Beyond Knowledge: A Multi-Level Behavioral and Health System Model Explaining Low Cervical Cancer Screening Uptake in Rural Northern Nigeria

Abstract

Cervical cancer remains one of the leading causes of cancer-related morbidity and mortality among women in low- and middle-income countries, despite being preventable through vaccination and screening. Persistent infection with Human papillomavirus is responsible for nearly all cervical cancer cases globally. Recent evidence indicates that screening uptake in Nigeria remains critically low due to a complex interaction of socio-cultural, economic, behavioral, and health system barriers.
This study assessed determinants of cervical cancer screening uptake among women of reproductive age in Shira Local Government Area, Bauchi State, Nigeria, and proposed an Integrated Screening Uptake Model (ISUM). A community-based cross-sectional study involving 290 respondents was conducted using structured questionnaires. Data were analyzed using descriptive and inferential statistics.
Findings revealed poor knowledge (64.5%), negative attitude (73.1%), and low screening uptake (78.3%). No statistically significant association was observed between knowledge or attitude and uptake. Major barriers included poverty, long distance to facilities, out-of-pocket payment, and cultural beliefs.
The study concludes that low screening uptake is primarily driven by structural and systemic constraints rather than lack of awareness alone. Interventions should therefore adopt multi-level strategies addressing healthcare accessibility, affordability, gender norms, and culturally responsive service delivery.