Factors Associated with Cervical Cancer Screening Overuse and Underuse, and Attitude towards Human Papillomavirus Self-sampling among Hospital Staffs

Objective: To investigate the rates of and factors associated with cervical cancer screening overuse and underuse, and the attitude towards human papillomavirus (HPV) self-sampling among hospital staffs. Materials and Methods: This cross-sectional study included female hospital staff undergoing an annual health check-up. A questionnaire was used to collect sociodemographic characteristics, indication for cervical cancer screening, reasons for screening decision, and attitude toward HPV self-sampling. Screening overuse was defined as having cervical cancer screening without indication while screening underuse was having indication for screening but not receiving it. Results: Among the 600 included participants, 220 and 380 women decided to screen and not to screen for cervical cancer, respectively. The prevalence of screening overuse and underuse was 11.8% and 33.0%, respectively. Multivariate analysis revealed age was associated with screening underuse (aOR: 1.06, 95% CI: 1.04-1.09; p<0.001), whereas married status was associated with screening overuse (aOR: 3.73, 95% CI: 2.05-6.79; p<0.001). The common reasons for screening were “add-on to annual health check-up” (93.2%), “fear of cancer” (84.1%), and “family/organizational support” (54.5%). The common reasons for not screening were “feeling healthy” (73.7%), “fear of pain” (58.7%), and “embarrassment” (57.1%). Most women (65.1%) expressed interest in screening via HPV self-sampling. Conclusion: Overuse and underuse of cervical cancer screening were common. An accurate information regarding screening indication should be provided and indication restriction should be implemented to a health system to avoid screening overuse. In addition, an encouragement should be enhanced to the target population to attend the screening program.