title: Women's perceptions and social barriers determine compliance to cervical screening: results from a population based study in India.
abstract: BACKGROUND
  Success of cervical screening initiatives depends on high participation of the target population, which in turn is determined by the women's perceptions, health orientation and other socio-cultural issues. The present study identifies the immediate social and cultural barriers that prevent women to attend cervical screening facilities.
  
  
  METHODS
  Women non-compliant to a community-based cervical screening program were identified. From them 500 were randomly selected for interview using a structured questionnaire that was designed on the basis of feedbacks received from several focused group discussions. Questionnaire listed 24 possible reasons for non-compliance. The women were asked to select the most pertinent reason(s) for her non-attendance or to reveal if they had any reason other than the listed ones.
  
  
  RESULTS
  A total of 469 non-compliant women were interviewed. They had significantly lower literacy rate compared to the compliant women (OR=2.25; 95% CI: 1.23-4.13). Nearly half of the interviewed women responded that they themselves opted to stay away from the program. Most common reasons cited for non-attendance in this group were reluctance to go for medical test in the absence of any symptoms and apprehension to have a test that detects cancer. Second major group of responders comprised of women who were willing, yet could not attend due to various hurdles. Most common hurdles were inability to leave household chores, pre-occupation with family problems and lack of approval from husbands.
  
  
  CONCLUSIONS
  Modification of health behavior through education and social empowerment of women are essential for a population based cervical screening program to succeed in India.
authors.affiliation: Department of Gynecologic Oncology, Chittaranjan National Cancer Institute, 37 S. P. Mukherjee Road, Kolkata 700026, India. ceds@vsnl.com <ceds@vsnl.com>
authors.forename: Partha
authors.initials: P
authors.lastname: Basu
authors.forename: Srabanti
authors.initials: S
authors.lastname: Sarkar
authors.forename: Supriya
authors.initials: S
authors.lastname: Mukherjee
authors.forename: Mousumi
authors.initials: M
authors.lastname: Ghoshal
authors.forename: Srabani
authors.initials: S
authors.lastname: Mittal
authors.forename: Sutapa
authors.initials: S
authors.lastname: Biswas
authors.forename: Ranajit
authors.initials: R
authors.lastname: Mandal
authors.forename: Rengaswamy
authors.initials: R
authors.lastname: Sankaranarayanan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India; D008403:Mass Screening / Q000523:psychology; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000523:psychology*; D012938:Social Perception; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D014626:Vaginal Smears; D016387:Women's Health / Q000208:ethnology