Knowledge, attitudes, and practices regarding cervical cancer screening among women in Damascus, Syria: A cross-sectional study.
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BACKGROUND: Cervical cancer remains one of the most preventable yet deadly diseases affecting women in low-resource and conflict-affected regions such as Syria. Persistent challenges including limited access to health care, disrupted health infrastructure, sociocultural taboos, and inadequate health education have severely restricted the implementation and uptake of screening programs. Understanding the multifaceted determinants of women's awareness, perceptions, and health-seeking behavior is essential for designing sustainable, context-sensitive prevention strategies. OBJECTIVES: This study aimed to evaluate Syrian women's knowledge, attitudes, and screening practices toward cervical cancer and to identify demographic, educational, and psychosocial predictors influencing these domains. It also sought to explore the paradoxical role of education in shaping self-efficacy, awareness, and screening-related attitudes within this population. DESIGN: A descriptive cross-sectional design was employed. METHODS: Data were collected between November 2024 and May 2025 in Damascus, Syria, using a validated self-administered electronic questionnaire. A total of 606 women aged 15 years and above participated voluntarily. The questionnaire assessed knowledge, attitudes, and self-efficacy related to cervical cancer and screening behaviors. Descriptive statistics and linear regression analyses were performed to examine associations between sociodemographic factors and outcome measures. RESULTS: Although 49% of respondents demonstrated moderate knowledge, only 10% had ever undergone a Pap smear. Major barriers included embarrassment (59%), fear of discomfort (51%), and financial limitations (21%). Higher education significantly predicted better knowledge (p < 0.05) but was paradoxically linked to less favorable attitudes and lower self-efficacy. Greater knowledge correlated positively with self-efficacy, while older age showed a negative association. CONCLUSION: A profound disconnect persists between awareness and screening behavior among Syrian women. Interventions must extend beyond information delivery to address cultural, emotional, and economic barriers through comprehensive, community-based, and empowerment-oriented public health initiatives.