Effect of a Theory-Based Nurse-Led Behaviour Change Intervention on Psychosocial Determinants and Uptake of VIA Cervical Cancer Screening Among Women Aged 30–49 Years: A Randomized Controlled Trial

Abstract

Background: India accounts for nearly a quarter of global cervical cancer deaths, yet only a small minority of women aged 30–49 years have ever been screened. Visual Inspection with Acetic Acid (VIA) is effective and widely available, making screening uptake rather than service availability the binding constraint. We evaluated whether a theory-based, nurse-led behaviour change intervention could increase VIA screening uptake and improve its psychosocial determinants. Methods: A parallel-group, two-arm randomized controlled trial was conducted in the rural and urban health training centre catchment areas of a medical college hospital in Indore, India. Three hundred women aged 30–49 years, not screened in the preceding three years, were randomized 1:1 using computer-generated random numbers with allocation concealment by sequentially numbered opaque sealed envelopes. The intervention comprised five nurse-delivered sessions over 4–6 weeks, grounded in the Health Belief Model (HBM) and COM-B framework, covering cervical cancer education, VIA and its benefits, barrier problem-solving, motivational interviewing with action planning, and reinforcement with appointment finalization. Controls received routine health education. The primary outcome was VIA screening uptake at 3 and 6 months, verified through screening registers. Secondary outcomes were knowledge, the six HBM constructs, and satisfaction. Analysis was by intention to treat with multiple imputation for missing data. Results: Groups were comparable at baseline across all socio-demographic, reproductive, knowledge, and belief measures (all p > 0.05); overall attrition was 10.7%. VIA screening uptake was significantly higher in the intervention arm at 3 months (30.0% vs 12.0%; difference 18.0%, 95% CI 8.8–27.2; p < 0.001) and at 6 months (36.0% vs 16.0%; difference 20.0%, 95% CI 10.3–29.7; p < 0.001). After adjustment for age, education, income, parity, baseline knowledge, and baseline self-efficacy, allocation to the intervention remained the strongest independent predictor of uptake (adjusted OR 3.02, 95% CI 1.68–5.43, p < 0.001). Knowledge rose from 8.6 ± 3.2 to 19.4 ± 2.8 out of 25 immediately post-intervention and remained at 18.1 ± 3.0 at 6 months versus 9.8 ± 3.2 in controls (p < 0.001). All six HBM constructs improved significantly, with the largest gains in perceived benefits and self-efficacy (+1.1 each) and a marked fall in perceived barriers (−0.9); group × time interactions were significant for every construct (p < 0.001). Overall satisfaction was 91.2%, and 95.6% would recommend the programme. Conclusion: A structured, theory-based, nurse-led counselling intervention more than doubled verified VIA screening uptake and produced broad, sustained improvements in the psychosocial determinants of screening behaviour. The approach is acceptable and replicable, and merits integration into community-based cervical screening programmes.