CERVICAL CANCER SCREENING AWARENESS, KNOWLEDGE, AND WILLINGNESS AMONG WOMEN ATTENDING HOSPITALS IN OKARA AND LAHORE, PAKISTAN: A COMPARATIVE CROSS-SECTIONAL STUDY

Abstract

Background: Cervical cancer is preventable through human papillomavirus (HPV) vaccination, high-performance screening, and timely treatment, yet screening and HPV awareness remain limited in many low- and middle income settings. This study compared cervical-cancer knowledge, screening awareness, previous screening, barriers, and willingness to screen among women attending two hospitals in Punjab, Pakistan. Methods: We conducted a comparative cross-sectional study among 422 women attending two public-sector hospitals in Punjab, Pakistan: DHQ Hospital Okara (n=211) and Services Hospital Lahore (n=211). Data were collected from October 2025 to March 2026. Categorical variables were compared using Pearson chi-square tests, age using Welch’s independent-samples t-test, and ordinal/count variables using the Mann-Whitney U test. Crude odds ratios (ORs) were calculated for site comparisons, and multivariable binary logistic regression was used to identify factors independently associated with adequate knowledge and willingness to undergo screening. Adequate knowledge was defined as a knowledge score of at least 5 out of 8. Statistical analyses were performed using IBM SPSS Statistics version 25.0. Ethical approval was obtained from the institutional ethics committee before data collection, and written informed consent was obtained from all participants. Age-at-marriage was excluded from inferential analyses because 80 records contained implausible values greater than current age. Results: The mean age of participants was 33.9 ± 9.2 years; 57.8% lived in rural areas and 69.4% were housewives. Overall, 50.9% had heard of cervical cancer, 19.7% were aware of HPV, 5.2% were aware of HPV vaccination, 39.3% had heard of cervical screening, and 12.3% had previously undergone screening. Nevertheless, 71.3% were willing to undergo screening. Adequate knowledge was present in 23.0% overall and was higher at the Lahore site than the Okara site (34.1% vs 11.8%; OR 3.85, 95% CI 2.33-6.39; p<0.001). Participants at the Lahore site also more frequently reported HPV awareness (26.5% vs 12.8%), receiving information from a health worker (46.9% vs 24.6%), and willingness to screen (80.1% vs 62.6%). In adjusted analyses, adequate knowledge was independently associated with Lahore site (adjusted OR [aOR] 2.44, 95% CI 1.37-4.32), prior campaign exposure (aOR 4.24, 95% CI 2.45-7.33), and information from a health worker (aOR 4.77, 95% CI 2.80-8.13). Willingness to screen was independently associated with adequate knowledge (aOR 6.72, 95% CI 2.82-16.06) and Lahore site (aOR 1.74, 95% CI 1.08-2.80). Lack of information was the most frequently reported barrier (31.8%). Conclusion: Cervical-cancer and HPV knowledge and previous screening were low, whereas willingness to undergo screening was comparatively high. The marked site differences and the strong associations of adequate knowledge with campaign exposure and health-worker information support locally tailored, provider-led education linked directly to accessible screening pathways. These findings are timely as Pakistan expands HPV vaccination and strengthens cervical-cancer prevention services.