Determinants of cervical cancer screening in Southeast Asia: A systematic review using the COM-B model and the theoretical domains framework.

Abstract

To identify the determinants of cervical cancer screening (CCS) uptake in Southeast Asia (SEA), using the COM-B model and the Theoretical Domains Framework (TDF). A comprehensive search was conducted in PubMed/Medline, Scopus, Web of Science, CINAHL, Embase, ProQuest and PsycINFO. Primary qualitative and quantitative studies published in English from January 2015 to October 2025 that reported determinants of CCS uptake in SEA were included. The Joanna Briggs Institute critical appraisal tool was used to conduct the quality assessment of the studies. A total of 72 articles were included, with most studies from Malaysia (n = 20) and using the Pap smear screening method (n = 39). The review mapped 230 items onto COM-B and the TDF as either barriers or facilitators, with every TDF domain appearing in at least one study. The most reported domains were 'knowledge' (60/72 studies) and 'environmental context and resources' (52/72 studies), with 'social influence' also frequently identified (35/72 studies). The findings highlight that CCS uptake in SEA is shaped not only by knowledge but also by opportunity-related factors and motivational factors. Interventions could therefore combine education with measures to address access and emotional barriers, in addition to leveraging provider and community support.