{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T23:48:34Z","timestamp":1785800914200,"version":"3.56.0"},"reference-count":36,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,30]],"date-time":"2022-12-30T00:00:00Z","timestamp":1672358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Korean government (MSIT)","award":["2021R1A2C200686311"],"award-info":[{"award-number":["2021R1A2C200686311"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>This study aimed to identify the decisional stages for cervical screening and corresponding cognitive factors in female university students. A cross-sectional study was conducted among Korean female university students aged 20\u201329 years through an online survey. The main outcome was the decisional stage of cervical screening adoption using the precaution adoption process model. The stages were classified into pre-adoption (the unawareness, unengaged, and undecided stages), adoption (the decided to act and acting stages), and refusal (the decided not to act stage). The cognitive factors in each stage were analyzed using the key concepts of the health-belief model. Cervical screening was defined as a clinical Papanicolaou (Pap) smear performed by a physician in a clinic. The final analysis included 1024 students. Approximately 89.0%, 1.0%, and 10.2% were classified as the pre-adoption, refusal, and adoption stages, respectively. Compared to the pre-adoption stage group, the adoption stage group was more likely to be older and have higher self-efficacy and knowledge. Most participants belonged to the pre-adoption stage\u2014those unaware of cervical screening. Furthermore, most had a low level of knowledge and perception of cervical cancer and its screening. Therefore, our study highlighted the need for education to increase awareness and knowledge of cervical screening in this population.<\/jats:p>","DOI":"10.3390\/ijerph20010700","type":"journal-article","created":{"date-parts":[[2023,1,2]],"date-time":"2023-01-02T04:07:09Z","timestamp":1672632429000},"page":"700","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Understanding of Cervical Screening Adoption among Female University Students Based on the Precaution Adoption Process Model and Health-Belief Model"],"prefix":"10.3390","volume":"20","author":[{"given":"Hye Young","family":"Shin","sequence":"first","affiliation":[{"name":"Department of Nursing, Gangseo University, Seoul 07661, Republic of Korea"},{"name":"National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0458-099X","authenticated-orcid":false,"given":"Purum","family":"Kang","sequence":"additional","affiliation":[{"name":"College of Nursing, Woosuk University, Wanju 55338, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo Yeon","family":"Song","sequence":"additional","affiliation":[{"name":"National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1647-0675","authenticated-orcid":false,"given":"Jae Kwan","family":"Jun","sequence":"additional","affiliation":[{"name":"National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea"},{"name":"Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"232","DOI":"10.3802\/jgo.2015.26.3.232","article-title":"The Korean guideline for cervical cancer screening","volume":"26","author":"Min","year":"2015","journal-title":"J. Ggynecol. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1002\/ijc.23841","article-title":"Effectiveness of an organized cervical cancer screening program in Korea: Results from a cohort study","volume":"124","author":"Jun","year":"2009","journal-title":"Int. J. Cancer."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e39","DOI":"10.3802\/jgo.2022.33.e39","article-title":"Trends in cervical cancer screening rates among Korean women: Results of the Korean National Cancer Screening Survey, 2005\u20132020","volume":"33","author":"Shin","year":"2022","journal-title":"J. Ggynecol. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"282","DOI":"10.4278\/060829120R2.1","article-title":"Predictors of stage transitions in the precaution adoption process model","volume":"22","author":"Oenema","year":"2008","journal-title":"Am. J. Health Promot."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1080\/13557858.2018.1520813","article-title":"Analyzing factors associated with decisional stage of adopting breast cancer screening among Korean American women using precaution adoption process model","volume":"3","author":"Jin","year":"2021","journal-title":"Ethn. Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.ejca.2017.04.017","article-title":"Understanding the heterogeneity of cervical cancer screening non-participants: Data from a national sample of British women","volume":"80","author":"Marlow","year":"2017","journal-title":"Eur. J. Cancer."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.ypmed.2018.03.014","article-title":"Variation in health beliefs across different types of cervical screening non-participants","volume":"111","author":"Marlow","year":"2018","journal-title":"Prev. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1177\/1043659618811910","article-title":"Analyzing factors associated with decisional stage of adoption for colorectal cancer screening among older Korean Americans using precaution adoption process model","volume":"30","author":"Jin","year":"2019","journal-title":"J. Transcult. Nurs."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.9734\/JPRI\/2017\/34911","article-title":"The Effect of Training Based on Precaution Adoption Process Model (PAPM) on Rural Females\u2019 Participation in Pap smear","volume":"16","author":"Bahmani","year":"2017","journal-title":"J. Pharm. Res. Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1093\/her\/cyv006","article-title":"Decisional stage distribution for colorectal cancer screening among diverse, low-income study participants","volume":"30","author":"Hester","year":"2015","journal-title":"Health Educ. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2488","DOI":"10.1002\/pon.4857","article-title":"Decision-making about cervical screening in a heterogeneous sample of nonparticipants: A qualitative interview study","volume":"27","author":"Marlow","year":"2018","journal-title":"Psycho-Onco."},{"key":"ref_12","unstructured":"Champion, V.L., and Skinner, C.S. (2008). The Health-belief model. Health Behaviour and Health Education: Theory, Research, and Practice, Jossey-Bass."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12905-018-0701-2","article-title":"Using the health-belief model to assess beliefs and behaviors regarding cervical cancer screening among Saudi women: A cross-sectional observational study","volume":"19","author":"Aldohaian","year":"2019","journal-title":"BMC Womens Health"},{"key":"ref_14","first-page":"217","article-title":"Cancer knowledge, self-efficacy, and cancer screening behaviors among Mexican-American women","volume":"10","author":"Carpenter","year":"1995","journal-title":"J. Cancer Educ."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.31557\/APJCP.2020.21.7.2075","article-title":"The Outcome of a Self-Efficacy Enhancement Program for Cervical Cancer Screening among Women in Phrasaeng District, Suratthani Province, Thailand","volume":"21","author":"Bunkarn","year":"2020","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Miri, M.R., Moodi, M., Sharif-Zadeh, G.-R., Malaki Moghadam, H., Miri, M., and Norozi, E. (2018). Cognitive predictors of cervical cancer screening\u2019s stages of change among sample of Iranian women health volunteers: A path analysis. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0193638"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1080\/07399332.2018.1425873","article-title":"Cognitive determinants of cervical cancer screening behavior among housewife women in Iran: An application of Health-belief model","volume":"39","author":"Babazadeh","year":"2018","journal-title":"Health Care Women Int."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Ampofo, A.G., Adumatta, A.D., Owusu, E., and Awuviry-Newton, K. (2020). A cross-sectional study of barriers to cervical cancer screening uptake in Ghana: An application of the health-belief model. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0231459"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Shin, H.Y., Song, S.Y., Jun, J.K., Kim, K.Y., and Kang, P. (2021). Barriers and strategies for cervical cancer screening: What do female university students know and want?. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0257529"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kim, H.W. (2014). Awareness of Pap testing and factors associated with intent to undergo Pap testing by level of sexual experience in unmarried university students in Korea: Results from an online survey. BMC Womens Health, 14.","DOI":"10.1186\/1472-6874-14-100"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1097\/00012272-198404000-00011","article-title":"Instrument development for health-belief model constructs","volume":"6","author":"Champion","year":"1984","journal-title":"Adv. Nurs. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1002\/nur.20088","article-title":"Development of a self-efficacy scale for mammography","volume":"28","author":"Champion","year":"2005","journal-title":"Res. Nurs. Health."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1111\/j.1365-2648.2010.05450.x","article-title":"Health-belief model scale for cervical cancer and Pap smear test: Psychometric testing","volume":"67","author":"Guvenc","year":"2011","journal-title":"J. Adv. Nurs."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kaneko, N. (2018). Factors associated with cervical cancer screening among young unmarried Japanese women: Results from an internet-based survey. BMC Womens Health, 18.","DOI":"10.1186\/s12905-018-0623-z"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1007\/s13187-016-1131-1","article-title":"Characteristics Associated with HPV Diagnosis and Perceived Risk for Cervical Cancer Among Unmarried, Sexually Active College Women","volume":"33","author":"Wilson","year":"2018","journal-title":"J. Cancer. Educ."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"526","DOI":"10.4143\/crt.2016.316","article-title":"Trends and age-period-cohort effects on the incidence and mortality rate of cervical cancer in Korea","volume":"49","author":"Moon","year":"2017","journal-title":"Cancer Res. Treat."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Hoque, M.E., Ghuman, S., Coopoosmay, R., and van Hal, G. (2014). Cervical cancer screening among university students in South Africa: A theory-based study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0111557"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1007\/s10900-020-00837-5","article-title":"Self-efficacy and HPV vaccine attitudes mediate the relationship between social norms and intentions to receive the HPV vaccine among college students","volume":"45","author":"Stout","year":"2020","journal-title":"J. Commun. Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"S314","DOI":"10.4103\/JPBS.JPBS_21_19","article-title":"Knowledge and awareness toward cervical cancer screening and prevention among the professional college female students","volume":"11","author":"Manikandan","year":"2019","journal-title":"J. Pharm. Bioallied Sci."},{"key":"ref_30","first-page":"275","article-title":"Cervical cancer, its screening and vaccination: A KAP study among female healthcare students in a Private University, Malaysia","volume":"5","author":"Ali","year":"2018","journal-title":"MOJ Bioequival. Bioavail."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"18","DOI":"10.4103\/aam.aam_37_16","article-title":"Knowledge, attitude, and experience of cervical cancer and screening among Sub-saharan African female students in a UK University","volume":"16","author":"Ogbonna","year":"2017","journal-title":"Ann. Afr. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1111\/1475-6773.13271","article-title":"Effect of culturally tailored education on attendance at mammography and the Papanicolaou test","volume":"55","author":"Brevik","year":"2020","journal-title":"Health Serv. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1080\/03630242.2015.1101736","article-title":"Evaluating the stage of change model to a cervical cancer screening intervention among Ohio Appalachian women","volume":"56","author":"Oliveri","year":"2016","journal-title":"Women Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.ygyno.2017.10.015","article-title":"An educational intervention to improve human papilloma virus (HPV) and cervical cancer knowledge among African American college students","volume":"149","author":"Staples","year":"2018","journal-title":"Gynecol. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1177\/0969141317696518","article-title":"A cluster randomized trial of strategies to increase uptake amongst young women invited for their first cervical screen: The STRATEGIC trial","volume":"25","author":"Kitchener","year":"2018","journal-title":"J. Med. Screen."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"15","DOI":"10.17703\/JCCT.2015.1.1.15","article-title":"Analysis of sexual related predicting factors for female university students in Korea","volume":"1","author":"Kim","year":"2015","journal-title":"J. Converg. Cult. Technol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/1\/700\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:48:31Z","timestamp":1760147311000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/1\/700"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,30]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["ijerph20010700"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20010700","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,30]]}}}