Journal of Cancer Education

, Volume 33, Issue 6, pp 1270–1278 | Cite as

Cervical Cancer Knowledge, Self-Efficacy, and Health Literacy Levels of Married Women

  • Zeliha Tiraki
  • Medine YılmazEmail author


The purpose of this descriptive and relational study is to investigate the relationship between cervical cancer knowledge and self-efficacy and health literacy levels of married women aged 18–65 years. The study sample consisted of 400 married women (18–65 years old) who presented to a family health center. Independent variables were sociodemographic characteristics; dependent variables were cancer knowledge, self-efficacy, and health literacy level. Of the participants, 67% had a Pap smear. The participants’ median knowledge score was 13 (min–max = 1–21). As the age increased, so did the knowledge score (p = 0.001). The secondary school graduates had the lowest knowledge level (p = 0.009). The participants’ self-efficacy level was moderate (83.18 ± 7.70). As the educational status increased, so did their self-efficacy. Of the participants, 55.2% had a health literacy level of 7th–8th grade. The health literacy level was lower among the literate, primary school graduate, and advanced-age participants (p = 0.000). Increases in the self-efficacy and health literacy levels of the participants positively affected their knowledge status. The participants’ cervical cancer and Pap smear screening knowledge levels increased as their self-efficacy levels increased. The literate or primary school graduate participants had the self-efficacy and health literacy levels.


Self-efficacy Health literacy Cervical cancer prevention REALM 



We would like to thank the women for collaboration.

Compliance with Ethical Standards


There is no any funding for this study.

Conflict of Interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E359–E386CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ferlay J, Soerjomataram I, Ervik M. Dikshit R, Eser S, Mathers C, et al. (2013) GLOBOCAN 2012, Cancer incidence and mortality worldwide: IARC CancerBase No. 11: International Agency for Research on Cancer; 2013. Erişim: https://www.Iarc.Fr/en/Mmedia-centre/pr/2013/pdfs/pr223_E.pdf (Access: 16.06.2016).
  3. 3.
    T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu, Kanser Daire Başkanlığı (2014) Birim Faaliyet Raporu, 2015. Erişim:, (27.04.2016)
  4. 4.
    Turkish Cancer Statistics, (2013). Türkiye Halk Sağlığı Kurumu-Kanser Daire Başkanlığı. Access:, (Access: 02.08.2016).
  5. 5.
    Gözüm S, Aksayan S (1999) The reliability and validity of Turkish form of the self-efficacy scale. J Anatolia Nurs Health Sci 2(1):21–32Google Scholar
  6. 6.
    Fernandez ME, Diamaond PE, Rokowski W, Gonzales A, Tortolero-Luna G, Williams J et al (2009) Development and validation of a cervical cancer screening self-efficacy scale for low-income Mexican American women. Cancer Epidemiol Biomark Prev 18(3):866–875CrossRefGoogle Scholar
  7. 7.
    Suk MH, Bong CK, Sun KJ (2013) Effects of peer cervical cancer prevention education program on Korean female college students’ knowledge, attitude, self-efficacy and intention. Korean J Adult Nurs 25(6):736–746CrossRefGoogle Scholar
  8. 8.
    Flores BE, Acton GJ (2013) Older Hispanic women, health literacy, and cervical cancer screening. Clin Nurs Res 22(4):402–415CrossRefPubMedGoogle Scholar
  9. 9.
    Zhang MF, Zheng MC, Liu W, Wen YS, Wu XD, Liu QW (2015) The influence of demographics, psychological factors and self-efficacy on symptom distress in colorectal cancer patients undergoing post-surgical adjuvant chemotherapy. Eur J Oncol Nurs 19(1):89–96CrossRefPubMedGoogle Scholar
  10. 10.
    Howard D, Gazmararian JA, Parker R (2005) The impact of low health literacy on the medical costs of medicare managed care enrollees. Am J Med 118(4):371–377CrossRefPubMedGoogle Scholar
  11. 11.
    Morris NS, Field TS, Wagner JL, Cutrona SL, Roblin DW, Gaglio B et al (2013) The association between health literacy and cancer-related attitudes, behaviors, and knowledge. J Health Commun 18(sup1):223–241CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kim K, Han HR (2016) Potential links between health literacy and cervical cancer screening behaviors: a systematic review. Psycho-Oncology 25(2):122–130CrossRefPubMedGoogle Scholar
  13. 13.
    Oldach BR, Katz ML (2014) Health literacy and cancer screening: a systematic review. Patient Educ Couns 94(2):149–157CrossRefPubMedGoogle Scholar
  14. 14.
    Lindau ST, Tomori C, Lyons T, Langseth L, Bennett CL, Garcia P (2002) The association of health literacy with cervical cancer prevention knowledge and health behaviors in a multiethnic cohort of women. Am J Obstet Gynecol 186(5):938–943CrossRefPubMedGoogle Scholar
  15. 15.
    Garbers S, Schmitt K, Rappa AM, Chiasson MA (2010) Functional health literacy in Spanish-speaking Latinas seeking breast cancer screening through the National Breast and Cervical Cancer Screening Program. Int J Women’s Health 9(1):21–29Google Scholar
  16. 16.
    Corrarino JE (2013) Health literacy and women's health: challenges and opportunities. J Midwifery Women’s Health 58(3):257–264CrossRefGoogle Scholar
  17. 17.
    Lee SYD, Tsai TI, Tsai YW, Kuo KN (2012) Health literacy and women’s health-related behaviors in Taiwan. Health Educ Behav 39(2):210–218CrossRefPubMedGoogle Scholar
  18. 18.
    Garbers S, MPA, Chiasson MA (2004) Inadequate functional health literacy in spanish as a barrier to cervical cancer screening among immigrant Latinas in New York City. Prev Chronic Dis 4:1–10Google Scholar
  19. 19.
    Lindau ST, Basu A, Leitsch SA (2006) Health literacy as a predictor of follow-up after an abnormal pap smear: a prospective study. J Gen Intern Med 21(8):829–834CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Schapira MM, Neuner J, Fletcher KE, Gilligan MA, Hayes E, Laud P (2011) The relationship of health numeracy to cancer screening. J Cancer Educ 26(1):103–110CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Bynum SA, Wigfall LT, Brandt HM, Richter DL, Glover SH, Hébert JR (2013) Assessing the influence of health literacy on HIV-positive women’s cervical cancer prevention knowledge and behaviors. J Cancer Educ 28(2):352–356CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Özdemir H, Alper Z, Uncu Y, Bilgel N (2010) Health literacy among adults: a study from Turkey. Health Educ Res 25(3):464–477CrossRefPubMedGoogle Scholar
  23. 23.
    Sherer M, Maddux JE (1982) The self efficacy scale construction and validation. Psychological reports. ERIC 51:663–671Google Scholar
  24. 24.
    Miller DP, Brownlee CD, McCoy TP, Pignone MP (2007) The effect of health literacy on knowledge and receipt of colorectal cancer screening: a survey study. BMC Fam Pract 8(1):16CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Shea J, Beers B, McDonald V, McDonald VJ, Quistberg DA et al (2004) Assessing health literacy in African American and Caucasian adults: disparities in Rapid Estimate of Adult Literacy in Medicine (REALM) scores. Fam Med 36:75–581Google Scholar
  26. 26.
    Nilaweera RI, Perera S, Paranagama N, Anushyanthan AS (2015) Knowledge and practices on breast and cervical cancer screening methods among female health care workers: a Kangmennaang J, Thogarapalli N, Mkandawire P, Luginaah I. Investigating the disparities in cervical cancer screening among Namibian women. Gynecol Oncol 138:411–416CrossRefGoogle Scholar
  27. 27.
    Health United States (2016) Centers for disease kontrol and prevention. National center for health statistics. Erişim: 01.08.2016.
  28. 28.
    Bal MD (2014) Evaluation of women having pap smear test by Health Belief Model Scale. MÜSBED 4(3):133–138Google Scholar
  29. 29.
    Gülten G, Memnun S, Ayşe K, Aygül A, Gülçin A (2012) Breast, cervical and colorectal cancer screening status of a group of Turkish women. Asian Pac J Cancer Prev 13:4273–4279CrossRefPubMedGoogle Scholar
  30. 30.
    Azaiza F, Cohen M (2008) Between traditional and modern perceptions of breast and cervical cancer screenings: a qualitative study of Arab women in Israel. Psycho-Oncology 17(1):34–41CrossRefPubMedGoogle Scholar
  31. 31.
    Sönmez Y, Nayir T, Köse S, Gökçe B, Kişioğlu AN (2012) Attitude of women older than 20 years towards early detection of breast and cervix cancer. Med J Suleyman Demirel University 19(4):124–130Google Scholar
  32. 32.
    Işık O, Çelik M, Keten HS, Dalgacı AF, Yıldırım F (2016) Determination of knowledge, attitude, and behaviors of female physicians about Pap smear test. Çukurova Med J 41(2):291–298CrossRefGoogle Scholar
  33. 33.
    Rosser JI, Njoroge B, Huchko MJ (2015) Knowledge about cervical cancer screening and perception of risk among women attending outpatient clinics in rural Kenya. Int J Gynaecol Obstet 128(3):211–215CrossRefPubMedGoogle Scholar
  34. 34.
    Tung, W. C., Lu, M., Granner, M., & Sohn, J. (2017) Assessing perceived benefits/barriers and self-efficacy for cervical cancer screening among Korean American women. Health Care for Women International, (just-accepted), 00-00.Google Scholar
  35. 35.
    Kangmennaang J, Thogarapalli N, Mkandawire P, Luginaah I (2015) Investigating the disparities in cervical cancer screening among Namibian women. Gynecol Oncol 138(2):411–416CrossRefPubMedGoogle Scholar
  36. 36.
    Altsitsiadis E, Undheim T, de Vries E, Hinrichs B, Stockfleth E, Trakatelli M (2012) Health literacy, sunscreen and sunbed use: an uneasy association. Br J Dermatol 167(2):14–21CrossRefPubMedGoogle Scholar
  37. 37.
    Kolutek R, Avci IA, Sevig U (2016) Effect of planned follow-up on married women’s health beliefs and behaviors concerning breast and cervical cancer screenings. J Cancer Educ:1–8. doi: 10.1007/s13187-016-1114-2
  38. 38.
    Pagan JA, Brown CJ, Asch DA, Armstrong K, Bastida E, Guerra C (2012) Health literacy and breast cancer screening among Mexican American women in South Texas. J Cancer Educ 27:132–137Google Scholar
  39. 39.
    Kobayashi LC, Wardle J, von Wagner C (2014) Limited health literacy is a barrier to colorectal cancer screening in England: evidence from the English Longitudinal Study of Ageing. Prev Med 61:100–105CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Sentell TL, Tsoh JY, Davis T, Davis J, Braun KL (2015) Low health literacy and cancer screening among Chinese Americans in California: a cross-sectional analysis. BMJ Open 25:e006104. doi: 10.1136/bmjopen-2014-006104 CrossRefGoogle Scholar
  41. 41.
    Han HR, Song Y, Kim M, Hedlin HK, Kim K, Ben Lee H et al (2017) Breast and cervical cancer screening literacy among Korean American women: a community health worker–led ıntervention. Am J Public Health 107(1):159–165CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Hwang H (2016) Health literacy, cancer knowledge, and cancer preventive behaviors among rural older adults. Asian Oncol Nurs 16(4):234–241CrossRefGoogle Scholar

Copyright information

© American Association for Cancer Education 2017

Authors and Affiliations

  1. 1.Clinical NurseEge University HospitalİzmirTurkey
  2. 2.Faculty of Health Sciences, Department of Public Health NursingIzmir Katip Celebi UniversityIzmirTurkey

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