Abstract
BACKGROUND: Cervical cancer is a major public health issue. While HPV screening and vaccination are crucial preventive measures, many countries still struggle to meet the WHO’s participation targets due to a range of systemic, socioeconomic, and psychological barriers. Recent studies suggest that beyond these factors, women’s decisions to attend screening are increasingly shaped by cultural norms that promote health as a personal responsibility, framing participation as both a moral obligation and an expression of a responsible lifestyle. METHODS: This study examines the relationship between a healthy lifestyle and HPV screening participation using data from the European Health Interview Survey (EHIS, 2019) for Italy. We use binomial logistic regression as statistical method, with regular screening attendance (versus irregular) as dependent variable. RESULTS: Our findings indicate that women who adopt healthier lifestyles—particularly in terms of physical activity and dietary habits—are more likely to participate in pap tests. Furthermore, younger women exhibit higher screening participation rates, with early screening initiation (before age 25) associated with greater long-term adherence. CONCLUSIONS: These results suggest that healthism, understood as the pursuit of a healthy lifestyle, plays a significant role in fostering engagement with preventive healthcare measures, although unmeasured confounders may influence both healthy behaviors and screening adherence, thereby limiting the causal interpretation of our findings. Adopting a sociological perspective on surveillance medicine, we argue that healthism is not merely a moral imperative but can serve as a mechanism for empowered agency, encouraging proactive health behaviours. Our findings may inform complementary public health strategies that promote voluntary screening participation by supporting health-oriented behaviours, rather than relying exclusively on top-down interventions. Recognising screening as a social intervention offers a broader analytical framework for addressing cultural and structural barriers to participation, ultimately contributing to more effective and inclusive public health policies. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-24631-x.