BRIDGING THE COVERAGE-PARTICIPATION GAP: BEHAVIORAL DETERMINANTS OF CERVICAL CANCER SCREENING AMONG WOMEN IN ADJARA, GEORGIA.
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Cervical cancer (CCa) is largely preventable through human papillomavirus vaccination, organized screening, and timely management of precancerous lesions; however, screening participation may remain suboptimal even when services are formally available. This cross-sectional, questionnaire-based study examined behavioral and perceptual determinants of CCa screening participation among women in the Adjara region of Georgia. A total of 520 women aged 18-60 years from urban and rural municipalities were recruited using a convenience sampling approach; screening participation was interpreted primarily with reference to the nationally recommended screening age group of 25-60 years. Data were collected from October to December 2024 and analyzed between January and March 2025. The questionnaire was developed using a Health Belief Model-based framework supplemented by selected Knowledge, Attitudes, and Practices components. The primary outcome was self-reported CCa screening participation, defined as having undergone screening at least once. Descriptive statistics, Spearman's rank correlation analysis, and multivariable logistic regression were used. Overall, 33.3% of participants reported previous cervical cancer screening. HPV vaccination coverage was 22.7%, while 43.8% of participants expressed willingness to receive vaccination. Perceived barriers were the most frequently reported Health Belief Model construct, followed by perceived benefits and positive attitudes toward screening. Screened women more frequently reported perceived benefits, positive attitudes, perceived susceptibility, cues to action, and healthcare provider recommendation than non-screened women. Spearman's rank correlation analysis showed that perceived benefits and self-efficacy were positively associated with screening participation, whereas perceived barriers were inversely associated with participation. In multivariable logistic regression analysis, perceived benefits were associated with increased odds of screening participation (aOR=1.80, 95% CI: 1.59-2.05, p<0.001), whereas perceived barriers were associated with reduced odds of participation (aOR=0.83, 95% CI: 0.77-0.89, p<0.001). Positive attitudes toward screening were also independently associated with screening uptake (aOR=1.24, 95% CI: 1.11-1.39, p<0.001). Knowledge score and perceived severity were not significant independent predictors. These findings indicate a persistent coverage-participation gap in Adjara and suggest that CCa screening uptake is associated mainly with behavioral, perceptual, and communication-related factors rather than knowledge or service availability alone. Thus, behaviorally informed, patient-centered, and provider-supported strategies are needed to reduce perceived barriers, strengthen perceived benefits and self-efficacy, and promote consistent healthcare provider recommendations. The low HPV vaccination rate and moderate willingness to be vaccinated further support the need for integrated CCa prevention strategies linking screening promotion with HPV vaccination communication.