Skip to main content

Individual and Community Effectiveness of a Cervical Cancer Screening Program for Semi-Urban Mexican Women


The effectiveness at the individual and community level of an educational intervention to increase cervical cancer screening self-efficacy among semi-urban Mexican women was evaluated and changes in reported community barriers were measured after the intervention was implemented. The educational intervention was evaluated with a quasi-experimental pre-test/post-test design and a control group, based on the Integrative Model of Behavior Prediction and AMIGAS project materials. For the intervention group, increased self-efficacy increased requests to obtain a Pap (p < 0.05). Barriers to obtaining a Pap were embarrassment and lack of time at the individual level, and lack of time, test conditions and fear of social rejection in the community’s cultural domain. At both the individual and community levels, having more information about the test and knowing it would be performed by a woman were primary facilitators. Few women used medically precise information when referring to the Pap and cervical uterine cancer. Although the level of self-efficacy of the participants increased, barriers in the health system affect the women’s perceived ability to get a Pap. Better care for users is needed to increase consistent use of the test. The study shows the importance of using culturally adapted, multilevel, comprehensive interventions to achieve successful results in target populations.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Fernandes, J., Rodrigues, S., Costa, Y., Silva Luiz, C., Brito, A., Azevedo J, et al. (2009). Knowledge, attitudes, and practices related to Pap test by women, Northeastern Brazil. Revista de Saúde Pública [Internet series] [consulted 2010 Jun 24], 43(5), 851–858.

  2. Hogenmiller, J., Atwood, J., Lindsey, A., Johnson, D., Hertzog, M., Scott, J. (2007). Self-efficacy scale for Pap smear screening participation in sheltered women. Nursing Research [Internet series] [consulted 2010 Aug 29], 56(6), 369–377.

  3. Flores, Y., Bishai, D., Lazcano, E., Shah, K., Lörincz, A., Hernández, M. et al. (2003). Improving cervical cancer screening in Mexico: Results from the Morelos HPV Study. Salud Pública de México [Internet series] [consulted 2010 Sep 07], 45, 388–398.

  4. Hunter, J. (2004). Cervical cancer in Iquitos, Peru: Local realities to guide prevention planning. Cadernos de Saúde Pública [Internet series] [consulted 2010 Jun 24], 20(1), 160–171.

  5. Byrd, T., Peterson, S., Chavez, R., & Heckert, A. (2004). Cervical cancer screening beliefs among young Hispanic women. Preventive Medicine, 38, 192–197.

    PubMed  Article  Google Scholar 

  6. Al, M., Mohamed, F. (2009). Knowledge, attitudes, and practice related to cervical cancer screening among Kuwaiti women. Medical Principles and Practice [Internet series] [consulted 2010 Aug 10] 18, 35–42.

  7. Valdés, C. R. (2004). Factores que influyen en el comportamiento preventivo del cáncer cérvicouterino. Red de revistas científicas de América Latina y el Caribe, España y Portugal. Avances en Psicología Latinoamericana [Internet series] [consulted 2010 Jun 26], 22, 49–59.

  8. Aguilar, J., Leyva, A., Angulo, D., Salinas, A., Lazcano, E. (2003). Tamizaje en cáncer cervical: Conocimiento de la utilidad y uso de citología cervical en México. Revista de Saúde Pública [Internet series] [consulted 2010 Jun 24], 37(1), 100–106.

  9. Palacio, L., Rangel, G., Hernández, M., Lazcano, E. (2003). Cervical cancer, a disease of poverty: Mortality differences between urban and rural areas in Mexico. Salud Pública de México [Internet series] [consulted 2010 Jun 04], 45, S315–S325.

  10. Lazcano, E., Alonso, P., Ruiz, J., Hernández, M. (2003). Recommendations for cervical cancer screening programs in developing countries: the need for equity and technological development. Salud Pública de México [Internet series] [consulted 2010 Jun 24], 45, 449–462.

  11. Lazcano, E., Moss, S., Cruz, A., Alonso, P., Casares, S., Martínez, C. (1999). Factores que determinan la participación en el tamizaje de cáncer cervical en el estado de Morelos. Salud Pública de México [Internet series] [consulted 2010 Sep 07], 41(4), 278–285.

  12. Bingham, A., Bishop, A., Coffey, P., Winkler, J., Bradley, J., Dzuba, I., et al. (2003). Factors affecting utilization of cervical cancer prevention services in low-resource settings. Salud Pública de México [Internet series] [consulted 2010 Sep 07], 45, 408–416.

  13. Lazcano, E., Castro, R., Allen, B., Nájera, P., Alonso, P., & Hernández, M. (1999). Barriers to early detection of cervical-uterine cancer in Mexico. Journal of Women’s Health, 8, 399–408.

    Article  Google Scholar 

  14. Hidalgo, A. (2006). El cáncer cérvico-uterino, su impacto en México y el por qué no funciona el programa nacional de detección oportuna. Revista Biomédica [Internet series] [consulted 2010 May 02], 17, 81–84.

  15. Sosa, S., Walker, D., Serván, E. (2009). Práctica de mastografías y pruebas de Papanicolaou entre mujeres de áreas rurales de México. Salud Pública de México [Internet series] [consulted 2010 Jun 26], 51, S236–S245.

  16. Leyva, M., Byrd, T., Tarwater, P. (2006). Attitudes toward cervical cancer screening: A study of beliefs among women in Mexico. Californian Journal of Health Promotion [Internet series] [consulted 2010 Aug 09], 4, 13–24.

  17. Lewis, M. (2004). Análisis de la situación del cáncer cérvicouterino en América Latina y el Caribe. Biblioteca sede OPS [website] [consulted 2010 May 02], 8–9.

  18. Pan American Health Organization. (2010). Mexico health in figures OPS [website] [consulted 2010 May 10].

  19. School of Public Health of Mexico. (2010). Interviews with director, nurse and medical intern Health Center of Santa Maria Ahuacatitlán, on May 11th and 21st, 2010. Health Diagnosis. Master of Public Health. INSP. (unpublished).

  20. Fernández, M., Gonzáles, A., Tortolero, G., Williams, J., Saavedra, M., Chan, W., Vernon, S. (2009). Effectiveness of Cultivando la Salud: A breast and cervical cancer screening promotion program for low-income Hispanic women. American Journal of Public Health [Internet series] [consulted 2010 Jun 30], 99, 936–943.

  21. Byrd, T., Wilson, K., Lee, J., Coronado, G., Vernon, S., Fernández, M., et al. (2012). AMIGAS: A multicity, multicomponent cervical cancer prevention trial among Mexican American Women. Cancer, 119(7), 1365–1372.

    Google Scholar 

  22. Byrd, T., Wilson, K., Lee, J., Heckert, A., Orians, C., Vernon, S., et al. (2012). Using intervention mapping as a participatory strategy: Development of a cervical cancer screening intervention for Hispanic women. Health Education & Behavior, 39(5), 603–6011.

    Article  Google Scholar 

  23. Byrd, T., Chavez, R., Wilson, K. (2007). Barriers and facilitators of cervical cancer screening among Hispanic women. Ethnicity and Disease [Internet series] [consulted 2010 May 29], 17, 129–134.

  24. Fishbein, M., & Yzer, M. (2003). Using theory to design effective health behavior interventions. International Communication Association, 13, 164–183.

    Google Scholar 

  25. Bandura, A. (2001) Guía para la construcción de escalas de autoeficacia [monograph on internet]. EU Universidad de Stanford, [consulted 2010 Aug 09].

  26. Olivari, C., Urra, E. (2007). Autoeficacia y conductas de salud. Ciencia y Enfermería [Internet series] [consulted 2010 Jun 26], 13, 9–15.

  27. Fernández, M., Diamond, P., Rakowski, W., González, A., Tortolero, G., Williams, J., et al. (2009). Development and validation of a cervical cancer screening self-efficacy scale for low-income Mexican American women. Cancer Epidemiology, Biomarkers & Prevention [Internet series] [consulted 2010 Jun 12], 18, 866–873.

  28. Villamarin, F. (1994). Autoeficacia: investigación en psicología de la salud. Anuario de Psicología [monografía en internet]. Barcelona: Facultad de Psicología, Universidad de Barcelona, [consulted 2010 Aug 13], 61, 9–18.

  29. Borgatti, S. (1999). Elicitation techniques for cultural domain analysis. In J. Schensul & M. LeCompte (Eds.), The ethnographer’s toolkit (Vol. 3, pp. 1–2). Walnut Creek, CA: Altimira Press.

    Google Scholar 

  30. Trickett, E., Beehler, S., Deutsch, C., Green, L., Hawe, P., McLeroy, K., et al. (2011). Advancing the science of community-level interventions. American Journal of Public Health, 101, 1410–1419.

    PubMed Central  PubMed  Article  Google Scholar 

  31. Arenas-Monreal, L., Cortez-Lugo, M., & Parada-Toro, I. M. (2011). Community-based participatory research and the Escuela de Salud Pública in Mexico. Public Health Reports, 126, 436–440.

    PubMed Central  PubMed  Google Scholar 

  32. Secretaría de Salud. (1986). Reglamento de la Ley General de Salud en la Investigación para la Salud [website]. México: SSA, [consulted 2011 Oct 3].

  33. Schensul, J. J., & Trickett, E. (2009). Introduction to multilevel community based culturally situated interventions. American Journal of Community Psychology, 43(3–4), 232–240.

    PubMed  Article  Google Scholar 

  34. Márquez-Serrano, M., González-Juárez, X., González-González, L., Castillo-Castillo, L. E., & Idrovo, A. J. (2012). Social network analysis to evaluate nursing interventions to improve self-care. Public Health Nursing, 29(4), 361–369.

    PubMed  Article  Google Scholar 

  35. Ryan, G., & Nolan, J. (2000). Successive free listing: Using multiple free lists to generate explanatory models. Field Methods, 12(2), 83–107.

    Article  Google Scholar 

  36. Bousfield, W. A., & Barclay, W. D. (1950). The relationship between order and frequency of occurrence of restricted associative responses. Journal of Experimental Psychology, 40(5), 643–647.

    CAS  PubMed  Article  Google Scholar 

  37. Thompson, E. C., & Juan, Z. (2006). Comparative cultural salience: measures using free-list data. Field Methods, 18(4), 398–412.

    Article  Google Scholar 

  38. Smith, J. (1993). Using Anthropac 3.5 and spreadsheet to compute a free-list salience index. Field Methods, 5, 1–3.

    CAS  Article  Google Scholar 

  39. Fernández, M., DeBor, M., Candreia, M., & Flores, B. (2008). Dissemination of breast and cervical cancer early detection program through a network of community-based organizations. Health Promotion Practice, 20(20), 1–11.

    Google Scholar 

  40. Paz, V., Lee, F., Carcamo, C., Holmes, K., Garnett, G., García, P. (2008). Who is getting Pap smears in urban Peru? International Journal of Epidemiology [consulted 2010 Apr 25], 37, 862–869.

Download references


To Theresa Byrd of the University of Texas—Houston, and Judith Lee and Katherine Wilson of the Centers for Disease Control and Prevention for their useful advices during the study.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Margarita Márquez-Serrano.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Figueroa-Muñoz Ledo, A.A., Márquez-Serrano, M., Idrovo, A.J. et al. Individual and Community Effectiveness of a Cervical Cancer Screening Program for Semi-Urban Mexican Women. J Community Health 39, 423–431 (2014).

Download citation

  • Published:

  • Issue Date:

  • DOI:


  • Women
  • Self-efficacy
  • Papanicolaou
  • Cervical uterine cancer
  • Health services utilization