A comprehensive analysis of factors affecting adherence to Pap test and evidence-based solutions to improve screening rates
Imagine a disease that can be easily detected in early stages and is highly treatable when identified early, yet continues to cause thousands of deaths every year. This is the reality of cervical cancer in Brazil and worldwide. Despite the availability of the Pap test in the public health system, a significant portion of women do not undergo the exam with the recommended frequency, making them vulnerable to a disease that could be prevented.
17,010
New cases per year in Brazil (2023-2025) 3
3rd
Most frequent malignant tumor in Brazilian women 3
1st
Cause of cancer death in women in Northern Brazil 3
These statistics reveal not only a medical challenge but a complex social problem with multiple dimensions that deserve our attention.
Scientific research has identified over the years the various factors that contribute to non-adherence to the screening exam. These barriers can be grouped into four main dimensions: sociodemographic, cultural, healthcare service-related, and individual factors.
| Barrier Category | Specific Examples | Prevalence in Studies |
|---|---|---|
| Sociodemographic | Low education, unfavorable economic conditions, marital status | 31.58% of studies (6 of 19) 3 |
| Cultural & Psychological | Shame, beliefs and customs, fear of results, anxiety | 10.53% of studies (2 of 19) 3 |
| Healthcare Services | Geographic location, low coverage, quality of care | 31.58% of studies (6 of 19) 3 |
| Individual | Lack of time, perception of good health, lack of information | 26.31% of studies (5 of 19) 3 |
Misconception about the purpose of preventive screening
Difficulty balancing work, family and healthcare
Anxiety about discomfort during the procedure
The success of behavioral intervention compared to traditional education suggests that information alone is not enough to generate behavior change. The approach based on Motivational Interviewing proved more effective because it:
This study is particularly relevant for demonstrating that low-cost strategies with easy applicability, such as telephone interventions, can have a significant impact on public health, especially in resource-limited contexts 1 .
The relationship between knowledge about Human Papillomavirus (HPV) and adherence to screening exams was explored in a study with women who had abnormal Pap test results and needed follow-up with colposcopy 2 .
was independently associated with non-adherence to follow-up, even after controlling for factors like race and education 2
These results highlight the importance of educational strategies that provide complex information about HPV and cervical cancer in an accessible and understandable format for women at higher risk of non-adherence 2 .
Faced with evidence about factors associated with non-adherence to the Pap test, it is clear that multifaceted strategies are needed to address this complex public health problem. The analyzed research suggests promising paths:
Telephone interventions, especially those based on Motivational Interviewing, proved effective and likely cost-effective for increasing adherence 1 .
Develop educational materials that translate complex information about HPV and its relationship to cervical cancer into accessible formats 2 .
Investments in professional training, patient welcoming and organization of care flows can remove significant obstacles 3 .
Establish systems to share exam results and remind patients about follow-up appointments using multiple communication channels .
Active search for women with overdue exams, combined with alternative scheduling (extended hours or Saturday appointments) and elimination of logistical barriers (such as transport costs) represent additional evidence-based strategies.
The factors associated with non-adherence to cervical cancer screening are multidimensional and interconnected, involving sociodemographic, cultural, individual and healthcare service-related aspects. Scientific evidence demonstrates that one-size-fits-all solutions are not enough—stratified and targeted interventions are needed for specific groups of women, considering their particular barriers.
The study of telephone interventions offers us a promising model of how simple technology combined with effective behavioral approaches can overcome traditional barriers in access to prevention services 1 . Similarly, the correlation between HPV knowledge and adherence to follow-up 2 underscores the continuing importance of health education, provided it is conducted in an accessible and culturally sensitive manner.
Overcoming barriers to Pap test adherence is not just a medical issue—it is an imperative of equity and social justice. Science has already shown us the way; now we need to transform this evidence into concrete actions that save lives.