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

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.