Exploring Reasons Women Aged 50 to 65 Did Not Attend Regular Pap Smear Screening

Reasons Women Did Not Attend Regular Pap Smear
Vol. 20 No. 1 : 2025 (314-327)

Arputajulie Anthony Arputajulie Anthony
Syahnaz Mohd Hashim Syahnaz Mohd Hashim
Zuhra Hamzah Zuhra Hamzah
Azmawati Mohammed Nawi Azmawati Mohammed Nawi

Abstract
Cervical cancer (CC) prevalence is increasing worldwide and in Malaysia, especially among women between 50 and 65 years old. Regular pap smear screening is advocated for early detection of CC, but many women do not adhere to its recommended schedule. The objective of this study was to explore the reasons behind this non-adherence among women aged 50 to 65 years old. A qualitative study was conducted from June until August 2022 in a public primary care clinic, Klinik Primer Hospital Canselor Tuanku Muhriz (HCTM). Twelve women who did not have regular pap smear screening were purposively sampled. In-depth interviews were performed. Data were analysed using thematic analysis. Seven themes with four subthemes were generated and categorised into internal and external factors. There are five themes and two subthemes under internal factors: (i) perceived not being at risk of CC (subthemes: wrong understanding of CC risk factors and felt protected from having CC); (ii) misconception about the purpose of pap smear and its recommended schedule; (iii) prioritise other life commitments; (iv) fatalistic belief; and (v) negative experiences with pap smear procedure. Two themes and two subthemes under external factors: (i) poor healthcare facilities and services (subthemes: a non-conducive environment and lack of reminders from healthcare providers; and (ii) felt pap smear was costly. Our findings uncovered widespread misconceptions about CC and pap smears. Non-adherence was also related to less satisfactory healthcare services and perceiving that pap smears were costly. Efforts should be made to correct women’s perceptions and improve healthcare services for pap smear screening.
Keywords : Cervical cancer; pap smear; qualitative; screening; women,
Abstrak
Prevalen kanser pangkal rahim semakin meningkat di seluruh dunia dan di Malaysia, terutamanya dalam kalangan wanita berusia 50 hingga 60 tahun. Saringan pap smear secara berkala adalah disarankan untuk mengesan tanda awal kanser pangkal rahim, namun kebanyakan wanita tidak mematuhi saranan ini. Tujuan kajian ini adalah untuk mengkaji punca ketidakpatuhan ini dalam kalangan wanita berumur 50 hingga 60 tahun. Satu kajian kualitatif telah dijalankan dari bulan Jun hingga Ogos 2022 di klinik penjagaan primer awam, Klinik Primer Hospital Canselor Tuanku Muhriz (HCTM). Dua belas wanita yang tidak melakukan saringan pap smear secara berkala dipilih secara persampelan bertujuan. Temubual secara mendalam telah dijalankan. Data dianalisis dengan menggunakan analisis tematik. Tujuh tema dengan empat subtema telah dihasilkan dan dikategorikan kepada faktor dalaman dan luaran. Terdapat lima tema dan dua subtema di bawah faktor dalaman: (i) beranggapan tidak berisiko menghidapi kanser pangkal rahim (subtema: salah faham mengenai faktor risiko kanser pangkal rahim dan berasa terlindung dari menghidapi kanser); (ii) salah faham tentang tujuan pap smear dan jadual yang disarankan; (iii) mengutamakan komitmen hidup yang lain; (iv) kepercayaan fatalistik; dan (v) pengalaman negatif dengan prosedur pap smear. Dua tema dan dua subtema di bawah faktor luaran: (i) kekurangan fasiliti dan perkhidmatan kesihatan (subtema: persekitaran yang tidak kondusif dan kurangnya peringatan dari kakitangan kesihatan); dan (ii) beranggapan bahawa pap smear adalah mahal. Penemuan kami mendedahkan salah tanggapan yang meluas tentang kanser pangkal rahim serta saringan pap smear. Ketidakpatuhan juga dikaitkan dengan perkhidmatan kesihatan yang kurang memuaskan dan beranggapan kos pap smear adalah tinggi. Usaha harus dilakukan untuk membetulkan persepsi wanita dan memperbaiki perkhidmatan kesihatan untuk saringan pap smear.
Kata Kunci : Kanser pangkal rahim; kualitatif; pap smear; saringan; wanita,

Correspondance Address
Dr. Syahnaz Mohd Hashim. Department of Family Medicine, 14th floor, Preclinical Block, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: 603-9149459 Email: syahnaz@ukm.edu.my / syahnaz@hctm.ukm.edu.my