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Educational interventions for cervical cancer prevention: a scoping review

Intervenciones educativas para la prevención del cáncer cervicouterino: revisión del alcance

ABSTRACT

Objectives:

to identify, map and describe characteristics of educational interventions for cervical cancer prevention in adult women.

Methods:

a scoping review conducted on eleven databases and the gray literature, including studies that described educational interventions aimed at preventing cervical cancer in adult women.

Results:

thirty-three articles with 151,457 participants were analyzed. The most used educational strategies were participatory discussions and educational leaflets. Most of the interventions took place in a single session, ranging from 40 to 60 minutes. The most used theoretical model in interventions to improve women’s compliance with Pap smear was the Health Belief Model.

Conclusions:

group discussions, lectures and educational brochures can increase knowledge and reduce barriers to cervical cancer prevention. Theory-based and culturally sensitive interventions can have a positive impact on women’s health.

Descriptors:
Uterine Cervical Neoplasms; Mass Screening; Papanicolaou Test; Health Education; Primary Health Care.

RESUMEN

Objetivos:

identificar, mapear y describir las características de las intervenciones educativas para la prevención del cáncer de cuello uterino en mujeres adultas.

Métodos:

revisión de alcance, realizada en once bases de datos y en la literatura gris, incluyendo estudios que describían intervenciones educativas dirigidas a la prevención del cáncer de cuello uterino en mujeres adultas.

Resultados:

se analizaron 33 artículos con 151.457 participantes. Las estrategias educativas más utilizadas fueron las discusiones participativas y los folletos educativos. La mayoría de las intervenciones se realizaron en una sola sesión, con una duración de 40 a 60 minutos. El modelo teórico más utilizado en las intervenciones para mejorar la adherencia de las mujeres al Papanicolaou fue el Modelo de Creencias de Salud.

Conclusiones:

las discusiones grupales, las conferencias y los folletos educativos pueden aumentar el conocimiento y reducir las barreras para la prevención del cáncer de cuello uterino. Las intervenciones basadas en teorías y culturalmente sensibles pueden tener un impacto positivo en la salud de las mujeres.

Descriptores:
Neoplasias del Cuello Uterino; Tamizaje Masivo; Prueba de Papanicolaou; Educación en Salud; Atención Primaria de Salud.

RESUMO

Objetivos:

identificar, mapear e descrever as características de intervenções educativas para a prevenção do câncer cervical em mulheres adultas.

Métodos:

revisão de escopo, conduzida em onze bases de dados e na literatura cinzenta, incluindo estudos que descreveram intervenções educativas voltadas à prevenção do câncer cervical em mulheres adultas.

Resultados:

33 artigos com 151.457 participantes foram analisados. As estratégias educativas mais utilizadas foram as discussões participativas e folhetos educativos. A maior parte das intervenções ocorreu em sessão única, com variação de 40 a 60 minutos. O modelo teórico mais utilizado nas intervenções para melhorar a adesão das mulheres ao exame Papanicolau foi o Modelo de Crenças em Saúde.

Conclusões:

discussões em grupo, palestras e folhetos educativos podem aumentar o conhecimento e reduzir barreiras para a prevenção do câncer do colo do útero. Intervenções baseadas em teoria e culturalmente sensíveis podem ter impacto positivo na saúde das mulheres.

Descritores:
Neoplasias do Colo do Útero; Programas de Rastreamento; Teste de Papanicolaou; Educação em Saúde; Atenção Primária à; Saúde.

INTRODUCTION

Cervical cancer (CC) is the fourth most common cancer among women in the world, with an estimated 604,000 new cases and 342,000 deaths in 2020(11 Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49. https://doi.org/10.3322/caac.21660
https://doi.org/10.3322/caac.21660...
). About 90% of new cases and deaths occur in lowand middle-income countries(11 Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49. https://doi.org/10.3322/caac.21660
https://doi.org/10.3322/caac.21660...
). CC mortality can be reduced through regular examinations and early treatment(22 Fontham ETH, Wolf AMD, Church TR, Etzioni R, Flowers CR, Herzig A, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020;70(5):321-46. https://doi.org/10.3322/caac.21628
https://doi.org/10.3322/caac.21628...
). However, inadequate infrastructure and funding difficulties to implement CC control strategies are limiting in developing countries(33 Cerqueira RS, Luan H, Campos P, Maria N, Lima DB. Controle do câncer do colo do útero na atenção primária à saúde em países sul-americanos: revisão sistemática. Rev Panam Salud Publica. 2022;1-11. https://doi.org/10.26633%2FRPSP.2022.107
https://doi.org/10.26633%2FRPSP.2022.107...
).

Periodic Pap smear testing continues to be the most adopted strategy for the screening of precursor CC lesions(44 Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). Estimativa 2020: incidência de câncer no Brasil [Internet]. 2019[cited 2023 Jan 17]. Available from: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//estimativa-2020-incidencia-de-cancer-no-brasil.pdf
https://www.inca.gov.br/sites/ufu.sti.in...
). The World Health Organization (WHO) recommends performing Papanicolaou smear every three years in women aged 25 to 64 years after two negative tests with an annual interval(55 Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). Estimativa INCA[Internet]. Rio de Janeiro; 2023[cited 2023 Jan 17]. Available from: https://www.gov.br/inca/pt-br/assuntos/cancer/tipos/colo-do-utero
https://www.gov.br/inca/pt-br/assuntos/c...
).

Awareness of the benefits of CC screening, diagnostic methods, the importance of early follow-up and treatment are among the main factors that encourage women to perform Pap smears(66 Akinola A, Constance MS. Impact of educational intervention on cervical cancer screening uptake among reproductive age women. Int J Community Med Public Health 2021;8(4):2053-60. https://doi.org/10.18203/2394-6040.ijcmph20211280
https://doi.org/10.18203/2394-6040.ijcmp...
). Higher return rates are expected for well-informed women, who more easily adhere to the recommendations of health professionals and find innovative ways to deal with the disease, being less susceptible to complications(77 Samami E, Seyedi-Andi SJ, Bayat B, Shojaeizadeh D, Tori NA. The effect of educational intervention based on the health belief model on knowledge, attitude, and function of women about Pap smear test at Iranian health centers: a randomized controlled clinical trial. J Educ Health Promot. 2021;10(1). https://doi.org/10.4103%2Fjehp.jehp_33_20
https://doi.org/10.4103%2Fjehp.jehp_33_2...
).

Several studies have tested educational strategies to strengthen the attitudes, practices and knowledge of women candidates for CC screening as well as to reduce barriers to compliance with these programs(88 Ernawati, Oktaviana D, Mantasia, Yusuf RA, Sumarmi. The effect of health education based on the health belief model about pap smear test on women in rural district Indonesia. Medico-Legal Updat. 2021;21(2):1-6. https://doi.org/10.37506/mlu.v21i2.2636
https://doi.org/10.37506/mlu.v21i2.2636...

9 Hosseini Z, Mohseni S, Momeni R, Aghamolaei T, Alavi A. Increasing the prevalence of cervical cancer screening in Iran: effectiveness of a theory-based educational intervention. Reprod Health. 2022;19(1):1-13. https://doi.org/10.21203/rs.3.rs-1311063/v1
https://doi.org/10.21203/rs.3.rs-1311063...

10 Koç Z, Özdeş EK, Topatan S, Çinarli T, Şener A, Danaci E, et al. The impact of education about cervical cancer and human papillomavirus on women’s healthy lifestyle behaviors and beliefs: using the PRECEDE Educational Model. Cancer Nurs. 2019;42(2):106-18. https://doi.org/10.1097/ncc.0000000000000570
https://doi.org/10.1097/ncc.000000000000...

11 McDonough AM, Vargas M, Nguyen-Rodriguez S, Garcia M, Galvez G, Rios-Ellis B. Mujer sana, familia fuerte: the effects of a culturally-relevant, community-based, promotores program to increase cervical cancer screening among Latinas. J Health Care Poor Underserved. 2016;27(2):568-79. https://doi.org/10.1353%2Fhpu.2016.0094
https://doi.org/10.1353%2Fhpu.2016.0094...

12 Mirzaei-Alavijeh M, Karami-Matin B, Jalilian F, Rakhshan F, Mahboubi M, Emdadi S. Pap smear test promotion among women: an educational intervention based on theory of planned behavior. J Biol Today’s World [Internet]. 2014 [cited 2023 Jan 17];3(4):100-3. Available from: https://oaji.net/articles/2014/598-1398623374.pdf
https://oaji.net/articles/2014/598-13986...

13 Pirzadeh A, Mazaheri MA. The effect of education on women’s practice based on the health belief model about pap smear test. Int J Prev Med [Internet]. 2012 [cited 2023 Jan 17];3(8):585-90. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429807/
https://www.ncbi.nlm.nih.gov/pmc/article...
-1414 Ramaswamy M, Simmons R, Kelly PJ. The development of a brief jail-based cervical health promotion intervention. Health Promot Pract. 2015;16(3):432-42. https://doi.org/10.1177/1524839914541658
https://doi.org/10.1177/1524839914541658...
). Among these theoretical models, we can mention the Health Belief Model (HBM)(1515 Yanikkerem E, Selçuk AK, Esmeray N. Cancer and clinical research women’s attitude and beliefs about cervical cancer and pap smear test by using the health belief model. Int J Cancer Clin Res. 2020;5(3):102-11. https://doi.org/10.23937/2378-3419/1410102
https://doi.org/10.23937/2378-3419/14101...
), the Motivation Protection Theory (MPT)(1616 Rahaei Z, Ghofranipour F, Morowatisharifabad M, Mohammadi E. Determinants of cancer early detection behaviors: application of protection motivation theory. Health Promot Perspect. 2015;5(2):138-46. https://doi.org/10.15171%2Fhpp.2015.016
https://doi.org/10.15171%2Fhpp.2015.016...
) and the Social Cognitive Theory (SCT)(1717 Nuño T, Martinez ME, Harris R, García F. A Promotora-administered group education intervention to promote breast and cervical cancer screening in a rural community along the U.S.-Mexico border: a randomized controlled trial. Cancer Causes Control. 2011;22(3):367-74. https://doi.org/10.1007/s10552-010-9705-4
https://doi.org/10.1007/s10552-010-9705-...
).

Despite CC screening campaigns, compliance remains low in most developing countries. Thus, it is important to know the educational intervention characteristics that have been used to improve CC prevention.

OBJECTIVES

To identify, map and describe the characteristics of educational interventions for CC prevention in adult women.

METHODS

This is a scoping review conducted according to the JBI methodology, described in the JBI Reviewer Manual 2020(1818 Peters M, Godfrey C, McInerney P, Munn Z, Trico A, Khalil H. Chapter 11: Scoping Reviews [Internet]. JBI Manual for Evidence Synthesis. JBI; 2020 [cited 2020 Dec 11]. Available from: https://synthesismanual.jbi.global/
https://synthesismanual.jbi.global/...
), and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) recommendation(1919 Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-73. https://doi.org/10.7326/M18-0850
https://doi.org/10.7326/M18-0850...
), seeking to answer the following research question: what is the scientific evidence on educational interventions for CC prevention in adult women? The protocol for this review was registered on the Open Science Framework (OSF) platform and can be consulted at the link: osf.io/4zgex.

The search strategy organization used the acronym PCC, with P for population, C for concept and C for context(1818 Peters M, Godfrey C, McInerney P, Munn Z, Trico A, Khalil H. Chapter 11: Scoping Reviews [Internet]. JBI Manual for Evidence Synthesis. JBI; 2020 [cited 2020 Dec 11]. Available from: https://synthesismanual.jbi.global/
https://synthesismanual.jbi.global/...
). Population consisted of studies involving adult women (age ≥18 years) with no previous diagnosis of CC. The key Concept of this review was composed of studies that detailed the characteristics of educational interventions aimed at preventing CC (elements, mode of delivery, dose, educational materials, educational content, type of theory). Context was primary care, hospitals, clinics, community centers, schools or churches.

The search strategy aimed to locate published and unpublished studies, and occurred in two stages. In the first one, a search was carried out in the MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, followed by the analysis of title and abstract words and study descriptors with the terms as follows: “Cervix cancer; cervical cancer; Uterine Cervical Neoplasms; screening; Prevention and control; Papanicolaou test; Pap test; Pap smear; education; intervention”.

In the second stage, a new search using all identified keywords and descriptors was carried out in the previously described databases. To develop the search strategy, we had the help of an experienced librarian. The searches used modified controlled vocabulary for each database.

Data collection took place between June 7 and August 14, 2022, in the PubMed/MEDLINE, Scientific Electronic Library Online (SciELO), PsycINFO, Cochrane Library databases, through Virtual Health Library (VHL) portal; in the Latin American and Caribbean Literature in Health Sciences (LILACS) and Nursing Database (BDENF) databases, through the Coordination for the Improvement of Higher Education Personnel (CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) portal; and in the CINAHL, Web of Science, Embase, Scopus databases. Unpublished studies were searched in the gray literature (Google Scholar, Catalog of Theses and Dissertations CAPES - Brazil and Brazilian Registry of Clinical Trials - ReBEC, Digital Library of Theses and Dissertations (BDTD).

This review included qualitative and quantitative studies focusing on educational interventions aimed at preventing CC in adult women. Qualitative studies of any theoretical and methodological approaches were considered as well as studies published in English, Spanish or Portuguese, with no date limit.

Intervention studies that addressed other types of cancer (breast cancer, colon cancer, colorectal cancer and others), studies that used only an invitation letter or reminder for Pap smear, without educational content based on literature or theory, were excluded. Systematic or integrative reviews and study protocols were also excluded, as they did not present in detail the elements of the educational intervention (method of delivery, dose, educational materials, intervenor). Disagreements were resolved by discussion between the two reviewers and, when necessary, by a third reviewer.

All titles and abstracts retrieved in searches were pooled in the Mendeley® reference management database for identification and exclusion of duplicates. For selection and assessment of sample studies, the Rayyan software was used(2020 Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):1-10. https://doi.org/10.1186/s13643-016-0384-4
https://doi.org/10.1186/s13643-016-0384-...
). Study pre-selection was performed by reading the title and abstract by two reviewers independently, based on established inclusion criteria.

Data extraction from the studies included in the review was performed using a standardized data extraction tool (Appendix 2). General data extracted included data on the authors, year of publication, objectives, methods, study design, outcomes, target population characteristics (age, race/ethnicity), intervention characteristics (educational strategies, mode of delivery, dose, intervenor), theoretical structure, type of intervention (individual, group or multicomponent) and main results of the intervention.

RESULTS

Figure 1 expresses the search and selection results presented by the PRISMA-ScR flowchart(1919 Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-73. https://doi.org/10.7326/M18-0850
https://doi.org/10.7326/M18-0850...
). After reading, some studies were excluded for not describing the elements of the intervention and the type of theory used, leaving 33 articles for analysis.

Figure 1
Study search flowchart based on Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews, Coari, Amazonas, Brazil, 2022

In the analyzed studies, the most used design was the quasi-experimental, which appeared in 18 studies (54.5%)(88 Ernawati, Oktaviana D, Mantasia, Yusuf RA, Sumarmi. The effect of health education based on the health belief model about pap smear test on women in rural district Indonesia. Medico-Legal Updat. 2021;21(2):1-6. https://doi.org/10.37506/mlu.v21i2.2636
https://doi.org/10.37506/mlu.v21i2.2636...
,1111 McDonough AM, Vargas M, Nguyen-Rodriguez S, Garcia M, Galvez G, Rios-Ellis B. Mujer sana, familia fuerte: the effects of a culturally-relevant, community-based, promotores program to increase cervical cancer screening among Latinas. J Health Care Poor Underserved. 2016;27(2):568-79. https://doi.org/10.1353%2Fhpu.2016.0094
https://doi.org/10.1353%2Fhpu.2016.0094...

12 Mirzaei-Alavijeh M, Karami-Matin B, Jalilian F, Rakhshan F, Mahboubi M, Emdadi S. Pap smear test promotion among women: an educational intervention based on theory of planned behavior. J Biol Today’s World [Internet]. 2014 [cited 2023 Jan 17];3(4):100-3. Available from: https://oaji.net/articles/2014/598-1398623374.pdf
https://oaji.net/articles/2014/598-13986...
-1313 Pirzadeh A, Mazaheri MA. The effect of education on women’s practice based on the health belief model about pap smear test. Int J Prev Med [Internet]. 2012 [cited 2023 Jan 17];3(8):585-90. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429807/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2121 Daryani S, Shojaeezadeh D, Batebi A, Charati JY, Naghibi A. The effect of education based on a health belief model in women’s practice with regard to the Pap smear test. J Cancer Policy. 2016;8:51-6. https://doi.org/10.1016/j.jcpo.2015.11.001
https://doi.org/10.1016/j.jcpo.2015.11.0...

22 Drokow EK, Effah CY, Agboyibor C, Sasu E, Amponsem-Boateng C, Akpabla GS, et al. The impact of video-based educational interventions on cervical cancer, Pap Smear and HPV Vaccines. Front Public Health. 2021;9:681319. https://doi.org/10.3389/fpubh.2021.681319
https://doi.org/10.3389/fpubh.2021.68131...

23 Fang CY, Ma GX, Tan Y, Chi N. A multifaceted intervention to increase cervical cancer screening among underserved Korean women: Cancer Epidemiol Biomarkers Prev. 2007;16(6):1298-302. https://doi.org/10.1158/1055-9965.EPI-07-0091
https://doi.org/10.1158/1055-9965.EPI-07...

24 Ghahremani L, Harami ZK, Kaveh MH, Keshavarzi S. Investigation of the Role of Training Health Volunteers in Promoting Pap Smear Test Use among Iranian Women Based on the Protection Motivation Theory. Asian Pac J Cancer Prev. 2016;17(3):1157-62. https://doi.org/10.7314/APJCP.2016.17.3.1157
https://doi.org/10.7314/APJCP.2016.17.3....

25 Guvenc G, Akyuz A, Yenen MC. Effectiveness of nursing interventions to increase pap smear test screening. Res Nurs Health. 2013;36(2):146-57. https://doi.org/10.1002/nur.21526
https://doi.org/10.1002/nur.21526...

26 Kurt G, Akyuz A. Evaluating the effectiveness of interventions on increasing participation in cervical cancer screening. J Nurs Res. 2019;27(5):e40. https://doi.org/10.1097/jnr.0000000000000317
https://doi.org/10.1097/jnr.000000000000...

27 Lee HY, Koopmeiners JS, Rhee TG, Raveis VH, Ahluwalia JS. Mobile phone text messaging intervention for cervical cancer screening: Changes in knowledge and behavior pre-post intervention. Obstet Gynecol Surv. 2015;70(1):26-7. https://doi.org/10.1097/OGX.0000000000000142
https://doi.org/10.1097/OGX.000000000000...

28 Lima TM, Nicolau AIO, Carvalho FHC, Vasconcelos CTM, Aquino PS, Pinheiro AKB. Intervenções por telefone para adesão ao exame colpocitológico1. Rev Latino-Am Enfermagem. 2017;25. https://doi.org/10.1590/1518-8345.1683.2844
https://doi.org/10.1590/1518-8345.1683.2...

29 Love GD, Mouttapa M, Tanjasiri SP. Everybody’s talking: using entertainment-education video to reduce barriers to discussion of cervical cancer screening among Thai women. Health Educ Res. 2009;24(5):829-38. https://doi.org/10.1093/her/cyp019
https://doi.org/10.1093/her/cyp019...

30 Luque JS, Tarasenko YN, Reyes-Garcia C, Alfonso ML, Suazo N, Rebing L, et al. Salud es vida: a cervical cancer screening intervention for rural Latina Immigrant Women. J Cancer Educ Off. 2017;32(4):690-9. https://doi.org/10.1007/s13187-015-0978-x
https://doi.org/10.1007/s13187-015-0978-...

31 Parsa P, Sharifi F, Shobeiri F, Karami M. Effects of group counseling based on health belief model on cervical cancer screening beliefs and performance of rural women in Kaboudrahang, Iran. Asian Pacific J Cancer Prev. 2017;18(6):1525-30. https://doi.org/10.22034%2FAPJCP.2017.18.6.1525
https://doi.org/10.22034%2FAPJCP.2017.18...

32 Shobeiri F, Shobeiri F, Javad M, Parsa P, Roshanaei G. 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 J Cancer Prev. 2016;17(6):2871-2876. https://doi.org/APJCP.2016.17.6.2871
https://doi.org/APJCP.2016.17.6.2871...

33 Thompson B, Vilchis H, Moran C, Copeland W, Holte S, Duggan C. Increasing cervical cancer screening in the United States-Mexico border region. J Rural Heal Off J Am Rural Heal Assoc Natl Rural Heal Care Assoc. 2014;30(2):196-205. doi: https://doi.org/10.1111/jrh.12044
https://doi.org/10.1111/jrh.12044...
-3434 Wang X, Fang C, Tan Y, Liu A, Ma GX. Evidence-based intervention to reduce access barriers to cervical cancer screening among underserved Chinese American women. J Womens Health (Larchmt). 2010;19(3):463-9. https://doi.org/10.1089/jwh.2009.1422
https://doi.org/10.1089/jwh.2009.1422...
). Twelve studies were Randomized Clinical Trials (RCTs)(77 Samami E, Seyedi-Andi SJ, Bayat B, Shojaeizadeh D, Tori NA. The effect of educational intervention based on the health belief model on knowledge, attitude, and function of women about Pap smear test at Iranian health centers: a randomized controlled clinical trial. J Educ Health Promot. 2021;10(1). https://doi.org/10.4103%2Fjehp.jehp_33_20
https://doi.org/10.4103%2Fjehp.jehp_33_2...
,1010 Koç Z, Özdeş EK, Topatan S, Çinarli T, Şener A, Danaci E, et al. The impact of education about cervical cancer and human papillomavirus on women’s healthy lifestyle behaviors and beliefs: using the PRECEDE Educational Model. Cancer Nurs. 2019;42(2):106-18. https://doi.org/10.1097/ncc.0000000000000570
https://doi.org/10.1097/ncc.000000000000...
,1212 Mirzaei-Alavijeh M, Karami-Matin B, Jalilian F, Rakhshan F, Mahboubi M, Emdadi S. Pap smear test promotion among women: an educational intervention based on theory of planned behavior. J Biol Today’s World [Internet]. 2014 [cited 2023 Jan 17];3(4):100-3. Available from: https://oaji.net/articles/2014/598-1398623374.pdf
https://oaji.net/articles/2014/598-13986...
,3535 Abu SH, Woldehanna BT, Nida ET, Tilahun AW, Gebremariam MY, Sisay MM. The role of health education on cervical cancer screening uptake at selected health centers in Addis Ababa. PLoS One. 2020;15(10):e0239580. https://doi.org/10.1371/journal.pone.0239580
https://doi.org/10.1371/journal.pone.023...

36 Byrd TL, Wilson KM, Smith JL, Coronado G, Vernon SW, Fernandez-Esquer ME, et al. AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer. 2013;119(7):1365-72. https://doi.org/10.1002/cncr.27926
https://doi.org/10.1002/cncr.27926...

37 Calderón-Mora J, Byrd TL, Alomari A, Salaiz R, Dwivedi A, Mallawaarachchi I, et al. Group versus individual culturally tailored and theory-based education to promote cervical cancer screening among the underserved Hispanics: a cluster randomized trial. Am J Health Promot. 2020;34(1):15-24. https://doi.org/10.1177/0890117119871004
https://doi.org/10.1177/0890117119871004...

38 Calderon-Mora J, Alomari A, Shokar N. Comparison of narrative video and flipchart presentation to promote cervical cancer screening among Latinas along the border. Health Educ Behav. 2022. https://doi.org/10.1177/10901981221074918
https://doi.org/10.1177/1090198122107491...

39 Malmir S, Barati M, Jeihooni AK, Bashirian S. Effect of an educational intervention based on protection motivation theory on preventing cervical cancer among marginalized women in West Iran. Asian Pac J Cancer Prev 2018;19(3):755-61. https://doi.org/10.22034/apjcp.2018.19.3.755
https://doi.org/10.22034/apjcp.2018.19.3...

40 Mboineki JF, Wang P, Dhakal K, Getu MA, Chen C. The effect of peer-led navigation approach as a form of task shifting in promoting cervical cancer screening knowledge, intention, and practices among urban women in Tanzania: a randomized controlled trial. Cancer Control. 2022;29:10732748221089480. https://doi.org/10.1177/10732748221089480
https://doi.org/10.1177/1073274822108948...

41 Mishra SI, Luce PH, Baquet CR. Increasing Pap Smear Utilization among Samoan Women: results from a community based participatory randomized trial. J Health Care Poor Underserved. 2009;20(2):85-101. https://doi.org/10.1353%2Fhpu.0.0160
https://doi.org/10.1353%2Fhpu.0.0160...

42 O’Brien MJ, Halbert CH, Bixby R, Pimentel S, Shea JA. Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med. 2010;25(11):1186-92. https://doi.org/10.1007/s11606-010-1434-6
https://doi.org/10.1007/s11606-010-1434-...
-4343 Thompson B, Carosso EA, Jhingan E, Wang L, Holte SE, Byrd TL, et al. Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas. Cancer. 2017;123(4):666-74. https://doi.org/10.1002/cncr.30399
https://doi.org/10.1002/cncr.30399...
); two were pre-test and post-test pilot studies(1414 Ramaswamy M, Simmons R, Kelly PJ. The development of a brief jail-based cervical health promotion intervention. Health Promot Pract. 2015;16(3):432-42. https://doi.org/10.1177/1524839914541658
https://doi.org/10.1177/1524839914541658...
,4444 Fleming K, Simmons VN, Christy SM, Sutton SK, Romo M, Luque JS, et al. Educating hispanic women about cervical cancer prevention: feasibility of a promotora-led charla intervention in a farmworker community. Ethn Dis. 2018;28(3):169-76. https://doi.org/10.18865/ed.28.3.169
https://doi.org/10.18865/ed.28.3.169...
); and one was mixed method study(1010 Koç Z, Özdeş EK, Topatan S, Çinarli T, Şener A, Danaci E, et al. The impact of education about cervical cancer and human papillomavirus on women’s healthy lifestyle behaviors and beliefs: using the PRECEDE Educational Model. Cancer Nurs. 2019;42(2):106-18. https://doi.org/10.1097/ncc.0000000000000570
https://doi.org/10.1097/ncc.000000000000...
). Most of studies were carried out in the USA (36.3%)(1111 McDonough AM, Vargas M, Nguyen-Rodriguez S, Garcia M, Galvez G, Rios-Ellis B. Mujer sana, familia fuerte: the effects of a culturally-relevant, community-based, promotores program to increase cervical cancer screening among Latinas. J Health Care Poor Underserved. 2016;27(2):568-79. https://doi.org/10.1353%2Fhpu.2016.0094
https://doi.org/10.1353%2Fhpu.2016.0094...
,1414 Ramaswamy M, Simmons R, Kelly PJ. The development of a brief jail-based cervical health promotion intervention. Health Promot Pract. 2015;16(3):432-42. https://doi.org/10.1177/1524839914541658
https://doi.org/10.1177/1524839914541658...
,2727 Lee HY, Koopmeiners JS, Rhee TG, Raveis VH, Ahluwalia JS. Mobile phone text messaging intervention for cervical cancer screening: Changes in knowledge and behavior pre-post intervention. Obstet Gynecol Surv. 2015;70(1):26-7. https://doi.org/10.1097/OGX.0000000000000142
https://doi.org/10.1097/OGX.000000000000...
,2929 Love GD, Mouttapa M, Tanjasiri SP. Everybody’s talking: using entertainment-education video to reduce barriers to discussion of cervical cancer screening among Thai women. Health Educ Res. 2009;24(5):829-38. https://doi.org/10.1093/her/cyp019
https://doi.org/10.1093/her/cyp019...
,3434 Wang X, Fang C, Tan Y, Liu A, Ma GX. Evidence-based intervention to reduce access barriers to cervical cancer screening among underserved Chinese American women. J Womens Health (Larchmt). 2010;19(3):463-9. https://doi.org/10.1089/jwh.2009.1422
https://doi.org/10.1089/jwh.2009.1422...
,3636 Byrd TL, Wilson KM, Smith JL, Coronado G, Vernon SW, Fernandez-Esquer ME, et al. AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer. 2013;119(7):1365-72. https://doi.org/10.1002/cncr.27926
https://doi.org/10.1002/cncr.27926...

37 Calderón-Mora J, Byrd TL, Alomari A, Salaiz R, Dwivedi A, Mallawaarachchi I, et al. Group versus individual culturally tailored and theory-based education to promote cervical cancer screening among the underserved Hispanics: a cluster randomized trial. Am J Health Promot. 2020;34(1):15-24. https://doi.org/10.1177/0890117119871004
https://doi.org/10.1177/0890117119871004...
-3838 Calderon-Mora J, Alomari A, Shokar N. Comparison of narrative video and flipchart presentation to promote cervical cancer screening among Latinas along the border. Health Educ Behav. 2022. https://doi.org/10.1177/10901981221074918
https://doi.org/10.1177/1090198122107491...
,4141 Mishra SI, Luce PH, Baquet CR. Increasing Pap Smear Utilization among Samoan Women: results from a community based participatory randomized trial. J Health Care Poor Underserved. 2009;20(2):85-101. https://doi.org/10.1353%2Fhpu.0.0160
https://doi.org/10.1353%2Fhpu.0.0160...

42 O’Brien MJ, Halbert CH, Bixby R, Pimentel S, Shea JA. Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med. 2010;25(11):1186-92. https://doi.org/10.1007/s11606-010-1434-6
https://doi.org/10.1007/s11606-010-1434-...

43 Thompson B, Carosso EA, Jhingan E, Wang L, Holte SE, Byrd TL, et al. Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas. Cancer. 2017;123(4):666-74. https://doi.org/10.1002/cncr.30399
https://doi.org/10.1002/cncr.30399...
-4444 Fleming K, Simmons VN, Christy SM, Sutton SK, Romo M, Luque JS, et al. Educating hispanic women about cervical cancer prevention: feasibility of a promotora-led charla intervention in a farmworker community. Ethn Dis. 2018;28(3):169-76. https://doi.org/10.18865/ed.28.3.169
https://doi.org/10.18865/ed.28.3.169...
), Iran (30.3%)(77 Samami E, Seyedi-Andi SJ, Bayat B, Shojaeizadeh D, Tori NA. The effect of educational intervention based on the health belief model on knowledge, attitude, and function of women about Pap smear test at Iranian health centers: a randomized controlled clinical trial. J Educ Health Promot. 2021;10(1). https://doi.org/10.4103%2Fjehp.jehp_33_20
https://doi.org/10.4103%2Fjehp.jehp_33_2...
,2121 Daryani S, Shojaeezadeh D, Batebi A, Charati JY, Naghibi A. The effect of education based on a health belief model in women’s practice with regard to the Pap smear test. J Cancer Policy. 2016;8:51-6. https://doi.org/10.1016/j.jcpo.2015.11.001
https://doi.org/10.1016/j.jcpo.2015.11.0...
,2424 Ghahremani L, Harami ZK, Kaveh MH, Keshavarzi S. Investigation of the Role of Training Health Volunteers in Promoting Pap Smear Test Use among Iranian Women Based on the Protection Motivation Theory. Asian Pac J Cancer Prev. 2016;17(3):1157-62. https://doi.org/10.7314/APJCP.2016.17.3.1157
https://doi.org/10.7314/APJCP.2016.17.3....
,3131 Parsa P, Sharifi F, Shobeiri F, Karami M. Effects of group counseling based on health belief model on cervical cancer screening beliefs and performance of rural women in Kaboudrahang, Iran. Asian Pacific J Cancer Prev. 2017;18(6):1525-30. https://doi.org/10.22034%2FAPJCP.2017.18.6.1525
https://doi.org/10.22034%2FAPJCP.2017.18...
-3232 Shobeiri F, Shobeiri F, Javad M, Parsa P, Roshanaei G. 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 J Cancer Prev. 2016;17(6):2871-2876. https://doi.org/APJCP.2016.17.6.2871
https://doi.org/APJCP.2016.17.6.2871...
,3939 Malmir S, Barati M, Jeihooni AK, Bashirian S. Effect of an educational intervention based on protection motivation theory on preventing cervical cancer among marginalized women in West Iran. Asian Pac J Cancer Prev 2018;19(3):755-61. https://doi.org/10.22034/apjcp.2018.19.3.755
https://doi.org/10.22034/apjcp.2018.19.3...
,4545 Jeihooni AK, Jormand H, Harsini PA. The effect of educational program based on beliefs, subjective norms and perceived behavior control on doing pap-smear test in sample of Iranian women. BMC Womens Health. 2021;21(1):290. https://doi.org/10.1186/s12905-021-01419-w
https://doi.org/10.1186/s12905-021-01419...
) and Turkey (9.1%)(1010 Koç Z, Özdeş EK, Topatan S, Çinarli T, Şener A, Danaci E, et al. The impact of education about cervical cancer and human papillomavirus on women’s healthy lifestyle behaviors and beliefs: using the PRECEDE Educational Model. Cancer Nurs. 2019;42(2):106-18. https://doi.org/10.1097/ncc.0000000000000570
https://doi.org/10.1097/ncc.000000000000...
,2525 Guvenc G, Akyuz A, Yenen MC. Effectiveness of nursing interventions to increase pap smear test screening. Res Nurs Health. 2013;36(2):146-57. https://doi.org/10.1002/nur.21526
https://doi.org/10.1002/nur.21526...
-2626 Kurt G, Akyuz A. Evaluating the effectiveness of interventions on increasing participation in cervical cancer screening. J Nurs Res. 2019;27(5):e40. https://doi.org/10.1097/jnr.0000000000000317
https://doi.org/10.1097/jnr.000000000000...
) and published between 2007 and 2022 (Chart 1).

Chart 1
Description of the main characteristics of analyzed studies

The population of most of analyzed studies consisted of women aged 21 to 65 years, immigrants, Hispanic/Latina, and from rural environments, with a history of low adherence to Pap smear, no previous history of CC, married, non-pregnant, who had never received health education about CC and without health insurance. The total sample size in this review was 151,457 (Chart 1).

Regarding the context, most of studies were carried out in community health centers (n=19)(77 Samami E, Seyedi-Andi SJ, Bayat B, Shojaeizadeh D, Tori NA. The effect of educational intervention based on the health belief model on knowledge, attitude, and function of women about Pap smear test at Iranian health centers: a randomized controlled clinical trial. J Educ Health Promot. 2021;10(1). https://doi.org/10.4103%2Fjehp.jehp_33_20
https://doi.org/10.4103%2Fjehp.jehp_33_2...

8 Ernawati, Oktaviana D, Mantasia, Yusuf RA, Sumarmi. The effect of health education based on the health belief model about pap smear test on women in rural district Indonesia. Medico-Legal Updat. 2021;21(2):1-6. https://doi.org/10.37506/mlu.v21i2.2636
https://doi.org/10.37506/mlu.v21i2.2636...
-99 Hosseini Z, Mohseni S, Momeni R, Aghamolaei T, Alavi A. Increasing the prevalence of cervical cancer screening in Iran: effectiveness of a theory-based educational intervention. Reprod Health. 2022;19(1):1-13. https://doi.org/10.21203/rs.3.rs-1311063/v1
https://doi.org/10.21203/rs.3.rs-1311063...
,1111 McDonough AM, Vargas M, Nguyen-Rodriguez S, Garcia M, Galvez G, Rios-Ellis B. Mujer sana, familia fuerte: the effects of a culturally-relevant, community-based, promotores program to increase cervical cancer screening among Latinas. J Health Care Poor Underserved. 2016;27(2):568-79. https://doi.org/10.1353%2Fhpu.2016.0094
https://doi.org/10.1353%2Fhpu.2016.0094...

12 Mirzaei-Alavijeh M, Karami-Matin B, Jalilian F, Rakhshan F, Mahboubi M, Emdadi S. Pap smear test promotion among women: an educational intervention based on theory of planned behavior. J Biol Today’s World [Internet]. 2014 [cited 2023 Jan 17];3(4):100-3. Available from: https://oaji.net/articles/2014/598-1398623374.pdf
https://oaji.net/articles/2014/598-13986...
-1313 Pirzadeh A, Mazaheri MA. The effect of education on women’s practice based on the health belief model about pap smear test. Int J Prev Med [Internet]. 2012 [cited 2023 Jan 17];3(8):585-90. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429807/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2121 Daryani S, Shojaeezadeh D, Batebi A, Charati JY, Naghibi A. The effect of education based on a health belief model in women’s practice with regard to the Pap smear test. J Cancer Policy. 2016;8:51-6. https://doi.org/10.1016/j.jcpo.2015.11.001
https://doi.org/10.1016/j.jcpo.2015.11.0...
,2424 Ghahremani L, Harami ZK, Kaveh MH, Keshavarzi S. Investigation of the Role of Training Health Volunteers in Promoting Pap Smear Test Use among Iranian Women Based on the Protection Motivation Theory. Asian Pac J Cancer Prev. 2016;17(3):1157-62. https://doi.org/10.7314/APJCP.2016.17.3.1157
https://doi.org/10.7314/APJCP.2016.17.3....
,2828 Lima TM, Nicolau AIO, Carvalho FHC, Vasconcelos CTM, Aquino PS, Pinheiro AKB. Intervenções por telefone para adesão ao exame colpocitológico1. Rev Latino-Am Enfermagem. 2017;25. https://doi.org/10.1590/1518-8345.1683.2844
https://doi.org/10.1590/1518-8345.1683.2...
,3030 Luque JS, Tarasenko YN, Reyes-Garcia C, Alfonso ML, Suazo N, Rebing L, et al. Salud es vida: a cervical cancer screening intervention for rural Latina Immigrant Women. J Cancer Educ Off. 2017;32(4):690-9. https://doi.org/10.1007/s13187-015-0978-x
https://doi.org/10.1007/s13187-015-0978-...

31 Parsa P, Sharifi F, Shobeiri F, Karami M. Effects of group counseling based on health belief model on cervical cancer screening beliefs and performance of rural women in Kaboudrahang, Iran. Asian Pacific J Cancer Prev. 2017;18(6):1525-30. https://doi.org/10.22034%2FAPJCP.2017.18.6.1525
https://doi.org/10.22034%2FAPJCP.2017.18...

32 Shobeiri F, Shobeiri F, Javad M, Parsa P, Roshanaei G. 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 J Cancer Prev. 2016;17(6):2871-2876. https://doi.org/APJCP.2016.17.6.2871
https://doi.org/APJCP.2016.17.6.2871...
-3333 Thompson B, Vilchis H, Moran C, Copeland W, Holte S, Duggan C. Increasing cervical cancer screening in the United States-Mexico border region. J Rural Heal Off J Am Rural Heal Assoc Natl Rural Heal Care Assoc. 2014;30(2):196-205. doi: https://doi.org/10.1111/jrh.12044
https://doi.org/10.1111/jrh.12044...
,3535 Abu SH, Woldehanna BT, Nida ET, Tilahun AW, Gebremariam MY, Sisay MM. The role of health education on cervical cancer screening uptake at selected health centers in Addis Ababa. PLoS One. 2020;15(10):e0239580. https://doi.org/10.1371/journal.pone.0239580
https://doi.org/10.1371/journal.pone.023...
-3636 Byrd TL, Wilson KM, Smith JL, Coronado G, Vernon SW, Fernandez-Esquer ME, et al. AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer. 2013;119(7):1365-72. https://doi.org/10.1002/cncr.27926
https://doi.org/10.1002/cncr.27926...
,3838 Calderon-Mora J, Alomari A, Shokar N. Comparison of narrative video and flipchart presentation to promote cervical cancer screening among Latinas along the border. Health Educ Behav. 2022. https://doi.org/10.1177/10901981221074918
https://doi.org/10.1177/1090198122107491...
,4040 Mboineki JF, Wang P, Dhakal K, Getu MA, Chen C. The effect of peer-led navigation approach as a form of task shifting in promoting cervical cancer screening knowledge, intention, and practices among urban women in Tanzania: a randomized controlled trial. Cancer Control. 2022;29:10732748221089480. https://doi.org/10.1177/10732748221089480
https://doi.org/10.1177/1073274822108948...
,4343 Thompson B, Carosso EA, Jhingan E, Wang L, Holte SE, Byrd TL, et al. Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas. Cancer. 2017;123(4):666-74. https://doi.org/10.1002/cncr.30399
https://doi.org/10.1002/cncr.30399...
,4545 Jeihooni AK, Jormand H, Harsini PA. The effect of educational program based on beliefs, subjective norms and perceived behavior control on doing pap-smear test in sample of Iranian women. BMC Womens Health. 2021;21(1):290. https://doi.org/10.1186/s12905-021-01419-w
https://doi.org/10.1186/s12905-021-01419...
), followed by community centers (n=5)(1010 Koç Z, Özdeş EK, Topatan S, Çinarli T, Şener A, Danaci E, et al. The impact of education about cervical cancer and human papillomavirus on women’s healthy lifestyle behaviors and beliefs: using the PRECEDE Educational Model. Cancer Nurs. 2019;42(2):106-18. https://doi.org/10.1097/ncc.0000000000000570
https://doi.org/10.1097/ncc.000000000000...
,2323 Fang CY, Ma GX, Tan Y, Chi N. A multifaceted intervention to increase cervical cancer screening among underserved Korean women: Cancer Epidemiol Biomarkers Prev. 2007;16(6):1298-302. https://doi.org/10.1158/1055-9965.EPI-07-0091
https://doi.org/10.1158/1055-9965.EPI-07...
,2929 Love GD, Mouttapa M, Tanjasiri SP. Everybody’s talking: using entertainment-education video to reduce barriers to discussion of cervical cancer screening among Thai women. Health Educ Res. 2009;24(5):829-38. https://doi.org/10.1093/her/cyp019
https://doi.org/10.1093/her/cyp019...
,3434 Wang X, Fang C, Tan Y, Liu A, Ma GX. Evidence-based intervention to reduce access barriers to cervical cancer screening among underserved Chinese American women. J Womens Health (Larchmt). 2010;19(3):463-9. https://doi.org/10.1089/jwh.2009.1422
https://doi.org/10.1089/jwh.2009.1422...
,4444 Fleming K, Simmons VN, Christy SM, Sutton SK, Romo M, Luque JS, et al. Educating hispanic women about cervical cancer prevention: feasibility of a promotora-led charla intervention in a farmworker community. Ethn Dis. 2018;28(3):169-76. https://doi.org/10.18865/ed.28.3.169
https://doi.org/10.18865/ed.28.3.169...
), churches (n=4)(2222 Drokow EK, Effah CY, Agboyibor C, Sasu E, Amponsem-Boateng C, Akpabla GS, et al. The impact of video-based educational interventions on cervical cancer, Pap Smear and HPV Vaccines. Front Public Health. 2021;9:681319. https://doi.org/10.3389/fpubh.2021.681319
https://doi.org/10.3389/fpubh.2021.68131...
,3636 Byrd TL, Wilson KM, Smith JL, Coronado G, Vernon SW, Fernandez-Esquer ME, et al. AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer. 2013;119(7):1365-72. https://doi.org/10.1002/cncr.27926
https://doi.org/10.1002/cncr.27926...
-3737 Calderón-Mora J, Byrd TL, Alomari A, Salaiz R, Dwivedi A, Mallawaarachchi I, et al. Group versus individual culturally tailored and theory-based education to promote cervical cancer screening among the underserved Hispanics: a cluster randomized trial. Am J Health Promot. 2020;34(1):15-24. https://doi.org/10.1177/0890117119871004
https://doi.org/10.1177/0890117119871004...
,4141 Mishra SI, Luce PH, Baquet CR. Increasing Pap Smear Utilization among Samoan Women: results from a community based participatory randomized trial. J Health Care Poor Underserved. 2009;20(2):85-101. https://doi.org/10.1353%2Fhpu.0.0160
https://doi.org/10.1353%2Fhpu.0.0160...
), home (n=3)(2222 Drokow EK, Effah CY, Agboyibor C, Sasu E, Amponsem-Boateng C, Akpabla GS, et al. The impact of video-based educational interventions on cervical cancer, Pap Smear and HPV Vaccines. Front Public Health. 2021;9:681319. https://doi.org/10.3389/fpubh.2021.681319
https://doi.org/10.3389/fpubh.2021.68131...
,2525 Guvenc G, Akyuz A, Yenen MC. Effectiveness of nursing interventions to increase pap smear test screening. Res Nurs Health. 2013;36(2):146-57. https://doi.org/10.1002/nur.21526
https://doi.org/10.1002/nur.21526...
-2626 Kurt G, Akyuz A. Evaluating the effectiveness of interventions on increasing participation in cervical cancer screening. J Nurs Res. 2019;27(5):e40. https://doi.org/10.1097/jnr.0000000000000317
https://doi.org/10.1097/jnr.000000000000...
), in addition to a study carried out in a prison environment(1414 Ramaswamy M, Simmons R, Kelly PJ. The development of a brief jail-based cervical health promotion intervention. Health Promot Pract. 2015;16(3):432-42. https://doi.org/10.1177/1524839914541658
https://doi.org/10.1177/1524839914541658...
) and one in a virtual environment(2727 Lee HY, Koopmeiners JS, Rhee TG, Raveis VH, Ahluwalia JS. Mobile phone text messaging intervention for cervical cancer screening: Changes in knowledge and behavior pre-post intervention. Obstet Gynecol Surv. 2015;70(1):26-7. https://doi.org/10.1097/OGX.0000000000000142
https://doi.org/10.1097/OGX.000000000000...
). The designs of analyzed studies, sample, country and target population sociodemographic characteristics are shown in Chart 1. The main variables assessed in the analyzed studies were knowledge, attitude, self-efficacy and Pap smear compliance.

The most common teaching strategies were participatory discussion sessions held in groups, in which women had the opportunity to ask questions and express personal issues related to CC prevention(88 Ernawati, Oktaviana D, Mantasia, Yusuf RA, Sumarmi. The effect of health education based on the health belief model about pap smear test on women in rural district Indonesia. Medico-Legal Updat. 2021;21(2):1-6. https://doi.org/10.37506/mlu.v21i2.2636
https://doi.org/10.37506/mlu.v21i2.2636...

9 Hosseini Z, Mohseni S, Momeni R, Aghamolaei T, Alavi A. Increasing the prevalence of cervical cancer screening in Iran: effectiveness of a theory-based educational intervention. Reprod Health. 2022;19(1):1-13. https://doi.org/10.21203/rs.3.rs-1311063/v1
https://doi.org/10.21203/rs.3.rs-1311063...

10 Koç Z, Özdeş EK, Topatan S, Çinarli T, Şener A, Danaci E, et al. The impact of education about cervical cancer and human papillomavirus on women’s healthy lifestyle behaviors and beliefs: using the PRECEDE Educational Model. Cancer Nurs. 2019;42(2):106-18. https://doi.org/10.1097/ncc.0000000000000570
https://doi.org/10.1097/ncc.000000000000...

11 McDonough AM, Vargas M, Nguyen-Rodriguez S, Garcia M, Galvez G, Rios-Ellis B. Mujer sana, familia fuerte: the effects of a culturally-relevant, community-based, promotores program to increase cervical cancer screening among Latinas. J Health Care Poor Underserved. 2016;27(2):568-79. https://doi.org/10.1353%2Fhpu.2016.0094
https://doi.org/10.1353%2Fhpu.2016.0094...

12 Mirzaei-Alavijeh M, Karami-Matin B, Jalilian F, Rakhshan F, Mahboubi M, Emdadi S. Pap smear test promotion among women: an educational intervention based on theory of planned behavior. J Biol Today’s World [Internet]. 2014 [cited 2023 Jan 17];3(4):100-3. Available from: https://oaji.net/articles/2014/598-1398623374.pdf
https://oaji.net/articles/2014/598-13986...

13 Pirzadeh A, Mazaheri MA. The effect of education on women’s practice based on the health belief model about pap smear test. Int J Prev Med [Internet]. 2012 [cited 2023 Jan 17];3(8):585-90. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429807/
https://www.ncbi.nlm.nih.gov/pmc/article...
-1414 Ramaswamy M, Simmons R, Kelly PJ. The development of a brief jail-based cervical health promotion intervention. Health Promot Pract. 2015;16(3):432-42. https://doi.org/10.1177/1524839914541658
https://doi.org/10.1177/1524839914541658...
,2121 Daryani S, Shojaeezadeh D, Batebi A, Charati JY, Naghibi A. The effect of education based on a health belief model in women’s practice with regard to the Pap smear test. J Cancer Policy. 2016;8:51-6. https://doi.org/10.1016/j.jcpo.2015.11.001
https://doi.org/10.1016/j.jcpo.2015.11.0...
,2323 Fang CY, Ma GX, Tan Y, Chi N. A multifaceted intervention to increase cervical cancer screening among underserved Korean women: Cancer Epidemiol Biomarkers Prev. 2007;16(6):1298-302. https://doi.org/10.1158/1055-9965.EPI-07-0091
https://doi.org/10.1158/1055-9965.EPI-07...
,2929 Love GD, Mouttapa M, Tanjasiri SP. Everybody’s talking: using entertainment-education video to reduce barriers to discussion of cervical cancer screening among Thai women. Health Educ Res. 2009;24(5):829-38. https://doi.org/10.1093/her/cyp019
https://doi.org/10.1093/her/cyp019...
,3232 Shobeiri F, Shobeiri F, Javad M, Parsa P, Roshanaei G. 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 J Cancer Prev. 2016;17(6):2871-2876. https://doi.org/APJCP.2016.17.6.2871
https://doi.org/APJCP.2016.17.6.2871...
,3737 Calderón-Mora J, Byrd TL, Alomari A, Salaiz R, Dwivedi A, Mallawaarachchi I, et al. Group versus individual culturally tailored and theory-based education to promote cervical cancer screening among the underserved Hispanics: a cluster randomized trial. Am J Health Promot. 2020;34(1):15-24. https://doi.org/10.1177/0890117119871004
https://doi.org/10.1177/0890117119871004...
,3939 Malmir S, Barati M, Jeihooni AK, Bashirian S. Effect of an educational intervention based on protection motivation theory on preventing cervical cancer among marginalized women in West Iran. Asian Pac J Cancer Prev 2018;19(3):755-61. https://doi.org/10.22034/apjcp.2018.19.3.755
https://doi.org/10.22034/apjcp.2018.19.3...
,4141 Mishra SI, Luce PH, Baquet CR. Increasing Pap Smear Utilization among Samoan Women: results from a community based participatory randomized trial. J Health Care Poor Underserved. 2009;20(2):85-101. https://doi.org/10.1353%2Fhpu.0.0160
https://doi.org/10.1353%2Fhpu.0.0160...
,4444 Fleming K, Simmons VN, Christy SM, Sutton SK, Romo M, Luque JS, et al. Educating hispanic women about cervical cancer prevention: feasibility of a promotora-led charla intervention in a farmworker community. Ethn Dis. 2018;28(3):169-76. https://doi.org/10.18865/ed.28.3.169
https://doi.org/10.18865/ed.28.3.169...
-4545 Jeihooni AK, Jormand H, Harsini PA. The effect of educational program based on beliefs, subjective norms and perceived behavior control on doing pap-smear test in sample of Iranian women. BMC Womens Health. 2021;21(1):290. https://doi.org/10.1186/s12905-021-01419-w
https://doi.org/10.1186/s12905-021-01419...
). Other strategies used were lecture(77 Samami E, Seyedi-Andi SJ, Bayat B, Shojaeizadeh D, Tori NA. The effect of educational intervention based on the health belief model on knowledge, attitude, and function of women about Pap smear test at Iranian health centers: a randomized controlled clinical trial. J Educ Health Promot. 2021;10(1). https://doi.org/10.4103%2Fjehp.jehp_33_20
https://doi.org/10.4103%2Fjehp.jehp_33_2...
-88 Ernawati, Oktaviana D, Mantasia, Yusuf RA, Sumarmi. The effect of health education based on the health belief model about pap smear test on women in rural district Indonesia. Medico-Legal Updat. 2021;21(2):1-6. https://doi.org/10.37506/mlu.v21i2.2636
https://doi.org/10.37506/mlu.v21i2.2636...
,1111 McDonough AM, Vargas M, Nguyen-Rodriguez S, Garcia M, Galvez G, Rios-Ellis B. Mujer sana, familia fuerte: the effects of a culturally-relevant, community-based, promotores program to increase cervical cancer screening among Latinas. J Health Care Poor Underserved. 2016;27(2):568-79. https://doi.org/10.1353%2Fhpu.2016.0094
https://doi.org/10.1353%2Fhpu.2016.0094...
-1212 Mirzaei-Alavijeh M, Karami-Matin B, Jalilian F, Rakhshan F, Mahboubi M, Emdadi S. Pap smear test promotion among women: an educational intervention based on theory of planned behavior. J Biol Today’s World [Internet]. 2014 [cited 2023 Jan 17];3(4):100-3. Available from: https://oaji.net/articles/2014/598-1398623374.pdf
https://oaji.net/articles/2014/598-13986...
,2323 Fang CY, Ma GX, Tan Y, Chi N. A multifaceted intervention to increase cervical cancer screening among underserved Korean women: Cancer Epidemiol Biomarkers Prev. 2007;16(6):1298-302. https://doi.org/10.1158/1055-9965.EPI-07-0091
https://doi.org/10.1158/1055-9965.EPI-07...
,2525 Guvenc G, Akyuz A, Yenen MC. Effectiveness of nursing interventions to increase pap smear test screening. Res Nurs Health. 2013;36(2):146-57. https://doi.org/10.1002/nur.21526
https://doi.org/10.1002/nur.21526...
,3232 Shobeiri F, Shobeiri F, Javad M, Parsa P, Roshanaei G. 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 J Cancer Prev. 2016;17(6):2871-2876. https://doi.org/APJCP.2016.17.6.2871
https://doi.org/APJCP.2016.17.6.2871...
,3939 Malmir S, Barati M, Jeihooni AK, Bashirian S. Effect of an educational intervention based on protection motivation theory on preventing cervical cancer among marginalized women in West Iran. Asian Pac J Cancer Prev 2018;19(3):755-61. https://doi.org/10.22034/apjcp.2018.19.3.755
https://doi.org/10.22034/apjcp.2018.19.3...
,4141 Mishra SI, Luce PH, Baquet CR. Increasing Pap Smear Utilization among Samoan Women: results from a community based participatory randomized trial. J Health Care Poor Underserved. 2009;20(2):85-101. https://doi.org/10.1353%2Fhpu.0.0160
https://doi.org/10.1353%2Fhpu.0.0160...
,4343 Thompson B, Carosso EA, Jhingan E, Wang L, Holte SE, Byrd TL, et al. Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas. Cancer. 2017;123(4):666-74. https://doi.org/10.1002/cncr.30399
https://doi.org/10.1002/cncr.30399...
), expository lesson(99 Hosseini Z, Mohseni S, Momeni R, Aghamolaei T, Alavi A. Increasing the prevalence of cervical cancer screening in Iran: effectiveness of a theory-based educational intervention. Reprod Health. 2022;19(1):1-13. https://doi.org/10.21203/rs.3.rs-1311063/v1
https://doi.org/10.21203/rs.3.rs-1311063...
,1111 McDonough AM, Vargas M, Nguyen-Rodriguez S, Garcia M, Galvez G, Rios-Ellis B. Mujer sana, familia fuerte: the effects of a culturally-relevant, community-based, promotores program to increase cervical cancer screening among Latinas. J Health Care Poor Underserved. 2016;27(2):568-79. https://doi.org/10.1353%2Fhpu.2016.0094
https://doi.org/10.1353%2Fhpu.2016.0094...
) and card games(3636 Byrd TL, Wilson KM, Smith JL, Coronado G, Vernon SW, Fernandez-Esquer ME, et al. AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer. 2013;119(7):1365-72. https://doi.org/10.1002/cncr.27926
https://doi.org/10.1002/cncr.27926...
).

Educational leaflets, or booklets, were the most used resources as support or complementary material, with the purpose of reinforcing the content(3434 Wang X, Fang C, Tan Y, Liu A, Ma GX. Evidence-based intervention to reduce access barriers to cervical cancer screening among underserved Chinese American women. J Womens Health (Larchmt). 2010;19(3):463-9. https://doi.org/10.1089/jwh.2009.1422
https://doi.org/10.1089/jwh.2009.1422...
,3939 Malmir S, Barati M, Jeihooni AK, Bashirian S. Effect of an educational intervention based on protection motivation theory on preventing cervical cancer among marginalized women in West Iran. Asian Pac J Cancer Prev 2018;19(3):755-61. https://doi.org/10.22034/apjcp.2018.19.3.755
https://doi.org/10.22034/apjcp.2018.19.3...
,4242 O’Brien MJ, Halbert CH, Bixby R, Pimentel S, Shea JA. Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med. 2010;25(11):1186-92. https://doi.org/10.1007/s11606-010-1434-6
https://doi.org/10.1007/s11606-010-1434-...
,4444 Fleming K, Simmons VN, Christy SM, Sutton SK, Romo M, Luque JS, et al. Educating hispanic women about cervical cancer prevention: feasibility of a promotora-led charla intervention in a farmworker community. Ethn Dis. 2018;28(3):169-76. https://doi.org/10.18865/ed.28.3.169
https://doi.org/10.18865/ed.28.3.169...
-4545 Jeihooni AK, Jormand H, Harsini PA. The effect of educational program based on beliefs, subjective norms and perceived behavior control on doing pap-smear test in sample of Iranian women. BMC Womens Health. 2021;21(1):290. https://doi.org/10.1186/s12905-021-01419-w
https://doi.org/10.1186/s12905-021-01419...
). These materials were usually delivered at the end of the educational activity(1414 Ramaswamy M, Simmons R, Kelly PJ. The development of a brief jail-based cervical health promotion intervention. Health Promot Pract. 2015;16(3):432-42. https://doi.org/10.1177/1524839914541658
https://doi.org/10.1177/1524839914541658...
,2121 Daryani S, Shojaeezadeh D, Batebi A, Charati JY, Naghibi A. The effect of education based on a health belief model in women’s practice with regard to the Pap smear test. J Cancer Policy. 2016;8:51-6. https://doi.org/10.1016/j.jcpo.2015.11.001
https://doi.org/10.1016/j.jcpo.2015.11.0...
,2424 Ghahremani L, Harami ZK, Kaveh MH, Keshavarzi S. Investigation of the Role of Training Health Volunteers in Promoting Pap Smear Test Use among Iranian Women Based on the Protection Motivation Theory. Asian Pac J Cancer Prev. 2016;17(3):1157-62. https://doi.org/10.7314/APJCP.2016.17.3.1157
https://doi.org/10.7314/APJCP.2016.17.3....

25 Guvenc G, Akyuz A, Yenen MC. Effectiveness of nursing interventions to increase pap smear test screening. Res Nurs Health. 2013;36(2):146-57. https://doi.org/10.1002/nur.21526
https://doi.org/10.1002/nur.21526...
-2626 Kurt G, Akyuz A. Evaluating the effectiveness of interventions on increasing participation in cervical cancer screening. J Nurs Res. 2019;27(5):e40. https://doi.org/10.1097/jnr.0000000000000317
https://doi.org/10.1097/jnr.000000000000...
,3131 Parsa P, Sharifi F, Shobeiri F, Karami M. Effects of group counseling based on health belief model on cervical cancer screening beliefs and performance of rural women in Kaboudrahang, Iran. Asian Pacific J Cancer Prev. 2017;18(6):1525-30. https://doi.org/10.22034%2FAPJCP.2017.18.6.1525
https://doi.org/10.22034%2FAPJCP.2017.18...
-3232 Shobeiri F, Shobeiri F, Javad M, Parsa P, Roshanaei G. 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 J Cancer Prev. 2016;17(6):2871-2876. https://doi.org/APJCP.2016.17.6.2871
https://doi.org/APJCP.2016.17.6.2871...
,3535 Abu SH, Woldehanna BT, Nida ET, Tilahun AW, Gebremariam MY, Sisay MM. The role of health education on cervical cancer screening uptake at selected health centers in Addis Ababa. PLoS One. 2020;15(10):e0239580. https://doi.org/10.1371/journal.pone.0239580
https://doi.org/10.1371/journal.pone.023...
,3737 Calderón-Mora J, Byrd TL, Alomari A, Salaiz R, Dwivedi A, Mallawaarachchi I, et al. Group versus individual culturally tailored and theory-based education to promote cervical cancer screening among the underserved Hispanics: a cluster randomized trial. Am J Health Promot. 2020;34(1):15-24. https://doi.org/10.1177/0890117119871004
https://doi.org/10.1177/0890117119871004...
,3939 Malmir S, Barati M, Jeihooni AK, Bashirian S. Effect of an educational intervention based on protection motivation theory on preventing cervical cancer among marginalized women in West Iran. Asian Pac J Cancer Prev 2018;19(3):755-61. https://doi.org/10.22034/apjcp.2018.19.3.755
https://doi.org/10.22034/apjcp.2018.19.3...
,4242 O’Brien MJ, Halbert CH, Bixby R, Pimentel S, Shea JA. Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med. 2010;25(11):1186-92. https://doi.org/10.1007/s11606-010-1434-6
https://doi.org/10.1007/s11606-010-1434-...
). Other visual resources were used, such as flipchart(1111 McDonough AM, Vargas M, Nguyen-Rodriguez S, Garcia M, Galvez G, Rios-Ellis B. Mujer sana, familia fuerte: the effects of a culturally-relevant, community-based, promotores program to increase cervical cancer screening among Latinas. J Health Care Poor Underserved. 2016;27(2):568-79. https://doi.org/10.1353%2Fhpu.2016.0094
https://doi.org/10.1353%2Fhpu.2016.0094...
,3030 Luque JS, Tarasenko YN, Reyes-Garcia C, Alfonso ML, Suazo N, Rebing L, et al. Salud es vida: a cervical cancer screening intervention for rural Latina Immigrant Women. J Cancer Educ Off. 2017;32(4):690-9. https://doi.org/10.1007/s13187-015-0978-x
https://doi.org/10.1007/s13187-015-0978-...
,3636 Byrd TL, Wilson KM, Smith JL, Coronado G, Vernon SW, Fernandez-Esquer ME, et al. AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer. 2013;119(7):1365-72. https://doi.org/10.1002/cncr.27926
https://doi.org/10.1002/cncr.27926...

37 Calderón-Mora J, Byrd TL, Alomari A, Salaiz R, Dwivedi A, Mallawaarachchi I, et al. Group versus individual culturally tailored and theory-based education to promote cervical cancer screening among the underserved Hispanics: a cluster randomized trial. Am J Health Promot. 2020;34(1):15-24. https://doi.org/10.1177/0890117119871004
https://doi.org/10.1177/0890117119871004...
-3838 Calderon-Mora J, Alomari A, Shokar N. Comparison of narrative video and flipchart presentation to promote cervical cancer screening among Latinas along the border. Health Educ Behav. 2022. https://doi.org/10.1177/10901981221074918
https://doi.org/10.1177/1090198122107491...
), PowerPoint(3232 Shobeiri F, Shobeiri F, Javad M, Parsa P, Roshanaei G. 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 J Cancer Prev. 2016;17(6):2871-2876. https://doi.org/APJCP.2016.17.6.2871
https://doi.org/APJCP.2016.17.6.2871...
-3333 Thompson B, Vilchis H, Moran C, Copeland W, Holte S, Duggan C. Increasing cervical cancer screening in the United States-Mexico border region. J Rural Heal Off J Am Rural Heal Assoc Natl Rural Heal Care Assoc. 2014;30(2):196-205. doi: https://doi.org/10.1111/jrh.12044
https://doi.org/10.1111/jrh.12044...
) and posters(3131 Parsa P, Sharifi F, Shobeiri F, Karami M. Effects of group counseling based on health belief model on cervical cancer screening beliefs and performance of rural women in Kaboudrahang, Iran. Asian Pacific J Cancer Prev. 2017;18(6):1525-30. https://doi.org/10.22034%2FAPJCP.2017.18.6.1525
https://doi.org/10.22034%2FAPJCP.2017.18...
), in addition to audiovisual resources such as informative videos(2222 Drokow EK, Effah CY, Agboyibor C, Sasu E, Amponsem-Boateng C, Akpabla GS, et al. The impact of video-based educational interventions on cervical cancer, Pap Smear and HPV Vaccines. Front Public Health. 2021;9:681319. https://doi.org/10.3389/fpubh.2021.681319
https://doi.org/10.3389/fpubh.2021.68131...
-2323 Fang CY, Ma GX, Tan Y, Chi N. A multifaceted intervention to increase cervical cancer screening among underserved Korean women: Cancer Epidemiol Biomarkers Prev. 2007;16(6):1298-302. https://doi.org/10.1158/1055-9965.EPI-07-0091
https://doi.org/10.1158/1055-9965.EPI-07...
,2929 Love GD, Mouttapa M, Tanjasiri SP. Everybody’s talking: using entertainment-education video to reduce barriers to discussion of cervical cancer screening among Thai women. Health Educ Res. 2009;24(5):829-38. https://doi.org/10.1093/her/cyp019
https://doi.org/10.1093/her/cyp019...
-3030 Luque JS, Tarasenko YN, Reyes-Garcia C, Alfonso ML, Suazo N, Rebing L, et al. Salud es vida: a cervical cancer screening intervention for rural Latina Immigrant Women. J Cancer Educ Off. 2017;32(4):690-9. https://doi.org/10.1007/s13187-015-0978-x
https://doi.org/10.1007/s13187-015-0978-...
,3333 Thompson B, Vilchis H, Moran C, Copeland W, Holte S, Duggan C. Increasing cervical cancer screening in the United States-Mexico border region. J Rural Heal Off J Am Rural Heal Assoc Natl Rural Heal Care Assoc. 2014;30(2):196-205. doi: https://doi.org/10.1111/jrh.12044
https://doi.org/10.1111/jrh.12044...
-3434 Wang X, Fang C, Tan Y, Liu A, Ma GX. Evidence-based intervention to reduce access barriers to cervical cancer screening among underserved Chinese American women. J Womens Health (Larchmt). 2010;19(3):463-9. https://doi.org/10.1089/jwh.2009.1422
https://doi.org/10.1089/jwh.2009.1422...
,3838 Calderon-Mora J, Alomari A, Shokar N. Comparison of narrative video and flipchart presentation to promote cervical cancer screening among Latinas along the border. Health Educ Behav. 2022. https://doi.org/10.1177/10901981221074918
https://doi.org/10.1177/1090198122107491...
,4343 Thompson B, Carosso EA, Jhingan E, Wang L, Holte SE, Byrd TL, et al. Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas. Cancer. 2017;123(4):666-74. https://doi.org/10.1002/cncr.30399
https://doi.org/10.1002/cncr.30399...
), movies(1313 Pirzadeh A, Mazaheri MA. The effect of education on women’s practice based on the health belief model about pap smear test. Int J Prev Med [Internet]. 2012 [cited 2023 Jan 17];3(8):585-90. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429807/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2121 Daryani S, Shojaeezadeh D, Batebi A, Charati JY, Naghibi A. The effect of education based on a health belief model in women’s practice with regard to the Pap smear test. J Cancer Policy. 2016;8:51-6. https://doi.org/10.1016/j.jcpo.2015.11.001
https://doi.org/10.1016/j.jcpo.2015.11.0...
,4141 Mishra SI, Luce PH, Baquet CR. Increasing Pap Smear Utilization among Samoan Women: results from a community based participatory randomized trial. J Health Care Poor Underserved. 2009;20(2):85-101. https://doi.org/10.1353%2Fhpu.0.0160
https://doi.org/10.1353%2Fhpu.0.0160...
,4545 Jeihooni AK, Jormand H, Harsini PA. The effect of educational program based on beliefs, subjective norms and perceived behavior control on doing pap-smear test in sample of Iranian women. BMC Womens Health. 2021;21(1):290. https://doi.org/10.1186/s12905-021-01419-w
https://doi.org/10.1186/s12905-021-01419...
), soap operas(3636 Byrd TL, Wilson KM, Smith JL, Coronado G, Vernon SW, Fernandez-Esquer ME, et al. AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer. 2013;119(7):1365-72. https://doi.org/10.1002/cncr.27926
https://doi.org/10.1002/cncr.27926...
), infographics(3838 Calderon-Mora J, Alomari A, Shokar N. Comparison of narrative video and flipchart presentation to promote cervical cancer screening among Latinas along the border. Health Educ Behav. 2022. https://doi.org/10.1177/10901981221074918
https://doi.org/10.1177/1090198122107491...
), role-play(2323 Fang CY, Ma GX, Tan Y, Chi N. A multifaceted intervention to increase cervical cancer screening among underserved Korean women: Cancer Epidemiol Biomarkers Prev. 2007;16(6):1298-302. https://doi.org/10.1158/1055-9965.EPI-07-0091
https://doi.org/10.1158/1055-9965.EPI-07...
), practical shows(77 Samami E, Seyedi-Andi SJ, Bayat B, Shojaeizadeh D, Tori NA. The effect of educational intervention based on the health belief model on knowledge, attitude, and function of women about Pap smear test at Iranian health centers: a randomized controlled clinical trial. J Educ Health Promot. 2021;10(1). https://doi.org/10.4103%2Fjehp.jehp_33_20
https://doi.org/10.4103%2Fjehp.jehp_33_2...
,2121 Daryani S, Shojaeezadeh D, Batebi A, Charati JY, Naghibi A. The effect of education based on a health belief model in women’s practice with regard to the Pap smear test. J Cancer Policy. 2016;8:51-6. https://doi.org/10.1016/j.jcpo.2015.11.001
https://doi.org/10.1016/j.jcpo.2015.11.0...
,4141 Mishra SI, Luce PH, Baquet CR. Increasing Pap Smear Utilization among Samoan Women: results from a community based participatory randomized trial. J Health Care Poor Underserved. 2009;20(2):85-101. https://doi.org/10.1353%2Fhpu.0.0160
https://doi.org/10.1353%2Fhpu.0.0160...
) and telegram(4545 Jeihooni AK, Jormand H, Harsini PA. The effect of educational program based on beliefs, subjective norms and perceived behavior control on doing pap-smear test in sample of Iranian women. BMC Womens Health. 2021;21(1):290. https://doi.org/10.1186/s12905-021-01419-w
https://doi.org/10.1186/s12905-021-01419...
).

Education through telephone interviews was also used in some studies to provide explanations about CC and its risks, the purpose of Pap smear test, the importance of correct frequency of testing, pre-examination care, in addition to information about returning to access post-exam result(2525 Guvenc G, Akyuz A, Yenen MC. Effectiveness of nursing interventions to increase pap smear test screening. Res Nurs Health. 2013;36(2):146-57. https://doi.org/10.1002/nur.21526
https://doi.org/10.1002/nur.21526...
,2828 Lima TM, Nicolau AIO, Carvalho FHC, Vasconcelos CTM, Aquino PS, Pinheiro AKB. Intervenções por telefone para adesão ao exame colpocitológico1. Rev Latino-Am Enfermagem. 2017;25. https://doi.org/10.1590/1518-8345.1683.2844
https://doi.org/10.1590/1518-8345.1683.2...
,3535 Abu SH, Woldehanna BT, Nida ET, Tilahun AW, Gebremariam MY, Sisay MM. The role of health education on cervical cancer screening uptake at selected health centers in Addis Ababa. PLoS One. 2020;15(10):e0239580. https://doi.org/10.1371/journal.pone.0239580
https://doi.org/10.1371/journal.pone.023...
).

Another strategy used was the PLNav, used to help women access health services through professionals from the same community who work, speak the same language and/or come from the same context as the target population. This format was applied in studies that demonstrated an increase in knowledge about CC screening and screening among participating women(2323 Fang CY, Ma GX, Tan Y, Chi N. A multifaceted intervention to increase cervical cancer screening among underserved Korean women: Cancer Epidemiol Biomarkers Prev. 2007;16(6):1298-302. https://doi.org/10.1158/1055-9965.EPI-07-0091
https://doi.org/10.1158/1055-9965.EPI-07...
,3434 Wang X, Fang C, Tan Y, Liu A, Ma GX. Evidence-based intervention to reduce access barriers to cervical cancer screening among underserved Chinese American women. J Womens Health (Larchmt). 2010;19(3):463-9. https://doi.org/10.1089/jwh.2009.1422
https://doi.org/10.1089/jwh.2009.1422...
,4040 Mboineki JF, Wang P, Dhakal K, Getu MA, Chen C. The effect of peer-led navigation approach as a form of task shifting in promoting cervical cancer screening knowledge, intention, and practices among urban women in Tanzania: a randomized controlled trial. Cancer Control. 2022;29:10732748221089480. https://doi.org/10.1177/10732748221089480
https://doi.org/10.1177/1073274822108948...
).

The content of the educational activities used in the interventions addressed themes related to CC, including risk factors, ways of preventing the disease and possible symptoms, with emphasis on the importance of performing Pap smear. Moreover, many interventions addressed the benefits and barriers in relation to Pap smear, including knowledge, attitudes, beliefs and information about access to health services. Some activities also emphasized the relationship between CC and Human Papillomavirus (HPV) infection, healthy lifestyle behaviors including healthy nutrition, physical activity, and weight management.

Educational activities took place in a single session, in most of analyzed studies (n=14), lasting from 40 to 60 minutes(88 Ernawati, Oktaviana D, Mantasia, Yusuf RA, Sumarmi. The effect of health education based on the health belief model about pap smear test on women in rural district Indonesia. Medico-Legal Updat. 2021;21(2):1-6. https://doi.org/10.37506/mlu.v21i2.2636
https://doi.org/10.37506/mlu.v21i2.2636...
,1111 McDonough AM, Vargas M, Nguyen-Rodriguez S, Garcia M, Galvez G, Rios-Ellis B. Mujer sana, familia fuerte: the effects of a culturally-relevant, community-based, promotores program to increase cervical cancer screening among Latinas. J Health Care Poor Underserved. 2016;27(2):568-79. https://doi.org/10.1353%2Fhpu.2016.0094
https://doi.org/10.1353%2Fhpu.2016.0094...
,2323 Fang CY, Ma GX, Tan Y, Chi N. A multifaceted intervention to increase cervical cancer screening among underserved Korean women: Cancer Epidemiol Biomarkers Prev. 2007;16(6):1298-302. https://doi.org/10.1158/1055-9965.EPI-07-0091
https://doi.org/10.1158/1055-9965.EPI-07...
,2525 Guvenc G, Akyuz A, Yenen MC. Effectiveness of nursing interventions to increase pap smear test screening. Res Nurs Health. 2013;36(2):146-57. https://doi.org/10.1002/nur.21526
https://doi.org/10.1002/nur.21526...
-2626 Kurt G, Akyuz A. Evaluating the effectiveness of interventions on increasing participation in cervical cancer screening. J Nurs Res. 2019;27(5):e40. https://doi.org/10.1097/jnr.0000000000000317
https://doi.org/10.1097/jnr.000000000000...
,2828 Lima TM, Nicolau AIO, Carvalho FHC, Vasconcelos CTM, Aquino PS, Pinheiro AKB. Intervenções por telefone para adesão ao exame colpocitológico1. Rev Latino-Am Enfermagem. 2017;25. https://doi.org/10.1590/1518-8345.1683.2844
https://doi.org/10.1590/1518-8345.1683.2...
-2929 Love GD, Mouttapa M, Tanjasiri SP. Everybody’s talking: using entertainment-education video to reduce barriers to discussion of cervical cancer screening among Thai women. Health Educ Res. 2009;24(5):829-38. https://doi.org/10.1093/her/cyp019
https://doi.org/10.1093/her/cyp019...
,3333 Thompson B, Vilchis H, Moran C, Copeland W, Holte S, Duggan C. Increasing cervical cancer screening in the United States-Mexico border region. J Rural Heal Off J Am Rural Heal Assoc Natl Rural Heal Care Assoc. 2014;30(2):196-205. doi: https://doi.org/10.1111/jrh.12044
https://doi.org/10.1111/jrh.12044...
,3535 Abu SH, Woldehanna BT, Nida ET, Tilahun AW, Gebremariam MY, Sisay MM. The role of health education on cervical cancer screening uptake at selected health centers in Addis Ababa. PLoS One. 2020;15(10):e0239580. https://doi.org/10.1371/journal.pone.0239580
https://doi.org/10.1371/journal.pone.023...

36 Byrd TL, Wilson KM, Smith JL, Coronado G, Vernon SW, Fernandez-Esquer ME, et al. AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer. 2013;119(7):1365-72. https://doi.org/10.1002/cncr.27926
https://doi.org/10.1002/cncr.27926...

37 Calderón-Mora J, Byrd TL, Alomari A, Salaiz R, Dwivedi A, Mallawaarachchi I, et al. Group versus individual culturally tailored and theory-based education to promote cervical cancer screening among the underserved Hispanics: a cluster randomized trial. Am J Health Promot. 2020;34(1):15-24. https://doi.org/10.1177/0890117119871004
https://doi.org/10.1177/0890117119871004...
-3838 Calderon-Mora J, Alomari A, Shokar N. Comparison of narrative video and flipchart presentation to promote cervical cancer screening among Latinas along the border. Health Educ Behav. 2022. https://doi.org/10.1177/10901981221074918
https://doi.org/10.1177/1090198122107491...
,4040 Mboineki JF, Wang P, Dhakal K, Getu MA, Chen C. The effect of peer-led navigation approach as a form of task shifting in promoting cervical cancer screening knowledge, intention, and practices among urban women in Tanzania: a randomized controlled trial. Cancer Control. 2022;29:10732748221089480. https://doi.org/10.1177/10732748221089480
https://doi.org/10.1177/1073274822108948...
,4343 Thompson B, Carosso EA, Jhingan E, Wang L, Holte SE, Byrd TL, et al. Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas. Cancer. 2017;123(4):666-74. https://doi.org/10.1002/cncr.30399
https://doi.org/10.1002/cncr.30399...
). In most studies, the educational activity was carried out in a group and delivered by a Community Health Worker (CHW)(1111 McDonough AM, Vargas M, Nguyen-Rodriguez S, Garcia M, Galvez G, Rios-Ellis B. Mujer sana, familia fuerte: the effects of a culturally-relevant, community-based, promotores program to increase cervical cancer screening among Latinas. J Health Care Poor Underserved. 2016;27(2):568-79. https://doi.org/10.1353%2Fhpu.2016.0094
https://doi.org/10.1353%2Fhpu.2016.0094...
,1313 Pirzadeh A, Mazaheri MA. The effect of education on women’s practice based on the health belief model about pap smear test. Int J Prev Med [Internet]. 2012 [cited 2023 Jan 17];3(8):585-90. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429807/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2222 Drokow EK, Effah CY, Agboyibor C, Sasu E, Amponsem-Boateng C, Akpabla GS, et al. The impact of video-based educational interventions on cervical cancer, Pap Smear and HPV Vaccines. Front Public Health. 2021;9:681319. https://doi.org/10.3389/fpubh.2021.681319
https://doi.org/10.3389/fpubh.2021.68131...
-2323 Fang CY, Ma GX, Tan Y, Chi N. A multifaceted intervention to increase cervical cancer screening among underserved Korean women: Cancer Epidemiol Biomarkers Prev. 2007;16(6):1298-302. https://doi.org/10.1158/1055-9965.EPI-07-0091
https://doi.org/10.1158/1055-9965.EPI-07...
,3333 Thompson B, Vilchis H, Moran C, Copeland W, Holte S, Duggan C. Increasing cervical cancer screening in the United States-Mexico border region. J Rural Heal Off J Am Rural Heal Assoc Natl Rural Heal Care Assoc. 2014;30(2):196-205. doi: https://doi.org/10.1111/jrh.12044
https://doi.org/10.1111/jrh.12044...
,3636 Byrd TL, Wilson KM, Smith JL, Coronado G, Vernon SW, Fernandez-Esquer ME, et al. AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer. 2013;119(7):1365-72. https://doi.org/10.1002/cncr.27926
https://doi.org/10.1002/cncr.27926...

37 Calderón-Mora J, Byrd TL, Alomari A, Salaiz R, Dwivedi A, Mallawaarachchi I, et al. Group versus individual culturally tailored and theory-based education to promote cervical cancer screening among the underserved Hispanics: a cluster randomized trial. Am J Health Promot. 2020;34(1):15-24. https://doi.org/10.1177/0890117119871004
https://doi.org/10.1177/0890117119871004...
-3838 Calderon-Mora J, Alomari A, Shokar N. Comparison of narrative video and flipchart presentation to promote cervical cancer screening among Latinas along the border. Health Educ Behav. 2022. https://doi.org/10.1177/10901981221074918
https://doi.org/10.1177/1090198122107491...
,4242 O’Brien MJ, Halbert CH, Bixby R, Pimentel S, Shea JA. Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med. 2010;25(11):1186-92. https://doi.org/10.1007/s11606-010-1434-6
https://doi.org/10.1007/s11606-010-1434-...
). It should be noted that, in only four studies, the participation of nurses in delivering the educational intervention was explicit(88 Ernawati, Oktaviana D, Mantasia, Yusuf RA, Sumarmi. The effect of health education based on the health belief model about pap smear test on women in rural district Indonesia. Medico-Legal Updat. 2021;21(2):1-6. https://doi.org/10.37506/mlu.v21i2.2636
https://doi.org/10.37506/mlu.v21i2.2636...
,1414 Ramaswamy M, Simmons R, Kelly PJ. The development of a brief jail-based cervical health promotion intervention. Health Promot Pract. 2015;16(3):432-42. https://doi.org/10.1177/1524839914541658
https://doi.org/10.1177/1524839914541658...
,2525 Guvenc G, Akyuz A, Yenen MC. Effectiveness of nursing interventions to increase pap smear test screening. Res Nurs Health. 2013;36(2):146-57. https://doi.org/10.1002/nur.21526
https://doi.org/10.1002/nur.21526...
,3535 Abu SH, Woldehanna BT, Nida ET, Tilahun AW, Gebremariam MY, Sisay MM. The role of health education on cervical cancer screening uptake at selected health centers in Addis Ababa. PLoS One. 2020;15(10):e0239580. https://doi.org/10.1371/journal.pone.0239580
https://doi.org/10.1371/journal.pone.023...
).

Regarding the theoretical model used, the most frequent one as a basis for the intervention was the HBM, which aims to increase knowledge, improve attitudes, broaden the perception of the benefits of the test and health motivation, in addition to reducing the barriers to performing Pap smear, factors that can contribute to CC prevention(77 Samami E, Seyedi-Andi SJ, Bayat B, Shojaeizadeh D, Tori NA. The effect of educational intervention based on the health belief model on knowledge, attitude, and function of women about Pap smear test at Iranian health centers: a randomized controlled clinical trial. J Educ Health Promot. 2021;10(1). https://doi.org/10.4103%2Fjehp.jehp_33_20
https://doi.org/10.4103%2Fjehp.jehp_33_2...
-88 Ernawati, Oktaviana D, Mantasia, Yusuf RA, Sumarmi. The effect of health education based on the health belief model about pap smear test on women in rural district Indonesia. Medico-Legal Updat. 2021;21(2):1-6. https://doi.org/10.37506/mlu.v21i2.2636
https://doi.org/10.37506/mlu.v21i2.2636...
,1010 Koç Z, Özdeş EK, Topatan S, Çinarli T, Şener A, Danaci E, et al. The impact of education about cervical cancer and human papillomavirus on women’s healthy lifestyle behaviors and beliefs: using the PRECEDE Educational Model. Cancer Nurs. 2019;42(2):106-18. https://doi.org/10.1097/ncc.0000000000000570
https://doi.org/10.1097/ncc.000000000000...
,1313 Pirzadeh A, Mazaheri MA. The effect of education on women’s practice based on the health belief model about pap smear test. Int J Prev Med [Internet]. 2012 [cited 2023 Jan 17];3(8):585-90. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429807/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2121 Daryani S, Shojaeezadeh D, Batebi A, Charati JY, Naghibi A. The effect of education based on a health belief model in women’s practice with regard to the Pap smear test. J Cancer Policy. 2016;8:51-6. https://doi.org/10.1016/j.jcpo.2015.11.001
https://doi.org/10.1016/j.jcpo.2015.11.0...
,2626 Kurt G, Akyuz A. Evaluating the effectiveness of interventions on increasing participation in cervical cancer screening. J Nurs Res. 2019;27(5):e40. https://doi.org/10.1097/jnr.0000000000000317
https://doi.org/10.1097/jnr.000000000000...
,3131 Parsa P, Sharifi F, Shobeiri F, Karami M. Effects of group counseling based on health belief model on cervical cancer screening beliefs and performance of rural women in Kaboudrahang, Iran. Asian Pacific J Cancer Prev. 2017;18(6):1525-30. https://doi.org/10.22034%2FAPJCP.2017.18.6.1525
https://doi.org/10.22034%2FAPJCP.2017.18...
-3232 Shobeiri F, Shobeiri F, Javad M, Parsa P, Roshanaei G. 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 J Cancer Prev. 2016;17(6):2871-2876. https://doi.org/APJCP.2016.17.6.2871
https://doi.org/APJCP.2016.17.6.2871...
,3535 Abu SH, Woldehanna BT, Nida ET, Tilahun AW, Gebremariam MY, Sisay MM. The role of health education on cervical cancer screening uptake at selected health centers in Addis Ababa. PLoS One. 2020;15(10):e0239580. https://doi.org/10.1371/journal.pone.0239580
https://doi.org/10.1371/journal.pone.023...
,4242 O’Brien MJ, Halbert CH, Bixby R, Pimentel S, Shea JA. Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med. 2010;25(11):1186-92. https://doi.org/10.1007/s11606-010-1434-6
https://doi.org/10.1007/s11606-010-1434-...
).

The Protective Motivation Theory was used in two studies and incorporates the cognitive process into a conceptual framework that describes intention and behavior(2424 Ghahremani L, Harami ZK, Kaveh MH, Keshavarzi S. Investigation of the Role of Training Health Volunteers in Promoting Pap Smear Test Use among Iranian Women Based on the Protection Motivation Theory. Asian Pac J Cancer Prev. 2016;17(3):1157-62. https://doi.org/10.7314/APJCP.2016.17.3.1157
https://doi.org/10.7314/APJCP.2016.17.3....
,3939 Malmir S, Barati M, Jeihooni AK, Bashirian S. Effect of an educational intervention based on protection motivation theory on preventing cervical cancer among marginalized women in West Iran. Asian Pac J Cancer Prev 2018;19(3):755-61. https://doi.org/10.22034/apjcp.2018.19.3.755
https://doi.org/10.22034/apjcp.2018.19.3...
). Two studies used mapping principles, which consider the needs empirically observed in the target population(3333 Thompson B, Vilchis H, Moran C, Copeland W, Holte S, Duggan C. Increasing cervical cancer screening in the United States-Mexico border region. J Rural Heal Off J Am Rural Heal Assoc Natl Rural Heal Care Assoc. 2014;30(2):196-205. doi: https://doi.org/10.1111/jrh.12044
https://doi.org/10.1111/jrh.12044...
,3636 Byrd TL, Wilson KM, Smith JL, Coronado G, Vernon SW, Fernandez-Esquer ME, et al. AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer. 2013;119(7):1365-72. https://doi.org/10.1002/cncr.27926
https://doi.org/10.1002/cncr.27926...
). In these studies, the intervention was applied by CHW(3333 Thompson B, Vilchis H, Moran C, Copeland W, Holte S, Duggan C. Increasing cervical cancer screening in the United States-Mexico border region. J Rural Heal Off J Am Rural Heal Assoc Natl Rural Heal Care Assoc. 2014;30(2):196-205. doi: https://doi.org/10.1111/jrh.12044
https://doi.org/10.1111/jrh.12044...
,3636 Byrd TL, Wilson KM, Smith JL, Coronado G, Vernon SW, Fernandez-Esquer ME, et al. AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer. 2013;119(7):1365-72. https://doi.org/10.1002/cncr.27926
https://doi.org/10.1002/cncr.27926...
).

Studies have also used the Beliefs, Attitudes, Subjective Norms and Facilitating Factors (BASNEF) Model(99 Hosseini Z, Mohseni S, Momeni R, Aghamolaei T, Alavi A. Increasing the prevalence of cervical cancer screening in Iran: effectiveness of a theory-based educational intervention. Reprod Health. 2022;19(1):1-13. https://doi.org/10.21203/rs.3.rs-1311063/v1
https://doi.org/10.21203/rs.3.rs-1311063...
), the SCT(2929 Love GD, Mouttapa M, Tanjasiri SP. Everybody’s talking: using entertainment-education video to reduce barriers to discussion of cervical cancer screening among Thai women. Health Educ Res. 2009;24(5):829-38. https://doi.org/10.1093/her/cyp019
https://doi.org/10.1093/her/cyp019...
,4343 Thompson B, Carosso EA, Jhingan E, Wang L, Holte SE, Byrd TL, et al. Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas. Cancer. 2017;123(4):666-74. https://doi.org/10.1002/cncr.30399
https://doi.org/10.1002/cncr.30399...
), the Theory of Planned Behavior(1212 Mirzaei-Alavijeh M, Karami-Matin B, Jalilian F, Rakhshan F, Mahboubi M, Emdadi S. Pap smear test promotion among women: an educational intervention based on theory of planned behavior. J Biol Today’s World [Internet]. 2014 [cited 2023 Jan 17];3(4):100-3. Available from: https://oaji.net/articles/2014/598-1398623374.pdf
https://oaji.net/articles/2014/598-13986...
), the PRECEDE-PROCEED Conceptual Model(1010 Koç Z, Özdeş EK, Topatan S, Çinarli T, Şener A, Danaci E, et al. The impact of education about cervical cancer and human papillomavirus on women’s healthy lifestyle behaviors and beliefs: using the PRECEDE Educational Model. Cancer Nurs. 2019;42(2):106-18. https://doi.org/10.1097/ncc.0000000000000570
https://doi.org/10.1097/ncc.000000000000...
) and the Fogg Behavior Model(2727 Lee HY, Koopmeiners JS, Rhee TG, Raveis VH, Ahluwalia JS. Mobile phone text messaging intervention for cervical cancer screening: Changes in knowledge and behavior pre-post intervention. Obstet Gynecol Surv. 2015;70(1):26-7. https://doi.org/10.1097/OGX.0000000000000142
https://doi.org/10.1097/OGX.000000000000...
), among others. Twelve articles included in this review used combined theoretical models(1111 McDonough AM, Vargas M, Nguyen-Rodriguez S, Garcia M, Galvez G, Rios-Ellis B. Mujer sana, familia fuerte: the effects of a culturally-relevant, community-based, promotores program to increase cervical cancer screening among Latinas. J Health Care Poor Underserved. 2016;27(2):568-79. https://doi.org/10.1353%2Fhpu.2016.0094
https://doi.org/10.1353%2Fhpu.2016.0094...
,1414 Ramaswamy M, Simmons R, Kelly PJ. The development of a brief jail-based cervical health promotion intervention. Health Promot Pract. 2015;16(3):432-42. https://doi.org/10.1177/1524839914541658
https://doi.org/10.1177/1524839914541658...
,2222 Drokow EK, Effah CY, Agboyibor C, Sasu E, Amponsem-Boateng C, Akpabla GS, et al. The impact of video-based educational interventions on cervical cancer, Pap Smear and HPV Vaccines. Front Public Health. 2021;9:681319. https://doi.org/10.3389/fpubh.2021.681319
https://doi.org/10.3389/fpubh.2021.68131...
-2323 Fang CY, Ma GX, Tan Y, Chi N. A multifaceted intervention to increase cervical cancer screening among underserved Korean women: Cancer Epidemiol Biomarkers Prev. 2007;16(6):1298-302. https://doi.org/10.1158/1055-9965.EPI-07-0091
https://doi.org/10.1158/1055-9965.EPI-07...
,3030 Luque JS, Tarasenko YN, Reyes-Garcia C, Alfonso ML, Suazo N, Rebing L, et al. Salud es vida: a cervical cancer screening intervention for rural Latina Immigrant Women. J Cancer Educ Off. 2017;32(4):690-9. https://doi.org/10.1007/s13187-015-0978-x
https://doi.org/10.1007/s13187-015-0978-...
,3434 Wang X, Fang C, Tan Y, Liu A, Ma GX. Evidence-based intervention to reduce access barriers to cervical cancer screening among underserved Chinese American women. J Womens Health (Larchmt). 2010;19(3):463-9. https://doi.org/10.1089/jwh.2009.1422
https://doi.org/10.1089/jwh.2009.1422...
,3636 Byrd TL, Wilson KM, Smith JL, Coronado G, Vernon SW, Fernandez-Esquer ME, et al. AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer. 2013;119(7):1365-72. https://doi.org/10.1002/cncr.27926
https://doi.org/10.1002/cncr.27926...

37 Calderón-Mora J, Byrd TL, Alomari A, Salaiz R, Dwivedi A, Mallawaarachchi I, et al. Group versus individual culturally tailored and theory-based education to promote cervical cancer screening among the underserved Hispanics: a cluster randomized trial. Am J Health Promot. 2020;34(1):15-24. https://doi.org/10.1177/0890117119871004
https://doi.org/10.1177/0890117119871004...
-3838 Calderon-Mora J, Alomari A, Shokar N. Comparison of narrative video and flipchart presentation to promote cervical cancer screening among Latinas along the border. Health Educ Behav. 2022. https://doi.org/10.1177/10901981221074918
https://doi.org/10.1177/1090198122107491...
,4040 Mboineki JF, Wang P, Dhakal K, Getu MA, Chen C. The effect of peer-led navigation approach as a form of task shifting in promoting cervical cancer screening knowledge, intention, and practices among urban women in Tanzania: a randomized controlled trial. Cancer Control. 2022;29:10732748221089480. https://doi.org/10.1177/10732748221089480
https://doi.org/10.1177/1073274822108948...
-4141 Mishra SI, Luce PH, Baquet CR. Increasing Pap Smear Utilization among Samoan Women: results from a community based participatory randomized trial. J Health Care Poor Underserved. 2009;20(2):85-101. https://doi.org/10.1353%2Fhpu.0.0160
https://doi.org/10.1353%2Fhpu.0.0160...
,4444 Fleming K, Simmons VN, Christy SM, Sutton SK, Romo M, Luque JS, et al. Educating hispanic women about cervical cancer prevention: feasibility of a promotora-led charla intervention in a farmworker community. Ethn Dis. 2018;28(3):169-76. https://doi.org/10.18865/ed.28.3.169
https://doi.org/10.18865/ed.28.3.169...
-4545 Jeihooni AK, Jormand H, Harsini PA. The effect of educational program based on beliefs, subjective norms and perceived behavior control on doing pap-smear test in sample of Iranian women. BMC Womens Health. 2021;21(1):290. https://doi.org/10.1186/s12905-021-01419-w
https://doi.org/10.1186/s12905-021-01419...
).

Study analysis showed that educational strategies, based on theories and culturally sensitive, can be used in combination for CC prevention, with emphasis on group discussions and lectures. Educational interventions that address knowledge about CC, barriers to screening and the importance of performing Pap smear seem to influence women’s health beliefs and behavior. Educational interventions that rely on the collaboration of CHW can contribute to the reduction of barriers to screening.

DISCUSSION

CC is still common in women. This review analyzed thirty-three studies that used educational interventions aimed at CC prevention in women aged ≥18 years, in any context of care.

With technological advances, one can think of using different educational strategies to educate the population on a given topic. However, it is important to consider the available resources, the target population characteristics (e.g., educational level) and the feasibility of applying the technology. In the present review, the focus group sessions(88 Ernawati, Oktaviana D, Mantasia, Yusuf RA, Sumarmi. The effect of health education based on the health belief model about pap smear test on women in rural district Indonesia. Medico-Legal Updat. 2021;21(2):1-6. https://doi.org/10.37506/mlu.v21i2.2636
https://doi.org/10.37506/mlu.v21i2.2636...

9 Hosseini Z, Mohseni S, Momeni R, Aghamolaei T, Alavi A. Increasing the prevalence of cervical cancer screening in Iran: effectiveness of a theory-based educational intervention. Reprod Health. 2022;19(1):1-13. https://doi.org/10.21203/rs.3.rs-1311063/v1
https://doi.org/10.21203/rs.3.rs-1311063...

10 Koç Z, Özdeş EK, Topatan S, Çinarli T, Şener A, Danaci E, et al. The impact of education about cervical cancer and human papillomavirus on women’s healthy lifestyle behaviors and beliefs: using the PRECEDE Educational Model. Cancer Nurs. 2019;42(2):106-18. https://doi.org/10.1097/ncc.0000000000000570
https://doi.org/10.1097/ncc.000000000000...

11 McDonough AM, Vargas M, Nguyen-Rodriguez S, Garcia M, Galvez G, Rios-Ellis B. Mujer sana, familia fuerte: the effects of a culturally-relevant, community-based, promotores program to increase cervical cancer screening among Latinas. J Health Care Poor Underserved. 2016;27(2):568-79. https://doi.org/10.1353%2Fhpu.2016.0094
https://doi.org/10.1353%2Fhpu.2016.0094...

12 Mirzaei-Alavijeh M, Karami-Matin B, Jalilian F, Rakhshan F, Mahboubi M, Emdadi S. Pap smear test promotion among women: an educational intervention based on theory of planned behavior. J Biol Today’s World [Internet]. 2014 [cited 2023 Jan 17];3(4):100-3. Available from: https://oaji.net/articles/2014/598-1398623374.pdf
https://oaji.net/articles/2014/598-13986...

13 Pirzadeh A, Mazaheri MA. The effect of education on women’s practice based on the health belief model about pap smear test. Int J Prev Med [Internet]. 2012 [cited 2023 Jan 17];3(8):585-90. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429807/
https://www.ncbi.nlm.nih.gov/pmc/article...
-1414 Ramaswamy M, Simmons R, Kelly PJ. The development of a brief jail-based cervical health promotion intervention. Health Promot Pract. 2015;16(3):432-42. https://doi.org/10.1177/1524839914541658
https://doi.org/10.1177/1524839914541658...
,2121 Daryani S, Shojaeezadeh D, Batebi A, Charati JY, Naghibi A. The effect of education based on a health belief model in women’s practice with regard to the Pap smear test. J Cancer Policy. 2016;8:51-6. https://doi.org/10.1016/j.jcpo.2015.11.001
https://doi.org/10.1016/j.jcpo.2015.11.0...
,2323 Fang CY, Ma GX, Tan Y, Chi N. A multifaceted intervention to increase cervical cancer screening among underserved Korean women: Cancer Epidemiol Biomarkers Prev. 2007;16(6):1298-302. https://doi.org/10.1158/1055-9965.EPI-07-0091
https://doi.org/10.1158/1055-9965.EPI-07...
,2929 Love GD, Mouttapa M, Tanjasiri SP. Everybody’s talking: using entertainment-education video to reduce barriers to discussion of cervical cancer screening among Thai women. Health Educ Res. 2009;24(5):829-38. https://doi.org/10.1093/her/cyp019
https://doi.org/10.1093/her/cyp019...
,3232 Shobeiri F, Shobeiri F, Javad M, Parsa P, Roshanaei G. 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 J Cancer Prev. 2016;17(6):2871-2876. https://doi.org/APJCP.2016.17.6.2871
https://doi.org/APJCP.2016.17.6.2871...
,3737 Calderón-Mora J, Byrd TL, Alomari A, Salaiz R, Dwivedi A, Mallawaarachchi I, et al. Group versus individual culturally tailored and theory-based education to promote cervical cancer screening among the underserved Hispanics: a cluster randomized trial. Am J Health Promot. 2020;34(1):15-24. https://doi.org/10.1177/0890117119871004
https://doi.org/10.1177/0890117119871004...
,3939 Malmir S, Barati M, Jeihooni AK, Bashirian S. Effect of an educational intervention based on protection motivation theory on preventing cervical cancer among marginalized women in West Iran. Asian Pac J Cancer Prev 2018;19(3):755-61. https://doi.org/10.22034/apjcp.2018.19.3.755
https://doi.org/10.22034/apjcp.2018.19.3...
,4141 Mishra SI, Luce PH, Baquet CR. Increasing Pap Smear Utilization among Samoan Women: results from a community based participatory randomized trial. J Health Care Poor Underserved. 2009;20(2):85-101. https://doi.org/10.1353%2Fhpu.0.0160
https://doi.org/10.1353%2Fhpu.0.0160...
,4444 Fleming K, Simmons VN, Christy SM, Sutton SK, Romo M, Luque JS, et al. Educating hispanic women about cervical cancer prevention: feasibility of a promotora-led charla intervention in a farmworker community. Ethn Dis. 2018;28(3):169-76. https://doi.org/10.18865/ed.28.3.169
https://doi.org/10.18865/ed.28.3.169...
-4545 Jeihooni AK, Jormand H, Harsini PA. The effect of educational program based on beliefs, subjective norms and perceived behavior control on doing pap-smear test in sample of Iranian women. BMC Womens Health. 2021;21(1):290. https://doi.org/10.1186/s12905-021-01419-w
https://doi.org/10.1186/s12905-021-01419...
) and educational leaflets were the most used strategies to promote prevention behaviors(1111 McDonough AM, Vargas M, Nguyen-Rodriguez S, Garcia M, Galvez G, Rios-Ellis B. Mujer sana, familia fuerte: the effects of a culturally-relevant, community-based, promotores program to increase cervical cancer screening among Latinas. J Health Care Poor Underserved. 2016;27(2):568-79. https://doi.org/10.1353%2Fhpu.2016.0094
https://doi.org/10.1353%2Fhpu.2016.0094...
,1414 Ramaswamy M, Simmons R, Kelly PJ. The development of a brief jail-based cervical health promotion intervention. Health Promot Pract. 2015;16(3):432-42. https://doi.org/10.1177/1524839914541658
https://doi.org/10.1177/1524839914541658...
,2121 Daryani S, Shojaeezadeh D, Batebi A, Charati JY, Naghibi A. The effect of education based on a health belief model in women’s practice with regard to the Pap smear test. J Cancer Policy. 2016;8:51-6. https://doi.org/10.1016/j.jcpo.2015.11.001
https://doi.org/10.1016/j.jcpo.2015.11.0...
,2424 Ghahremani L, Harami ZK, Kaveh MH, Keshavarzi S. Investigation of the Role of Training Health Volunteers in Promoting Pap Smear Test Use among Iranian Women Based on the Protection Motivation Theory. Asian Pac J Cancer Prev. 2016;17(3):1157-62. https://doi.org/10.7314/APJCP.2016.17.3.1157
https://doi.org/10.7314/APJCP.2016.17.3....

25 Guvenc G, Akyuz A, Yenen MC. Effectiveness of nursing interventions to increase pap smear test screening. Res Nurs Health. 2013;36(2):146-57. https://doi.org/10.1002/nur.21526
https://doi.org/10.1002/nur.21526...
-2626 Kurt G, Akyuz A. Evaluating the effectiveness of interventions on increasing participation in cervical cancer screening. J Nurs Res. 2019;27(5):e40. https://doi.org/10.1097/jnr.0000000000000317
https://doi.org/10.1097/jnr.000000000000...
,3131 Parsa P, Sharifi F, Shobeiri F, Karami M. Effects of group counseling based on health belief model on cervical cancer screening beliefs and performance of rural women in Kaboudrahang, Iran. Asian Pacific J Cancer Prev. 2017;18(6):1525-30. https://doi.org/10.22034%2FAPJCP.2017.18.6.1525
https://doi.org/10.22034%2FAPJCP.2017.18...
-3232 Shobeiri F, Shobeiri F, Javad M, Parsa P, Roshanaei G. 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 J Cancer Prev. 2016;17(6):2871-2876. https://doi.org/APJCP.2016.17.6.2871
https://doi.org/APJCP.2016.17.6.2871...
,3535 Abu SH, Woldehanna BT, Nida ET, Tilahun AW, Gebremariam MY, Sisay MM. The role of health education on cervical cancer screening uptake at selected health centers in Addis Ababa. PLoS One. 2020;15(10):e0239580. https://doi.org/10.1371/journal.pone.0239580
https://doi.org/10.1371/journal.pone.023...
,3737 Calderón-Mora J, Byrd TL, Alomari A, Salaiz R, Dwivedi A, Mallawaarachchi I, et al. Group versus individual culturally tailored and theory-based education to promote cervical cancer screening among the underserved Hispanics: a cluster randomized trial. Am J Health Promot. 2020;34(1):15-24. https://doi.org/10.1177/0890117119871004
https://doi.org/10.1177/0890117119871004...
,3939 Malmir S, Barati M, Jeihooni AK, Bashirian S. Effect of an educational intervention based on protection motivation theory on preventing cervical cancer among marginalized women in West Iran. Asian Pac J Cancer Prev 2018;19(3):755-61. https://doi.org/10.22034/apjcp.2018.19.3.755
https://doi.org/10.22034/apjcp.2018.19.3...
,4242 O’Brien MJ, Halbert CH, Bixby R, Pimentel S, Shea JA. Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med. 2010;25(11):1186-92. https://doi.org/10.1007/s11606-010-1434-6
https://doi.org/10.1007/s11606-010-1434-...
), probably because their low cost makes them accessible and guarantees the delivery of the necessary educational content.

In the present research, the discussion sessions and the educational leaflets appeared combined with each other, or in a complementary way to other methodologies such as videos, lectures, telephone calls, among others. A systematic review that assessed the effects of educational interventions on CC screening behavior showed that the different methods used improved prevention behaviors among women(4646 Ghare-Naz MS, Kariman N, Ebadi A, Ozgoli G, Ghasemi V, Rashidi-Fakari F, et al. Educational interventions for cervical cancer screening behavior of women: a systematic review. Asian Pacific J Cancer Prev. 2018;19(4):875-84. https://doi.org/10.22034%2FAPJCP.2018.19.4.875
https://doi.org/10.22034%2FAPJCP.2018.19...
).

Studies that used video as an educational strategy showed a significant increase in CC knowledge. Participating women reported greater confidence in scheduling Pap smear, suggesting that video can be a potentially useful means of communicating health information(2222 Drokow EK, Effah CY, Agboyibor C, Sasu E, Amponsem-Boateng C, Akpabla GS, et al. The impact of video-based educational interventions on cervical cancer, Pap Smear and HPV Vaccines. Front Public Health. 2021;9:681319. https://doi.org/10.3389/fpubh.2021.681319
https://doi.org/10.3389/fpubh.2021.68131...
-2323 Fang CY, Ma GX, Tan Y, Chi N. A multifaceted intervention to increase cervical cancer screening among underserved Korean women: Cancer Epidemiol Biomarkers Prev. 2007;16(6):1298-302. https://doi.org/10.1158/1055-9965.EPI-07-0091
https://doi.org/10.1158/1055-9965.EPI-07...
,2929 Love GD, Mouttapa M, Tanjasiri SP. Everybody’s talking: using entertainment-education video to reduce barriers to discussion of cervical cancer screening among Thai women. Health Educ Res. 2009;24(5):829-38. https://doi.org/10.1093/her/cyp019
https://doi.org/10.1093/her/cyp019...
-3030 Luque JS, Tarasenko YN, Reyes-Garcia C, Alfonso ML, Suazo N, Rebing L, et al. Salud es vida: a cervical cancer screening intervention for rural Latina Immigrant Women. J Cancer Educ Off. 2017;32(4):690-9. https://doi.org/10.1007/s13187-015-0978-x
https://doi.org/10.1007/s13187-015-0978-...
,3333 Thompson B, Vilchis H, Moran C, Copeland W, Holte S, Duggan C. Increasing cervical cancer screening in the United States-Mexico border region. J Rural Heal Off J Am Rural Heal Assoc Natl Rural Heal Care Assoc. 2014;30(2):196-205. doi: https://doi.org/10.1111/jrh.12044
https://doi.org/10.1111/jrh.12044...
-3434 Wang X, Fang C, Tan Y, Liu A, Ma GX. Evidence-based intervention to reduce access barriers to cervical cancer screening among underserved Chinese American women. J Womens Health (Larchmt). 2010;19(3):463-9. https://doi.org/10.1089/jwh.2009.1422
https://doi.org/10.1089/jwh.2009.1422...
,3838 Calderon-Mora J, Alomari A, Shokar N. Comparison of narrative video and flipchart presentation to promote cervical cancer screening among Latinas along the border. Health Educ Behav. 2022. https://doi.org/10.1177/10901981221074918
https://doi.org/10.1177/1090198122107491...
,4343 Thompson B, Carosso EA, Jhingan E, Wang L, Holte SE, Byrd TL, et al. Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas. Cancer. 2017;123(4):666-74. https://doi.org/10.1002/cncr.30399
https://doi.org/10.1002/cncr.30399...
).

Phone call was also a strategy used to provide information about CC(2828 Lima TM, Nicolau AIO, Carvalho FHC, Vasconcelos CTM, Aquino PS, Pinheiro AKB. Intervenções por telefone para adesão ao exame colpocitológico1. Rev Latino-Am Enfermagem. 2017;25. https://doi.org/10.1590/1518-8345.1683.2844
https://doi.org/10.1590/1518-8345.1683.2...
,3535 Abu SH, Woldehanna BT, Nida ET, Tilahun AW, Gebremariam MY, Sisay MM. The role of health education on cervical cancer screening uptake at selected health centers in Addis Ababa. PLoS One. 2020;15(10):e0239580. https://doi.org/10.1371/journal.pone.0239580
https://doi.org/10.1371/journal.pone.023...
) or as a form of invitation to women who did not initially respond to the screening test(2525 Guvenc G, Akyuz A, Yenen MC. Effectiveness of nursing interventions to increase pap smear test screening. Res Nurs Health. 2013;36(2):146-57. https://doi.org/10.1002/nur.21526
https://doi.org/10.1002/nur.21526...
). Consistent with a scoping review, telephone contact increased attendance at the health service for performing Pap smear(4747 Bhochhibhoya S, Dobbs PD, Maness SB. Interventions using health strategies to improve screening rates of cervical cancer: a scoping review. Obstet Gynecol Surv. 2021;76(12):737-9. https://doi.org/10.1016/j.ypmed.2020.106387
https://doi.org/10.1016/j.ypmed.2020.106...
).

The content of the educational activities used in the analyzed studies is similar to the findings of a systematic review that concluded that the interventions mainly emphasize CC, Pap smear and HPV(4848 Agide FD, Garmaroudi G, Sadeghi R, Shakibazadeh E, Yaseri M, Koricha ZB, et al. A systematic review of the effectiveness of health education interventions to increase cervical cancer screening uptake. Eur J Public Health. 2018;28(6):1156-62. https://doi.org/10.1093/eurpub/cky197
https://doi.org/10.1093/eurpub/cky197...
). Effective educational programs targeting CC awareness need sophisticated and comprehensive planning and assessment of target audience needs, such as level of knowledge, beliefs, attitudes and behaviors.

In the present study, most participants were Latino or from rural communities. Latin women expressed better response to educational interventions; however, they were more likely to be diagnosed at an advanced stage of the disease, due to relatively low screening rates, poorer quality of life, and lack of health insurance(4949 Atere-Roberts J, Smith JL, Hall IJ. Interventions to increase breast and cervical cancer screening uptake among rural women: a scoping review. Cancer Causes Control. 2020;31(11):965-77. https://doi.org/10.1007/s10552-020-01340-x
https://doi.org/10.1007/s10552-020-01340...
). Women from rural areas presented a number of barriers to obtaining health care, such as travel distance, transportation difficulties and access to specialized care(4949 Atere-Roberts J, Smith JL, Hall IJ. Interventions to increase breast and cervical cancer screening uptake among rural women: a scoping review. Cancer Causes Control. 2020;31(11):965-77. https://doi.org/10.1007/s10552-020-01340-x
https://doi.org/10.1007/s10552-020-01340...
).

Studies using the HBM indicated that providing information on CC risk factors and early detection are crucial elements to increase the intention to perform CC screening and that educational interventions delivered by CHWs helped to reduce CC disparities among women. women from different backgrounds(77 Samami E, Seyedi-Andi SJ, Bayat B, Shojaeizadeh D, Tori NA. The effect of educational intervention based on the health belief model on knowledge, attitude, and function of women about Pap smear test at Iranian health centers: a randomized controlled clinical trial. J Educ Health Promot. 2021;10(1). https://doi.org/10.4103%2Fjehp.jehp_33_20
https://doi.org/10.4103%2Fjehp.jehp_33_2...
-88 Ernawati, Oktaviana D, Mantasia, Yusuf RA, Sumarmi. The effect of health education based on the health belief model about pap smear test on women in rural district Indonesia. Medico-Legal Updat. 2021;21(2):1-6. https://doi.org/10.37506/mlu.v21i2.2636
https://doi.org/10.37506/mlu.v21i2.2636...
,1313 Pirzadeh A, Mazaheri MA. The effect of education on women’s practice based on the health belief model about pap smear test. Int J Prev Med [Internet]. 2012 [cited 2023 Jan 17];3(8):585-90. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429807/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2121 Daryani S, Shojaeezadeh D, Batebi A, Charati JY, Naghibi A. The effect of education based on a health belief model in women’s practice with regard to the Pap smear test. J Cancer Policy. 2016;8:51-6. https://doi.org/10.1016/j.jcpo.2015.11.001
https://doi.org/10.1016/j.jcpo.2015.11.0...
,2626 Kurt G, Akyuz A. Evaluating the effectiveness of interventions on increasing participation in cervical cancer screening. J Nurs Res. 2019;27(5):e40. https://doi.org/10.1097/jnr.0000000000000317
https://doi.org/10.1097/jnr.000000000000...
,3131 Parsa P, Sharifi F, Shobeiri F, Karami M. Effects of group counseling based on health belief model on cervical cancer screening beliefs and performance of rural women in Kaboudrahang, Iran. Asian Pacific J Cancer Prev. 2017;18(6):1525-30. https://doi.org/10.22034%2FAPJCP.2017.18.6.1525
https://doi.org/10.22034%2FAPJCP.2017.18...
-3232 Shobeiri F, Shobeiri F, Javad M, Parsa P, Roshanaei G. 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 J Cancer Prev. 2016;17(6):2871-2876. https://doi.org/APJCP.2016.17.6.2871
https://doi.org/APJCP.2016.17.6.2871...
,3535 Abu SH, Woldehanna BT, Nida ET, Tilahun AW, Gebremariam MY, Sisay MM. The role of health education on cervical cancer screening uptake at selected health centers in Addis Ababa. PLoS One. 2020;15(10):e0239580. https://doi.org/10.1371/journal.pone.0239580
https://doi.org/10.1371/journal.pone.023...
,4242 O’Brien MJ, Halbert CH, Bixby R, Pimentel S, Shea JA. Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med. 2010;25(11):1186-92. https://doi.org/10.1007/s11606-010-1434-6
https://doi.org/10.1007/s11606-010-1434-...
).

Using educational booklets can be effective in increasing screening when the objective is to reach many women, with little or no knowledge about CC(2626 Kurt G, Akyuz A. Evaluating the effectiveness of interventions on increasing participation in cervical cancer screening. J Nurs Res. 2019;27(5):e40. https://doi.org/10.1097/jnr.0000000000000317
https://doi.org/10.1097/jnr.000000000000...
). On the other hand, providing individual information over the phone, explaining the importance of the subject and making a personal invitation can be more effective strategies in reducing barriers(2626 Kurt G, Akyuz A. Evaluating the effectiveness of interventions on increasing participation in cervical cancer screening. J Nurs Res. 2019;27(5):e40. https://doi.org/10.1097/jnr.0000000000000317
https://doi.org/10.1097/jnr.000000000000...
).

A study revealed a significant increase in screening rates in CHW-led interventions, which could be a useful approach as it uses trusted peer relationships to provide education and promote healthy behaviors, with an emphasis on CC prevention(4242 O’Brien MJ, Halbert CH, Bixby R, Pimentel S, Shea JA. Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med. 2010;25(11):1186-92. https://doi.org/10.1007/s11606-010-1434-6
https://doi.org/10.1007/s11606-010-1434-...
).

The theoretical model most used by the studies included in this review was the HBM, similar to data observed in a systematic review and meta-analysis that showed that this model can be effective in promoting Pap smear compliance(5050 Simbar M, Ghazanfarpour M, Abdolahian S. Effects of training based on the health belief model on Iranian women’s performance about cervical screening: a systematic review and meta-analysis. J Educ Health Promot. 2020;9:179. https://doi.org/10.4103%2Fjehp.jehp_684_19
https://doi.org/10.4103%2Fjehp.jehp_684_...
).

Study limitations

The present study presents as a limitation the lack of checking the references of analyzed studies to locate additional studies.

Contributions to nursing

Educational interventions have the potential to increase knowledge, change health beliefs and reduce barriers to CC prevention. Theory-based and culturally sensitive interventions appear to have a positive impact on women’s health. This research revealed low participation of nurses in educational intervention programs and it is questioned whether the participation of this professional could contribute to reducing barriers to health prevention behaviors. This hypothesis should be tested in future studies.

CONCLUSIONS

Study analysis showed that different educational strategies can be used in combination for CC prevention, with emphasis on group discussions and lectures. Educational leaflets were used as support material. The content of the interventions emphasized knowledge about CC, barriers to screening and the importance of performing Pap smear.

Most of studies indicated benefits of CHW’s performance and few had nurses as an intervenor. Studies that test theory-based, culturally sensitive educational interventions, with nurses as the intervenor, are needed to assess the impact of these interventions on women’s health.

  • FUNDING
    This study was carried out with the support of CAPES - Brazil - Financing Code 0001.

REFERENCES

  • 1
    Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49. https://doi.org/10.3322/caac.21660
    » https://doi.org/10.3322/caac.21660
  • 2
    Fontham ETH, Wolf AMD, Church TR, Etzioni R, Flowers CR, Herzig A, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020;70(5):321-46. https://doi.org/10.3322/caac.21628
    » https://doi.org/10.3322/caac.21628
  • 3
    Cerqueira RS, Luan H, Campos P, Maria N, Lima DB. Controle do câncer do colo do útero na atenção primária à saúde em países sul-americanos: revisão sistemática. Rev Panam Salud Publica. 2022;1-11. https://doi.org/10.26633%2FRPSP.2022.107
    » https://doi.org/10.26633%2FRPSP.2022.107
  • 4
    Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). Estimativa 2020: incidência de câncer no Brasil [Internet]. 2019[cited 2023 Jan 17]. Available from: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//estimativa-2020-incidencia-de-cancer-no-brasil.pdf
    » https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//estimativa-2020-incidencia-de-cancer-no-brasil.pdf
  • 5
    Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). Estimativa INCA[Internet]. Rio de Janeiro; 2023[cited 2023 Jan 17]. Available from: https://www.gov.br/inca/pt-br/assuntos/cancer/tipos/colo-do-utero
    » https://www.gov.br/inca/pt-br/assuntos/cancer/tipos/colo-do-utero
  • 6
    Akinola A, Constance MS. Impact of educational intervention on cervical cancer screening uptake among reproductive age women. Int J Community Med Public Health 2021;8(4):2053-60. https://doi.org/10.18203/2394-6040.ijcmph20211280
    » https://doi.org/10.18203/2394-6040.ijcmph20211280
  • 7
    Samami E, Seyedi-Andi SJ, Bayat B, Shojaeizadeh D, Tori NA. The effect of educational intervention based on the health belief model on knowledge, attitude, and function of women about Pap smear test at Iranian health centers: a randomized controlled clinical trial. J Educ Health Promot. 2021;10(1). https://doi.org/10.4103%2Fjehp.jehp_33_20
    » https://doi.org/10.4103%2Fjehp.jehp_33_20
  • 8
    Ernawati, Oktaviana D, Mantasia, Yusuf RA, Sumarmi. The effect of health education based on the health belief model about pap smear test on women in rural district Indonesia. Medico-Legal Updat. 2021;21(2):1-6. https://doi.org/10.37506/mlu.v21i2.2636
    » https://doi.org/10.37506/mlu.v21i2.2636
  • 9
    Hosseini Z, Mohseni S, Momeni R, Aghamolaei T, Alavi A. Increasing the prevalence of cervical cancer screening in Iran: effectiveness of a theory-based educational intervention. Reprod Health. 2022;19(1):1-13. https://doi.org/10.21203/rs.3.rs-1311063/v1
    » https://doi.org/10.21203/rs.3.rs-1311063/v1
  • 10
    Koç Z, Özdeş EK, Topatan S, Çinarli T, Şener A, Danaci E, et al. The impact of education about cervical cancer and human papillomavirus on women’s healthy lifestyle behaviors and beliefs: using the PRECEDE Educational Model. Cancer Nurs. 2019;42(2):106-18. https://doi.org/10.1097/ncc.0000000000000570
    » https://doi.org/10.1097/ncc.0000000000000570
  • 11
    McDonough AM, Vargas M, Nguyen-Rodriguez S, Garcia M, Galvez G, Rios-Ellis B. Mujer sana, familia fuerte: the effects of a culturally-relevant, community-based, promotores program to increase cervical cancer screening among Latinas. J Health Care Poor Underserved. 2016;27(2):568-79. https://doi.org/10.1353%2Fhpu.2016.0094
    » https://doi.org/10.1353%2Fhpu.2016.0094
  • 12
    Mirzaei-Alavijeh M, Karami-Matin B, Jalilian F, Rakhshan F, Mahboubi M, Emdadi S. Pap smear test promotion among women: an educational intervention based on theory of planned behavior. J Biol Today’s World [Internet]. 2014 [cited 2023 Jan 17];3(4):100-3. Available from: https://oaji.net/articles/2014/598-1398623374.pdf
    » https://oaji.net/articles/2014/598-1398623374.pdf
  • 13
    Pirzadeh A, Mazaheri MA. The effect of education on women’s practice based on the health belief model about pap smear test. Int J Prev Med [Internet]. 2012 [cited 2023 Jan 17];3(8):585-90. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429807/
    » https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429807/
  • 14
    Ramaswamy M, Simmons R, Kelly PJ. The development of a brief jail-based cervical health promotion intervention. Health Promot Pract. 2015;16(3):432-42. https://doi.org/10.1177/1524839914541658
    » https://doi.org/10.1177/1524839914541658
  • 15
    Yanikkerem E, Selçuk AK, Esmeray N. Cancer and clinical research women’s attitude and beliefs about cervical cancer and pap smear test by using the health belief model. Int J Cancer Clin Res. 2020;5(3):102-11. https://doi.org/10.23937/2378-3419/1410102
    » https://doi.org/10.23937/2378-3419/1410102
  • 16
    Rahaei Z, Ghofranipour F, Morowatisharifabad M, Mohammadi E. Determinants of cancer early detection behaviors: application of protection motivation theory. Health Promot Perspect. 2015;5(2):138-46. https://doi.org/10.15171%2Fhpp.2015.016
    » https://doi.org/10.15171%2Fhpp.2015.016
  • 17
    Nuño T, Martinez ME, Harris R, García F. A Promotora-administered group education intervention to promote breast and cervical cancer screening in a rural community along the U.S.-Mexico border: a randomized controlled trial. Cancer Causes Control. 2011;22(3):367-74. https://doi.org/10.1007/s10552-010-9705-4
    » https://doi.org/10.1007/s10552-010-9705-4
  • 18
    Peters M, Godfrey C, McInerney P, Munn Z, Trico A, Khalil H. Chapter 11: Scoping Reviews [Internet]. JBI Manual for Evidence Synthesis. JBI; 2020 [cited 2020 Dec 11]. Available from: https://synthesismanual.jbi.global/
    » https://synthesismanual.jbi.global/
  • 19
    Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-73. https://doi.org/10.7326/M18-0850
    » https://doi.org/10.7326/M18-0850
  • 20
    Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):1-10. https://doi.org/10.1186/s13643-016-0384-4
    » https://doi.org/10.1186/s13643-016-0384-4
  • 21
    Daryani S, Shojaeezadeh D, Batebi A, Charati JY, Naghibi A. The effect of education based on a health belief model in women’s practice with regard to the Pap smear test. J Cancer Policy. 2016;8:51-6. https://doi.org/10.1016/j.jcpo.2015.11.001
    » https://doi.org/10.1016/j.jcpo.2015.11.001
  • 22
    Drokow EK, Effah CY, Agboyibor C, Sasu E, Amponsem-Boateng C, Akpabla GS, et al. The impact of video-based educational interventions on cervical cancer, Pap Smear and HPV Vaccines. Front Public Health. 2021;9:681319. https://doi.org/10.3389/fpubh.2021.681319
    » https://doi.org/10.3389/fpubh.2021.681319
  • 23
    Fang CY, Ma GX, Tan Y, Chi N. A multifaceted intervention to increase cervical cancer screening among underserved Korean women: Cancer Epidemiol Biomarkers Prev. 2007;16(6):1298-302. https://doi.org/10.1158/1055-9965.EPI-07-0091
    » https://doi.org/10.1158/1055-9965.EPI-07-0091
  • 24
    Ghahremani L, Harami ZK, Kaveh MH, Keshavarzi S. Investigation of the Role of Training Health Volunteers in Promoting Pap Smear Test Use among Iranian Women Based on the Protection Motivation Theory. Asian Pac J Cancer Prev. 2016;17(3):1157-62. https://doi.org/10.7314/APJCP.2016.17.3.1157
    » https://doi.org/10.7314/APJCP.2016.17.3.1157
  • 25
    Guvenc G, Akyuz A, Yenen MC. Effectiveness of nursing interventions to increase pap smear test screening. Res Nurs Health. 2013;36(2):146-57. https://doi.org/10.1002/nur.21526
    » https://doi.org/10.1002/nur.21526
  • 26
    Kurt G, Akyuz A. Evaluating the effectiveness of interventions on increasing participation in cervical cancer screening. J Nurs Res. 2019;27(5):e40. https://doi.org/10.1097/jnr.0000000000000317
    » https://doi.org/10.1097/jnr.0000000000000317
  • 27
    Lee HY, Koopmeiners JS, Rhee TG, Raveis VH, Ahluwalia JS. Mobile phone text messaging intervention for cervical cancer screening: Changes in knowledge and behavior pre-post intervention. Obstet Gynecol Surv. 2015;70(1):26-7. https://doi.org/10.1097/OGX.0000000000000142
    » https://doi.org/10.1097/OGX.0000000000000142
  • 28
    Lima TM, Nicolau AIO, Carvalho FHC, Vasconcelos CTM, Aquino PS, Pinheiro AKB. Intervenções por telefone para adesão ao exame colpocitológico1. Rev Latino-Am Enfermagem. 2017;25. https://doi.org/10.1590/1518-8345.1683.2844
    » https://doi.org/10.1590/1518-8345.1683.2844
  • 29
    Love GD, Mouttapa M, Tanjasiri SP. Everybody’s talking: using entertainment-education video to reduce barriers to discussion of cervical cancer screening among Thai women. Health Educ Res. 2009;24(5):829-38. https://doi.org/10.1093/her/cyp019
    » https://doi.org/10.1093/her/cyp019
  • 30
    Luque JS, Tarasenko YN, Reyes-Garcia C, Alfonso ML, Suazo N, Rebing L, et al. Salud es vida: a cervical cancer screening intervention for rural Latina Immigrant Women. J Cancer Educ Off. 2017;32(4):690-9. https://doi.org/10.1007/s13187-015-0978-x
    » https://doi.org/10.1007/s13187-015-0978-x
  • 31
    Parsa P, Sharifi F, Shobeiri F, Karami M. Effects of group counseling based on health belief model on cervical cancer screening beliefs and performance of rural women in Kaboudrahang, Iran. Asian Pacific J Cancer Prev. 2017;18(6):1525-30. https://doi.org/10.22034%2FAPJCP.2017.18.6.1525
    » https://doi.org/10.22034%2FAPJCP.2017.18.6.1525
  • 32
    Shobeiri F, Shobeiri F, Javad M, Parsa P, Roshanaei G. 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 J Cancer Prev. 2016;17(6):2871-2876. https://doi.org/APJCP.2016.17.6.2871
    » https://doi.org/APJCP.2016.17.6.2871
  • 33
    Thompson B, Vilchis H, Moran C, Copeland W, Holte S, Duggan C. Increasing cervical cancer screening in the United States-Mexico border region. J Rural Heal Off J Am Rural Heal Assoc Natl Rural Heal Care Assoc. 2014;30(2):196-205. doi: https://doi.org/10.1111/jrh.12044
    » https://doi.org/10.1111/jrh.12044
  • 34
    Wang X, Fang C, Tan Y, Liu A, Ma GX. Evidence-based intervention to reduce access barriers to cervical cancer screening among underserved Chinese American women. J Womens Health (Larchmt). 2010;19(3):463-9. https://doi.org/10.1089/jwh.2009.1422
    » https://doi.org/10.1089/jwh.2009.1422
  • 35
    Abu SH, Woldehanna BT, Nida ET, Tilahun AW, Gebremariam MY, Sisay MM. The role of health education on cervical cancer screening uptake at selected health centers in Addis Ababa. PLoS One. 2020;15(10):e0239580. https://doi.org/10.1371/journal.pone.0239580
    » https://doi.org/10.1371/journal.pone.0239580
  • 36
    Byrd TL, Wilson KM, Smith JL, Coronado G, Vernon SW, Fernandez-Esquer ME, et al. AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer. 2013;119(7):1365-72. https://doi.org/10.1002/cncr.27926
    » https://doi.org/10.1002/cncr.27926
  • 37
    Calderón-Mora J, Byrd TL, Alomari A, Salaiz R, Dwivedi A, Mallawaarachchi I, et al. Group versus individual culturally tailored and theory-based education to promote cervical cancer screening among the underserved Hispanics: a cluster randomized trial. Am J Health Promot. 2020;34(1):15-24. https://doi.org/10.1177/0890117119871004
    » https://doi.org/10.1177/0890117119871004
  • 38
    Calderon-Mora J, Alomari A, Shokar N. Comparison of narrative video and flipchart presentation to promote cervical cancer screening among Latinas along the border. Health Educ Behav. 2022. https://doi.org/10.1177/10901981221074918
    » https://doi.org/10.1177/10901981221074918
  • 39
    Malmir S, Barati M, Jeihooni AK, Bashirian S. Effect of an educational intervention based on protection motivation theory on preventing cervical cancer among marginalized women in West Iran. Asian Pac J Cancer Prev 2018;19(3):755-61. https://doi.org/10.22034/apjcp.2018.19.3.755
    » https://doi.org/10.22034/apjcp.2018.19.3.755
  • 40
    Mboineki JF, Wang P, Dhakal K, Getu MA, Chen C. The effect of peer-led navigation approach as a form of task shifting in promoting cervical cancer screening knowledge, intention, and practices among urban women in Tanzania: a randomized controlled trial. Cancer Control. 2022;29:10732748221089480. https://doi.org/10.1177/10732748221089480
    » https://doi.org/10.1177/10732748221089480
  • 41
    Mishra SI, Luce PH, Baquet CR. Increasing Pap Smear Utilization among Samoan Women: results from a community based participatory randomized trial. J Health Care Poor Underserved. 2009;20(2):85-101. https://doi.org/10.1353%2Fhpu.0.0160
    » https://doi.org/10.1353%2Fhpu.0.0160
  • 42
    O’Brien MJ, Halbert CH, Bixby R, Pimentel S, Shea JA. Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med. 2010;25(11):1186-92. https://doi.org/10.1007/s11606-010-1434-6
    » https://doi.org/10.1007/s11606-010-1434-6
  • 43
    Thompson B, Carosso EA, Jhingan E, Wang L, Holte SE, Byrd TL, et al. Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas. Cancer. 2017;123(4):666-74. https://doi.org/10.1002/cncr.30399
    » https://doi.org/10.1002/cncr.30399
  • 44
    Fleming K, Simmons VN, Christy SM, Sutton SK, Romo M, Luque JS, et al. Educating hispanic women about cervical cancer prevention: feasibility of a promotora-led charla intervention in a farmworker community. Ethn Dis. 2018;28(3):169-76. https://doi.org/10.18865/ed.28.3.169
    » https://doi.org/10.18865/ed.28.3.169
  • 45
    Jeihooni AK, Jormand H, Harsini PA. The effect of educational program based on beliefs, subjective norms and perceived behavior control on doing pap-smear test in sample of Iranian women. BMC Womens Health. 2021;21(1):290. https://doi.org/10.1186/s12905-021-01419-w
    » https://doi.org/10.1186/s12905-021-01419-w
  • 46
    Ghare-Naz MS, Kariman N, Ebadi A, Ozgoli G, Ghasemi V, Rashidi-Fakari F, et al. Educational interventions for cervical cancer screening behavior of women: a systematic review. Asian Pacific J Cancer Prev. 2018;19(4):875-84. https://doi.org/10.22034%2FAPJCP.2018.19.4.875
    » https://doi.org/10.22034%2FAPJCP.2018.19.4.875
  • 47
    Bhochhibhoya S, Dobbs PD, Maness SB. Interventions using health strategies to improve screening rates of cervical cancer: a scoping review. Obstet Gynecol Surv. 2021;76(12):737-9. https://doi.org/10.1016/j.ypmed.2020.106387
    » https://doi.org/10.1016/j.ypmed.2020.106387
  • 48
    Agide FD, Garmaroudi G, Sadeghi R, Shakibazadeh E, Yaseri M, Koricha ZB, et al. A systematic review of the effectiveness of health education interventions to increase cervical cancer screening uptake. Eur J Public Health. 2018;28(6):1156-62. https://doi.org/10.1093/eurpub/cky197
    » https://doi.org/10.1093/eurpub/cky197
  • 49
    Atere-Roberts J, Smith JL, Hall IJ. Interventions to increase breast and cervical cancer screening uptake among rural women: a scoping review. Cancer Causes Control. 2020;31(11):965-77. https://doi.org/10.1007/s10552-020-01340-x
    » https://doi.org/10.1007/s10552-020-01340-x
  • 50
    Simbar M, Ghazanfarpour M, Abdolahian S. Effects of training based on the health belief model on Iranian women’s performance about cervical screening: a systematic review and meta-analysis. J Educ Health Promot. 2020;9:179. https://doi.org/10.4103%2Fjehp.jehp_684_19
    » https://doi.org/10.4103%2Fjehp.jehp_684_19

Edited by

EDITOR IN CHIEF: Dulce Barbosa
ASSOCIATE EDITOR: Hugo Fernandes

Publication Dates

  • Publication in this collection
    27 Nov 2023
  • Date of issue
    2023

History

  • Received
    24 Jan 2023
  • Accepted
    12 June 2023
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