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Abstract

Abstract Cervical cancer remains a preventable disease, yet screening uptake in Malaysia continues to fall below national targets, particularly among women from lower socioeconomic groups. While previous studies have highlighted knowledge gaps and structural barriers, limited attention has been given to how women in vulnerable groups interpret the severity of cervical cancer and how these perceptions interact with self-efficacy to shape screening intention and behaviour. This qualitative study explored how lower socioeconomic status women perceived the severity of cervical cancer and assessed their ability to undergo Pap smear screening and how these perceptions influenced screening intention and behaviour. The study also examined healthcare workers’ observations of patient-related constraints and motivational factors affecting preventive behaviour. Four focus group discussions were conducted at two public health clinics in Selangor, Malaysia, with 11 women who had never been screened or were non-adherent to the Ministry of Health Malaysia’s recommendations and 11 healthcare workers involved in screening services. Data were analysed using abductive thematic analysis approach. Findings showed that perceived severity extended beyond biomedical consequences to include fear of losing the motherhood role and concern for children, fear of treatment side effects, fear of being a burden to family members, marital strain and impact on intimacy, family cancer experiences that reinforced fatalistic views of disease severity, fear of cancer progression and death as well as emotional and psychological distress. Self-efficacy was undermined by time constraints due to work commitments and daily responsibilities, fear and discomfort with the screening procedure, absence of social support and encouragement, feeling unready for screening and perceiving it as unnecessary, as well as negative experiences with healthcare workers. These findings suggest that future intervention research could explore approaches such as improved health communication, flexible service delivery models and HPV self-sampling to address barriers identified by women from lower socioeconomic backgrounds. The acceptability, feasibility and effectiveness of these approaches should be evaluated in subsequent intervention and implementation studies.