Cervical Cancer Screening Determinants and Pathways among Women in Lesotho: Structural Equation Modelling of a Cross-Sectional Study

Purpose: This study examines the determinants and their pathways on Cervical Cancer Screening uptake among women in Lesotho, South Africa. Methods: We used women data aged 25 to 49 years (n=1,875) of 2023/2024 Demographic and Health Survey of Lesotho, a cross-sectional survey. The outcome variable was CCS (screened or not). The determinants included sociodemographic characteristics (e.g., age, education, race, marital status, wealth quintile, rurality, and number of children), hormonal contraceptive use, smoking status, HIV status, intimate partner violence (IPV) experience, health facilities access, and prior breast cancer screening (BCS). We fitted logistic regression to examine determinants of CCS and performed structural equation modeling (SEM) to understand determinants pathways on CCS. Results: Of the total, 88.60% had heard about CC. Of them and 58.7% had CCS uptake. Logistic regression results identified that greater odds of CCS uptake compared to the reference categories were seen among individual aged 45-49 years, being in the poorer wealth quintile, married, used hormonal contraception, living with HIV, experienced any IPV, and had BCS examined. SEM results identified the following fit statistics: χ ² _M (df)=9.36, df =6, P=0.154; RMSEA=0.017, CFI=0.958, TLI=0.545, P<0.001; and SRMR=0.018. In the presence of HIV, there was a significant positive indirect effect of age (β=0.088), a significantly negative indirect effects of education (β=-0.013), and hormonal contraceptive use (β=-0.105) on CCS uptake. Conclusion: Populations with lower rates of CCS include younger, wealthier, unmarried individuals, and those who did not have any chronic disease or BCS screening, suggesting a need for further investigation to improve CCS uptake.