Ali Asadian

Introduction: Cervical cancer is the second most prevalent cancer worldwide among women and is also the second primary cause of cancer-induced mortalities among women at a global scale. The most effective educational programs are based on theoretical approaches derived from behavior change models. The present systematic review aimed to explore and identify the body of research with educational interventions based on a particular behavioral or cognitive model of cervical cancer. Methods: A number of keywords were search in the following databases: PubMed, Web of Science, Science Direct, Google Scholar, Embase, Scopus, Biomedcentral, IranMedex, SID and Magiran. These keywords were: Cervix cancer, uterine cervical neoplasms, screening, prevention and control, Papaniocolaou Test, Pap test, Pap smear, education, intervention, cervical cancer, theory and model, behavior model. The search time span was restricted to 2005 to 2020. Results: From among all the published academic papers with educational interventions, finally 22 papers were selected based on a particular theory or model. Among these papers, those based on the health belief model outnumbered the rest concerning cervical cancer. The Transtheoretical Model (TTM) model was the second most prevalent model adopted in the theory-based educational interventions. Conclusions: Educational interventions based on the behavioral theory or model showed to be effective on the target group concerning screening (secondary behavior) for cervical cancer. To further increase the effectiveness of the educational interventions, there is a need for a combination of new methods and theory-laden education to enhance the primary preventive behaviors of cervical cancer. 143 * Corresponding Author: Seyed Saeed Mazloomy Mahmoodabad Social Determinants of Health Research Center, Department of Health Education & Promotion, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Email Id: mazloomy@ssu.ac. ir Ali Asadian et.al., Educational interventions for women concerning cervical cancer: A systematic review Published online in http://ijam.co.in ISSN No: 0976-5921 conduction of Pap smear test (17-20) as secondary preventive measures of cervical cancer. Cervical cancer marked by a long-term precancer period, availability of appropriate screening and possibility of effective treatment of initial damages is known as a preventable cancer (21). Individuals’ education level and even training showed to be effective in preventing and diagnosing cervical cancer. Success in the primary cervical cancer prevention strategies depends on one’s level of awareness and knowledge of the disease on multiple aspects and the vaccine (22). More cervical cancer screening helps to the early diagnosis and treatment of the diseases. Thus, the occurrence and mortality rate of the disease can be reduced (23). Health education models and theories are basically a guide to the understanding of healthy behaviors as it provides a certain pathway for the intervention and development. Behavior change theories and models are derived from social and behavioral sciences that indicate the social, biological, cognitive, behavioral, psychological and environmental determiners of healthy behaviors (24). A systematic review can help to explain educational interventions based on educational theories/ models concerning primary and secondary behaviors to prevent cervical cancer and can be used to improve educational interventions and prevent cervical cancer. Materials and Methods The present systematic review aimed to identify the body of research on educational interventions concerning cervical cancer. In this systematic review, the aim was to find academic papers with educational interventions based on particular behavioral and cognitive models/theories conducted to prevent cervical cancer. The academic papers were searched in the following databases: PubMed, Web of Science, Science D i r e c t , G o o g l e S c h o l a r, E m b a s e , S c o p u s , Biomedcentral, IranMedex, SID and Magiran. These keywords were: Cervix cancer, uterine cervical neoplasms, screening, prevention and control, Papaniocolaou Test, Pap test, Pap smear, education, intervention, cervical cancer, theory and model, behavior model. The search was limited to the year span 2005 to 2020. Inclusion criteria The body of academic papers about cervical cancer were extracted with the aim of promoting preventive behaviors and measures. The target research population was 20-80 year-old women. The body of research searched for included those published in 2005-2020. Finally, only those were included that were enlightened by a behavioral theory or model. Health education models and theories are basically a guide to develop the required understanding of healthy behaviors. They actually provide a particular pathway for the intervention and development (25). Exclusion criteria The body of research excluded were descriptive, qualitative, case studies, reviews, structured reviews and meta-analyses. Those with screening for cervical cancer along with other cancer screenings such as breast cancer and colorectal were excluded. Exclusion was extended to interventions aiming to raise awareness and attitude and also those papers low in quality of education or those not following a certain behavioral theory or model. A summary of the features of the body of academic papers was recorded in a Table. These features included: author(s)’ name(s), year of publication, time and place of publication, target group, sample size, theory/model, intervention procedures, intervention results and behavior (Table 1). Figure 1: Flowchart for selection of studies Results In the present research, 3908 academic papers were collected according to title and abstract. After many were excluded, 92 remaining papers were carefully assessed and 22 which met the requirements Identification Initial search results: a total number of 3908 academic papers with different interventions were found concerning cervical cancer. Screening After a second scannign of the topic, abstract and full-text, a total number of 2736 article were eliminated from the study due to duplication and irrelevance. Eligibility An examination of 1172 academic papers led to the elimination of papers in which the interventions were not based on any theory or model. A total number of 92 papers were evaluated for eligibility. Thus, 70 papers were eliminated due to synchrony with other studies or as they did not fit in with the purpose of the research. Included Finally, 22 academic papers were included.