Socio-Cultural Norms and Compliance with Cervical Cancer Screening: A Phenomenological Study among High-Risk Women
https://doi.org/10.33860/jik.v19i3.3901
Keywords:
Socio-Cultural Norms; Compliance; Screening; Cervical Cancer.Abstract
Background: Cervical cancer can be prevented through HPV vaccination and screening. However, the screening rate among women in Indonesia is still below 10%. Screening coverage in Palu City in 2024 is still below the national target (90%), reaching only 19.9%. Low compliance with screening is not only due to a lack of knowledge but also to social and cultural norms. This study aims to analyze social and cultural norms in cervical cancer screening compliance among high-risk women in Palu City.
Methods: This study uses a naturalistic paradigm approach with a phenomenological research type. The participants in this study were women aged 30-50 years who met the established criteria. Data analysis is carried out through the stages of data reduction, thematic categorization, sociological interpretation, and theoretical synthesis using Durkheim's Collective Conscience theory, Bicchieri's Social Norms Theory, and Health Belief Model Theory.
Results: The results of the study suggest that taboo norms are most dominant in cervical cancer screening compliance, with women who undergo reproductive organ examinations being considered shameful and rude. Folkways norms reveal that women only get checked when symptoms appear and self-medicate with traditional remedies. Moral values such as shame or husband's permission weaken the decision to undergo screening. Preventive knowledge and barriers such as stigma, shame, and lack of support weaken screening awareness.
Conclusion: In conclusion, cervical cancer screening compliance is a social phenomenon shaped by taboo social norms, morality, customs, and symbolic power roles. Therefore, Socio-Normative Health Awareness Theory is a new intervention concept that reorients social norms into more effective empowerment tools, such as spousal consent, the role of religious leaders, customs, and morality as forces to strengthen awareness and participation in screening.
References
Afsah, Y. R., & Kaneko, N. (2025). Exploring cervical cancer screening awareness, beliefs, barriers, and practices among indonesian muslim women in Japan: a qualitative study. BMC Public Health, 25(1). https://doi.org/10.1186/s12889-025-22285-3
Alam, Z., Deol, H., Dean, J. A., & Janda, M. (2022). Reasons behind Low Cervical Screening Uptake among South Asian Immigrant Women: A Qualitative Exploration. International Journal of Environmental Research and Public Health, 19(3). https://doi.org/10.3390/ijerph19031527
Anwar, S. L., Tampubolon, G., Van Hemelrijck, M., Hutajulu, S. H., Watkins, J., & Wulaningsih, W. (2018). Determinants of cancer screening awareness and participation among Indonesian women. BMC Cancer, 18(1). https://doi.org/10.1186/s12885-018-4125-z
Arbyn, M., Weiderpass, E., Bruni, L., de Sanjosé, S., Saraiya, M., Ferlay, J., & Bray, F. (2020a). Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. The Lancet Global Health, 8(2), e191–e203. https://doi.org/10.1016/S2214-109X(19)30482-6
Bando, E. F., Said, M. S. M., Sansuwito, T. Bin, & Suyanto, J. (2025). Cultural Barrier and Cervical Cancer Stigma on Screening Program in Community: A Systematic Literature Review. In Public Health of Indonesia (Vol. 11, Issue 2, pp. 129–140). Yayasan Cipta Anak Bangsa (YCAB) Publisher. https://doi.org/10.36685/phi.v11i2.966
Becker, M. H. (n.d.). Advantages of the Health Belief Model.
Bennett, L. R., & Astari, P. (2025). Unpacking cervical cancer stigma in healthcare: lessons learnt from Indonesian patients and health professionals. Culture, Health and Sexuality. https://doi.org/10.1080/13691058.2025.2488036
Bicchieri, C., Muldoon, R., & Sontuoso, A. (2018). Social Norms.
Bicchieri, Cristina. (2006). The grammar of society : the nature and dynamics of social norms. Cambridge University Press.
Chen, N. N. T., Moran, M. B., Frank, L. B., Ball-Rokeach, S. J., & Murphy, S. T. (2018). Understanding Cervical Cancer Screening among Latinas through the Lens of Structure, Culture, Psychology and Communication. Journal of Health Communication, 23(7), 661–669. https://doi.org/10.1080/10810730.2018.1500661
De Abreu, C. S. (n.d.). How socio-cultrual factors affect cervical cancer screening adherence and treatment in disadvantaged communities in the Greater Cape Town, South Africa.
Durkheim, E. (1960). The Division Of Labour In Society.
Durkheim, E. (1997). The Division in Labor in Society.
Ekawati, F. M., Listiani, P., Idaiani, S., Thobari, J. A., & Hafidz, F. (2024). Cervical cancer screening program in Indonesia: is it time for HPV-DNA tests? Results of a qualitative study exploring the stakeholders’ perspectives. BMC Women’s Health, 24(1). https://doi.org/10.1186/s12905-024-02946-y
Hastuti, S., Kumoro Wulan, S., & Nurul Widyawati, M. (2024). Factors Influencing Cervical Cancer Screening Participation in Female: Systematic Review. Indonesian Journal of Medicine, 04, 495–505. https://doi.org/10.26911/theijmed.2024.09
Haynes, V. E. (2019). Sociocultural Factors Influencing Cervical Cancer Prevention and Control Behaviors in Cusco, Peru. https://scholarcommons.sc.edu/etd
Jansen, E. E. L., Zielonke, N., Gini, A., Anttila, A., Segnan, N., Vokó, Z., Ivanuš, U., McKee, M., de Koning, H. J., de Kok, I. M. C. M., Veerus, P., Heinävaara, S., Sarkeala, T., Csanádi, M., Pitter, J., Széles, G., Minozzi, S., Senore, C., van Ballegooijen, M., … Priaulx, J. (2020). Effect of organised cervical cancer screening on cervical cancer mortality in Europe: a systematic review. In European Journal of Cancer (Vol. 127, pp. 207–223). Elsevier Ltd. https://doi.org/10.1016/j.ejca.2019.12.013
Kementerian Kesehatan RI. (2023). Rencana Aksi Nasional Eliminasi Kanker Leher Rahim di Indonesia tahun 2023-2030.
Kussia, B., Shewangizaw, M., Abebe, S., Alemu, H., & Simon, T. (2024). Health care seeking behaviour towards cervical cancer screening among women aged 30–49 years in Arbaminch town, Southern Ethiopia, 2023. BMC Cancer, 24(1). https://doi.org/10.1186/s12885-023-11810-5
Lee, S. Y. (2015). Cultural Factors Associated with Breast and Cervical Cancer Screening in Korean American Women in the US: An Integrative Literature Review. In Asian Nursing Research (Vol. 9, Issue 2, pp. 81–90). Korean Society of Nursing Science. https://doi.org/10.1016/j.anr.2015.05.003
Liebermann, E. J., VanDevanter, N., Hammer, M. J., & Fu, M. R. (2018). Social and Cultural Barriers to Women’s Participation in Pap Smear Screening Programs in Low- and Middle-Income Latin American and Caribbean Countries: An Integrative Review. In Journal of Transcultural Nursing (Vol. 29, Issue 6, pp. 591–602). SAGE Publications Inc. https://doi.org/10.1177/1043659618755424
Mohd. Tohit, N. F., & Haque, M. (2024). Forbidden Conversations: A Comprehensive Exploration of Taboos in Sexual and Reproductive Health. Cureus. https://doi.org/10.7759/cureus.66723
Papakonstantinou, T., Flecke, S. L., Edmunds, C. E. R., Cross, R., Tran, A., & Gold, N. (2025). A systematic review and meta-analysis of the effectiveness of social norms messaging approaches for improving health behaviours in developed countries. Nature Human Behaviour. https://doi.org/10.1038/s41562-025-02275-6
Robbers, G. M. L., Bennett, L. R., Spagnoletti, B. R. M., & Wilopo, S. A. (2021). Facilitators and barriers for the delivery and uptake of cervical cancer screening in Indonesia: a scoping review. In Global Health Action (Vol. 14, Issue 1). Taylor and Francis Ltd. https://doi.org/10.1080/16549716.2021.1979280
Rosenstock, I. M. (2015). Historical Origins of the Health Belief Model. In Health Education Monographs (Vol. 2, Issue 4).
Sumarmi, S., Hsu, Y. Y., Cheng, Y. M., & Lee, S. H. (2021). Factors associated with the intention to undergo Pap smear testing in the rural areas of Indonesia: a health belief model. Reproductive Health, 18(1). https://doi.org/10.1186/s12978-021-01188-7
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 71(3), 209–249. https://doi.org/10.3322/caac.21660
Taqwin, Sumiaty, & Lasman, K. (2018). Penyuluhan, Pengetahuan Dan Sikap Pasangan Usia Subur Tentang Inpeksi Visual Asam Asetat (IVA) Di Kelurahan Birobuli (Vol. 12, Issue 1). http://jurnal.poltekkespalu.ac.id/index.php/JIK
Veridiana, N. N., & Rezkia. (2020). Determinan Keikutsertaan Wanita Usia Subur dalam Deteksi Dini Kanker Serviks di Wilayah Kerja Puskesmasi Singgani.
WHO. (2020). Global strategy to accelerate the elimination of cervical cancer as a public health problem.
Wilding, S., O’Connor, D. B., & Conner, M. (2025). Social Norms in Cervical Cancer Screening. Psychological Reports, 128(6), 4193–4209. https://doi.org/10.1177/00332941231219943
Zhang, J., Sha, Z., Gu, Y., Li, Y., Yang, Q., Zhu, Y., & He, Y. (2019). Predicting behavioral intentions related to cervical cancer screening using a three-level model for the TPB and SCT in Nanjing, China. International Journal of Environmental Research and Public Health, 16(19). https://doi.org/10.3390/ijerph16193575
Published
How to Cite
Issue
Section
License
Authors who publish with Poltekita : Jurnal Ilmu Kesehatan agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY-SA 4.0) that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
This work is licensed under a Creative Commons Attribution-ShareAlike 2.0 Generic License.
Poltekita : Jurnal Ilmu Kesehatan is licensed under a Creative Commons Attribution-Share Alike 4.0 International License
You are free to:
- Share, copy and redistribute the material in any medium or format
- Adapt, remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
