Knowledge, Socioeconomic Determinants, and Cervical Cancer Screening Participation in Longhua District, China: A Mixed Method Study

Abstract

Background: Cervical cancer screening is one of the most effective approaches to control the leading cancer among women as recommended by World Health Organization (WHO). To this end, Shenzhen has piloted a free cervical cancer screening service for its at-risk female residents. This study aims to the relationship between screening participation and knowledge and socioeconomic determinants in Longhua District, Shenzhen, China, and to provide insights for governments’ screening policies. Methods: This cross-sectional mixed-method study was conducted in Longhua District, Shenzhen, China. In 2022, a web survey was conducted among 3,230 women aged 30-65 years, and in-depth interviews (IDIs) were conducted with 10 unscreened women and 3 screening providers. Participants provided sociodemographic information and answered questions about their knowledge and cervical cancer screening experiences. The socioeconomic status (SES) and knowledge were considered exposures, and the cervical cancer screening participation in lifetime and in the recent 5 years were considered outcomes of interest. The interviews were conducted by phone calls. Quantitative data were analyzed using multivariate and multinomial logistic regression models, and qualitative data were analyzed using the thematic approach. Results: The overall rate of lifetime and recent 5-year cervical cancer screening were 82.3% and 72.9% respectively. After adjusting for SES, this study found a higher participation rate of cervical cancer screening associated with a higher knowledge score (Lifetime OR: 1.91, 95% CI: 1.63-2.23; Recent 5-year OR: 2.29, 95% CI: 1.77-2.98), going to college (Lifetime OR: 1.47, 95% CI: 1.08-1.99; Recent 5-year OR: 1.48, 95% CI: 1.22-1.80), and working for public sectors (Recent 5-year OR: 1.73, 95% CI: 1.19-2.51). However, participants with higher annual household income were less likely to take up free cervical cancer screening service (Lifetime OR: 0.72, 95% CI: 0.56-0.93; Recent 5-year OR: 0.71, 95% CI: 0.56, 0.89). Conclusions: This study indicated that cervical cancer screening participation in Longhua District, Shenzhen, China was overall associated with higher knowledge score and SES. It suggested that efforts should be made to reinforce health education and policy dissemination for women with low education level and to extend the free screening service to low-income group.