Cervical cancer screening: Does educational attainment moderate Protection Motivation Theory correlates?

Abstract

Purpose: Cervical cancer screening is recommended for women 21-65 years old. Disparities in cervical cancer screening exist by education attainment, yet no study to date has differentiated cervical cancer screening psychosocial predictors between women of varying education levels. This study assessed Protection Motivation Theory psychosocial factors (e.g., threat and coping appraisal) for cervical cancer screening adherence by educational attainment among U.S. women. Methods: Women, aged 30-65 years, without a hysterectomy, were surveyed online (n=812). The outcome was adherence (yes/no) to 2012 cervical cancer screening guidelines: 3-year pap testing or 5-year HPV co-testing. Threat and coping appraisal predictor variables were derived from the Protection Motivation Theory. Educational attainment was operationalized as high school or less (33%), some college (37%), and college graduate (30%). Using SAS 9.4, adjusted odds ratios estimated cervical cancer screening nonadherence, stratified by education. Results: Most women (71%) were adherent to screening recommendations: 68% of high school or less, 71% of some college, and 76% of college graduates. Salient predictors of screening nonadherence varied by educational attainment: lacking knowledge of community screening resources (aOR=3.05; 95%CI 1.44-6.45) for women with high school or less; perceiving screenings as painful (aOR=2.16; 95%CI 1.08-4.32) for women with some college; and uncertainty about cervical cancer curability (aOR=2.97; 95%CI 1.24-7.12) for women with college degrees. Conclusions: Designing interventions without factoring educational attainment may result in limited improvements to cervical cancer screening adherence. Accounting for education level can improve health-literate and population-specific initiatives seeking to address cervical cancer screening disparities.