Improving cervical cancer screening uptake through theory-informed education: a comprehensive systematic review and meta-analysis
DOI:
https://doi.org/10.2340/1651-226X.2026.45119Keywords:
cervical cancer, structured health education, behavioral theory, medically underserved populations, randomized controlled trial, meta-analysisAbstract
Background and purpose: This study examined whether theory-based education increases cervical cancer screening among underserved women.
Methods: Seven databases (PubMed, Embase, Scopus, Web of Science, Cochrane Library, CINAHL, and PsycINFO) were systematically searched for studies published between January 2005 and November 2025. A total of 1,200 records were identified; after duplicate removal, 900 titles and abstracts were screened, and 200 full-text articles were assessed. Fourteen studies met inclusion criteria for qualitative synthesis, and 12 trials contributed extractable binary outcome data for meta-analysis, including one study with two distinct intervention arms. The primary outcome was screening uptake (Pap smear, visual inspection with acetic acid [VIA], or human papillomavirus [HPV] testing). Data extraction and quality appraisal followed PRISMA 2020 and Joanna Briggs Institute guidance. Pooled odds ratios (ORs) were calculated using DerSimonian–Laird random-effects models with Hartung–Knapp adjustment, and heterogeneity, prediction intervals, small-study effects, and certainty of evidence (GRADE) were evaluated.
Results: Structured educational interventions significantly increased screening uptake compared with usual care or minimal information (OR = 4.41; 95% confidence interval [CI]: 2.21–8.80). Subgroup analyses showed substantial effects in both high-income (OR = 3.46; 95% CI: 1.43–8.36) and middle-income settings (OR = 6.55; 95% CI: 2.74–15.63). Interventions frequently incorporated behavioral frameworks, such as the Health Belief Model, Protection Motivation Theory, and BASNEF model, and were often culturally tailored or delivered through community-embedded formats.
Interpretation: Integrating such interventions into national and local screening programs represents an effective and equitable strategy to reduce disparities in cervical cancer prevention.
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Copyright (c) 2026 Huiying Qin, Nana Yang, Qianqian Wang, Lu Tian, Huan Wang, Mingming Ma, Chunfang Chen
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