Social, economic, and cultural factors have been associated with the level of participation in cervical cancer screening programs. This study identified factors associated with nonparticipation in cervical cancer screening, as well as reasons for not attending, in the context of a population-based, cluster-randomized trial in Ethiopia. A total of 2,356 women aged 30 to 49 years in 22 clusters were invited to receive one of two screening approaches, namely human papillomavirus (HPV) self-sampling or visual inspection with acetic acid (VIA). Participants and nonparticipants were analyzed according to their sociodemographic and economic characteristics. Reasons were determined for the refusal of women to participate in either screening method. More women in the VIA arm compared to the HPV arm declined participation in the screening [adjusted OR (AOR) 3.5; 95% confidence interval (CI), 2.6–4.8]. Women who declined attending screening were more often living in rural areas (AOR = 2.0; 95% CI, 1.1–3.5) and were engaged in informal occupations (AOR = 1.6; 95% CI, 1.1–2.4). The majority of nonattendants perceived themselves to be at no risk of cervical cancer (83.1%). The main reasons given for not attending screening for both screening approaches were lack of time to attend screening, self-assertion of being healthy, and fear of screening. We found that perceived time constraints and the perception of being at no risk of getting the disease were the most important barriers to screening. Living in rural settings and informal occupation were also associated with lower participation. Offering a swift and convenient screening service could increase the participation of women in cervical cancer screening at the community level.

中文翻译：

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埃塞俄比亚农村地区不参加宫颈癌筛查的原因及相关因素

社会、经济和文化因素与宫颈癌筛查项目的参与程度相关。这项研究在埃塞俄比亚进行的一项基于人群的整群随机试验中，确定了与不参加宫颈癌筛查相关的因素以及不参加的原因。22个群组的2,356名年龄在30至49岁的女性被邀请接受两种筛查方法之一，即人乳头瘤病毒（HPV）自我采样或醋酸目视检查（VIA）。根据参与者和非参与者的社会人口统计和经济特征进行分析。确定了女性拒绝参加这两种筛查方法的原因。与 HPV 组相比，VIA 组中有更多女性拒绝参与筛查 [调整后 OR (AOR) 3.5；95% 置信区间 (CI), 2.6–4.8]。拒绝参加筛查的女性通常生活在农村地区（AOR = 2.0；95% CI，1.1-3.5）并且从事非正式职业（AOR = 1.6；95% CI，1.1-2.4）。大多数未参加者认为自己没有患宫颈癌的风险（83.1%）。未参加这两种筛查方法的主要原因是缺乏时间参加筛查、自我主张健康以及害怕筛查。我们发现，感知时间限制和认为没有患病风险是筛查的最重要障碍。生活在农村和非正规职业也与参与率较低有关。