Exploring the Relationship between Health Literacy and the Effectiveness of Educational Intervention on Pap Smear Testing in Muchesh City in 2023 Exploring the Relationship between Health Literacy and the Effectiveness of Educational Intervention on Pap Smear Testing in Muchesh City in 2023
Advances in Nursing & Midwifery,
دوره 34 شماره 1 (2025),
15 ژانویهٔ 2025
,
صفحه 74-80
https://doi.org/10.22037/anm.v34i1.47191
چکیده
Introduction: Health literacy is a crucial determinant of preventive health behaviors;
however, its role in enhancing the effectiveness of educational interventions for
cervical cancer screening, particularly in underserved populations, remains
under-explored. This study investigated the interaction between health literacy and a
Protection Motivation Theory (PMT)-based educational intervention on Pap smear
testing among women in Muchesh City.
Methods: In 2023, a randomized controlled trial was conducted in Muchesh City,
Iran, involving 216 eligible women (aged 18–54, married for at least three years, with
no history of cancer or hysterectomy) recruited from local health centers. Participants
were stratified by health literacy level (high or insufficient), as measured by the
validated Health Literacy Assessment Tool for Iran (Cronbach’s alpha: 0.72–0.89),
and randomly assigned to intervention or control subgroups using block
randomization. The intervention group attended four 45-minute educational sessions
based on Protection Motivation Theory (PMT), while the control group received
standard information after the study concluded. Data were collected using a
Sociodemographic Information Questionnaire, the Health Literacy Assessment Tool,
and a PMT Constructs Questionnaire. Pap smear uptake was assessed three months
post-intervention. Logistic regression and the Sobel test were employed to examine
the relationships among health literacy, the intervention, and Pap smear uptake (p <
0.05), using SPSS version 26.
Results: Participants had a mean age of 31.69 ± 7.64 years. Regarding education,
34.2% had completed high school and 29.1% had completed middle school, while
92.2% were homemakers. The intervention group was significantly more likely to
undergo Pap smear testing compared to the control group (odds ratio = 2.503, 95%
CI: 2.848–9.505, p < 0.001). Additionally, each one-unit increase in health literacy
score was associated with a 2% increase in the likelihood of undergoing screening
(odds ratio = 1.020, 95% CI: 1.008–1.033, p = 0.002). Health literacy significantly
mediated the effect of the educational intervention on Pap smear uptake (Z = 2.5, p <
0.001).
Conclusions: The PMT-based educational intervention significantly increased Pap
smear uptake, with health literacy serving as a key mediating factor. These findings
underscore the importance of incorporating health literacy-oriented strategies into
cervical cancer screening programs, particularly in low-resource settings.
- Health Literacy
- Cervical Cancer Screening
- Pap Smear
- Protection Motivation Theory
- Educational Intervention
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