Meta Analysis: Application of Health Belief Model Theory on Pap Smear Screening Uptake in Women of Reproductive Age


  • Syndia Puspitasari Masters Program in Public Health, Universitas Sebelas Maret
  • Bhisma Murti Masters Program in Public Health, Universitas Sebelas Maret
  • Hanung Prasetya Health Polytechnics, Ministry of Health Surakarta


Background: Cervical cancer is the fourth cancer in the world that attacks women and causes death. Until now, cervical cancer causes high morbidity and mortality. Regular cervical cancer screening with the Papanicolaou (Pap) smear test remains an effective public health intervention in the prevention and subsequent reduction of the incidence, morbidity and mortality of cervical cancer. Health Belief Model (HBM) is a model developed to help understand human behavior in seeking health services and explain why people do not engage in behavior for disease prevention or early detection.

Subjects and Method: This was a systematic review and meta-analysis. Data collection was obtained from 3 databases, namely: Google Scholar, PubMed, and Science Direct. Analysis of this research using software RevMan 5.3. The inclusion criteria used were full English paper with cross sectional design in 2012-2022. The keywords used were “Pap Smear” OR “Cervical Cancer Screen­ing” AND “Health Belief Model” OR “Health Belief” AND “Cervical Cancer”.

Results: A total of 15 cross-sectional study articles from Indonesia, Malaysia, Turkey, Nepal, Lebanon, South Korea, Iran, South Africa, Ethiopia, the United States, and Italy were reviewed in the meta-analysis. Based on the results of the analysis, it was found that the perception of high susceptibility had an effect on the possibility of using Pap smear services 1.13 times compared to the perception of low susceptibility (aOR= 1.13; 95% CI= 1.03 to 1.07; p < 0.001), and the results were statistically significant. The perception of low barriers affects the possibility of using Pap smear services 0.91 times compared to perceptions of high barriers (aOR = 0.91; 95% CI = 0.86 to 0.97; p <0.001), and the results are statistically significant.

Conclusion: Perceptions of high susceptibility and perceptions of low barriers affect the possibility of using pap smear services.

Keywords: health belief model, cervical cancer, pap smear.


Syndia Puspitasari. Masters Program in Public Health, Universitas Sebelas Maret. Jalan Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: Mobile: +628 2234398706.

Journal of Health Promotion and Behavior (2022), 07(04): 322-335


Arbyn M, Weiderpass E, Bruni L, Sanjose SD, Saraiya M, Ferlay J, Bray F (2020). Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 8(2): e191-e203. doi: 10.-1016/S2214-109X(19)30482-6.

Babazadeh T, Nadrian H, Moghaddam HR, Ezzati E, Sarkhosh R, Aghemiri S (2018). Cognitive determinants of cervical cancer screening behavior among housewife women in Iran: An application of Health Belief Model. Health Care for Women International. 39(5): 555-570. doi: 10.1080/07399-332.2018.1425873.

Babazadeh T, Ghaffari-Fam S, Oliaei S, Sarbazi E, Gharabaghi PM, Azizi H (2019). Predictors of Pap Smear Screening Behavior Among Rural Women in Tabriz, Iran: An Application of Health Belief Model. Inter-national Journal of Cancer management. 12(5): e87246. doi: 10.5812/ijcm.87246.

Bayu H, Berhe Y, Mulat A, Alemu A (2016). Cervical cancer screening service uptake and associated factors among age eligible women in Mekelle zone, Northern Ethiopia, 2015: A community based study using health belief model. PLoS ONE. 11(3): 1–13. doi: 10.1371/journal.pone.0149908.

Cinar IO, Kara E (2019). Evaluation of Awareness of Cervical Cancer and Pap Spear Test of Working Women by Health Belief Model. Bezmialem Science. 8(2):113-9. doi: 10.14235/bas.galenos.2019.3062

Karimy M, Azarpira H, Araban M (2017). Using health belief model constructs to examine differences in adherence to pap test recommendations among Iranian women. Asian Pacific Journal of Cancer Prevention. 18(5): 1389–1394. doi: 10.22034/APJCP.2017.18.5.1389.

Kim HW (2016). The health beliefs of mothers about preventing cervical cancer and their intention to recommend the Pap test to their daughters: A cross-sectional survey. BMC Public Health. 16(1): 1–11. doi: 10.1186/s12889-016-3037-6.

Lambert CC, Chandler R, McMillan S, Kromrey J, Mallard VJ, Kurtyka D (2015). Pap Test Adherence, Cervical Cancer Perceptions, and HPV Know-ledge Among HIV-Infected Women in a Community Health Setting. Journal Association Nurses AIDS Care. 26(3): 271-80. doi: 10.1016/j.jana.¬2014.11.007.

Lai D, Bodson J, Warner EL, Ayres S, Moonrey R, Kepka D (2017). Younger Age and Health Beliefs Associated with Being Overdue for Pap Testing among Utah Latinas who were Non-Adherent to Cancer Screening Guidelines. Journal Immigrant Minor Health. 19(5):1088-1099. doi: 10.1007/s10903-017-0559-7.

Mabotja MC, Levin J, Kawonga M (2021). Beliefs and perceptions regarding cervical cancer and screening associated with Pap smear uptake in Johannesburg: A cross-sectional study. PLoS One. 16(2): 1-13. doi: 10.1371/journal.pone.0246574.

Maharjan M, Thapa N, Panthi D, Maharjan N, Petrini MA. Health beliefs and practices regarding cervical cancer screening among women in Nepal- A descriptive cross-sectional study (2020). Nurse Health Science. 22(4): 1084-1093. doi: 10.1111/nhs.12775.

Murti B. (2018). Prinsip dan metode riset epidemiologi (5th ed.) (Principles and methods of epidemiological research (5th ed). Program Studi Ilmu Kesehatan Masyarakat, Program Pascasarjana, Universitas Sebelas Maret.

Nigussie T, Admassu B, Nigussie A (2019). Cervical cancer screening service utilization and associated factors among age-eligible women in Jimma town using health belief model, South West Ethiopia. BMC Women’s Health. 19(1): 1–10. doi: 10.1186/s12905-019-0826-y.

Nkwabong E, Badjan, ILB, Sando, Z (2019). Pap smear accuracy for the diagnosis of cervical precancerous lesions. Tropical Doctor. 49(1): 34–39. doi: 10.11-77/0049475518798532.

Nwabichie CC, Manaf RA, Ismail SB (2018). Factors affecting uptake of cervical cancer screening among African Women in Klang Valley, Malaysia. Asian Pacific Journal of Cancer Prevention. 19(3): 825–831. doi: 10.22034/APJCP.2018.19.3.825.

Nyamhunga A, Ndlovu N, Kadzatsa W, Morse GD, Maponga CC (2020). Chemoradiation in Stage IIIB Cancer of the Uterine Cervix: A Review of the Zimbabwean Experience. JCO Global Oncology. (6): 1554–1564. doi: 10.1200/jgo.19.00412.

Oktaviani BD, Sriwidyani NP (2018). Karakteristik klinikopatologi penderita kanker serviks uteri berdasarkan data di laboratorium patologi anatomi RSUP Sanglah Denpasar tahun 2011-2015 (Clinicopathological characteristics of cervical cancer patients based on data from the anatomical pathology laboratory at Sanglah Hospital Denpasar in 2011-2015). E-Jurnal Medika Fakultas Kedokteran Univer-sitas Udayana. 7(8): 1–6. ISSN 2303-1395

Okunowo AA, Daramola ES, Soibi-Harry AP, Ezenwankwo FC, Kuku JO, Oku-nade KS, Anorlu RI (2018). Women’s knowledge of cervical cancer and uptake of Pap smear testing and the factors influencing it in a Nigerian tertiary hospital. Journal of Cancer Research and Practice. 5(3): 105–111. doi: 10.1016/J.JCRPR.2018.02.001

Restivo V, Costantino C, Marras A, Napoli G, Scelfo S, Scuderi T, Casuccio A, Cernigliaro, Giusti A, Alegiani SS (2018) Pap Testing in a High-Income Country with Suboptimal Compliance Levels: A Survey on Acceptance Factors among Sicilian Women. International Journal Environtmen Public Health. 15(9):1804. doi: 10.3390/ijerph15091804.

RevMan User guide (2020) ‘Welcome to RevMan 5 . 4, 4(May). Available at:

Shobeiri F, Javad MT, Parsa P, Roshanaeri G (2016). Effects of group training based on the health belief model on knowledge and behavior regarding the Pap smear test in Iranian Women: A Quasi experimental study. Asian Pacific Journal of Cancer Prevention. 17(6): 2871–2876. doi: 10.22034/-APJCP.2016.19.10.2871.

Sumarmi S, Hsu Y, Cheng Y, Lee, SM (2021). Factors associated with the intention to undergo Pap smear testing in the rural areas of Indonesia: a health belief model. Reproductive Health. 18(1): 1–10. doi: 10.1186/s12978-021-01188-7.

Yunus NA, Yusof HM, Nani D (2018). Non-adherence to recommended Pap smear screening guidelines and its associated factors among women attending health clinic in Malaysia. Malaysian Family Physician. 13(1): 10–17. PMID: 29796205.




How to Cite

Puspitasari, S., Murti, B., & Prasetya, H. (2022). Meta Analysis: Application of Health Belief Model Theory on Pap Smear Screening Uptake in Women of Reproductive Age. Journal of Health Promotion and Behavior, 7(4), 322–335. Retrieved from




Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 > >>