ArticleBMJ public health2025
Female sex workers and cervical cancer screening in Kilimanjaro region: Uptake and Behavioural Determinants in Health Belief Model Perspectives: A community-based cross-sectional study.
Article in BMJ public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
abstractIntroduction: Cervical cancer remains the fourth leading cause of cancer-related deaths among women globally. Female sex workers (FSWs) bear a disproportionately higher burden due to multiple risk factors, yet their uptake of screening remains unknown in Tanzania. Guided by the health belief model (HBM), this study assessed cervical cancer screening uptake and its behavioural determinants among FSWs in Kilimanjaro region. Methods: A community-based cross-sectional study targeting 355 FSWs aged 25-49 years was conducted from May to July 2024 using the respondent-driven sampling technique. Data were collected using a structured interviewer-administered questionnaire with Cronbach's alpha: 0.75-0.92 and analysed in IBM SPSS V.27.0. The primary outcome was the uptake of lifetime cervical cancer screening. χ Results: Of the 355 FSWs targeted, 351 (98.9%) participated. The participants' mean age was 36.11±5.24 years; with most residing in urban areas, 232 (66.1%), and 184 (52.3%) completed primary education. Screening uptake was critically low as only 17 (4.8%) (95% CI 2.6 - 7.0) had ever been screened. It was marginally higher among FSWs with a college education (11.1%) and those initiating sex work at ≥25 years (19.9%). Four behavioural factors were significantly associated with screening uptake: perceived severity (AOR)=3.25; 95% CI 1.16-9.07), perceived benefits (AOR=3.61; 95% CI 1.10 -11.84), self-efficacy (AOR=3.59; 95% CI 1.18-10.96) and cues to action (AOR=3.61; 95% CI 1.28- 10.15). Conclusion: Cervical cancer screening among FSWs in Kilimanjaro was critically low (4.8%). We strongly recommend designing HBM-tailored interventions that target the key behavioural determinants: perceived severity, perceived benefits, self-efficacy and cues to action, to improve the screening rate in this population. However, further study using a qualitative approach is necessary to explore the context-specific barriers.
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