What are the Factors Affecting the Use of Pap Smear for Cervical Cancer Early Detection in Women? A New Path Analysis Evidence from Banyumas, Central Java

Background: Cervical cancer is a major public health issue. It is the second most common cancer among women in the world, and one of leading cause of death by gynecologic malignant tumor in developing countries. Pap smear has been recognized as an effective strategy for reducing the incidence and mortality rate of cervical cancer. This study aimed to investigate the determinants of Pap smear utilization for cervical cancer early detection in women of reproductive age using path analysis model. Subjects and Method: This was a case-control study conducted in Cilongok and Ajibarang Sub-districts, Banyumas, Central Java, from January 3 to February 3, 2018. A total sample of 200 women reproductive age was selected for this study by fixed disease sampling. The dependent variable was Pap smear utilization. The independent variables were education level, attitude, perception on the quality health care, access to the health center, family support, peer support, and health personnel support. The data were collected by questionnaire and analyzed by path analysis. Results: The use of Pap smear increased with high education (b= 2.63; 95% CI= 1.77 to 3.48 p<0.001), good perception on quality of health care(b= 1.04; 95% CI= 0.22 to 1.86; p= 0.012), positive attitude (b= 1.48; 95% CI= 0.51 to 2.44 p= 0.003), good access to health center (b= 1.02; 95% CI= 0.20 to 1.84 p= 0.015), strong family support (b= 1.29; 95% CI= 0.22 to 2.61; p= 0.029), and strong health personnel support (b= 2.02; 95% CI= 0.60 to 3.45 p= 0.005). The use of Pap smear was indirectly associated with peer support through perception on quality health care. Conclusion: The use of Pap smear increases with education, perception on quality of health care, attitude, access to health center, family support, and health personnel support. Keywords: Pap smear, cervical cancer, education, attitude, perception, family support, peer support, health personnel suppor