Abstract
Cervical cancer is a major global health issue, particularly in developing countries. Pap smear-based cervical cancer screening (CCS) is crucial for prevention. The Protection Motivation Theory (PMT) aids in understanding psychological factors influencing CCS behaviors. This study investigated CCS determinants among Iranian women using Rogers' PMT. This cross-sectional study involved 254 women visiting health centers in Kermanshah and Tehran in 2024. A modified PMT was used with a validated questionnaire measuring fear, perceived vulnerability, perceived intensity, response efficacy, self-efficacy, response cost, demographics, and CCS-related knowledge, attitudes, and practices. Path analysis was conducted using AMOS. Participants exhibited a mean CCS behavior score of 3.62 (SD = 2.07). Path analysis revealed significant negative total effects on CCS behavior for fear (Standardized Estimate = -0.238, p = 0.009), response cost (Standardized Estimate = -0.111, p = 0.006), and perceived vulnerability (Standardized Estimate = -0.064, p = 0.021). Conversely, positive total effects on CCS behavior were observed for response efficacy (Standardized Estimate = 0.049, p = 0.003), protection motivation (Standardized Estimate = 0.155, p = 0.01), self-efficacy (Standardized Estimate = 0.106, p = 0.007), knowledge (Standardized Estimate = 0.011, p = 0.002), and attitude (Standardized Estimate = 0.052, p = 0.007). Fear, response costs and perceived vulnerability negatively impact CCS behavior among Iranian women, while perceived intensity, response efficacy, protection motivation, knowledge, attitude, and self-efficacy are positive factors. The PMT-based model can guide educational programs to promote CCS behavior, informing targeted counseling and program development to enhance CCS uptake.