Association between knowledge of cervical cancer prevention and screening behaviors among women aged 20 to 49 years: a cross-sectional study in six provinces, China

BackgroundCervical cancer is regarded as the fourth most common cancer in terms of both incidence and mortality among women worldwide. Cervical cancer screening is a crucial method to achieve early diagnosis and treatment of cervical intraepithelial neoplasia and cervical cancer. The screening behaviors among women have been linked to knowledge level of cervical cancer prevention, yet little is known about the association in various areas and regions of China.MethodsA cross-sectional study was conducted from June to September 2018 in six provinces of China. In this survey, knowledge level of cervical cancer prevention was assessed by a set of 7 question items, including the awareness, risk factors, preventive actions of cervical cancer, as well as awareness and effects of HPV vaccines, and also the benefits of regular cervical cancer screening. Screening behavior was determined by asking women whether they have had ever participated in cervical cancer screening. Socio-demographic characteristics were collected by questionnaire. Multivariate logistic regression models were used to analyze the association between cervical cancer screening behaviors and knowledge level.ResultsA total of 9144 women aged 20-49 years were involved in the analysis, with an average age of 37.9 +/- 8.5 years. There were 37.6% of participants reported having ever screened for cervical cancer. The rate of cervical cancer screening behaviors was significantly associated with region, area, age group, occupation, education level, marital status, gravidity and knowledge level. Women with a high level of knowledge (score >= 5) were more likely to have screening behaviors than those with a low knowledge level (OR = 2.91, 95% CI: 2.63-3.21). Compared to women in the knowledge score <= 1 group, the screening rate of women with the knowledge score >= 6 significantly increased regardless of the regions (western region: OR = 19.62, 95% CI: 12.39-31.04; central region: OR = 10.09, 95% CI: 6.76-15.06; eastern region: OR = 5.23, 95%CI: 3.62-7.56) and areas (urban area: OR = 12.70, 95% CI: 8.79-18.36; rural area: OR = 7.12, 95%CI: 5.19-9.77).ConclusionsOverall, our study demonstrated that the screening rate and knowledge level of cervical cancer among Chinese women still need to be improved. There was a significant association between knowledge scores and screening rates, regardless of region or area. Therefore, it is necessary to enhance the knowledge level of cervical cancer through intervention measures in order to promote regular cervical cancer screening.