背景：我国女性的宫颈癌筛查率、HPV疫苗接种率和宫颈癌五年生存率等关键指标目前仍然较低。研究宫颈癌的健康素养现状及其影响因素对于构建综合防控体系、提升预防意识和促进主动健康行为具有重要意义。目的：本研究旨在全面评估我国女性宫颈癌健康素养现状及其影响因素，并深入分析宫颈癌防治知识、态度与HPV疫苗接种及宫颈癌筛查行为之间的剂量-反应和网络关系，以及确定影响 HPV疫苗接种与宫颈癌筛查行为的主要障碍因素，为制定有效的干预措施和策略提供科学依据。方法：2023年7至8月，本研究对中国五省18至74岁女性进行分阶段整群随机抽样，使用横断面调查方法评估其宫颈癌健康素养水平。本研究采用单因素和多因素二元Logistic回归分析宫颈癌健康素养的现状及其影响因素。应用限制性立方样条模型和网络分析法来探索宫颈癌防治知识、态度和预防行为之间的复杂关系。结果：本研究共纳入36677名女性参与者，58.2%的参与者具备宫颈癌健康素养。多因素分析结果显示，文化程度、居住地、家庭年收入、生殖道疾病史、自我健康评价等因素显著影响女性宫颈癌健康素养水平。限制性立方样条模型分析结果显示，宫颈癌防治知识和态度与HPV疫苗接种、宫颈癌筛查之间存在显著非线性关系（P<0.001），当宫颈癌防治知识得分超过总分的80%时，其影响显著上升。网络分析结果显示，HPV疫苗接种意愿与实际接种行为的关联最强。了解阴道有异常症状或宫颈检查结果异常的应对措施与筛查行为之间的关联最强。宫颈癌筛查益处的感知在网络中均表现出最高的节点强度（rS1=2.226，rS2=2.307）。接种HPV疫苗的障碍因素包括疫苗价格贵、年龄限制以及疫苗预约困难，而宫颈癌筛查参与主要受限于时间限制、缺乏疾病感知、检查费用高。结论：在开展宫颈癌健康宣教活动时，应优先关注居住在农村、低收入、教育水平低和有不良生活习惯的女性，并对不同宫颈癌防治知识和态度的得分区间的女性进行针对性的干预。此外，提升对宫颈癌危险因素和HPV基础知识的了解，减轻接种HPV疫苗和宫颈癌筛查的经济负担，并优化疫苗接种和筛查服务流程对促进宫颈癌预防行为至关重要。
Background: The rates of cervical cancer screening, HPV vaccination, and the five-year survival rate of cervical cancer among Chinese women are currently low. Investigating health literacy on cervical cancer is crucial for establishing a comprehensive prevention and control system, enhancing awareness, and promoting proactive behaviors.Objective: To comprehensively assess the current status of cervical cancer health literacy and its influential factors in Chinese women, analyze the dose-response and network relationship between knowledge, attitude towards cervical cancer prevention, HPV vaccination, and screening behavior for cervical cancer, as well as identify the main obstacles affecting HPV vaccination and screening behavior for cervical cancer. This will provide a scientific basis for developing effective intervention measures and strategies.Methods: A cross-sectional survey was conducted from July to August 2023 in five provinces of China, involving women aged 18 to 74 years. Multi-stage cluster random sampling was used to evaluate their health literacy levels regarding cervical cancer. Univariate and multivariate binary logistic regression analyses were employed to assess the current status and influencing factors of cervical cancer health literacy. Restrictive cubic spline models and network analysis were applied to explore the complex relationships among knowledge, attitudes, and preventive behaviors towards cervical cancer.Results: A total of 36,677 female participants were included in the study, with 58.2% of them exhibiting cervical cancer health literacy. Multi-factor analysis revealed that education level, residence, family income, reproductive tract disease history, self-health evaluation and other factors significantly influenced female cervical cancer health literacy. Limited cubic spline model analysis indicated a significant nonlinear relationship between knowledge/attitude of cervical cancer prevention and treatment, HPV vaccination and cervical cancer screening (P<0.001), with the impact increasing significantly when the knowledge score exceeded 80%. Network analysis revealed a strong association between intention to receive HPV vaccination and actual vaccination behavior. The strongest correlation was found between knowledge of appropriate responses to unusual vaginal symptoms or abnormal Pap test results and adherence to screening behavior. The perception of the benefit of cervical cancer screening showed the highest node strength across the network (rS1=2.226, rS2=2.307). The obstacles to obtaining the HPV vaccine include its high cost, age restrictions, and difficulties in scheduling appointments. The primary barriers to cervical cancer screening involve time constraints, lack of awareness about the disease, and elevated screening expenses. Conclusion: When conducting health education activities for cervical cancer, priority should be given to women in rural areas with low income, limited education, and unhealthy lifestyles. Targeted interventions should also be implemented based on varying levels of knowledge and attitudes towards cervical cancer prevention. Furthermore, it is crucial to enhance understanding of risk factors and basic knowledge regarding HPV, reduce the economic burden associated with HPV vaccination and cervical cancer screening, as well as optimize the service process for vaccination and screening to promote preventive behaviors against cervical cancer.
