Knowledge, Attitude, Practice, and Correlates of Cervical Cancer Screening Uptake among Female Health Workers in Nigeria

Abstract

Cervical cancer remains a leading cause of cancer death among Nigerian women despite being largely preventable through early screening. Female health workers occupy an influential position in promoting screening uptake in the wider population, yet the extent to which their own knowledge, attitude, and screening practice align with this role is not well characterised. This study assessed the knowledge, attitude, and practice (KAP) of cervical cancer screening among female health workers in Nigeria and identified the sociodemographic and professional factors independently associated with screening uptake. A cross-sectional survey of 212 female health workers was analysed. A composite knowledge score (0–7) and attitude score (5–25, with negatively worded items reverse-scored) were constructed from structured questionnaire items. Practice was defined as ever having been screened for cervical cancer. Because both composite scores departed significantly from normality (Shapiro–Wilk p < .001), Mann-Whitney U tests were used to compare scores by screening status. Chi-square and Fisher's exact tests examined bivariate associations between sociodemographic/professional characteristics and screening uptake, and a multivariable logistic regression model identified independent predictors, adjusting simultaneously for age, marital status, religion, knowledge score, and attitude score. Most respondents (60.8%) demonstrated good knowledge and expressed strongly positive attitudes toward the importance of screening (92.9% agreement), yet only 48.1% had ever been screened themselves. A specific and actionable knowledge gap was identified: only 17.9% of respondents correctly identified the recommended screening interval. The most frequently perceived barriers were inadequate knowledge (39.2%), fear of diagnosis (33.5%), and limited access to services (21.7%). After multivariable adjustment, religion (Muslim vs. non-Muslim: adjusted OR = 0.29, 95% CI [0.13, 0.64], p = .002) and knowledge score (adjusted OR = 1.44 per point, 95% CI [1.19, 1.75], p < .001) were the only independent predictors of screening uptake; professional cadre, educational qualification, and years of experience were not significant. Despite generally favourable knowledge and attitudes, screening uptake among Nigerian female health workers remains suboptimal, and is independently shaped by religion and knowledge rather than by professional characteristics. Targeted, culturally sensitive interventions that correct specific knowledge gaps and improve institutional screening access are needed to close this knowledge-practice gap and strengthen health workers' capacity to model screening uptake for the wider population.