{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:38:04Z","timestamp":1789609084112,"version":"build-2803163510"},"reference-count":56,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Expectations"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>This study aimed to explore the emotional and cognitive perceptions of cervical cancer screening (CCS), with a focus on self\u2010sampling for human papillomavirus (HPV) by vulnerable Romanian women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>Eighteen semi\u2010structured individual interviews were conducted with vulnerable women, defined by their low socioeconomic status (SES), residence in rural areas and membership in ethnic minorities. Participants were recruited using snowball sampling. Interviews followed a guide designed to assess constructs from the Health Belief Model (knowledge, barriers, evaluation of vulnerability) as they relate to women's views of prevention, the healthcare system and CCS. A Think Aloud protocol was used with a subsample of six women to identify potential barriers, opportunities and attitudes related to the use of self\u2010sampling kits. A reflexive thematic analysis was conducted to identify the primary themes related to with women's perceptions of CCS and self\u2010sampling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four major themes emerged: (a) risk, fear and other emotional experiences; (b) women's perception of barriers; (c) knowledge, personal control and cues to action; and (d) women's perception of self\u2010sampling. Participants unravelled emotional and logistical barriers to CCS and self\u2010sampling. Limited health literacy, fear and shame influenced risk perceptions, hindering CCS participation. Logistical challenges and financial constraints further impeded access, while women often prioritized the needs of their families over their own health. The Think Aloud protocol revealed that initial concerns regarding self\u2010sampling could be alleviated by having clear instructions, highlighting the importance of support during the decision\u2010making process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study identified diverse barriers preventing vulnerable Romanian women from engaging in CCS, including logistical challenges, financial constraints and emotional factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>Patients or the public were not involved in the design, conduct, analysis or interpretation of the study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hex.70485","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T08:05:28Z","timestamp":1764576328000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Exploring Emotional and Cognitive Perceptions of Cervical Cancer Screening and Self\u2010Sampling Among Vulnerable Romanian Women: A Qualitative Study"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4875-5897","authenticated-orcid":false,"given":"Nicoleta\u2010Monica","family":"Pa\u0219ca","sequence":"first","affiliation":[{"name":"Department of Psychology Babe\u0219\u2010Bolyai University Cluj\u2010Napoca Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6566-927X","authenticated-orcid":false,"given":"Diana","family":"T\u0103ut","sequence":"additional","affiliation":[{"name":"Department of Psychology Babe\u0219\u2010Bolyai University Cluj\u2010Napoca Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Greenley","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, Centre for Global Mental Health London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"Kirkegaard","sequence":"additional","affiliation":[{"name":"University Research Clinic for Cancer Screening, Randers Regional Hospital Randers Denmark"},{"name":"Department of Clinical Medicine Aarhus University Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rikke Buus","family":"B\u00f8je","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine Aarhus University Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"McKee","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Bardou","sequence":"additional","affiliation":[{"name":"Inserm\u2010Centre d'Investigations Cliniques 1432 (CIC 1432), CHU Dijon\u2010Bourgogne Dijon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana\u2010Smaranda","family":"B\u0103ban","sequence":"additional","affiliation":[{"name":"Department of Psychology Babe\u0219\u2010Bolyai University Cluj\u2010Napoca Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"and the CBIG\u2010SCREEN Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,30]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jncc.2024.11.006"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(22)00241-8"},{"key":"e_1_2_12_4_1","unstructured":"National Plan for Combat Cancer and Control (PNCC). 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Retrieved fromhttp:\/\/www.ms.ro\/media\/documents\/Planul_Na\u021bional_de_Combatere_\u0219i_Control_al_Cancerului_RIQiTXG.pdf."},{"key":"e_1_2_12_5_1","unstructured":"\u201cEstimated Incidence \u201d Cancer Today cited October 27 2024 https:\/\/gco.iarc.who.int\/today\/."},{"key":"e_1_2_12_6_1","unstructured":"\u201cEstimated Number of Deaths \u201d Cancer Today cited October 27 2024 https:\/\/gco.iarc.who.int\/today\/."},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2022.115371"},{"key":"e_1_2_12_8_1","unstructured":"\u201cHPV Information Centre (n.d.). \u201d cited August 16 2023 Retrieved from\u00a0https:\/\/hpvcentre.net\/statistics\/reports\/ROU.pdf."},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12067"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1144674"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckad055"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-021-10390-y"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-020-01275-4"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/CEJ.0000000000000612"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/0969141319869957"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1359105318787616"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00038-009-8040-6"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/jfprhc-2011-100144"},{"key":"e_1_2_12_19_1","unstructured":"Population and Housing Census\u00a0\u2013 RPL2021 cited September 21 2025 Retrieved from\u00a0https:\/\/www.recensamantromania.ro\/."},{"key":"e_1_2_12_20_1","unstructured":"\u201cPoverty \u201d National Institute of Statistics cited September 21 2025 Retrieved fromhttps:\/\/insse.ro\/cms\/ro\/tags\/s%C4%83r%C4%83cia."},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.27790"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.21471"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2021.106900"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2018-001351"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6874-14-64"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(23)00094-4"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/109019817400200405"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0b013e31815d8d88"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2020.101223"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2648.2001.01699.x"},{"key":"e_1_2_12_31_1","doi-asserted-by":"crossref","unstructured":"M. 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