Observational Study Medicine ®

Factors associated with Pap test screening

among South Korean women aged 20 to 39 years
Yun Am Seo, PhDa, Young A Kim, RN, PhDb,*
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Abstract
The number of hospital visits with cervical cancer as the chief complaint among South Korean women aged 20 to 39 has
increased by 1.2 times between 2016 and 2020, indicating a need for active screening for the disease. This study aimed to
investigate the status of the Papanicolaou (Pap) test and identify factors influencing Pap test experience among South Korean
women aged 20 to 39 years. An online questionnaire survey was conducted over 5 days starting from November 19, 2021. A total
of 338 participants who were randomly sampled by age completed the survey. Data were analyzed using descriptive statistics, t
test, χ2 test, and logistic regression. The mean age of the participants was 29.9 years, and participants with and without Pap test
experience accounted for 60.7% and 39.3% of the total, respectively. There were significant differences in age, marital status,
employment status, smoking status, experience of coitus, awareness of the National Cancer Screening Program, and human
papillomavirus (HPV) vaccination status according to the Pap test experience (P < .05) of the participants. Pap test attitude, Pap
test self-efficacy, cervical cancer knowledge, HPV knowledge, and cancer prevention behavior scores were significantly higher
in the Pap test experience group than in the no Pap test experience group (P < .05). Logistic regression analysis showed that
experience of coitus (odds ratio [OR] = 10.46, 95% confidence interval [CI]: 4.54–24.11), marital status (OR = 5.96, 95% CI: 2.25–
15.77), awareness of the National Cancer Screening Program (OR = 4.39, 95% CI: 1.66–11.58), HPV vaccination (OR = 2.62,
95% CI: 1.35–5.09), employment status (OR = 2.22, 95% CI: 1.08–4.59), and self-efficacy (OR = 1.09, 95% CI: 1.01–1.19) were
the influencing factors in the Pap test experience group. To improve the Pap test screening rate among South Korean women
aged 20 to 39, reinforcement strategies and intervention programs that involve age-specific approaches must be established.
Abbreviations: CC = cervical cancer, CI = confidence interval, HPV = human papillomavirus, NCSP = National Cancer Screening
Program, non-PT = no Pap test experience, OR = odds ratio, Pap = Papanicolaou, PT = Pap test experience.
Keywords: cancer screening test, cervical cancer, knowledge, Pap test, self-efficacy, women

1. Introduction prevention. In addition, since 2016, the Korea Disease Control

The number of hospital visits with cervical cancer (CC) as
the chief complaint among South Korean women aged 20 to
39 years has increased by 1.2 times between 2016 and 2020,
from 14,572 to 17,806.[1] The primary cause of CC is human
papillomavirus (HPV) infection,[2] and the number of patients
with condyloma acuminata caused by the same virus has also
increased by 1.1 times among women aged 20 to 39 years
during the same period.[3] These findings indicate the need for
more intensive CC preventive care for South Korean women
aged 20 to 39 years.
Since CC can be treated if detected early by the Papanicolaou
(Pap) test, regular screening can drastically reduce the risk of
invasive cancer.[4] In South Korea, since 2016, Pap tests have
been performed every 2 years on women aged ≥ 20 years as a
part of the National Cancer Screening Program (NCSP) for CC
and Prevention Agency has been providing free HPV vaccina-
tion to girls aged 12 years for CC prevention.
However, many women do not undergo Pap testing. The Pap
test screening rate among South Korean women was 58.7% in
2019, which was lower than the screening rate for liver cancer
(73.5%) and breast cancer (64.8%), as well as lower than the
screening rates in the US (78.5%) and UK (71.4%). In particu-
lar, the screening rate among women aged 20 to 39 years was
54.0% in 2019, which represented a significant increase from
41.6% in 2016 when the screening age of women was expanded
to ≥ 20 years, although it is still lower than the average screen-
ing rate in South Korea and other countries.[5,6] In addition to
feeling embarrassment and fear about the Pap test procedure,[7]
lack of knowledge/awareness, sociocultural prejudice against
gynecological examination, and a negative attitude such as

This work was supported by the Basic Science Research Program through the
National Research Foundation of Korea (NRF) funded by the Ministry of Education
(no. NRF-2020R1I1A3065986).
The authors have no funding and conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are
available from the corresponding author on reasonable request.
a
Department of Data Science, College of Natural Sciences, Jeju National
University, Jeju-si, Jeju-do, Republic of Korea, b Department of Nursing, College
of Nursing, Jeju National University, Jeju-si, Jeju-do, Republic of Korea.
*Correspondence: Young A Kim, Department of Nursing, College of Nursing, Jeju
National University, 102 Jejudaehakno, Jeju-si, Jeju-do 63243, Republic of Korea
(e-mail: yakim@jejunu.ac.kr).
Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.
This is an open-access article distributed under the terms of the Creative
Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is
permissible to download, share, remix, transform, and buildup the work provided
it is properly cited. The work cannot be used commercially without permission
from the journal.
How to cite this article: Seo YA, Kim YA. Factors associated with Pap test
screening among South Korean women aged 20 to 39 years. Medicine
2023;102:30(e34539).
Received: 31 January 2023 / Received in final form: 26 June 2023 / Accepted:
11 July 2023
http://dx.doi.org/10.1097/MD.0000000000034539

1
 Seo and Kim • Medicine (2023) 102:30Medicine
feelings of shame can act as barriers to the screening in young
women.[8–11]
Considering that most patients with sexually transmitted
diseases in South Korea are young people and that the aver-
age age of the first sexual experience has gradually decreased
to 13.6 years, efforts to prevent CC among young women are
essential.[12,13] Above all, management through regular screening
is critical for CC prevention. Therefore, this study focused on
young adult women.
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This study aimed to survey the Pap test experience among
women aged 20 to 39 years, investigate the influencing factors,
and provide evidence-based data to raise awareness and encour-
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age regular Pap screening as a means of preventing CC, espe-
cially among women in their 20s and 30s who are experiencing
the NCSP for the first time.
2. Methods
2.1. Study design
This was a descriptive survey study investigating the status of
Pap test screening and identifying the factors influencing the Pap
test experience among women aged 20 to 39 years.
2.2. Ethics approval and consent to participate
This study was performed in line with the principles of the
Declaration of Helsinki. The study was conducted after obtain-
ing approval from the Institutional Review Board (IRB; JJNU-
IRB-2021-078) for the objective and methods of the study,
confidentiality, data management, study information sheet, con-
sent form, and questionnaire. Informed consent was obtained
from all the participants.
2.3. Participants and data collection
Macromill Embrain Co., an online research firm, was hired
for data collection, which was performed over 5 days starting
from November 19, 2021. The sample size was calculated using
G*power 3.1.9.4 program (Universität Düsseldorf, Düsseldorf,
Germany). When the parameters for binomial logistic regression
analysis were set to 2 tails, odds ratio (OR) = 1.5, significance
level (α) = 0.05, and statistical power (1-β) = 0.9, the minimum
sample size required was 275. The email addresses of a panel of
women aged 20 to 39 years who are registered with the online
research firm were extracted using equal allocation by age. A
request to participate in the survey was sent to the addresses,
and ultimately 338 participants completed the survey. The sys-
tem used for the survey was set up to close if the response time
was too short or some responses were missing. Women who
did not consent to participate or dropped out during the survey
were excluded.
2.4. Study tools
2.4.1. Sociodemographic characteristics Age, marital status,
education status, employment status, smoking status, experience
of coitus, family history of CC, Pap test experience, awareness
of the NCSP, and HPV vaccination status were investigated.
2.4.2. Attitude toward the Pap test This refers to the subjective
awareness of the benefits of undergoing a Pap test and the
consequences and barriers to not receiving one. In this study,
a tool developed by Jo (unpublished dissertation) was used to
measure the attitude toward the Pap test. The tool consists of
14 items, each rated on a 4-point Likert scale from “Not at all”
to “Very much so.” The total score ranged between 14 and 56
points, with higher scores indicating a more positive Pap test
2
attitude. The tool’s reliability was Cronbach α = 0.88 at the time
of development and Cronbach α = 0.86 in this study.
2.4.3. Pap test self-efficacy The tool developed by Jo
(unpublished dissertation) for measuring Pap test-related self-
efficacy of women was used. The tool consists of 10 items,
each rated on a 4-point Likert scale from “Not at all” to “Very
much so.” The total score ranged between 10 and 40 points,
with higher scores indicating higher self-efficacy for screening
behavior. The tool’s reliability was Cronbach α = 0.93 at the
time of development and Cronbach α = 0.90 in this study.
2.4.4. Knowledge of CC This study used a tool developed by
Kim and Park[14] for measuring CC knowledge among female
university students. The tool consists of 8 items, each answered
as “Yes,” “No,” or “Not sure.” Each correct answer was assigned
1 point, while a wrong or no answer was assigned 0 points. The
total score ranged between 0 and 8 points, with higher scores
indicating higher CC knowledge. The tool’s reliability was
Cronbach α = 0.83 at the time of development and Cronbach
α = 0.57 in this study.
2.4.5. Knowledge of HPV This study used a tool developed
by Kim and Ahn[15] for measuring HPV knowledge. The tool
consists of 20 items, each answered as “Yes,” “No,” or “Not
sure.” Each correct answer was assigned 1 point, while a wrong
or no answer was assigned 0 points. The total score ranged
between 0 and 20 points, with higher scores indicating higher
HPV knowledge. The tool’s reliability was Cronbach α = 0.87
at the time of development and Cronbach α = 0.88 in this study.
2.4.6. Cancer prevention behavior To identify the level of
general cancer prevention practice, participants were instructed
to check the items they practice among the 10 national cancer
prevention practice rules presented by the National Cancer
Information Center.[16] Each “Yes” response was assigned 1
point, and a “No” response was assigned 0 points. The total
score ranged between 0 and 10 points, with higher scores
indicating better cancer prevention behavior. The tool’s
reliability was Cronbach α = 0.73 in a previous study[17] and
Cronbach α = 0.70 in this study.
2.5. Statistical analyses
Collected data were analyzed using the SPSS 23.0/PC program
(IBM Corp., Armonk, NY). Descriptive statistics were used to
present the sociodemographic characteristics, Pap test attitude,
Pap test self-efficacy, CC knowledge, HPV knowledge, and can-
cer prevention behavior. Chi-square and t tests were performed
to compare the differences in sociodemographic characteristics,
Pap test attitude, Pap test self-efficacy, CC knowledge, HPV
knowledge, and cancer prevention behavior according to the
Pap test experience of the participants. Binomial logistic regres-
sion analysis was performed to investigate the influencing fac-
tors according to the Pap test experience of the participants.
3. Results
3.1. Sociodemographic characteristics
According to the age distribution, there were 165 (48.8%)
and 173 participants (51.2%) aged 20 to 29 and 30 to 39
years, respectively, with a mean age of 29.9 ± 5.1 years. The
number of married and unmarried participants was 107
(31.7%) and 231 (68.3%), respectively. With respect to edu-
cation level, most participants (n = 198, 58.6%) were univer-
sity graduates. Meanwhile, 227 participants (67.2%) were
employed, and 111 (32.8%) were unemployed. There were
63 smokers (18.6%). In addition, 256 participants (75.7%)
had coitus experience, with the mean age of first coitus being
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22.16 ± 3.89 years (min: 15, max: 36 years). The group with
Pap test experience (PT group) consisted of 205 participants
(60.7%), while the group with no Pap test experience (non-PT
group) consisted of 133 participants (29.3%). Furthermore, 21
participants (6.2%) had a family history of CC, 293 (86.7%)
were aware of the NCSP, and 129 (38.2%) had received HPV
vaccination (Table 1).
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3.4. Factors influencing Pap test experience
To identify the factors influencing Pap test experience, binomial
logistic regression was performed with factors that showed a
significant difference in univariate analysis (sociodemographic
characteristics [age, marital status, employment status, smoking
status, experience of coitus, awareness of the NCSP, and HPV
vaccination], Pap test attitude, Pap test self-efficacy, CC knowl-
edge, HPV knowledge, and cancer prevention behavior) as the

independent variables and Pap test experience as the dependent

3.2. Level of Pap test attitude, Pap test self-efficacy, variable.
CC knowledge, HPV knowledge, and cancer prevention The regression model used was significant (χ2 = 182.90,
behavior P < .001), and the explanatory power was 56.6% based on the
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The mean scores, as measured by the tools described above,
were as follows: Pap test attitude = 44.20 ± 5.42 points; Pap test
self-efficacy = 29.09 ± 4.69 points; CC knowledge = 3.49 ± 1.67
points; HPV knowledge = 5.21 ± 3.18 points; and cancer pre-
vention behavior = 7.55 ± 2.10 points (Table 1).
3.3. Differences in characteristics according to Pap test
experience
Differences in characteristics according to the Pap test experience
of the participants were investigated. Among the sociodemo-
graphic characteristics, age (P < .001), marital status (P < .001),
employment status (P < .001), smoking status (P = .026), expe-
rience of coitus (P < .001), awareness of the NCSP (P < .001),
and HPV vaccination (P < .001) showed significant differences
according to the Pap test experience. Furthermore, Pap test atti-
tude (P < .001), Pap test self-efficacy (P < .001), CC knowledge
(P = .001), HPV knowledge (P = .038), and cancer prevention
behavior (P = .027) all showed significant differences according
to the Pap test experience (Table 1).
Nagelkerke determination coefficient. Classification accuracy
was 81.7%. The model in the present study was determined to
fit the data analyzed herein since the hypothesis that this model
would show no difference between the measured and predicted
values could not be rejected based on the Hosmer–Lemeshow
test results (χ2 = 5.30, P = .725).
The identified significant factors influencing Pap test expe-
rience were marital status, employment status, experience of
coitus, awareness of the NCSP, HPV vaccination, and Pap test
self-efficacy. Married individuals had a 5.96 times higher OR of
having a Pap test compared to unmarried individuals. The odds
were 2.22 and 10.46 times higher for employed and individu-
als with coitus experience, compared to unemployed individu-
als and individuals without coitus experience, respectively. The
odds were 4.39 times higher for individuals aware of the NCSP
and 2.62 times higher for individuals who received HPV vacci-
nation, compared to those who were not aware and those who
did not receive the vaccination, respectively. Concerning the Pap
test self-efficacy, an increase of 1 point was associated with an
increase of 1.09 times in the likelihood of Pap test experience
(Table 2).

Table 1
Differences in characteristics according to Pap test experience (N = 338).
Experience with Pap test
Yes (n = 205) No (n = 133)
Variables Categories Total n (%) or M ± SD χ2 (p) or t (p)
Age (yr) 20–29 165 (48.8) 72 (35.1) 93 (69.9) 39.10 (<.001)
30–39 173 (51.2) 133 (64.9) 40 (30.1)
Marital status Yes 107 (31.7) 97 (47.3) 10 (7.5) 59.06 (<.001)
No 231 (68.3) 108 (52.7) 123 (92.5)
Education status ≤High school 37 (10.9) 17 (8.3) 20 (15.0) 3.80 (.283)
College 75 (22.2) 47 (22.9) 28 (21.1)
University 198 (58.6) 124 (60.5) 74 (55.6)
≥Graduate school 28 (8.3) 17 (8.3) 11 (8.3)
Employment status Employed 227 (67.2) 155 (75.6) 72 (54.1) 16.87 (<.001)
Unemployed 111 (32.8) 50 (24.4) 61 (45.9)
Smoking status nonsmoker 275 (81.4) 159 (77.6) 116 (87.2) 4.96 (.026)
Smoker 63 (18.6) 46 (22.4) 17 (12.8)
Experience of coitus Yes 256 (75.7) 195 (95.1) 61 (45.9) 106.52 (<.001)
Age of first coitus (n = 256) 22.16 ± 3.89 22.36 ± 4.14 21.51 ± 2.88
No 82 (24.3) 10 (4.9) 72 (54.1)
Family history of CC Yes 21 (6.2) 12 (5.9) 9 (6.8) 0.12 (.734)
No 317 (93.8) 193 (94.1) 124 (93.2)
Awareness of the NCSP Yes 293 (86.7) 196 (95.6) 97 (72.9) 35.94 (<.001)
No 45 (13.3) 9 (4.4) 36 (27.1)
HPV vaccination Yes 129 (38.2) 94 (45.9) 35 (26.3) 13.05 (<.001)
No 209 (61.8) 111 (54.1) 98 (73.7)
Attitude toward the Pap test 44.20 ± 5.42 45.18 ± 5.44 42.69 ± 5.04 4.23 (<.001)
Pap test self-efficacy 29.09 ± 4.69 30.09 ± 4.68 27.54 ± 4.29 5.06 (<.001)
Knowledge of CC 3.49 ± 1.67 3.73 ± 1.67 3.12 ± 1.62 3.33 (.001)
Knowledge of HPV 5.21 ± 3.18 5.50 ± 3.19 4.77 ± 3.12 2.09 (.038)
Cancer prevention behavior 7.55 ± 2.10 7.76 ± 2.02 7.24 ± 2.20 2.22 (.027)
CC = cervical cancer, HPV = human papillomavirus, NCSP = National Cancer Screening Program.

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 Seo and Kim • Medicine (2023) 102:30Medicine

Table 2
Factors affecting Pap test experience among South Korean women (20–39 years) by binary logistic regression (N = 338).
Variables B SE OR (95% CI) P value

Age (yr) 0.014 0.04 1.01 0.94–1.10 .729

Marital status (Ref. = No) 1.786 0.50 5.96 2.25–15.77 <.001
Employment status (Ref. = Unemployed) 0.799 0.37 2.22 1.08–4.59 .031
Smoking status (Ref. = non-smoker) 0.383 0.42 1.47 0.65–3.31 .357
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Experience of coitus (Ref. = No) 2.348 0.43 10.46 4.54–24.11 <.001

Awareness of the NCSP (Ref. = No) 1.478 0.50 4.39 1.66–11.58 .003
HPV vaccination (Ref. = No) 0.962 0.34 2.62 1.35–5.09 .005
Attitude toward the Pap test 0.012 0.04 1.01 0.94–1.08 .732
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Pap test self-efficacy 0.086 0.04 1.09 1.01–1.19 .046

Knowledge of CC 0.095 0.11 1.10 0.88–1.37 .407
Knowledge of HPV 0.068 0.06 1.07 0.95–1.20 .257
Cancer prevention behavior -0.008 0.08 0.99 0.85–1.15 .914
CC = cervical cancer, CI = confidence interval, HPV = human papillomavirus, NCSP = National Cancer Screening Program, OR = odds ratio, Pap = Papanicolaou, SE = standard error.

4. Discussion test self-efficacy was a facilitator of Pap screening practice.[10]

Intending to provide basic data for the development of educa-
tional programs to increase the CC screening rate, this study
investigated the status of the Pap test and analyzed the factors
affecting the Pap test experience among women aged 20 to 39
years.
The Pap test screening rate among the participants was
60.7%, which was higher than 54.0% for South Korean women
aged 20 to 39 years and 58.7% for South Korean women of all
ages reported in 2019,[6] confirming increased participation in
Pap testing. It could also be inferred that South Korean woman
had more awareness and a more positive attitude toward the
Pap test. However, upon investigating whether the participants
were aware that the NCSP was providing free Pap tests to
women aged ≥ 20 years once every 2 years, 13.3% of the partic-
ipants were found to be unaware of this information. This rate
was notably lower than the 41.7% found in a study on univer-
sity students,[18] suggesting that the NCSP is being implemented
successfully by the South Korean government to reduce the
incidence of CC.[19,20] However, because > 10% of participants
were unaware of the NCSP, continued efforts are needed to pre-
vent such women from missing the opportunity for CC preven-
tion owing to being unaware of available information. Young
women in South Korea usually prefer practical and realistic
messages regarding CC and HPV vaccination, including mes-
sages that include both men and women and campaigns with
high accessibility and exposure.[11] To raise awareness about Pap
testing, it is necessary to implement customized interventions
and to identify barriers in different age groups.[10]
The Pap test attitude and self-efficacy scores of the partici-
pants were similar to those in a previous study.[18] The cancer
prevention behavior score was also similar to that reported in
another study.[17] The CC knowledge score showed no signif-
icant difference when compared with the score in a study on
some female university students,[14] but was lower than the score
in a study on nursing students.[18] The HPV knowledge score
was lower than that in a study on nurses[9] and female univer-
sity students (nursing students accounting for 53.7%).[15] These
differences could be attributed to the differences in the study
population since the present study randomly sampled women
aged 20 to 39 years from a nationwide panel.
Among the sociodemographic characteristics, age, marital
status, employment status, smoking status, experience of coitus,
awareness of the NCSP, and HPV vaccination showed differ-
ences according to the Pap test experience. Moreover, Pap test
attitude and self-efficacy, CC knowledge, HPV knowledge, and
cancer prevention behavior scores were higher in the PT group
than in the non-PT group. Pap test attitude and Pap test self-ef-
ficacy were significant variables in the study by Jo (unpublished
dissertation) on CC prevention education. In particular, Pap
Therefore, to prevent CC, the screening rate could be enhanced
by promoting a positive attitude and higher self-efficacy toward
the Pap test based on understanding the characteristics that
demonstrate statistically significant differences. The PT group
had significantly higher CC knowledge, HPV knowledge, and
cancer prevention behavior scores than the non-PT group,
which supported the results of a previous study.[18] Disease-
related attitudes or lack of knowledge can act as barriers to
Pap tests.[10] Thus, CC and HPV knowledge accumulation can
improve understanding and motivation for proper health (can-
cer prevention) behavior, as well as promote a positive attitude,
which could encourage participation in Pap testing.
Analysis of the factors influencing the Pap test experience
identified marital status, employment status, experience of
coitus, awareness of the NCSP, HPV vaccination, and Pap test
self-efficacy as the influencing factors.
The OR of having a Pap test was 10.46 times higher among
participants with coitus experience. This was much higher than
the 5.6 times found in a study on nursing students,[18] which
could be attributed to a difference in the study population.
Women with coitus experience should be encouraged to take
part in regular screening, while education that actively empha-
sizes the importance and practice of regular Pap test screening
after having coitus experience should be provided as a CC pre-
vention strategy.[18]
The OR of having a Pap test was 5.96 times higher among
married versus unmarried individuals. This finding supports
data showing that unmarried women in South Korean society
are reluctant to undergo Pap tests owing to negative emotions,
including embarrassment and stigma about receiving gynecolog-
ical examinations.[8,9,11] Therefore, it is necessary to understand
such barriers and to implement programs that actively encour-
age screening to prevent unmarried women from having such
negative emotions. Moreover, urinalysis or vaginal self-sampling
for CC screening could be an alternative for women who are
reluctant to undergo Pap tests at healthcare institutions.[21–23]
For this, standardization of self-sampling procedures and guides
could contribute to improved screening rates and CC prevention.
The OR of having a Pap test was 4.39 times higher among
those who had an awareness of the NCSP than among those
who did not. Since 2016, women aged 20 to 29 years have been
included in the NCSP in South Korea; however, because some
women were unaware of this fact, this difference in the Pap test
experience was observed. Thus, a lack of awareness may be a
barrier to screening.[10]
Moreover, the OR of having a Pap test was 2.62 times higher
among those who received HPV vaccination than among
those who did not. This finding is consistent with the results
of previous studies where vaccinated women were found to

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 Seo and Kim • Medicine (2023) 102:30www.md-journal.com
have increased awareness about the benefits, increasing their
likelihood of undergoing a Pap test.[24] In addition, the OR
was 2.22 times higher among employed versus unemployed
individuals. The likelihood of receiving a Pap test increased
1.09 times with an increase of 1 point in the Pap test self-ef-
ficacy score. Self-efficacy may act as a facilitator of Pap test
practice.[10] If the factors influencing Pap tests among women
aged 20 to 39 years are properly understood and programs
are customized according to the characteristics of the different
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age groups, the Pap test screening rate in this population may
increase.
Finally, in the present study, a difference in the Pap test experi-
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ence was evident between women in their 20s and 30s, although
age was not found to be a significant determinant of the Pap test
experience (P = .729). The average age of the participants at the
time of their first sexual intercourse was 22.16 years, with the
youngest reported age being 15 years. Moreover, even though 82
participants reported no history of sexual intercourse, Pap tests
were performed on 10 of them. Sexual experience at an early age
is a well-known risk factor for CC.[25,26] In Korean culture, the
sexual behavior of young unmarried women is still considered
taboo, which may impede their ability to access the Pap test.[8]
However, young women who undergo screening are more likely
to continue the practice as a lifelong habit and recommend it to
their children and peers later.[10] Given that this was an online
questionnaire survey study focused on women in their 20s and
30s, it is recommended that future studies include women at high
risk for CC and samples drawn from hospital settings.
This study has some limitations. First, the study design was
a cross-sectional survey. Second, only an online panel of South
Korean women aged 20 to 39 years who voluntarily consented
to participate in the study was included. Third, since informa-
tion related to hysterectomy was not collected, women who had
undergone hysterectomy could not be excluded. However, the
reporting rate of hysterectomies in South Korea is very low.[19]
Furthermore, as the study relied on self-reported online ques-
tionnaire surveys, the results may not be entirely accurate.
Accordingly, caution should be exercised when interpreting the
findings.
Despite these limitations, identifying the knowledge level or
disease prevention experience of a particular population may
provide an opportunity to change the awareness level and habits
of the population in a favorable direction. Moreover, this study
is significant in that the findings can be used as supporting data
for establishing health policies for CC prevention.
5. Conclusion
Early screening for CC can improve the disease prognosis;
thus, the active promotion of Pap test screening is of utmost
importance. Accordingly, the present study investigated the
status of Pap test screening in addition to identifying the influ-
encing factors of Pap test screening among women aged 20
to 39 years who underwent the Pap test for the first time and
were supposed to regularly receive the test in the future. It is
essential to establish intervention strategies that target clinical
practices, communities, and schools based on an understand-
ing of the factors that influence Pap test uptake. The strategies
could involve a range of measures, including implementing
diverse publicity campaigns to increase access to the NCSP,
providing cost support to increase HPV vaccination rates, and
developing customized educational programs to enhance Pap
test self-efficacy. Government policies with regard to CC pre-
vention should prioritize understanding the needs of young
women and providing intensive support to address those needs.
The findings of the present study can inform the development
of effective health strategies to improve the CC screening rate,
utilizing the characteristics and influencing factors identified
in this study.
5
Acknowledgments
We would like to thank all the participants who contributed to
the production of this paper.
Author contributions
Conceptualization: Young A Kim.
Data curation: Yun Am Seo.
Formal analysis: Yun Am Seo.
Funding acquisition: Young A Kim.
Investigation: Yun Am Seo.
Methodology: Yun Am Seo, Young A Kim.
Project administration: Young A Kim.
Supervision: Young A Kim.
Validation: Yun Am Seo.
Writing – original draft: Yun Am Seo.
Writing – review & editing: Young A Kim.
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