Barriers to cervical cancer screening among middle-aged and older rural appalachian women

Christina R. Studts, Yelena N. Tarasenko, Nancy E. Schoenberg

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Although cervical cancer rates in the United States have declined sharply in recent decades, certain groups of women remain at elevated risk, including middle-aged and older women in central Appalachia. Cross-sectional baseline data from a community-based randomized controlled trial were examined to identify barriers to cervical cancer screening. Questionnaires assessing barriers were administered to 345 Appalachian women aged 40-64, years when Papanicolaou (Pap) testing declines and cervical cancer rates increase. Consistent with the PRECEDE/PROCEED framework, participants identified barriers included predisposing, enabling, and reinforcing factors. Descriptive and bivariate analyses are reported, identifying (a) the most frequently endorsed barriers to screening, and (b) significant associations of barriers with sociodemographic characteristics in the sample. Recommendations are provided to decrease these barriers and, ultimately, improve rates of Pap tests among this traditionally underserved and disproportionately affected group.

Original languageEnglish
Pages (from-to)500-512
Number of pages13
JournalJournal of Community Health
Issue number3
StatePublished - Jun 2013

Bibliographical note

Funding Information:
Acknowledgments This project was supported by the National Cancer Institute (R01CA108696). We acknowledge and thank all Faith Moves Mountains’ community and scientific staff and participants. Last, but not least, we wish to express our appreciation to the community members who have offered extensive support to this project.


  • Appalachia
  • Barriers
  • Cervical cancer
  • Middle-aged
  • Screening

ASJC Scopus subject areas

  • Health(social science)
  • Public Health, Environmental and Occupational Health


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