Graduation Year

2023

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Public Health

Major Professor

Janice Zgibor, RPh, Ph.D.

Co-Major Professor

Ellen M. Daley, Ph.D., MPH

Committee Member

Jason Beckstead, Ph.D.

Committee Member

Eun Sook Kim, Ph.D.

Committee Member

Stacey Griner, Ph.D.

Keywords

At-home HPV testing, Health Belief Model, Pap smear, Systems of processing

Abstract

This dissertation includes three studies, and the purpose was to explore cervical cancer screening adherence and factors related to screening behaviors among women.

The purpose of the first study was to examine cervical cancer screening recommendation adherence trends in a nationally representative sample using Behavioral Risk Factor Surveillance System 1995-2018 data. Adherence rates declined for every definition of adherence evaluated over time. Social determinants of health predictors and their impacts varied based on the years of data included in and the data source.

The second study examined the hypothesized factor structure underlying multiple scales (i.e., Health Belief Model constructs and Rational-Experiential Inventory-10). Three-hundred women 30-65 years old were recruited via Prolific to complete a survey. The instrument was evaluated for validity and reliability through confirmatory factor analysis. Evidence for validity showed weak to moderate correlations between HBM and REI latent factors and model fit statistics indicating the model fit the data; however, the chi-square tests indicated the HBM and REI models did not fit the data well (HBM: χ2 (528) = 1093.8, p < .001; REI: χ2 (34) = 121.5, p < .001 ). Reliability scores ranged from .561 to .957 with three falling below the ≥ .70 threshold.

The purpose of the final study was to determine the relative importance of Health Belief Model constructs and possible moderation by a person’s decision-making style on intention to use at-home HPV self-sampling. The survey data of 300 women was analyzed using regression analysis with product terms to explore moderating effects. Four Health Belief Model factors were significant and neither decision-making style was significant in the model of direct effects (R2 = .493, F(12, 287) = 25.2). Self-efficacy related to the test was the strongest predictor of intention. The model including product terms did not significantly increase the R2 (ΔR2 = .012, F (14, 273) = .479) and there was no evidence of moderation.

The results of this study were consistent with current literature showing a decline in cervical cancer screening adherence. Alternative methods of screening, such as at-home HPV testing, should be evaluated for acceptability. This study found that self-efficacy related to the at-home test was the strongest predictor of intention to use at-home testing. Future research should work to develop health literate, consumer-centered instructions that increase users’ confidence in their own ability to perform the test and be confident in the results through the use of mixed-method studies. Development of these messages should be evaluated for effectiveness while continuing to explore the acceptability and feasibility of at-home HPV testing in underserved populations.

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