Cervical cancer screening program in Thailand: Assessment of service coverage and determinants of program uptake

OBJECTIVES: In Thailand two approaches for cervical cancer screening, namely Pap smear and visual inspection with acetic acid (VIA), are introduced in the public sector. This study aims to assess the service coverage and the factors associating with screening test seeking behavior in two provinces, namely Chiangmai and Nakon Si Thammarat. METHODS: A cross-sectional household survey was conducted in 2009 in the two study provinces, among women aged 30-60 years old. A total of 1600 women were randomly selected by stratified four-stage sampling. Of these, 1577 were interviewed (98% respondent rate). Descriptive statistics and logistic regression were used in the data analysis. RESULTS: This study suggests that the coverage rates of cervical screening tests in the past 5 years were relatively high; 76% in Chiangmai and 70% in Nakon Si Thammarat. In both provinces, Pap smear was more commonly introduced than the VIA around two to three times. The most common reasons for not seeking screening tests was “the absence of symptoms,” followed by “the lack of time” and “feeling shy toward health workers.” A multivariate logistic regression analysis indicates that supporting and impeding factors of the screening service seeking behavior were significantly associated with screening test. Women with the following characteristics were more likely to seek the tests than others: age 40-50 years, agriculture occupation, child-bearing experience, cervical cancer history in family member, and ever exposing to the information regarding cervical cancer and screening tests. Meanwhile, respondents who were less likely than others to seek the screening services included cigarette smokers. CONCLUSIONS: There were several factors associating with the service seeking practices among women in these settings. In order to increase the service uptake, it is suggested that extensive education program concerning cervical cancer and screenings should be provided with the aim to abolish the misunderstandings and increase awareness among target population.