In the ongoing battle against cervical cancer, a new study from Ghana sheds critical light on why a significant majority of pregnant women remain unscreened, despite repeated opportunities to engage with healthcare systems. Cervical cancer continues to be a devastating cause of mortality, particularly in low- and middle-income countries, where screening programs are less accessible or underutilized. This groundbreaking research, set within the Pru East Municipality in Ghana’s Bono East Region, unpacks the complex social and systemic factors that contribute to these alarming screening gaps among pregnant women who regularly attend antenatal clinics.
Cervical cancer screening has long been recognized as a vital preventive measure, capable of detecting precancerous changes before they develop into invasive disease. Yet in Ghana, uptake remains critically low among women of reproductive age. Strikingly, pregnant women—a group with frequent healthcare interactions—have received scant attention in previous research, despite their unique access points to antenatal services. The study leveraged Andersen’s Behavioural Model of Health Services Use to dig deeper into the behavioral dimensions shaping health service utilization specifically within this cohort.
Methodologically, the research employed a facility-based cross-sectional design encompassing 456 pregnant women, gathering data through meticulously structured closed-ended questionnaires. This approach provided robust quantitative insights into screening behaviors, knowledge levels, and the socio-cultural influences at play. Advanced statistical tools, including STATA 17 and IBM SPSS AMOS 29, were harnessed to perform sophisticated analyses such as chi-square testing, logistic regression, and confirmatory factor analysis. These methods ensured both the reliability and validity of the findings, capturing the latent constructs influencing health behavior through a structural modeling lens.
Remarkably, the study revealed that 87.3% of participants had never undergone cervical cancer screening—not before pregnancy nor during the current gestation. This high prevalence of non-screening is particularly concerning given antenatal care’s potential as a pivotal intervention point. The majority of women demonstrated only moderate knowledge about cervical cancer and screening procedures, highlighting a significant educational gap. This knowledge deficit likely contributes to low perceived susceptibility and motivation, further exacerbated by socioeconomic and cultural factors.
A constellation of predictors emerged as significant barriers within the Andersen model’s framework. Women lacking formal education were disproportionately less likely to be screened, underscoring the critical role of literacy and health education. Unemployment and rural residency also correlated strongly with non-screening, reflecting socioeconomic and geographic disparities in health access. These predisposing characteristics interact with enabling resources—such as media exposure, which was limited among many—and community-level factors including social stigma and cultural norms that restrict healthcare-seeking behaviors.
Systemic obstacles were no less influential in curbing screening uptake. Perceived high costs of screening, irrespective of actual charges, contributed to reluctance, as did the presence of unfriendly healthcare personnel, which discourages attendance and engagement. Community unawareness of cervical cancer risks further compounds these issues by failing to generate demand for preventive services. The research’s structural model confirmed these multifaceted relationships, achieving an excellent model fit that validates the integrated nature of predisposing, enabling, and systemic factors driving behavior.
Intriguingly, the analysis demonstrated strong correlations among the three domains of Andersen’s Behavioural Model—particularly between enabling and systemic factors—indicating that health service utilization is shaped by a complex interdependence of personal, community, and healthcare system elements. The predisposing construct exerted the most direct influence on the likelihood of non-screening, followed by systemic barriers, emphasizing that internal dispositions and external healthcare environment features are jointly critical in determining health outcomes.
These findings suggest that piecemeal interventions targeting isolated factors are unlikely to substantially improve cervical cancer screening rates in this population. Rather, comprehensive, integrated approaches that address educational deficits, empower women economically and socially, and reform health system interactions are necessary. Strategies must transcend conventional health messaging, embedding culturally sensitive and community-engaged frameworks that dismantle stigmas and misinformation.
Moreover, leveraging antenatal care platforms for cervical cancer screening presents a pragmatic solution, capitalizing on existing healthcare contact points to minimize access barriers. Healthcare providers’ attitudes and training must be a focus, ensuring respectful, supportive interactions when offering screening. Accessible media campaigns can elevate awareness broadly while tailoring messages to rural and less educated demographics to maximize impact.
The implications of this research extend beyond the borders of Ghana, resonating with broader challenges in global health equity. As cervical cancer disproportionately affects women in resource-constrained settings, the insights from Pru East Municipality provide an evidence-based blueprint for optimizing screening programs. Interventions designed with Andersen’s model as a framework promise more holistic and effective pathways to reducing preventable cancer mortality.
Looking forward, policymakers, healthcare planners, and international partners need to prioritize multi-sectoral collaborations that integrate educational, social, and health system reforms. Aligning community engagement with policy commitment will be crucial to dismantling entrenched barriers. Systematic monitoring and evaluation using behavioral models can guide adaptive strategies, ensuring interventions remain responsive to the evolving needs of populations.
In conclusion, the new study not only quantifies the extent of cervical cancer screening gaps among pregnant women in Ghana but also elucidates the underlying behavioral determinants with scientific precision. By capturing the dynamic interplay between individual characteristics, enabling factors, and systemic influences, the research charts a clear course toward transformative action. Embracing integrated, culturally congruent, and multi-dimensional strategies will be pivotal to achieving meaningful increases in cervical cancer screening, ultimately saving lives and reducing health disparities in Ghana and similar contexts globally.
Subject of Research: Predictors of non-screening for cervical cancer among pregnant women in the Pru East Municipality, Ghana, using Andersen’s Behavioural Model of Health Services Use.
Article Title: Predictors of non-screening for cervical cancer in Ghana: an application of Andersen’s behavioural model of health services use among pregnant women in Pru East municipality
Article References:
Bardoe, D. Predictors of non-screening for cervical cancer in Ghana: an application of Andersen’s behavioural model of health services use among pregnant women in Pru East municipality. BMC Cancer 25, 1783 (2025). https://doi.org/10.1186/s12885-025-15147-z
Image Credits: Scienmag.com
DOI: 18 November 2025
