently shown that regular screening enables the early detection of precancerous lesions, which can be effectively treated to prevent the development of invasive cervical cancer [ 6 , 7 ] Despite the proven benefits of cervical cancer screening, participation rates remain low, especially in sub-Saharan Africa, where the burden of the disease is disproportionately high. In the region, the incidence and mortality rates are estimated at 28.8 and 22.1 per 100,000 women, respectively [ 8 ] . High-risk factors, limited access to screening services, and weak health systems contribute to the escalating disease burden [ 9 ] . Notably, around 85% of cervical cancer diagnoses and 88% of related deaths occur in low- and middle-income countries, with the highest rates recorded in southern, western, middle, and eastern Africa [ 10 ] . In Ghana, the situation is particularly concerning. Cervical cancer is the second leading cause of cancer among women, with approximately 3,028 new cases and 2,006 deaths reported in 2020 alone [ 5 , 11 ] . The mortality rate in Ghana exceeds the global average by more than threefold [ 12 ] , and nearly 70% of cases are attributed to human papillomavirus (HPV) types 16 and 18 [ 13 , 14 ] . While national guidelines recommend screening for women between ages 21 and 64, implementation remains weak due to the absence of a national screening policy, limited infrastructure, and a reliance on opportunistic screening approaches within family planning, outpatient, and gynecological departments [ 15 ] . As a result, screening coverage remains very low—estimated at just 0.8% of women nationally—with about half of diagnosed cases occurring in women who were never screened [ 16 , 17 ] These gaps point to the urgent need for understanding the underlying reasons why women do not utilize cervical cancer screening services. Multiple studies in Ghana have identified common barriers such as fear of results, lack of awareness, cultural stigma, and perceived susceptibility [ 17 – 19 ] . Few studies have systematically categorized barriers at the individual, institutional, and community levels, and most have focused on urban settings, overlooking peri-urban communities like Aburaso, where women often face distinct challenges such as limited healthcare access, stronger traditional beliefs, and less exposure to health education [ 20 ] . These contextual differences may significantly influence screening behaviors and require localized, evidence-informed responses. This study aims to address this gap by examining the individual, institutional, and community-level factors that hinder cervical cancer screening among women in Aburaso, and by recommending practical solutions to increase uptake. The findings are intended to inform policies and programs that can help reduce cervical cancer morbidity and mortality in peri-urban Ghana. 2.0 METHODS 2.1 Study setting The study site was Methodist hospital, located at Aburaso in the Atwima Kwanwoma District of Ghana’s Ashanti Region, operated under the Ghana Health Service and the Methodist Church. With about 50 beds, the hospital offers a broad range of medical, surgical, maternal, and public health services, and serves as a key referral center for nearby communities. It features essential departments such as outpatient, inpatient, maternity, pediatric, surgical, laboratory, radiology, and pharmacy units. The hospital’s Public Health Department provides preventive services, including immunizations, disease surveillance, and cervical cancer screening. Equipped with 24-hour emergency care and public health outreach programs, the hospital plays a critical role in improving healthcare access and awareness in the district. 2.2 Research Design A descriptive cross-sectional design was used to assess factors influencing non-utilization of cervical cancer screening by collecting data at a single point in time. This approach was suitable as it enabled the simultaneous examination of various factors such as demographics, institutional barriers, and community influences related to screening uptake. The design’s cost-effectiveness and time efficiency also made it ideal for research within a limited timeframe [ 21 ] . 2.3 Sample Size and Sampling Techniques The sample size was calculated using Cochran’s formula [ 22 ] , which is commonly used to determine the appropriate sample size for prevalence studies. n = \(\:\frac{Z2P(1-P)}{d2}\) Where: n = Sample size Z = Standard normal deviation at a 95% confidence level (1.96) P = Estimated prevalence of cervical cancer screening utilization (50% or 0.50, since no prior data exists for this population) d = Margin of error (5% or 0.05) Substituting the values: n = \(\:\frac{\left(1.96\right)2\:\times\:0.50\:\times\:\:(1-0.50)}{\left(0.05\right)2}\) = 384.16 Rounding up, the minimum required sample size is 384 participants. To account for a 10% non-response rate, the final adjusted sample size is 427 participants. The study employed a stratified random sampling technique to ensure adequate representation of different subgroups within the study population. Stratified sampling involves dividing the population into distinct subgroups (strata) based on relevant characteristics before selecting participants randomly from each stratum [ 23 ] . In this study, stratification was done by age groups (15–24, 25–34, 35–44, and 45–49 years) to ensure adequate representation and capture variations in cervical cancer screening utilization across different age categories. This approach enhanced the precision of the findings, reduced sampling bias, and enabled meaningful comparisons between age-specific subgroups to identify unique barriers to screening. The total sample size of 427 was proportionally allocated across these age groups based on the hospital’s outpatient records on the distribution of women in reproductive age. The proportional allocation was determined using the formula: n i = \(\:\left(\frac{Ni}{\text{N}}\right)\) × n Where: n i = Sample size for each age group Ni = Total number of women in that age group from hospital records N = Total number of women in reproductive age attending the hospital n = Total sample size (427). For example, if the hospital’s outpatient records indicate that women aged 15–24 years form 20% of the reproductive-age population, then their sample size will be (20/100) × 427 = 85 participants. The same proportional approach was applied to the remaining age groups. After determining the proportion of participants needed from each age group, simple random sampling was conducted within each category using a lottery method. Eligible women were assigned unique identification numbers, which were drawn randomly to ensure every individual had an equal chance of selection. An independent observer or research assistant supervised the process to maintain transparency. Women were approached in various hospital departments, and those who consented voluntarily were included in the study. 2.4 Data Collection Instruments A structured, closed-ended questionnaire adapted from validated instruments in previous studies on cervical cancer screening [ 24 , 25 ] was used to collect quantitative data on factors influencing screening uptake and strategies to improve participation among women of reproductive age. The questionnaire comprised sections on demographics, personal attributes, institutional and community influences, and potential strategies to enhance screening uptake. Trained research assistants administered the survey in person at Aburaso Hospital, providing explanations and assistance as needed. To ensure inclusivity, the questionnaire was translated into the local language (Twi) for respondents with limited English proficiency. Standardized procedures were followed to minimize bias and protect participant confidentiality throughout data collection. 2.5 Data Analysis Techniques Data were analyzed using SPSS version 26, with all responses checked for completeness and consistency before entry. Variables were coded for analysis, and descriptive statistics (frequencies and percentages) summarized demographic and key study variables. Inferential analyses, including Chi-square tests and logistic regression, were performed to identify associations and independent predictors of cervical cancer screening uptake, with significance set at p < 0.05. Results were presented in tables, graphs, and charts for clarity. 2.6 Inclusion and exclusion criteria Women eligible for the study were those aged 18 years and above who attended Aburaso Hospital during the data collection period, consented to participate, and were able to understand and complete the questionnaire. Exclusion criteria included women younger than 18 years, those who declined or did not provide consent, those with cognitive or communication impairments, and those who were too ill or distressed to participate. 2.7 Ethical Considerations Ethical approval was obtained from the Local Ethical Committee of Garden City University College, on the 20th o March 2025 and permission was also granted by Aburaso Hospital authorities for data collection. Written informed consent was secured from all participants, who were informed of their voluntary participation and right to withdraw at any time. Confidentiality and anonymity were rigorously maintained, and the study upheld strict ethical standards throughout to protect participants’ rights and privacy. 3.0 RESULTS 3.1 Demographic characteristics of respondents The respondents represented a diverse demographic mix in age, income, employment, education, and religion, all influencing cervical cancer screening behaviors. The largest age groups were 25–34 (30.2%) and 35–44 (28.3%), with nearly equal proportions of married (42.6%) and single (42.9%) women. Most had at least basic education, with 18.7% holding university degrees and 65.3% completing junior high or above. Occupational backgrounds were varied, and 17.6% earned less than GHS 500 per month, reflecting financial barriers. Christianity was the predominant religion (75.6%), followed by Islam (17.6%) and traditional faiths (6.8%), potentially shaping attitudes towards screening (Table 1 ). Table 1 Demographic characteristics of respondents Socio-Demographics Frequency (N = 427) Percentage (%) Age 18–24 years 97 22.7 25–34 years 129 30.2 35–44 years 121 28.3 45–49 years 80 18.7 Total 427 100 Marita status Single 182 42.6 Married 183 42.9 Divorced 27 6.3 Widowed 35 8.2 Total 427 100 Highest level of education Primary school 68 15.9 Junior High School 129 30.2 Senior High School 150 35.1 Tertiary education 80 18.7 Total 427 100 Occupation Unemployed 71 16.6 Self-employed 106 24.8 Formal employment 146 34.2 Informal employment 104 24.4 Total 427 100 Monthly income level Below GHS 500 75 17.6 GHS 500 – GHS 999 126 29.5 GHS 1,000 – GHS 1,499 117 27.4 GHS 1,500 and above 109 25.5 Total 427 100 Religious affiliation Christianity 323 75.6 Islam 75 17.6 Traditional religion 29 6.8 Total 427 100 3.2: Individual Awareness and prevalence of cervical cancer screening The bar graph shows information about 427 women's awareness and prevalence of cervical cancer screening, grouped by whether they answered "Yes" or "No." Forty percent of the respondents had never heard of cervical cancer screening, whereas roughly sixty percent had heard of it. Most women, 81.7%, have never been screened for cervical cancer, whereas only 18.3% of all respondents have ever had a screening (Fig. 1). 3.3: Association Between Sociodemographic Factors and Cervical Cancer Screening Uptake Chi-square analysis showed that higher education (χ² = 12.35, p = 0.006), awareness of screening (χ² = 30.11, p < 0.001), and being married (χ² = 10.44, p = 0.015) were all significantly associated with greater cervical cancer screening uptake among women at Methodist Hospital, Aburaso. Conversely, perceived stigma was linked to lower screening rates (χ² = 8.73, p = 0.003), underscoring the negative impact of stigma on screening participation (Table 2 ). Table 2 Association Between Sociodemographic Factors and Cervical Cancer Screening Uptake Variable Category Screened (n = 78) Not Screened (n = 349) χ² value p-value Education Level Primary 5 63 12.35 0.006 JHS 20 109 SHS 28 122 Tertiary 25 55 Awareness Yes 72 184 30.11 < 0.001 No 6 165 Marital Status Single 23 159 10.44 0.015 Married 45 138 Divorced/Widowed 10 52 Stigma Yes 15 228 8.73 0.003 No 63 121 3.4 Predictors of Cervical Cancer Screening Uptake Logistic regression analysis revealed that tertiary education (aOR = 2.4, p = 0.012), awareness of cervical cancer screening (aOR = 3.1, p < 0.001), and willingness to undergo free screening (aOR = 2.8, p = 0.001) were significant independent predictors of screening uptake among women at Methodist Hospital, Aburaso. In contrast, perceived stigma significantly reduced screening likelihood (aOR = 0.5, p = 0.025), while high cost and age group were not significant predictors (Table 3 ). Table 3 Logistic Regression Analysis of Predictors of Cervical Cancer Screening Predictor aOR (Adjusted Odds Ratio) 95% CI p-value Tertiary Education 2.4 1.2–4.7 0.012 Awareness (Yes) 3.1 1.8–5.2 < 0.001 Stigma (Yes) 0.5 0.3–0.9 0.025 Willing (Free) 2.8 1.5–5.0 0.001 High Cost (Yes) 0.7 0.4–1.2 0.17 Age Group 1.1 0.8–1.5 0.32 3.5 Individual Barriers to cervical cancer screening among the respondents Nearly half of women (48.7%) have not undergone cervical cancer screening mainly due to lack of awareness, with additional barriers including fear of pain (47.6%) and fear of a positive diagnosis (34.7%). While 52.9% consider screening important, 71% report low knowledge, only 33% are willing to participate in free screening, and many cite fears, embarrassment, distrust in healthcare, and social disapproval as key obstacles (Table 4 ). Table 4 Individual barriers to cervical cancer screening among the respondents Reasons and Perceptions Frequency Percentage (%) Reasons for Not Undergoing Screening (N = 349) Lack of awareness about cervical cancer screening 170 48.7 Fear of pain or discomfort 166 47.6 Fear of a positive diagnosis 121 34.7 Lack of time 93 26.6 Screening is not a priority 78 22.4 Cultural or religious beliefs 55 15.8 Perceptions and Beliefs about Screening (N = 427) Think cervical cancer screening is important for women’s health 226 52.9 Do not think screening is important 201 47.1 Very knowledgeable about cervical cancer screening 44 10.3 Somewhat knowledgeable 80 18.7 Not knowledgeable 303 71.0 Believe at risk of developing cervical cancer 230 53.9 Do not believe at risk 197 46.1 Willing to undergo screening if free 141 33.0 Not willing to undergo free screening 286 67.0 Reasons for Not Attending Free Screening (N = 286) Fear of pain or discomfort 144 50.3 Fear of a positive diagnosis 118 41.3 Embarrassment about the procedure 104 36.4 Feeling screening unnecessary due to no symptoms 87 30.4 Distrust in the healthcare system 65 22.7 Partner or family disapproval 51 17.8 3.6 Institutional factors influencing non-utilization of cervical cancer screening. Merely 25% of women stated that cervical cancer screening services are accessible in their area, and many of them were not aware of these services' existence. Fewer than half said that their doctors encouraged them to be checked. More than half of respondents felt uneasy talking to doctors about screening, and opinions on the quality of healthcare were divided. The following were the main obstacles to access: high cost (51.3%), lack of service (47.8%), lengthy wait times (43.8%), absence of female providers (41.2%), and unfavorable provider attitudes (38.2%) (Table 5 ). Table 5 Institutional factors influencing non-utilization of cervical cancer screening Institutional Factors and Challenges Frequency (N = 427) Percentage (%) Availability of Screening Services at Nearest Healthcare Facility Yes 109 25.5 No 146 34.2 I don’t know 172 40.3 Encouragement by Healthcare Provider to Get Screened Yes 173 40.5 No 254 59.5 Perception of Healthcare Service Quality at Aburaso Hospital Excellent 50 11.7 Good 96 22.5 Average 197 46.1 Poor 84 19.7 Comfort Discussing Screening with Healthcare Providers Yes 198 46.4 No 229 53.6 Challenges in Accessing Cervical Cancer Screening Services High cost of screening 219 51.3 Unavailability of screening services in community 204 47.8 Long waiting time at health facilities 187 43.8 Lack of female healthcare providers 176 41.2 Negative attitude of healthcare providers 163 38.2 Factors That Would Encourage Screening Uptake Reduced cost of screening 288 67.4 Availability of female healthcare providers 246 57.6 More information from healthcare providers 235 55.0 Shorter waiting times 215 50.4 Increased privacy during screening 198 46.4 3.7 Community factors affecting non-utilization of cervical cancer screening Less than 40% of women heard about cervical cancer screening through community programs, and fewer than 30% reported discussions about it among friends or family. Cultural and religious beliefs influenced decisions for 37%, while over half (56.9%) felt stigma or fear of judgment in their community. Only about one-third perceived male support for screening, and involvement of traditional or religious leaders in promoting screening was limited (32.6%). Myths and misconceptions were common (41.7%), and discussion of screening in women’s groups or gatherings was low (31.4%) (Table 6 ). Table 6 Community factors affecting non-utilization of cervical cancer screening Community factors Frequency (N = 427) Percentage (%) Have you ever heard about cervical cancer screening from community-based programs or campaigns? Yes 164 38.4 No 263 61.6 Total 427 100 Do your friends or family members discuss cervical cancer screening? Yes 127 29.7 No 300 70.3 Total 427 100 Do cultural or religious beliefs influence your decision to undergo cervical cancer screening? Yes 158 37.0 No 269 63.0 Total 427 100 Do you feel any stigma or fear of judgment from your community regarding cervical cancer screening? Yes 243 56.9 No 184 43.1 Total 427 100 Are men in your community supportive of women going for cervical cancer screening? Yes 147 34.4 No 280 65.6 Total 427 100 Are traditional or religious leaders involved in promoting cervical cancer screening? Yes 139 32.6 No 172 40.3 Don’t know 116 27.2 Total 427 100 Are there myths or misconceptions in your community about cervical cancer screening? Yes 178 41.7 No 169 39.6 Don’t know 80 18.7 Total 427 100 Is cervical cancer screening discussed in women’s group meetings or community gatherings? Yes 134 31.4 No 104 24.4 Don’t know 189 44.3 Total 427 100 4.0 DISCUSSION According to the respondents' demographic profile, the majority of women were in the reproductive years, with a fairly balanced distribution between the ages of 25 and 44. This result is consistent with [ 26 ] and other research highlighting the elevated risk of cervical cancer in this age range and the necessity of screening as a top priority. Targeting women of reproductive age is relevant, as evidenced by similar age trends seen in other sub-Saharan African communities. The fact that almost equal numbers of married and unmarried women took part offers information about how screening behavior is influenced by marital status. In line with earlier studies [ 25 , 27 ] , married women are more likely to get screened, frequently as a result of partner support and increased involvement with maternal health services. In contrast, single women might not have these support networks, which emphasizes the need for targeted interventions catered to their specific situation. A comparatively high level of educational success, which is typically linked to improved health knowledge and habits, was demonstrated by the fact that more than two-thirds of respondents had completed at least junior high school [ 26 ] . Despite educational efforts, screening rates remained low, showing that education alone is not enough without addressing systemic, psychological, and cultural barriers. Financial constraints were a persistent obstacle, as nearly one-fifth of women earned less than GHC 500 per month and even employed women often deprioritized screening due to competing demands, according to research by [ 24 , 28 ] This highlights the importance of free or subsidized screening programs in making cervical cancer screening more accessible. Overall, the findings show that tailored, multifaceted public health interventions—considering factors like age, marital status, education, and economic status—are essential to increasing screening uptake and reducing the disease burden in the community. Inferential analysis revealed that education level, awareness, marital status, and stigma were all significantly linked to cervical cancer screening uptake. Women with higher education, greater awareness, and those willing to participate in free screening were more likely to be screened, while perceived stigma greatly reduced uptake. This finding is similar that of [ 29 , 30 ] . However, high cost and age were not significant predictors after adjustment, indicating that education, awareness, and stigma are the primary drivers of screening behavior in this population. Although nearly two-thirds of women had heard about cervical cancer screening, only a small percentage, that is less than one-fifth; had ever had the procedure, indicating a significant discrepancy between awareness and actual screening practice. This discrepancy is consistent with research from other low- and middle-income contexts, which show that information exposure does not always result in knowledge or behavior [ 31 ] . Fear of discomfort, inadequate knowledge, and anxiety about a positive diagnosis were major psychological and informational barriers to screening, with most women rating their knowledge as poor despite recognizing its importance. Low willingness to participate in free screening also points to deeper cultural and emotional barriers—such as social disapproval, fear, shame, and mistrust of the healthcare system—that must be addressed to improve screening uptake. The study found that institutional barriers significantly affect cervical cancer screening uptake, with only about 25% of women reporting local access to screening services and many others unaware of or unable to access available services. This in consistent with the findings of [ 24 , 32 , 33 ] . Furthermore, less than half of the women said that they had ever received encouragement from medical professionals to get screened, which indicates that the health system has lost out on opportunities to encourage preventative treatment. Over half of respondents felt uncomfortable discussing screening with providers, and nearly one-fifth rated healthcare quality as bad, indicating that interpersonal factors may erode trust and discourage screening. Access was further restricted by practical issues such as exorbitant expenses, protracted wait times, a shortage of female healthcare professionals, and unfavorable provider attitudes. These findings are in consonance with [ 34 , 35 ] The logistic regression results highlight that removing financial barriers, like offering free screening, greatly increases the likelihood of women participating in cervical cancer screening. This underscores the need for institutional interventions—such as subsidized programs and improved service delivery—as key parts of an effective prevention strategy. The study revealed significant deficiencies in social support and community knowledge about cervical cancer screening, with fewer than two-fifths of women learning about screening through community initiatives. Additionally, only about one-third reported discussing screening with friends or family, showing that the topic remains largely absent from everyday conversations and social media. This conclusion is in line with [ 35 ] . This lack of open dialogue may stem in part from the stigma associated with cervical cancer; more than half of the women surveyed expressed feelings of stigma or fear of judgment, which likely hindered candid discussions about screening and deterred many from seeking medical attention [ 24 ] . The study’s inferential analysis shows that perceived stigma significantly reduces cervical cancer screening uptake, as demonstrated by both chi-square and logistic regression results. These findings highlight the urgent need for community interventions to reduce stigma and create supportive environments through awareness and advocacy involving leaders, men, and women’s groups. Additionally, the study emphasized the lost chances to use powerful community members to encourage screening. The fact that just one-third of respondents indicated male support—a crucial component in many cultural contexts—reflects men's lack of interest in women's health issues [ 36 ] . Similarly, it was observed that traditional and religious leaders, who frequently have a significant influence on community attitudes and behaviors, were not very involved in promoting cervical cancer screening. [ 37 ] . This gap suggests that key community gatekeepers are not being effectively mobilized to advocate for screening programs. Adding to these difficulties, a substantial number of participants said they believed widespread falsehoods and misconceptions regarding cervical cancer and screening methods. These misconceptions fuel misinformation and increased anxiety about the screening procedure, as shown by [ 38 ] . The absence of community forums or support groups for open discussion makes it even harder for women to talk about and normalize cervical cancer screening. Overall, the results indicate that targeted efforts are required to address community-level barriers to cervical cancer screening. Strategies such as strengthening community health education, engaging influential leaders and men, combating myths, and creating supportive environments for women are essential to normalize and promote screening uptake. In conclusion, the study highlights a significant gap between awareness and actual use of cervical cancer screening among women in Aburaso, largely due to individual, institutional, and community-level barriers such as limited provider engagement, stigma, fear, misinformation, and financial constraints. Without addressing these challenges, screening rates are unlikely to improve, sustaining high rates of preventable illness and death. To enhance uptake, interventions should focus on culturally sensitive health education, provider training, improved service accessibility, financial support, and greater involvement of men and families. These strategies can help overcome barriers and reduce the burden of cervical cancer in the community. ABRREVIATIONS Human Papillomavirus HPV Low- and Middle-Income Countries LMICs Junior High School JHS Senior High School SHS Odds Ratio OR Ghana cedis GHC World Health Organization WHO Declarations ETHICAL APPROVAL AND CONSENT TO PARTICIPATE Ethical approval was obtained from the Local Ethical Committee of Garden City University College, on the 20 th o March 2025 and permission was also granted by Aburaso Hospital authorities for data collection. The study adhered to the ethical standards of the Declaration of Helsinki. Written informed consent was obtained from all participants after providing a clear explanation of the study’s purpose and relevance, along with assurances of confidentiality. Participation was completely voluntary, and rigorous procedures were followed to protect participants’ anonymity and maintain confidentiality throughout the research process. CONSENT FOR PUBLICATION Not applicable AVAILABILITY OF DATA AND MATERIALS The datasets generated and/or analyzed during the current study are not publicly available due to participant confidentiality but are available from the corresponding author on reasonable request. CONFLICT OF INTEREST Authors declare no conflict of interest FINANCIAL SUPPORT Nil AUTHORS CONTRIBUTION GNAA conceived and designed the study, supervised data collection, and contributed to the interpretation of findings. CNZ contributed to the study design, performed data analysis, drafted the initial manuscript, and participated in critical revisions for intellectual content. IOD assisted with data collection, data cleaning, and contributed to the development of the Methods and Results sections. JA supported questionnaire administration, literature review, and contributed to drafting and revising sections of the Background and Discussion. RF contributed to community engagement, data validation, and provided critical review and editing of the manuscript. All authors reviewed the final manuscript and approved it for submission. FUNDING The authors did not receive any funding for this work. ACKNOWLEDGEMENT The authors thank everyone who played a key role in producing this paper. References DeSantis CE, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for African Americans, 2019. CA Cancer J Clin. 2019;69(3):211–33. Singh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, Lauby-Secretan B, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health. 2023;11(2):e197–206. Sengayi-Muchengeti M, Joko-Fru WY, Miranda-Filho A, Egue M, Akele-Akpo MT, N’da G, et al. Cervical cancer survival in sub-Saharan Africa by age, stage at diagnosis and Human Development Index: A population-based registry study. 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WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention: use of dual-stain cytology to triage women after a positive test for human papillomavirus (HPV). World Health Organization; 2024. Calys-Tagoe BNL, Aheto JMK, Mensah G, Biritwum RB, Yawson AE. Cervical cancer screening practices among women in Ghana: evidence from wave 2 of the WHO study on global AGEing and adult health. BMC Womens Health [Internet] 2020 [cited 2025 Jun 23];20(1):49. Available from: https://bmcwomenshealth.biomedcentral.com/articles/ 10.1186/s12905-020-00915-9 Nartey Y, Hill PC, Amo-Antwi K, Nyarko KM, Yarney J, Cox B. Cervical cancer in the Greater Accra and Ashanti Regions of Ghana. J Glob Oncol. 2017;3(6):782–90. Gyamfua AA, Nkrumah I, Ibitoye BM, Agyemang BA, Ofosu ES, Tsoka-Gwegweni JM et al. The level of knowledge and associated socio-demographic factors on cervical cancer among women: A cross-sectional study at kenyase bosore community, Ghana. Pan Afr Med J 2019;34. Ampofo GD, Tagbor H, Bates I. Effectiveness of pregnant women’s active participation in their antenatal care for the control of malaria and anaemia in pregnancy in Ghana: A cluster randomized controlled trial ISRTCTN88917252 ISRTCTN. Malar J 2018;17(1). Calys-Tagoe BNL, Aheto JMK, Mensah G, Biritwum RB, Yawson AE. Cervical cancer screening practices among women in Ghana: Evidence from wave 2 of the WHO study on global AGEing and adult health. BMC Womens Health [Internet] 2020 [cited 2025 Jun 23];20(1):1–9. Available from: https://bmcwomenshealth.biomedcentral.com/articles/ 10.1186/s12905-020-00915-9 Wongnaah FG, Osborne A, Duodu PA, Seidu AA, Ahinkorah BO. Barriers to healthcare services utilisation among women in Ghana: evidence from the 2022 Ghana Demographic and Health Survey. BMC Health Serv Res [Internet] 2025 [cited 2025 Jun 23];25(1):1–12. Available from: https://bmchealthservres.biomedcentral.com/articles/ 10.1186/s12913-025-12226-6 Leavy P. Research Design: Quantitative, Qualitative, Mixed Methods, Arts-Based, and Community-Based Participatory Research Approaches. 2017. Cochran W. Subsampling with units of unequal sizes. Sampling Techniques [Internet] 1977 [cited 2025 Jun 23];303. Available from: https://archive.org/details/cochran-1977-sampling-techniques Nanjundeswaraswamy TS, Divakar S, DETERMINATION OF SAMPLE SIZE, AND SAMPLING METHODS IN APPLIED RESEARCH. Proceedings on Engineering Sciences. 2021;3(1):25–32. Gracias A. Barriers to Cervical Cancer Screening in Low-Income Populations [Internet]. 2024. Available from: https://www.researchgate.net/publication/386097911 Adzigbli LA, Aboagye RG, Adeleye K, Osborne A, Ahinkorah BO. Cervical cancer screening uptake and its predictors among women aged 30–49 in Ghana: Providing evidence to support the World Health Organization’s cervical cancer elimination initiative. BMC Infect Dis [Internet] 2025 [cited 2025 Jun 23];25(1):246. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11843744/ Enyan NIE. Sociodemographic factors predicting cervical cancer screening in a peri-urban community in Ghana. Afr J Midwifery Womens Health. 2022;16(4):1–8. Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):e191–203. Mantula F, Toefy Y, Sewram V. Barriers to cervical cancer screening in Africa: a systematic review. BMC Public Health [Internet] 2024 [cited 2025 Jun 23];24(1):1–22. Available from: https://bmcpublichealth.biomedcentral.com/articles/ 10.1186/s12889-024-17842-1 Apaw CK, Mnyanga RS, Asiedu C, Teye J. Identifying Clusters of Reproductive-Age Women Not Screened for Cervical and Breast Cancer in Ghana. Adv Breast Cancer Res. 2025;14(01):29–49. Saaka SA, Hambali MG. Factors associated with cervical cancer screening among women of reproductive age in Ghana. BMC Womens Health 2024;24(1). Debrah O, Agyemang-Yeboah F, Donkoh ET, Asmah RH. Prevalence of vaccine and non-vaccine human papillomavirus types among women in Accra and Kumasi, Ghana: a cross-sectional study. BMC Womens Health 2021;21(1). Agyeiwaa J, Kusi-Amponsah Diji A, Amoo SA, Asare H, Yeboah D, Antwi G et al. Experiences of women living with cervical cancer in Ghana: challenges and coping strategies. BMC Womens Health [Internet] 2024 [cited 2025 Jun 23];24(1):1–11. Available from: https://bmcwomenshealth.biomedcentral.com/articles/ 10.1186/s12905-024-03472-7 Hhera JJ, Dahaye R, Zakayo WE, Kazula YZ, Abdul S, Mamseri R et al. Factors associated with cervical cancer screening among women of reproductive age in Moshi municipality, Kilimanjaro, Tanzania: a cross-sectional study. BMJ Open [Internet] 2025 [cited 2025 Jun 23];15(1):e085223. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11758691/ Austad K, Chary A, Xocop SM, Messmer S, King N, Carlson L, et al. Barriers to cervical cancer screening and the cervical cancer care continuum in rural Guatemala: A mixed-method analysis. J Glob Oncol. 2018;2018(4):1–10. Bateman LB, Blakemore S, Koneru A, Mtesigwa T, McCree R, Lisovicz NF, et al. Barriers and Facilitators to Cervical Cancer Screening, Diagnosis, Follow-Up Care and Treatment: Perspectives of Human Immunodeficiency Virus-Positive Women and Health Care Practitioners in Tanzania. Oncologist. 2019;24(1):69–75. Adegboyega A, Aleshire M, Dignan M, Hatcher J. Spousal support and knowledge related to cervical cancer screening: Are Sub-Saharan African immigrant men interested? Health Care Women Int. 2019;40(6):665–81. Gutusa F, Roets L. Early cervical cancer screening: The influence of culture and religion. Afr J Prim Health Care Fam Med [Internet] 2023 [cited 2025 Jun 23];15(1):3776. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9900302/ Srinath A, Van Merode F, Rao SV, Pavlova M. Barriers to cervical cancer and breast cancer screening uptake in low- and middle-income countries: a systematic review. Health Policy Plan [Internet] 2022 [cited 2025 Jun 23];38(4):509. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10089064/ Additional Declarations No competing interests reported. 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Over the past decade, this upward trend has been largely attributed to the low uptake of cervical cancer screening services, despite the availability of effective preventive measures \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Cervical cancer is the fourth most common cancer affecting women globally, after breast, colorectal, and lung cancers, with approximately 570,000 new cases and 311,000 deaths recorded annually \u003csup\u003e[\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e with a global incidence rate of 13.1 per 100,000 women and a mortality rate of 6.5 per 100,000 \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Evidence has consistently shown that regular screening enables the early detection of precancerous lesions, which can be effectively treated to prevent the development of invasive cervical cancer \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDespite the proven benefits of cervical cancer screening, participation rates remain low, especially in sub-Saharan Africa, where the burden of the disease is disproportionately high. In the region, the incidence and mortality rates are estimated at 28.8 and 22.1 per 100,000 women, respectively \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. High-risk factors, limited access to screening services, and weak health systems contribute to the escalating disease burden \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Notably, around 85% of cervical cancer diagnoses and 88% of related deaths occur in low- and middle-income countries, with the highest rates recorded in southern, western, middle, and eastern Africa \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn Ghana, the situation is particularly concerning. Cervical cancer is the second leading cause of cancer among women, with approximately 3,028 new cases and 2,006 deaths reported in 2020 alone \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. The mortality rate in Ghana exceeds the global average by more than threefold \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, and nearly 70% of cases are attributed to human papillomavirus (HPV) types 16 and 18 \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. While national guidelines recommend screening for women between ages 21 and 64, implementation remains weak due to the absence of a national screening policy, limited infrastructure, and a reliance on opportunistic screening approaches within family planning, outpatient, and gynecological departments \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. As a result, screening coverage remains very low\u0026mdash;estimated at just 0.8% of women nationally\u0026mdash;with about half of diagnosed cases occurring in women who were never screened \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThese gaps point to the urgent need for understanding the underlying reasons why women do not utilize cervical cancer screening services. Multiple studies in Ghana have identified common barriers such as fear of results, lack of awareness, cultural stigma, and perceived susceptibility \u003csup\u003e[\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Few studies have systematically categorized barriers at the individual, institutional, and community levels, and most have focused on urban settings, overlooking peri-urban communities like Aburaso, where women often face distinct challenges such as limited healthcare access, stronger traditional beliefs, and less exposure to health education \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. These contextual differences may significantly influence screening behaviors and require localized, evidence-informed responses.\u003c/p\u003e \u003cp\u003eThis study aims to address this gap by examining the individual, institutional, and community-level factors that hinder cervical cancer screening among women in Aburaso, and by recommending practical solutions to increase uptake. The findings are intended to inform policies and programs that can help reduce cervical cancer morbidity and mortality in peri-urban Ghana.\u003c/p\u003e"},{"header":"2.0 METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study setting\u003c/h2\u003e \u003cp\u003eThe study site was Methodist hospital, located at Aburaso in the Atwima Kwanwoma District of Ghana\u0026rsquo;s Ashanti Region, operated under the Ghana Health Service and the Methodist Church. With about 50 beds, the hospital offers a broad range of medical, surgical, maternal, and public health services, and serves as a key referral center for nearby communities. It features essential departments such as outpatient, inpatient, maternity, pediatric, surgical, laboratory, radiology, and pharmacy units. The hospital\u0026rsquo;s Public Health Department provides preventive services, including immunizations, disease surveillance, and cervical cancer screening. Equipped with 24-hour emergency care and public health outreach programs, the hospital plays a critical role in improving healthcare access and awareness in the district.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Research Design\u003c/h2\u003e \u003cp\u003eA descriptive cross-sectional design was used to assess factors influencing non-utilization of cervical cancer screening by collecting data at a single point in time. This approach was suitable as it enabled the simultaneous examination of various factors such as demographics, institutional barriers, and community influences related to screening uptake. The design\u0026rsquo;s cost-effectiveness and time efficiency also made it ideal for research within a limited timeframe \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Sample Size and Sampling Techniques\u003c/h2\u003e \u003cp\u003eThe sample size was calculated using Cochran\u0026rsquo;s formula \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e, which is commonly used to determine the appropriate sample size for prevalence studies.\u003c/p\u003e \u003cp\u003en = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\frac{Z2P(1-P)}{d2}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cp\u003eWhere:\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;Sample size\u003c/p\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;Standard normal deviation at a 95% confidence level (1.96)\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;Estimated prevalence of cervical cancer screening utilization (50% or 0.50, since no prior data exists for this population)\u003c/p\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;Margin of error (5% or 0.05)\u003c/p\u003e \u003cp\u003eSubstituting the values:\u003c/p\u003e \u003cp\u003en = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\frac{\\left(1.96\\right)2\\:\\times\\:0.50\\:\\times\\:\\:(1-0.50)}{\\left(0.05\\right)2}\\)\u003c/span\u003e\u003c/span\u003e = 384.16\u003c/p\u003e \u003cp\u003eRounding up, the minimum required sample size is 384 participants. To account for a 10% non-response rate, the final adjusted sample size is 427 participants.\u003c/p\u003e \u003cp\u003eThe study employed a stratified random sampling technique to ensure adequate representation of different subgroups within the study population. Stratified sampling involves dividing the population into distinct subgroups (strata) based on relevant characteristics before selecting participants randomly from each stratum \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. In this study, stratification was done by age groups (15\u0026ndash;24, 25\u0026ndash;34, 35\u0026ndash;44, and 45\u0026ndash;49 years) to ensure adequate representation and capture variations in cervical cancer screening utilization across different age categories. This approach enhanced the precision of the findings, reduced sampling bias, and enabled meaningful comparisons between age-specific subgroups to identify unique barriers to screening.\u003c/p\u003e \u003cp\u003eThe total sample size of 427 was proportionally allocated across these age groups based on the hospital\u0026rsquo;s outpatient records on the distribution of women in reproductive age. The proportional allocation was determined using the formula:\u003c/p\u003e \u003cp\u003e \u003cem\u003en\u003c/em\u003e \u003csub\u003e \u003cem\u003ei\u003c/em\u003e \u003c/sub\u003e = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\left(\\frac{Ni}{\\text{N}}\\right)\\)\u003c/span\u003e\u003c/span\u003e\u0026times;\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003cp\u003eWhere:\u003c/p\u003e \u003cp\u003e \u003cem\u003en\u003c/em\u003e \u003csub\u003e \u003cem\u003ei\u003c/em\u003e \u003c/sub\u003e = Sample size for each age group\u003c/p\u003e \u003cp\u003e \u003cem\u003eNi\u003c/em\u003e\u0026thinsp;=\u0026thinsp;Total number of women in that age group from hospital records\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;Total number of women in reproductive age attending the hospital\u003c/p\u003e \u003cp\u003e \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;Total sample size (427).\u003c/p\u003e \u003cp\u003eFor example, if the hospital\u0026rsquo;s outpatient records indicate that women aged 15\u0026ndash;24 years form 20% of the reproductive-age population, then their sample size will be (20/100) \u0026times; 427\u0026thinsp;=\u0026thinsp;85 participants. The same proportional approach was applied to the remaining age groups. After determining the proportion of participants needed from each age group, simple random sampling was conducted within each category using a lottery method. Eligible women were assigned unique identification numbers, which were drawn randomly to ensure every individual had an equal chance of selection. An independent observer or research assistant supervised the process to maintain transparency. Women were approached in various hospital departments, and those who consented voluntarily were included in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Data Collection Instruments\u003c/h2\u003e \u003cp\u003eA structured, closed-ended questionnaire adapted from validated instruments in previous studies on cervical cancer screening \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e was used to collect quantitative data on factors influencing screening uptake and strategies to improve participation among women of reproductive age. The questionnaire comprised sections on demographics, personal attributes, institutional and community influences, and potential strategies to enhance screening uptake. Trained research assistants administered the survey in person at Aburaso Hospital, providing explanations and assistance as needed. To ensure inclusivity, the questionnaire was translated into the local language (Twi) for respondents with limited English proficiency. Standardized procedures were followed to minimize bias and protect participant confidentiality throughout data collection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data Analysis Techniques\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS version 26, with all responses checked for completeness and consistency before entry. Variables were coded for analysis, and descriptive statistics (frequencies and percentages) summarized demographic and key study variables. Inferential analyses, including Chi-square tests and logistic regression, were performed to identify associations and independent predictors of cervical cancer screening uptake, with significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Results were presented in tables, graphs, and charts for clarity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Inclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eWomen eligible for the study were those aged 18 years and above who attended Aburaso Hospital during the data collection period, consented to participate, and were able to understand and complete the questionnaire. Exclusion criteria included women younger than 18 years, those who declined or did not provide consent, those with cognitive or communication impairments, and those who were too ill or distressed to participate.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.7 Ethical Considerations\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was obtained from the Local Ethical Committee of Garden City University College, on the 20th o March 2025 and permission was also granted by Aburaso Hospital authorities for data collection. Written informed consent was secured from all participants, who were informed of their voluntary participation and right to withdraw at any time. Confidentiality and anonymity were rigorously maintained, and the study upheld strict ethical standards throughout to protect participants\u0026rsquo; rights and privacy.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3.0 RESULTS","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.1 \u003cb\u003eDemographic characteristics of respondents\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThe respondents represented a diverse demographic mix in age, income, employment, education, and religion, all influencing cervical cancer screening behaviors. The largest age groups were 25\u0026ndash;34 (30.2%) and 35\u0026ndash;44 (28.3%), with nearly equal proportions of married (42.6%) and single (42.9%) women. Most had at least basic education, with 18.7% holding university degrees and 65.3% completing junior high or above. Occupational backgrounds were varied, and 17.6% earned less than GHS 500 per month, reflecting financial barriers. Christianity was the predominant religion (75.6%), followed by Islam (17.6%) and traditional faiths (6.8%), potentially shaping attitudes towards screening (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of respondents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSocio-Demographics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (N\u0026thinsp;=\u0026thinsp;427)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;24 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;34 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ndash;44 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;49 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e427\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eMarita status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e427\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHighest level of education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJunior High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSenior High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e427\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFormal employment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInformal employment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e427\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eMonthly income level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBelow GHS 500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGHS 500 \u0026ndash; GHS 999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGHS 1,000 \u0026ndash; GHS 1,499\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGHS 1,500 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e427\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eReligious affiliation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraditional religion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e427\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2: \u003cb\u003eIndividual Awareness and prevalence of cervical cancer screening\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThe bar graph shows information about 427 women's awareness and prevalence of cervical cancer screening, grouped by whether they answered \"Yes\" or \"No.\" Forty percent of the respondents had never heard of cervical cancer screening, whereas roughly sixty percent had heard of it. Most women, 81.7%, have never been screened for cervical cancer, whereas only 18.3% of all respondents have ever had a screening (Fig.\u0026nbsp;1).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.3: Association Between Sociodemographic Factors and Cervical Cancer Screening Uptake\u003c/h2\u003e \u003cp\u003eChi-square analysis showed that higher education (χ\u0026sup2; = 12.35, p\u0026thinsp;=\u0026thinsp;0.006), awareness of screening (χ\u0026sup2; = 30.11, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and being married (χ\u0026sup2; = 10.44, p\u0026thinsp;=\u0026thinsp;0.015) were all significantly associated with greater cervical cancer screening uptake among women at Methodist Hospital, Aburaso. Conversely, perceived stigma was linked to lower screening rates (χ\u0026sup2; = 8.73, p\u0026thinsp;=\u0026thinsp;0.003), underscoring the negative impact of stigma on screening participation (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation Between Sociodemographic Factors and Cervical Cancer Screening Uptake\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScreened (n\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot Screened (n\u0026thinsp;=\u0026thinsp;349)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u0026sup2; value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAwareness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced/Widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStigma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Predictors of Cervical Cancer Screening Uptake\u003c/h2\u003e \u003cp\u003eLogistic regression analysis revealed that tertiary education (aOR\u0026thinsp;=\u0026thinsp;2.4, p\u0026thinsp;=\u0026thinsp;0.012), awareness of cervical cancer screening (aOR\u0026thinsp;=\u0026thinsp;3.1, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and willingness to undergo free screening (aOR\u0026thinsp;=\u0026thinsp;2.8, p\u0026thinsp;=\u0026thinsp;0.001) were significant independent predictors of screening uptake among women at Methodist Hospital, Aburaso. In contrast, perceived stigma significantly reduced screening likelihood (aOR\u0026thinsp;=\u0026thinsp;0.5, p\u0026thinsp;=\u0026thinsp;0.025), while high cost and age group were not significant predictors (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic Regression Analysis of Predictors of Cervical Cancer Screening\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePredictor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eaOR (Adjusted Odds Ratio)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.2\u0026ndash;4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAwareness (Yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.8\u0026ndash;5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStigma (Yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.3\u0026ndash;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWilling (Free)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.5\u0026ndash;5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh Cost (Yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.4\u0026ndash;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.8\u0026ndash;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.5 \u003cb\u003eIndividual Barriers to cervical cancer screening among the respondents\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eNearly half of women (48.7%) have not undergone cervical cancer screening mainly due to lack of awareness, with additional barriers including fear of pain (47.6%) and fear of a positive diagnosis (34.7%). While 52.9% consider screening important, 71% report low knowledge, only 33% are willing to participate in free screening, and many cite fears, embarrassment, distrust in healthcare, and social disapproval as key obstacles (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIndividual barriers to cervical cancer screening among the respondents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReasons and Perceptions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReasons for Not Undergoing Screening (N\u0026thinsp;=\u0026thinsp;349)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of awareness about cervical cancer screening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear of pain or discomfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear of a positive diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScreening is not a priority\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCultural or religious beliefs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerceptions and Beliefs about Screening (N\u0026thinsp;=\u0026thinsp;427)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThink cervical cancer screening is important for women\u0026rsquo;s health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo not think screening is important\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery knowledgeable about cervical cancer screening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSomewhat knowledgeable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot knowledgeable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelieve at risk of developing cervical cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo not believe at risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWilling to undergo screening if free\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot willing to undergo free screening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReasons for Not Attending Free Screening (N\u0026thinsp;=\u0026thinsp;286)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear of pain or discomfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear of a positive diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmbarrassment about the procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeeling screening unnecessary due to no symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistrust in the healthcare system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartner or family disapproval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.6 \u003cb\u003eInstitutional factors influencing non-utilization of cervical cancer screening.\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eMerely 25% of women stated that cervical cancer screening services are accessible in their area, and many of them were not aware of these services' existence. Fewer than half said that their doctors encouraged them to be checked. More than half of respondents felt uneasy talking to doctors about screening, and opinions on the quality of healthcare were divided. The following were the main obstacles to access: high cost (51.3%), lack of service (47.8%), lengthy wait times (43.8%), absence of female providers (41.2%), and unfavorable provider attitudes (38.2%) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInstitutional factors influencing non-utilization of cervical cancer screening\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstitutional Factors and Challenges\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (N\u0026thinsp;=\u0026thinsp;427)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvailability of Screening Services at Nearest Healthcare Facility\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEncouragement by Healthcare Provider to Get Screened\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerception of Healthcare Service Quality at Aburaso Hospital\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComfort Discussing Screening with Healthcare Providers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChallenges in Accessing Cervical Cancer Screening Services\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh cost of screening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnavailability of screening services in community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLong waiting time at health facilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of female healthcare providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative attitude of healthcare providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFactors That Would Encourage Screening Uptake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced cost of screening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e288\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvailability of female healthcare providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore information from healthcare providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShorter waiting times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased privacy during screening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.7 Community factors affecting non-utilization of cervical cancer screening\u003c/h2\u003e \u003cp\u003eLess than 40% of women heard about cervical cancer screening through community programs, and fewer than 30% reported discussions about it among friends or family. Cultural and religious beliefs influenced decisions for 37%, while over half (56.9%) felt stigma or fear of judgment in their community. Only about one-third perceived male support for screening, and involvement of traditional or religious leaders in promoting screening was limited (32.6%). Myths and misconceptions were common (41.7%), and discussion of screening in women\u0026rsquo;s groups or gatherings was low (31.4%) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCommunity factors affecting non-utilization of cervical cancer screening\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCommunity factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (N\u0026thinsp;=\u0026thinsp;427)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHave you ever heard about cervical cancer screening from community-based programs or campaigns?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e427\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDo your friends or family members discuss cervical cancer screening?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e427\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDo cultural or religious beliefs influence your decision to undergo cervical cancer screening?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e269\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e427\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDo you feel any stigma or fear of judgment from your community regarding cervical cancer screening?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e427\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAre men in your community supportive of women going for cervical cancer screening?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e280\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e427\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAre traditional or religious leaders involved in promoting cervical cancer screening?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e427\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAre there myths or misconceptions in your community about cervical cancer screening?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e427\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eIs cervical cancer screening discussed in women\u0026rsquo;s group meetings or community gatherings?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e427\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4.0 DISCUSSION","content":"\u003cp\u003eAccording to the respondents' demographic profile, the majority of women were in the reproductive years, with a fairly balanced distribution between the ages of 25 and 44. This result is consistent with \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e and other research highlighting the elevated risk of cervical cancer in this age range and the necessity of screening as a top priority. Targeting women of reproductive age is relevant, as evidenced by similar age trends seen in other sub-Saharan African communities. The fact that almost equal numbers of married and unmarried women took part offers information about how screening behavior is influenced by marital status. In line with earlier studies \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e, married women are more likely to get screened, frequently as a result of partner support and increased involvement with maternal health services. In contrast, single women might not have these support networks, which emphasizes the need for targeted interventions catered to their specific situation. A comparatively high level of educational success, which is typically linked to improved health knowledge and habits, was demonstrated by the fact that more than two-thirds of respondents had completed at least junior high school \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. Despite educational efforts, screening rates remained low, showing that education alone is not enough without addressing systemic, psychological, and cultural barriers. Financial constraints were a persistent obstacle, as nearly one-fifth of women earned less than GHC 500 per month and even employed women often deprioritized screening due to competing demands, according to research by \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e This highlights the importance of free or subsidized screening programs in making cervical cancer screening more accessible. Overall, the findings show that tailored, multifaceted public health interventions\u0026mdash;considering factors like age, marital status, education, and economic status\u0026mdash;are essential to increasing screening uptake and reducing the disease burden in the community.\u003c/p\u003e \u003cp\u003eInferential analysis revealed that education level, awareness, marital status, and stigma were all significantly linked to cervical cancer screening uptake. Women with higher education, greater awareness, and those willing to participate in free screening were more likely to be screened, while perceived stigma greatly reduced uptake. This finding is similar that of \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. However, high cost and age were not significant predictors after adjustment, indicating that education, awareness, and stigma are the primary drivers of screening behavior in this population.\u003c/p\u003e \u003cp\u003eAlthough nearly two-thirds of women had heard about cervical cancer screening, only a small percentage, that is less than one-fifth; had ever had the procedure, indicating a significant discrepancy between awareness and actual screening practice. This discrepancy is consistent with research from other low- and middle-income contexts, which show that information exposure does not always result in knowledge or behavior \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. Fear of discomfort, inadequate knowledge, and anxiety about a positive diagnosis were major psychological and informational barriers to screening, with most women rating their knowledge as poor despite recognizing its importance. Low willingness to participate in free screening also points to deeper cultural and emotional barriers\u0026mdash;such as social disapproval, fear, shame, and mistrust of the healthcare system\u0026mdash;that must be addressed to improve screening uptake.\u003c/p\u003e \u003cp\u003eThe study found that institutional barriers significantly affect cervical cancer screening uptake, with only about 25% of women reporting local access to screening services and many others unaware of or unable to access available services. This in consistent with the findings of \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. Furthermore, less than half of the women said that they had ever received encouragement from medical professionals to get screened, which indicates that the health system has lost out on opportunities to encourage preventative treatment. Over half of respondents felt uncomfortable discussing screening with providers, and nearly one-fifth rated healthcare quality as bad, indicating that interpersonal factors may erode trust and discourage screening. Access was further restricted by practical issues such as exorbitant expenses, protracted wait times, a shortage of female healthcare professionals, and unfavorable provider attitudes. These findings are in consonance with\u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e The logistic regression results highlight that removing financial barriers, like offering free screening, greatly increases the likelihood of women participating in cervical cancer screening. This underscores the need for institutional interventions\u0026mdash;such as subsidized programs and improved service delivery\u0026mdash;as key parts of an effective prevention strategy.\u003c/p\u003e \u003cp\u003eThe study revealed significant deficiencies in social support and community knowledge about cervical cancer screening, with fewer than two-fifths of women learning about screening through community initiatives. Additionally, only about one-third reported discussing screening with friends or family, showing that the topic remains largely absent from everyday conversations and social media. This conclusion is in line with \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e. This lack of open dialogue may stem in part from the stigma associated with cervical cancer; more than half of the women surveyed expressed feelings of stigma or fear of judgment, which likely hindered candid discussions about screening and deterred many from seeking medical attention \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. The study\u0026rsquo;s inferential analysis shows that perceived stigma significantly reduces cervical cancer screening uptake, as demonstrated by both chi-square and logistic regression results. These findings highlight the urgent need for community interventions to reduce stigma and create supportive environments through awareness and advocacy involving leaders, men, and women\u0026rsquo;s groups.\u003c/p\u003e \u003cp\u003eAdditionally, the study emphasized the lost chances to use powerful community members to encourage screening. The fact that just one-third of respondents indicated male support\u0026mdash;a crucial component in many cultural contexts\u0026mdash;reflects men's lack of interest in women's health issues \u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e. Similarly, it was observed that traditional and religious leaders, who frequently have a significant influence on community attitudes and behaviors, were not very involved in promoting cervical cancer screening. \u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e. This gap suggests that key community gatekeepers are not being effectively mobilized to advocate for screening programs.\u003c/p\u003e \u003cp\u003eAdding to these difficulties, a substantial number of participants said they believed widespread falsehoods and misconceptions regarding cervical cancer and screening methods. These misconceptions fuel misinformation and increased anxiety about the screening procedure, as shown by \u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e. The absence of community forums or support groups for open discussion makes it even harder for women to talk about and normalize cervical cancer screening. Overall, the results indicate that targeted efforts are required to address community-level barriers to cervical cancer screening. Strategies such as strengthening community health education, engaging influential leaders and men, combating myths, and creating supportive environments for women are essential to normalize and promote screening uptake.\u003c/p\u003e \u003cp\u003eIn conclusion, the study highlights a significant gap between awareness and actual use of cervical cancer screening among women in Aburaso, largely due to individual, institutional, and community-level barriers such as limited provider engagement, stigma, fear, misinformation, and financial constraints. Without addressing these challenges, screening rates are unlikely to improve, sustaining high rates of preventable illness and death. To enhance uptake, interventions should focus on culturally sensitive health education, provider training, improved service accessibility, financial support, and greater involvement of men and families. These strategies can help overcome barriers and reduce the burden of cervical cancer in the community.\u003c/p\u003e"},{"header":"ABRREVIATIONS","content":"\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHuman Papillomavirus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHPV\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLow- and Middle-Income Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLMICs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eJunior High School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSenior High School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOdds Ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGhana cedis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGHC\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eETHICAL APPROVAL AND CONSENT TO PARTICIPATE\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Local Ethical Committee of Garden City University College, on the 20\u003csup\u003eth\u003c/sup\u003e o March 2025 and permission was also granted by Aburaso Hospital authorities for data collection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study adhered to the ethical standards of the Declaration of Helsinki. Written informed consent was obtained from all participants after providing a clear explanation of the study’s purpose and relevance, along with assurances of confidentiality. Participation was completely voluntary, and rigorous procedures were followed to protect participants’ anonymity and maintain confidentiality throughout the research process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONSENT FOR PUBLICATION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAVAILABILITY OF DATA AND MATERIALS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to participant confidentiality but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONFLICT OF INTEREST\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors declare no conflict of interest\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFINANCIAL SUPPORT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNil\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHORS CONTRIBUTION\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGNAA conceived and designed the study, supervised data collection, and contributed to the interpretation of findings.\u003cbr\u003e\u0026nbsp;CNZ contributed to the study design, performed data analysis, drafted the initial manuscript, and participated in critical revisions for intellectual content.\u003cbr\u003e\u0026nbsp;IOD assisted with data collection, data cleaning, and contributed to the development of the Methods and Results sections.\u003cbr\u003e\u0026nbsp;JA supported questionnaire administration, literature review, and contributed to drafting and revising sections of the Background and Discussion.\u003cbr\u003e\u0026nbsp;RF contributed to community engagement, data validation, and provided critical review and editing of the manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the final manuscript and approved it for submission.\u003c/p\u003e\n\u003cp\u003eFUNDING\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors did not receive any funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank everyone who played a key role in producing this paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDeSantis CE, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for African Americans, 2019. CA Cancer J Clin. 2019;69(3):211\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, Lauby-Secretan B, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health. 2023;11(2):e197\u0026ndash;206.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSengayi-Muchengeti M, Joko-Fru WY, Miranda-Filho A, Egue M, Akele-Akpo MT, N\u0026rsquo;da G, et al. Cervical cancer survival in sub-Saharan Africa by age, stage at diagnosis and Human Development Index: A population-based registry study. Int J Cancer. 2020;147(11):3037\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCastanon A, Sasieni P. Is the recent increase in cervical cancer in women aged 20\u0026ndash;24 years in England a cause for concern? 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Factors associated with cervical cancer screening among women of reproductive age in Ghana. BMC Womens Health 2024;24(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDebrah O, Agyemang-Yeboah F, Donkoh ET, Asmah RH. Prevalence of vaccine and non-vaccine human papillomavirus types among women in Accra and Kumasi, Ghana: a cross-sectional study. BMC Womens Health 2021;21(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgyeiwaa J, Kusi-Amponsah Diji A, Amoo SA, Asare H, Yeboah D, Antwi G et al. Experiences of women living with cervical cancer in Ghana: challenges and coping strategies. BMC Womens Health [Internet] 2024 [cited 2025 Jun 23];24(1):1\u0026ndash;11. 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Oncologist. 2019;24(1):69\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdegboyega A, Aleshire M, Dignan M, Hatcher J. Spousal support and knowledge related to cervical cancer screening: Are Sub-Saharan African immigrant men interested? Health Care Women Int. 2019;40(6):665\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGutusa F, Roets L. Early cervical cancer screening: The influence of culture and religion. Afr J Prim Health Care Fam Med [Internet] 2023 [cited 2025 Jun 23];15(1):3776. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC9900302/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC9900302/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSrinath A, Van Merode F, Rao SV, Pavlova M. Barriers to cervical cancer and breast cancer screening uptake in low- and middle-income countries: a systematic review. Health Policy Plan [Internet] 2022 [cited 2025 Jun 23];38(4):509. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC10089064/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC10089064/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cervical cancer screening, Non-utilization, Reproductive-age women, Community factors, Institutional factors, individual factors, Ghana, Methodist Aburaso","lastPublishedDoi":"10.21203/rs.3.rs-8370044/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8370044/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eCervical cancer remains a major health threat, especially in Ghana, due to low screening uptake. Despite the availability of prevention, participation is limited particularly in peri-urban areas with unique barriers; making it crucial to understand the reasons for non-utilization to reduce the disease burden.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA descriptive cross-sectional study of 427 women of reproductive age at Aburaso Hospital used stratified random sampling and structured questionnaires. Data were analyzed with SPSS version 26, utilizing descriptive statistics, Chi-square tests, and logistic regression to identify key factors associated with cervical cancer screening uptake.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eScreening uptake was low at 18.3% despite moderate awareness. Chi-square analysis showed that education level (p\u0026thinsp;=\u0026thinsp;0.006), awareness (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), marital status (p\u0026thinsp;=\u0026thinsp;0.015), and stigma (p\u0026thinsp;=\u0026thinsp;0.003) were significantly associated with screening uptake. Logistic regression revealed that tertiary education (aOR\u0026thinsp;=\u0026thinsp;2.4, p\u0026thinsp;=\u0026thinsp;0.012), awareness (aOR\u0026thinsp;=\u0026thinsp;3.1, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), willingness to undergo free screening (aOR\u0026thinsp;=\u0026thinsp;2.8, p\u0026thinsp;=\u0026thinsp;0.001), and perceived stigma (aOR\u0026thinsp;=\u0026thinsp;0.5, p\u0026thinsp;=\u0026thinsp;0.025) remained significant independent predictors.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eThere is a considerable disconnect between awareness and actual screening for cervical cancer among women in Aburaso, driven by individual, institutional, and community barriers. Key factors influencing uptake include education, awareness, willingness, and absence of stigma. Improving screening rates will require culturally tailored education, enhanced provider engagement, financial support, and efforts to reduce community stigma.\u003c/p\u003e","manuscriptTitle":"Determinants of Cervical Cancer Screening Uptake Among Women in Aburaso, Ghana: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-30 09:44:55","doi":"10.21203/rs.3.rs-8370044/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-08T09:57:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"8781792532157804607711598083145110271","date":"2026-03-27T15:59:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238150365506029892405482304183206710053","date":"2026-03-27T03:31:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"172421188235994715000112547739492867201","date":"2026-03-24T09:19:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-22T16:52:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325591202162074789032624879803069298450","date":"2026-03-22T16:16:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"148929837158156540941702174669855237635","date":"2026-03-21T00:15:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"258914847003552683514223921044394329124","date":"2026-03-19T09:29:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-10T13:09:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"172905488001211694185734643893138282729","date":"2026-03-02T18:42:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"167608392676893228206039153157251140858","date":"2026-02-28T13:00:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"137027572912497879434396508847089608429","date":"2026-02-28T12:25:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-28T11:51:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-19T17:49:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-16T23:23:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-16T23:23:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-12-15T21:34:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4c976af8-6b85-47ef-8336-9908e9b6add5","owner":[],"postedDate":"January 30th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-30T09:44:55+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-30 09:44:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8370044","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8370044","identity":"rs-8370044","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}