Introduction: Cervical cancer is the fourth most common cancer type among women in all age groups worldwide. The incidence rate of cervical cancer starts to increase after age 40 in Turkey (7.6 in 100.000), and it reaches the highest level between ages 50-55 (11.7 in 100.000).

Objectives :This study was intended to analyze the effect of multiple initiations on beliefs about cervical cancer, health responsibility, and screening participation.

Study Design: This study is pretest-posttest, randomized, and controlled experimental study.

Methods: The group that is be addressed is women between 40 and 55 years of age who are at risk of cervical cancer.The study was carried out between March 13 and June 18, 2017 in Turkey a primary health care center. The sample size of the randomized controlled experiment was determined with Power analysis considering the bi-directional p value. With 95% power and 0.231 effect size and using G * Power 3.1 program, it was determined that there should be 57 women in each group. 10 women were added to each group and thus, a total of 134 women formed the research group. The sample of this study included 134 women (experimental group: 64; control group; 67). The 14 weeks of sessions involving the experimental group included group training and delivery of brochures on cervical cancer, training and counseling during home visits, reminder phone calls, and delivery materials, all aimed to increase motivation to be screened regularly for cervical cancer. The control group maintained their routine practices. To prevent any ethical violations, the group training as well as the brochures, magnets, and mugs that were given to the experimental group before the sessions were provided after the posttests to the control group as well. Ethics committee approval. Before randomization, a visit was paid to the women in their houses, and those who could not be reached in their homes were contacted by phone to obtain their verbal or written consent. Following this procedure, pre-tests were applied to the women who agreed to participate in the study by the researcher between March 15 and March 18, 2017. The pre-tests included the Information Form, the Cervical Cancer and Pap-Smear Test Health Belief Model Scale, and the Health Responsibility Scale. The post-tests were applied to the experimental and control groups by the blinded researcher between 12-16 June 2017 by inviting the participants to the FHC or by paying home visits to those women who did not come to the FHC. The Cervical Cancer and Pap-Smear Test Health Belief Model Scale, the Health Responsibility Scale, and the Evaluation Form about having the Pap Smear Test were applied as post-tests. The data were analyzed using dependent groups t test and independent groups t test.

Results: After the multiple interventions, there was a significant difference between the test and control group's Health Responsibility, Pap smear benefit and motivation, Pap smear obstacle and health motivation scores (p<0,05). After multiple interventions, the participation rate of women in the experimental group to cervical cancer screening was found to be 93% and the rate of cervical cancer screening according to the control group was significantly higher (p<0.05).

Conclusions: According to the results of this study, it may be recommended to measure the cost-effectiveness in field studies, to make ITT analysis so that comparisons could be made in the discussion section of studies, to pay attention to the reporting of effect size and confidence intervals, and to increase the number of systematic reviews and meta-analysis studies so that the effects of studies could be evaluated in terms of participation in screenings.

Keywords: Cervical cancer, Early diagnosis, Risk group, Nursing