Authors

1 Department of Nursing and Midwifery, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran

2 Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

CONTEXT: Pap smear test is one of the most important actions in preventing cervical cancer. This
study aimed to perform a meta-analysis on all related literature about the effects of health belief
model (HBM)-based training on Pap smear screening test performance of Iranian women.
METHODS: The search was performed in Scopus, PubMed, and Web of Science. Eligibility criteria
were limited to English and Persian language articles with experimental or semi-experimental methods
until October 2019 that evaluated the effect of HBM-based training on Iranian women’s performance
of Pap smear test. We excluded studies that used both cervical and breast cancer screening together.
RESULTS: Twelve studies were performed on totally 1605 participants. This meta-analysis showed
that all of Health Belief Model (HBM) constructs improved significantly among HBM-based trained
women, perceived susceptibility (standard mean division [SMD] =0.785; P = 0.002; confidence interval
[CI] = 0.005 to 1.56; Heterogeneity; P = 0.013; I2 = 97%)., perceived severity (SMD = 1.14; P = 0.001;
CI = 0.66–1.62; heterogeneity; P < 0.001; I2 = 92%), perceived benefits (SMD = 1.25; P = 0.001;
CI = 0.545–0.135 heterogeneity; P = 0.003; I2 = 97%), perceived barrier (SMD = 0.20; P = 0.001;
CI = 0.44–1.24; heterogeneity; P < 0.001; I2 = 92%) and perceived self-efficacy (SMD = 0.638;
P < 0.001; CI =1.76–0.426; heterogeneity; P < 0.001; I2 = 97%).
CONCLUSION: Cervical screening education program based on the HBM can be effective on Iranian
women’s performance in their perceived susceptibility, perceived severity, perceived barrier, and
perceived self-efficacy about Pap smear test.

Keywords

  1. Miller AB, World Health Organization. Cervical Cancer Screening
    Programmes: Managerial Guidelines. Geneva: World Health
    Organization; 1992.
    2. Mohebi S, Sharifirad G, Gharlipour Z, Kamran A. The study of
    pap smear conduction and its related factors based on Health
    Belief Model in Women Referring to Health Care Centers in Qom
    During 2014. J Educ Community Health. 2016;2:25-33.
    3. Vasheghani F, Majlesi F, Mahmoudi M, Shojaeezadeh D. Effect
    of educational intervention based on Health Belief Model on
    knowledge and attitude about pap smear test among female
    secondary school teachers in district 11 of Tehran. Journal of
    School of Public Health and Institute of Public Health Research.
    2012;10:39-46.
    4. Yakhforushha A, Solhi M, Azar FE. Effects of education via health
    belief model on knowledge and attitude of voluntary health
    workers regarding Pap smear in urban centers of Qazvin. Adv
    Nurs Midwifery 2008;18: 27-33.
    5. Namdar A, Bigizadeh S, Naghizadeh MM. Measuring health belief
    model components in adopting preventive behaviors of cervical
    cancer. JFUMS 2012;2:34-44.
    6. Orumaa M, Leinonen MK, Campbell S, Møller B, Myklebust TA,
    Nygard M. Recent increase in incidence of cervical precancerous
    lesions in Norway: Nationwide study from 1992 to 2016. Int J
    Cancer 2019;145:2629-38.
    7. Morowatisharifabad MA, Norouzi S, Layeghy S, Norouzi A.
    Survey of Cervix Cancer screening determinants among 20-
    65 years old women based on health belief model in Lordegan,
    Chahar Mahal Bakhtiyaree, 2009. Tolooebehdasht. 2013;12:98-106.
    8. Mahdavifar M, Sabzevari S, Fasihi HT. Using Health Belief Model
    for Assessing Health Believes about Papsmear in Women Referred
    to Health Care Centers in Bandar Abbas, Iran. J Health Develop
    2015:4:133-45.
    9. Simbar M, Aarabi Z, Keshavarz Z, Ramezani-Tehrani F,
    Baghestani AR. Promotion of physical activity of adolescents by
    skill-based health education. Health Educ 2017;117:207-14.
    10. Taymoori P, Niknami S, Ghofranipour F. Cognitive and
    Psychosocial Factors of Physical Activities among Adolescents
    in Sanandaj by Frame Work of Pender’s Health Promotion and
    Stage of Change Models (2006). J Kermanshah Univ Med Sci
    2008;11: 393-406.
    11. Fathian Z, Sharifirad GR, Hasanzadeh A. Study of the effects of
    Behavioral Intention Model education on reducing the cesarean
    rate among pregnant women of Khomeiny-Shahr, Isfahan, in
    2006. 2007.
    12. Moshki M, Dehnoalian A, Alami A. Effect of precede–proceed
    model on preventive behaviors for type 2 diabetes mellitus in
    high-risk individuals. Clin Nurs Res 2017;26:241-53.
    13. Keshavarz Z, Simbar M, Ramezankhani A. Factors for performing
    breast and cervix cancer screening by Iranian female workers:
    A qualitative-model study. Asian Pac J Cancer Prev 2011;12:1517-
    22.
    14. Simbar M, Shayan Menesh M, Nahidi F, Akbar Zadeh AR.Health
    beliefs of midwives about HIV/AIDS protection and the barriers
    to reducing risk of infection: An Iranian study. Leadersh Health
    Serv 2011;24:106-17.
    15. Simbar M, Ramezani Tehrani F, Hashemi Z. Sexual-reproductive
    health belief model of college students. Iran South Med J
    2004;7:70-8.
    16. Higgins JP, Higgins JP, Altman DG, Gøtzsche PC, Jüni P,
    Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JA.
    The Cochrane Collaboration’s tool for assessing risk of bias in
    randomised trials. BMJ 2011;343:d5928.
    17. Moher D, Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred
    reporting items for systematic reviews and meta-analyses: The
    PRISMA statement. Annals of internal medicine 2009;4: 264-9.
    18. Abraido-Lanza AF, Chao MT, Gates CY. Acculturation and
    cancer screening among Latinas: Results from the national health
    interview survey. Ann Behav Med 2005;29:22-8.
    19. Hazavehei SM, Rahmati M, Hasanzade A. Effect of educational
    program based on health belief model on the practice of women
    about Pap smear. J Health Care Health Educ Suppl 2014; Health
    Education supplement:1858-67.
    20. Shobeiri F, Javad MT, 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 quasiexperimental study. Asian Pac J Cancer Prev 2016;17:2871-6.
    21. Tahmasebi R, Hosseini F, Noroozi A. The effect of education based
    on the health belief model on women’s practice about pap smear
    test. HAYAT 2016;21:80-92.
    22. Hossaini F, Tahmasebi R, Noroozi A. Comparing the effects of
    individual and group training methods based on health belief
    model on the belief and practice of Bushehr women regarding
    pap smear test. J Health 2017;7:668-79.
    23. 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.
    24. Rakhshani F, Jalilian F, Mirzaei Alavijeh M, Zinat Motlagh F,
    Aghaei A, Ahmadi-Jouibari T.Pap smear test among women: An
    educational intervention based on health belief model. J Birjand
    Univ Med Sci 2013;20:136-43.
  2. 25. Karimy M, Azarpira H, Araban M. Using health belief model
    constructs to examine differences in adherence to pap test
    recommendations among Iranian women. Asian Pac J Cancer
    Prev 2017;18:1389-94.
    26. Khiyali Z, Manoochri M, Babaei Heydarabadi A, Mobasheri F.
    Educational intervention on preventive behaviors on gestational
    diabetes in pregnant women: Application of health belief model.
    Int J Pediat 2017;5:4821-31.
    27. Baghianimoghadam MH, Khajedehi Z, Rahimi T, Jowzi F. The
    effect of educational intervention based on health belief model
    constructs on performing Pap smear in Yazd. J Health Care
    2018;20:72-81.
    28. Bahmani A, Gharib A, Rahmani K, Ahmadian F, Alizadeh
    Z, Akhtar B.Effect of health belief model education on the
    participation of rural women in papsmear test. J Nurs Educ
    2016;5:34-40.
    29. 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 2012;3:585-90.
    30. Byrd TL, Peterson SK, Chavez R, Heckert A.Cervical cancer
    screening beliefs among young Hispanic women. Health Care
    Women Int 2004;38:192-7.
    31. Saei Ghare Naz M, Kariman N, Ebadi A, Ozgoli G, Ghasemi V,
    Rashidi Fakari F. Educational interventions for cervical cancer
    screening behavior of women: A systematic review. Asian Pac J
    Cancer Prev 2018;19:875-84.
    32. Karimy M, Gallali M, Niknami S, Aminshokravi F, & Tavafian S.The
    effect of health education program based on health belief model
    on the performance of Pap smear test among women referring
    to health care centers in Zarandieh. J Jahrom Univ Med Sci
    2012;10:53-9.
    33. Allahverdipour H, Emami A. Perceptions of cervical cancer threat,
    benefits, and barriers of Papanicolaou smear screening programs
    for women in Iran. Women Health 2008;47:23-37.
    34. Tanner-Smith EE, Brown TN. Evaluating the health belief model:
    A critical review of studies predicting mammographic and pap
    screening. Soc Theory Health 2010;8:95-125.
    35. McFarland DM. Cervical cancer and pap smear screening
    in Botswana: Knowledge and perceptions. Int Nurs Rev
    2003;50:167-75.
    36. Taebi M, Riazi H, Keshavarz Z, Afrakhteh M. Knowledge and
    Attitude Toward Human Papillomavirus and HPV Vaccination
    in Iranian Population: A Systematic Review. Asian Pac J Cancer
    Prev 2019;20:1945–1949.
    37. Fallahi A, Nemat Shahrbabaki B, Hashemian M, Ahmadi Kahanali
    A. The needs of women referring to health care centers for doing
    Pap smear Test. The Iranian Journal of Obstetrics, Gynecology
    and Infertility. 2016;6:1-10.
    38. Bandura A. Self-efficacy: Toward a unifying theory of behavioral
    change. Psychol Rev 1977;84:191-215.
    39. Johnson CE, Mues KE, Mayne SL, Kiblawi AN. Cervical cancer
    screening among immigrants and ethnic minorities: A systematic
    review using the health belief model. J Low Genit Tract Dis
    2008;12:232-41.