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
- 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. - 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.