Adherence to HPV-Based Cervical Cancer Screening: A Concept Analysis for Nursing and Midwifery Practice

Cristina Lumia, Simona Fumagalli, Marianna Martinelli, Davide Ausili, Antonella Nespoli School of Medicine and Surgery, University of Milano-Bicocca, Monza, ItalyCorrespondence: Cristina Lumia, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy, Tel +39 3881648481, Email c.lumia2@campus.unimib.itAbstract: Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections worldwide and a necessary cause of cervical cancer. Although HPV vaccination and HPV-based cervical cancer screening have strengthened prevention strategies, participation across screening and follow-up pathways remains suboptimal in many settings, limiting programme effectiveness and equity. For nurses and midwives - who play a central role in counselling, education, and community-based prevention - a clear conceptualization of adherence is essential to guide practice, research, and policy. This study aimed to analyze the concept of adherence to HPV-based cervical cancer screening and to propose an operationally useful framework for nursing and midwifery practice. A literature review of peer-reviewed studies addressing adherence to HPV-based or cervical cancer screening published between 1997 and 2025 (n = 38) was conducted using PubMed, CINAHL, and PsycINFO, and Walker and Avant’s concept analysis method was applied. Adherence was defined as the extent to which eligible individuals initiate, complete, and sustain participation in recommended cervical cancer screening pathways over time in accordance with established guidelines, including appropriate timing, test modality, follow-up, and repeat screening. Defining attributes were knowledge, awareness, and empowerment; key antecedents included education and social support; and consequences encompassed improved health outcomes, fewer complications, and reduced healthcare costs. Age, gender-related factors, and healthcare professionals’ counselling practices emerged as moderators influencing adherence behaviors, while anxiety, fear, and perceived lack of need acted as mediators shaping individual screening decisions. This concept analysis clarifies adherence as a complex phenomenon extending beyond a single screening event and supports the development of tailored, nurse- and midwife-led strategies to improve equitable cervical cancer prevention.Keywords: cervical cancer screening, human papillomavirus, adherence, concept analysis, nursing, midwifery