A systematic review of barriers to cervical cancer screening among Thai women based on the social ecological model: a multi-level analysis of local evidence
Clinical Snapshot
PICO Framework
| P — Population | Thai women eligible for cervical cancer screening |
| I — Intervention | Identification and analysis of barriers to screening participation |
| C — Comparator | Not applicable (descriptive systematic review) |
| O — Outcomes | Multi-level barriers categorised using social ecological model framework |
Bottom Line
This systematic review provides valuable insights into the complex, multi-level barriers preventing Thai women from participating in cervical cancer screening. The use of the social ecological model effectively categorises barriers from individual factors (knowledge, fear, shame) through to policy-level issues (insurance coverage, awareness campaigns). The inclusion of local Thai evidence and cultural considerations strengthens the relevance of findings. However, the review is limited by the small number of included studies and lack of certainty assessment. The findings support the need for comprehensive, culturally-tailored interventions that address barriers across multiple levels simultaneously, moving beyond traditional single-level health education approaches. While specific to Thailand, the methodological approach offers a useful framework for understanding screening barriers in other cultural contexts.
Key Findings
Effect Size: Not applicable (qualitative synthesis)
Primary Outcome: Multi-level barriers to cervical cancer screening participation among Thai women
Nnt Or Sensitivity: Identified barriers across 5 ecological levels with culturally-specific Thai characteristics
Clinical Application
High feasibility for informing culturally-appropriate intervention design and healthcare policy development Limited direct applicability to Australian practice, but framework approach relevant for addressing barriers in culturally diverse Australian populations, particularly Thai-Australian communities Thai women of screening age, potentially applicable to other Southeast Asian populations with similar cultural contexts
Abstract
BACKGROUND: Cervical cancer is a significant public health issue in Thailand. Despite the implementation of a national screening program, its coverage remains suboptimal. This study aims to systematically review local Thai evidence and comprehensively analyze the multi-level barriers affecting women's participation in cervical cancer screening using the social ecological model (SEM). METHODS: Systematic searches were conducted in PubMed, Scopus, CINAHL and ThaiJO databases from inception to 2025. Literature was screened according to pre-defined inclusion and exclusion criteria, resulting in the inclusion of 11 studies. The Newcastle-Ottawa scale and a mixed-methods assessment tool were used for rigorous quality appraisal. Thematic synthesis was used to categorize screening barriers into five levels: individual, interpersonal, community, health system and public policy. RESULTS: The key obstacles identified include: at the individual level, lack of knowledge, fear, shame and insufficient risk perception; at the interpersonal level, the influence of family and social norms; at the community level, cultural, religious and regional factors; at the health system level, poor service accessibility and system inefficiencies; and at the public policy level, incomplete health insurance coverage and insufficient awareness campaigns. Many of these obstacles show distinct characteristics of Thai society and culture. CONCLUSION: Barriers to cervical cancer screening among Thai women constitute a complex, multi-level system. Future intervention strategies must move beyond single-level health education, and should develop cross-level, culturally-appropriate, comprehensive measures. These include promoting HPV self-sampling, conducting community empowerment education, optimizing the health service system and strengthening policy support to systematically increase screening participation.
References
- 1.Zou, Z., & Zhai, B. (2026). A systematic review of barriers to cervical cancer screening among Thai women based on the social ecological model: a multi-level analysis of local evidence. Sexual Health. https://doi.org/10.1071/SH26059
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