Study design, population and sampling
Dayyer city have 2 health centers: Hazrat Mahdi and Emam Khomeini health centers. This cross-sectional, descriptive, analytical study was performed among all the 20 to 49-year-old women visiting the health centers of Hazrat Mahdi and Emam Khomeini in Dayyer city. The total population of women the ages of 20–49 were 4100. Accordingly, 202 women who had electronic health records were selected through the systematic random sampling method from two health centers. The sample size was calculated considering the formula of estimating the sample size in descriptive studies with the confidence interval of 95%. Two health centers of the city were included in the study and according to the covered population, the subjects were randomly selected from women with electronic health records. Samples were selected by alternate (ie first person selected, second no, third yes, fourth no, etc.) and continued until the desired sample size was reached.
The review of the electronic files took a month. From the 1st of January until the end of January 2017. The names and phone numbers of the people are in the file. After determining the number of samples, we contacted them. We explained the purpose of the study and invited them to medical centers to complete the questionnaires. Questionnaires were designed based on BASNEF model constructs were completed through interviews with women in the centers and its data analysis took about 6 months.
The inclusion criteria included the lack of disability or inability to answer the questions, at least elementary education, lack of history of hysterectomy, age over 18 years, willingness to participate, and lack of cervical cancer or other cancers. The exclusion criteria were pregnancy and unwillingness to participate in the study.
Data collection tools
The data collection tool was a questionnaire including three parts (Additional File 1). The first part contained items on demographic information including age, marital status, education, spouse’s profile, pregnancy profile, and history of the Pap smear test. The second part consisted of 15 questions regarding Knowledge about cervical cancer and its preventative factors. The items were rated using three options (true, false, and I don’t know); correct responses were given one score while incorrect and I do not know responses were given a score of 0. The third section contained questions on the BASNEF model structures. The items that explored the BASNEF constructs (except for behavior), were rated on a 5-level Likert scale ranged from 0 to 4. The 5 choices included were totally agree, agree, undecided, disagree and totally disagree. The measurement scale for behavior, was yes and no.
Validity and reliability of one part of the questionnaire (awareness, attitudes, and behavior) have been approved in previous studies based on the Health Belief Model [19] and the other questions regarding the BASNEF model structures were designed by the researcher through studying the related papers and documents and using the suggestions of a panel of experts. The questionnaire was given to 10 faculty members of health education and gynecologists and their comments were applied to the questionnaire and 15 women that met the research population characteristics were asked to comment on the clarity, legibility, and relevance of the item. As a result, no item was omitted, but some were corrected.
Cronbach’s alpha test was used to establish the reliability of the BASNEF questionnaire and was comprised of the following components:
Attitude This structure was represented by 11 items, such as: “If I have cervical cancer, I prefer not to know about it”. The scores of the items were summed up and the overall scores ranged from 0 to 44. Cronbach’s alpha test for this component was estimated at 0.71.
Subjective Norms There were 16 items included within this component, such as: “My husband advises me to do a Pap smear test.”. The scores of the items were summed up and the overall scores ranged from 0 to 64. Cronbach’s alpha test for this component was estimated at 0.87.
Enabling Factors This structure was comprised by 6 items, such as: “I do not have enough time to do a Pap smear test”. The scores of the items were added up and the overall scores ranged from 0 to 24. Cronbach’s alpha test for this component was estimated at 0.78.
Behavioral Intention This component was represented by 5 items, such as: “in order to reduce the risk of cervical cancer, I intend to keep cleanliness my genital organ”. The scores of the items were added up so the overall scores would range from 0 to 20. Cronbach’s alpha test for this component was estimated at 0.75.
Behavior Behavior was measured by 1 items: “I perform the Pap smear test regularly (Once a year up to 3 years, if there is no problem every 3 years)”.
Ethics approval
The study protocol was approved by the Ethics Committee of Hormozgan University of Medical Sciences (HUMS.REC.1396.116). Prior to performing the study, informed consent was obtained verbally. Participation in the research did not have any financial burden for the participants. The respondents were fully informed of the purpose of the study and were ensured of the confidentiality of their personal data. Participants were also free to withdraw from the study at any stage.
Data analysis
Descriptive indices including mean and standard deviation for quantitative variables and number and percent for categorical variables were reported. Pearson correlation were used for investigate the correlation between BASNEF constructs. Then linear regression were used to assess the association between behavioral intention and other constructs. Logistic regression were performed to investigate the associated factor with behavior. All analysis were performed in SPSS version 18.
