The effect of health literacy level on attitude towards early diagnosis of cervical cancer
Year 2026,
Volume: 19 Issue: 2
,
204
-
215
,
14.04.2026
Selahattin Akyüz
,
Ugur Ugrak
,
Abide Aksungur
Abstract
Objective: The aim of this study is to determine the effect of women's health literacy levels on their attitudes towards early diagnosis of cervical cancer in a central district of Ankara.
Methods: The cross-sectional study was conducted in a central district of Ankara with the participation of 465 female trainees aged 18 and over with similar socio-demographic characteristics. Data were collected using socio-demographic questions, attitude scale towards early diagnosis of cervical cancer and Turkey health literacy scale. The construct validity, convergent and discriminant validity, and internal consistency reliability of the scales were evaluated. The effect of health literacy level on attitudes towards early diagnosis of cervical cancer was examined with structural equation modeling (SEM).
Results: It was determined that the scales had construct validity, convergent and discriminant validity. According to Cronbach Alpha (CA) and Composite Reliability (CR) coefficients, the scales were found to have internal consistency reliability. As a result of the SEM analysis, it was determined that the health literacy level had significant effects on the attitude towards the early diagnosis of cervical cancer.
Conclusion: In the study, it was determined that there was a relationship between the TSOY (Turkish Health Literacy) level and attitudes towards early diagnosis of cervical cancer in women.
References
-
Aksungur A, Bağcı HH., ve Özdemirkan T. (2024). Kanser eğitimleri kanser farkındalığını arttırıyor mu? Estüdam Halk Sağlığı Dergisi, 9(1):13-2. https://doi.org/10.35232/estudamhsd.1361295
-
Avcı, S., & Ayık, M. (2022). Investigation of the relationship between health literacy and quality of life in cancer patients treated in the oncology clinic. Journal of International Health Sciences and Management, 8(16): 41-50. https://10.48121/jihsam.1149749
-
Baharum, N. N., Ariffin, F., Isa, M. R., ve Tin, S. T. (2020). Health literacy, knowledge on cervical cancer and pap smear and its influence on pre-marital malay muslim women attitude towards pap smear. Asian Pac J
Cancer Prev, 21(7): 2021-2028. https://doi.org/10.31557/apjcp.2020.21.7.2021
-
Bazaz, M., Shahry, P., Latifi, S. M., ve Araban, M. (2019). Cervical cancer literacy in women of reproductive age and its related factors. Journal of Cancer Education, 34(1): 82-89. https://doi.org/10.1007/s13187-017-1270-z
-
Bruni, L., Barrionuevo-Rosas, L., Albero, G., Serrano, B., Mena, M., Gómez, D., … De Sanjosé, S. (2019). Human papillomavirus and related diseases report. Information Centre on HPV and Cancer (HPV Information Centre).
-
Cohen, J. (2013). Statistical power analysis for the behavioral sciences. Academic Press.
Çolban, E. K., ve Koçak, D. Y. (2023). The effects of health literacy on early diagnosis behaviors of breast and cervical cancer in women aged 18-65. Journal of Contemporary Medicine, 13(3): 1-8. https://doi.org/10.16899/jcm.1210914
-
Çelikkalp, Ü., ve Irmak, A. Y. (2024). Cancer screening behaviors and health literacy levels of women aged 30 and over in the northwest Turkey. European Journal of Gynaecological Oncology, 45(1): 96–105. https://doi.org/10.22514/ejgo.2024.015
-
Emiral, G., Aygar, H., Isiktekin, B., Göktas, S., Dagtekin, G., Arslantas, D., ve Unsal, A. (2018). Health literacy scale-European union-Q16: a validity and reliability study in Turkey. International Research Journal of Medical Sciences, 6(1): 1-7.
-
Fornell, C., ve Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of marketing research, 18(1): 39-50. https://doi.org/10.1177/002224378101800104
Gültop, F., ve Özkan, S. (2022). Kanser farkındalığında sağlık okuryazarlığının önemi. Turkish Bulletin of Hygiene & Experimental Biology/Türk Hijyen ve Deneysel Biyoloji, 79(3): 579. https://doi.org/10.5505/TurkHijyen.2022.02779
-
Hair, J., Hult, G. T. M., Ringle, C. M., ve Sarstedt, M. (2021). A primer on partial least squares structural equation modeling (PLS-SEM). Sage Publications.
-
Henseler, J., Ringle, C. M., ve Sarstedt, M. (2015). A new criterion for assessing discriminant validity in variance-based structural equation modeling. Journal of the Academy of Marketing Science, 43: 115-135. https://doi.org/10.1007/s11747-014-0403-8
-
HSGM. (2021). T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü Türkiye Kanser Kontrol Programı.
-
Huang, C. H., Lo, Y. J., Kuo, K. M., Lu, I. C., Wu, H., Hsieh, M. T., ... & Lin, C. W. (2021). Health literacy and cancer screening behaviors among community-dwelling female adults in Taiwan. Women & Health, 61(5): 408-419. https://doi.org/10.1080/03630242.2021.1917477
-
Kim, K., ve Han, H.-R. (2016). Potential links between health literacy and cervical cancer screening behaviors: a systematic review. Psycho-Oncology, 25(2): 122-130. https://doi.org/10.1002/pon.3883
-
Kim, K., ve Han, H.-R. (2019). The association between health literacy and breast and cervical cancer screening behaviors: Findings from the behavioral risk factor surveillance system. Nursing Research, 68(3). https://doi.org/10.1097/NNR.0000000000000346
-
Mohamed Amin, S., Metwally El-Sayed, M., Hashem El-Monshed, A., & Hussein Ramadan Atta, M. (2025). Unlocking prevention: the role of health literacy in cervical cancer screening: community nursing perspective. BMC nursing, 24(1): 160. https://doi.org/10.1186/s12912-025-02797-4
-
Nutbeam, D., ve Kickbusch, I. (1998). Health promotion glossary. Health Promotion International, 13(4): 349-364.
-
Oldach, B. R., ve Katz, M. L. (2014). Health literacy and cancer screening: A systematic review. Patient Education and Counseling, 94(2): 149-157. https://doi.org/https://doi.org/10.1016/j.pec.2013.10.001
-
Owokuhaisa, J., Turyakira, E., Ssedyabane, F., Tusubira, D., Kajabwangu, R., Musinguzi, P., ... & Maling, S. (2024). Barriers and facilitators of retention in care after cervical cancer screening: patients’ and healthcare providers’ perspectives. BMC Women's Health, 24(1): 516. https://doi.org/10.1186/s12905-024-03343-1
-
Özmen, D., ve Özsoy, S. (2009). Sağlık inanç modeli yaklaşımı ile servikal kanserin erken tanısına yönelik tutum ölçeği geliştirilmesi. Ege Üniversitesi Hemşirelik Yüksekokulu Dergisi, 25(1): 51-69.
-
Podsakoff, P. M., MacKenzie, S. B., Lee, J.-Y., ve Podsakoff, N. P. (2003). Common method biases in behavioral research: a critical review of the literature and recommended remedies. Journal of Applied Psychology, 88(5): 879.
-
Samoil, D., Kim, J., Fox, C., ve Papadakos, J. K. (2021). The importance of health literacy on clinical cancer outcomes: a scoping review. Annnals of Cancer Epidemiology, 5: 30.
-
Sarstedt, M., Ringle, C. M., ve Hair, J. F. (2021). Partial least squares structural equation modeling. İçinde Handbook of market research (pp. 587-632). Springer.
-
Sentell, T., Braun, K. L., Davis, J., ve Davis, T. (2015). Health literacy and meeting breast and cervical cancer screening guidelines among Asians and whites in California. SpringerPlus, 4(1): 432. https://doi.org/10.1186/s40064-015-1225-y
-
Silva Costa, A., Arriaga, M., Veloso Mendes, R., Miranda, D., Barbosa, P., Sakellarides, C., … Ribeiro, S. (2019). A strategy for the promotion of health literacy in Portugal, centered around the life-course approach: the importance of digital tools. Portuguese Journal of Public Health, 37(1): 50-54. https://doi.org/10.1159/000500247
-
Tafere, Y., Jemere, T., Desalegn, T.,ve Melak, A. (2021). Women’s knowledge and attitude towards cervical cancer preventive measures and associated factors In South Gondar Zone, Amhara Region, North Central Ethiopia: a cross-sectional study. Archives of Public Health, 79(1): 1-7. https://doi.org/10.1186/s13690-021-00659-4
-
Teixeira, C., Antão, C., Anes, E., Gomes, M. J., Versos, A., ve Tomé, C. (2022). Use of cervical cancer screening among patients of primary healthcare services: Northeast Portugal. Portuguese Journal of Public Health, 40(2): 61-68. https://doi.org/10.1159/000522666
-
Thompson, E. L., Wheldon, C. W., Vamos, C. A., Griner, S. B., & Daley, E. M. (2019). How is health literacy related to pap testing among us women? Journal of Cancer Education, 34(4): 789-795. https://doi.org/10.1007/s13187-018-1375-z
-
Tosun Güleroğlu, F (2023). The effect of women's health literacy status on their attitudes and behaviors towards the Pap Smear Test: a series in Turkey. Journal of Health Literacy, 8(2): 63-73. https://doi.org/10.22038/jhl.2023.69429.1374
-
Usman, I. M., Chama, N., Aigbogun Jr, E. O., Kabanyoro, A., Kasozi, K. I., Usman, C. O., ... & Ssebuufu, R. (2023). Knowledge, attitude, and practice toward cervical cancer screening among female university students in Ishaka Western Uganda. International journal of women's health, 611-620.World Health Organization. (2023). Turkey Human Papillomavirus and Related Cancers, Fact Sheet 2023. HPV Information Centre on HPV and Cancer.
-
Wang, Y., Li, X., Zhang, S., Liu, J., & Chen, W. (2025). Association between knowledge of cervical cancer prevention and screening behaviors among women aged 20 to 49 years: a cross-sectional study in six provinces, China. BMC Public Health, 25(1): 1821. https://doi.org/10.1186/s12889-025-22971-2
-
World Health Organization. (2020). Cervical Cancer Prevention and Control Costing Tool (C4P). World Health Organization. https://www.who.int/publications/m/item/WHO-Cervical-Cancer-Prevention-and-Control-Costing-tool
-
Yıldız, E. (2021). Smart PLS İle Yapısal Eşitlik Modellemesi. Seçkin Basımevi.
-
Yilmazel, G. (2019). Low health literacy, poor knowledge, and practice among Turkish women patients undergoing cervical cancer screening. Journal of Cancer Research and Therapeutics, 15(6): 1276-1281. https://doi.org/10.4103/jcrt.JCRT_1142_16
SERVİKS KANSERİNİN ERKEN TANISINA YÖNELİK TUTUM ÜZERİNDE SAĞLIK OKURYAZARLIK DÜZEYİNİN ETKİSİ
Year 2026,
Volume: 19 Issue: 2
,
204
-
215
,
14.04.2026
Selahattin Akyüz
,
Ugur Ugrak
,
Abide Aksungur
Abstract
Amaç: Bu çalışmanın amacı, Ankara’nın merkez bir ilçesinde kadınların sağlık okuryazarlık düzeylerinin serviks kanserinin erken tanısına yönelik tutumları üzerindeki etkisini saptamaktır.
Yöntemler: Kesitsel nitelikteki çalışma, Ankara’nın merkez bir ilçesinde, benzer sosyo-demografik özellikli 18 yaş ve üstü, 465 kadın kursiyerin katılımıyla yürütülmüştür. Sosyo-demografik sorular, serviks kanserinin erken tanısına yönelik tutum ölçeği ve Türkiye sağlık okuryazarlığı ölçeği kullanılarak veriler toplanmıştır. Ölçeklerin yapı geçerliliği, birleşme ve ayrışma geçerliliği ile iç tutarlılık güvenirliği değerlendirilmiştir. Sağlık okuryazarlık düzeyinin serviks kanserinin erken tanısına yönelik tutum üzerindeki etkisi yapısal eşitlik modeli (YEM) ile incelenmiştir.
Bulgular: Ölçeklerin yapı geçerliliği, birleşme ve ayrışma geçerliliğinin olduğu belirlenmiştir. Cronbach Alpha (CA) ve Composite Reliability (CR) katsayılarına göre ölçeklerin iç tutarlılık güvenirliğinin olduğu görülmüştür. YEM analizi sonucunda sağlık okuryazarlık düzeyinin serviks kanserinin erken tanısına yönelik tutum üzerinde anlamlı etkilere sahip olduğu tespit edilmiştir.
Sonuç: Çalışmada, kadınlarda TSOY (Türkiye Sağlık Okuryazarlığı) düzeyi ile serviks kanseri erken tanı tutumları arasında ilişki olduğu tespit edilmiştir.
Ethical Statement
Bu çalışma için etik komite onayı Çankırı Karatekin Üniversitesi Sağlık Bilimleri Etik Kurulu’ndan (Tarih: 16 Ekim 2023, Toplantı No: 9) alınmıştır. Araştırmanın tüm basamakları Helsinki Deklarasyonuna uygun yürütülmüştür.
References
-
Aksungur A, Bağcı HH., ve Özdemirkan T. (2024). Kanser eğitimleri kanser farkındalığını arttırıyor mu? Estüdam Halk Sağlığı Dergisi, 9(1):13-2. https://doi.org/10.35232/estudamhsd.1361295
-
Avcı, S., & Ayık, M. (2022). Investigation of the relationship between health literacy and quality of life in cancer patients treated in the oncology clinic. Journal of International Health Sciences and Management, 8(16): 41-50. https://10.48121/jihsam.1149749
-
Baharum, N. N., Ariffin, F., Isa, M. R., ve Tin, S. T. (2020). Health literacy, knowledge on cervical cancer and pap smear and its influence on pre-marital malay muslim women attitude towards pap smear. Asian Pac J
Cancer Prev, 21(7): 2021-2028. https://doi.org/10.31557/apjcp.2020.21.7.2021
-
Bazaz, M., Shahry, P., Latifi, S. M., ve Araban, M. (2019). Cervical cancer literacy in women of reproductive age and its related factors. Journal of Cancer Education, 34(1): 82-89. https://doi.org/10.1007/s13187-017-1270-z
-
Bruni, L., Barrionuevo-Rosas, L., Albero, G., Serrano, B., Mena, M., Gómez, D., … De Sanjosé, S. (2019). Human papillomavirus and related diseases report. Information Centre on HPV and Cancer (HPV Information Centre).
-
Cohen, J. (2013). Statistical power analysis for the behavioral sciences. Academic Press.
Çolban, E. K., ve Koçak, D. Y. (2023). The effects of health literacy on early diagnosis behaviors of breast and cervical cancer in women aged 18-65. Journal of Contemporary Medicine, 13(3): 1-8. https://doi.org/10.16899/jcm.1210914
-
Çelikkalp, Ü., ve Irmak, A. Y. (2024). Cancer screening behaviors and health literacy levels of women aged 30 and over in the northwest Turkey. European Journal of Gynaecological Oncology, 45(1): 96–105. https://doi.org/10.22514/ejgo.2024.015
-
Emiral, G., Aygar, H., Isiktekin, B., Göktas, S., Dagtekin, G., Arslantas, D., ve Unsal, A. (2018). Health literacy scale-European union-Q16: a validity and reliability study in Turkey. International Research Journal of Medical Sciences, 6(1): 1-7.
-
Fornell, C., ve Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of marketing research, 18(1): 39-50. https://doi.org/10.1177/002224378101800104
Gültop, F., ve Özkan, S. (2022). Kanser farkındalığında sağlık okuryazarlığının önemi. Turkish Bulletin of Hygiene & Experimental Biology/Türk Hijyen ve Deneysel Biyoloji, 79(3): 579. https://doi.org/10.5505/TurkHijyen.2022.02779
-
Hair, J., Hult, G. T. M., Ringle, C. M., ve Sarstedt, M. (2021). A primer on partial least squares structural equation modeling (PLS-SEM). Sage Publications.
-
Henseler, J., Ringle, C. M., ve Sarstedt, M. (2015). A new criterion for assessing discriminant validity in variance-based structural equation modeling. Journal of the Academy of Marketing Science, 43: 115-135. https://doi.org/10.1007/s11747-014-0403-8
-
HSGM. (2021). T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü Türkiye Kanser Kontrol Programı.
-
Huang, C. H., Lo, Y. J., Kuo, K. M., Lu, I. C., Wu, H., Hsieh, M. T., ... & Lin, C. W. (2021). Health literacy and cancer screening behaviors among community-dwelling female adults in Taiwan. Women & Health, 61(5): 408-419. https://doi.org/10.1080/03630242.2021.1917477
-
Kim, K., ve Han, H.-R. (2016). Potential links between health literacy and cervical cancer screening behaviors: a systematic review. Psycho-Oncology, 25(2): 122-130. https://doi.org/10.1002/pon.3883
-
Kim, K., ve Han, H.-R. (2019). The association between health literacy and breast and cervical cancer screening behaviors: Findings from the behavioral risk factor surveillance system. Nursing Research, 68(3). https://doi.org/10.1097/NNR.0000000000000346
-
Mohamed Amin, S., Metwally El-Sayed, M., Hashem El-Monshed, A., & Hussein Ramadan Atta, M. (2025). Unlocking prevention: the role of health literacy in cervical cancer screening: community nursing perspective. BMC nursing, 24(1): 160. https://doi.org/10.1186/s12912-025-02797-4
-
Nutbeam, D., ve Kickbusch, I. (1998). Health promotion glossary. Health Promotion International, 13(4): 349-364.
-
Oldach, B. R., ve Katz, M. L. (2014). Health literacy and cancer screening: A systematic review. Patient Education and Counseling, 94(2): 149-157. https://doi.org/https://doi.org/10.1016/j.pec.2013.10.001
-
Owokuhaisa, J., Turyakira, E., Ssedyabane, F., Tusubira, D., Kajabwangu, R., Musinguzi, P., ... & Maling, S. (2024). Barriers and facilitators of retention in care after cervical cancer screening: patients’ and healthcare providers’ perspectives. BMC Women's Health, 24(1): 516. https://doi.org/10.1186/s12905-024-03343-1
-
Özmen, D., ve Özsoy, S. (2009). Sağlık inanç modeli yaklaşımı ile servikal kanserin erken tanısına yönelik tutum ölçeği geliştirilmesi. Ege Üniversitesi Hemşirelik Yüksekokulu Dergisi, 25(1): 51-69.
-
Podsakoff, P. M., MacKenzie, S. B., Lee, J.-Y., ve Podsakoff, N. P. (2003). Common method biases in behavioral research: a critical review of the literature and recommended remedies. Journal of Applied Psychology, 88(5): 879.
-
Samoil, D., Kim, J., Fox, C., ve Papadakos, J. K. (2021). The importance of health literacy on clinical cancer outcomes: a scoping review. Annnals of Cancer Epidemiology, 5: 30.
-
Sarstedt, M., Ringle, C. M., ve Hair, J. F. (2021). Partial least squares structural equation modeling. İçinde Handbook of market research (pp. 587-632). Springer.
-
Sentell, T., Braun, K. L., Davis, J., ve Davis, T. (2015). Health literacy and meeting breast and cervical cancer screening guidelines among Asians and whites in California. SpringerPlus, 4(1): 432. https://doi.org/10.1186/s40064-015-1225-y
-
Silva Costa, A., Arriaga, M., Veloso Mendes, R., Miranda, D., Barbosa, P., Sakellarides, C., … Ribeiro, S. (2019). A strategy for the promotion of health literacy in Portugal, centered around the life-course approach: the importance of digital tools. Portuguese Journal of Public Health, 37(1): 50-54. https://doi.org/10.1159/000500247
-
Tafere, Y., Jemere, T., Desalegn, T.,ve Melak, A. (2021). Women’s knowledge and attitude towards cervical cancer preventive measures and associated factors In South Gondar Zone, Amhara Region, North Central Ethiopia: a cross-sectional study. Archives of Public Health, 79(1): 1-7. https://doi.org/10.1186/s13690-021-00659-4
-
Teixeira, C., Antão, C., Anes, E., Gomes, M. J., Versos, A., ve Tomé, C. (2022). Use of cervical cancer screening among patients of primary healthcare services: Northeast Portugal. Portuguese Journal of Public Health, 40(2): 61-68. https://doi.org/10.1159/000522666
-
Thompson, E. L., Wheldon, C. W., Vamos, C. A., Griner, S. B., & Daley, E. M. (2019). How is health literacy related to pap testing among us women? Journal of Cancer Education, 34(4): 789-795. https://doi.org/10.1007/s13187-018-1375-z
-
Tosun Güleroğlu, F (2023). The effect of women's health literacy status on their attitudes and behaviors towards the Pap Smear Test: a series in Turkey. Journal of Health Literacy, 8(2): 63-73. https://doi.org/10.22038/jhl.2023.69429.1374
-
Usman, I. M., Chama, N., Aigbogun Jr, E. O., Kabanyoro, A., Kasozi, K. I., Usman, C. O., ... & Ssebuufu, R. (2023). Knowledge, attitude, and practice toward cervical cancer screening among female university students in Ishaka Western Uganda. International journal of women's health, 611-620.World Health Organization. (2023). Turkey Human Papillomavirus and Related Cancers, Fact Sheet 2023. HPV Information Centre on HPV and Cancer.
-
Wang, Y., Li, X., Zhang, S., Liu, J., & Chen, W. (2025). Association between knowledge of cervical cancer prevention and screening behaviors among women aged 20 to 49 years: a cross-sectional study in six provinces, China. BMC Public Health, 25(1): 1821. https://doi.org/10.1186/s12889-025-22971-2
-
World Health Organization. (2020). Cervical Cancer Prevention and Control Costing Tool (C4P). World Health Organization. https://www.who.int/publications/m/item/WHO-Cervical-Cancer-Prevention-and-Control-Costing-tool
-
Yıldız, E. (2021). Smart PLS İle Yapısal Eşitlik Modellemesi. Seçkin Basımevi.
-
Yilmazel, G. (2019). Low health literacy, poor knowledge, and practice among Turkish women patients undergoing cervical cancer screening. Journal of Cancer Research and Therapeutics, 15(6): 1276-1281. https://doi.org/10.4103/jcrt.JCRT_1142_16