The Effect of Residence on Pap Smear Use: A Multilevel Analysis Evidence

Riska Armadhani1), Ambar Mudigdo2), Uki Retno Budihastuti3)


1)Masters Program in Public Health, Universitas Sebelas Maret

2)Department of Anatomic, Faculty of Medicine, Universitas Sebelas Maret

3)Department of Obstetrics and Gynecology, Dr. Moewardi Hospital, Surakarta



Background: Cervical cancer remains an important public health problem in women worldwide. The use of a Pap smear has been shown to be effective in reducing the bur­den of cer­vical cancer. But public awareness of the importance of Pap smear exa­mi­nation in developing coun­tries is very low. This study aimed to determine the effect of peer support, self-efficacy, per­cei­ved severity, perceived vulnerability, and the level of residence onthe use of Pap smear.

Subjects and Method:This was a case control study conducted in Tegal, Central Ja­va, from Oc­tober 04 to November 02, 2018.A sample of 200 women reproductive age was selected for this study by fixed disease sampling. The dependent variable was Pap smear use. The inde­pen­dent variables were self-efficacy, perceived severity, per­cei­ved susceptibility, and peer support. The higher level variable of interest was residence. The data were collected by questionnaire and analyzed by a multilevel logistic reg­res­sion.

Results: Pap smear use increased with self-efficacy(OR= 7.88; 95% CI=0.73 to 85.10; p= 0.089), perceived severity(OR= 4.34; 95% CI=1.11 to 16.91; p= 0.034), perceived sus­ceptibility(OR= 4.71; 95% CI=1.08 to 20.46; p= 0.038), and peer support (OR= 5.10; 95% CI=1.26 to 20.48; p= 0.022). Residence had strong contextual effect onPap smear use (ICC= 71.19%).

Conclusion: Pap smear utilization increases with self-efficacy, perceived severity, per­cei­ved sus­ceptibility, and peer support. Residence has strong contextual effect onPap smear use.

Keywords:Pap smear, self-efficacy, perceived severity, perceived susceptibility, peer sup­port, residence

Correspondence: Riska Armadhani. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta57126, Central Java, Indonesia. Email: Mobile: +6285642211169.


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