Interventions to Improve Cervical Cancer Screening Uptake Among Women in Middle Eastern Countries: A systematic Review (Preprint)

BACKGROUND Cervical cancer (CC) continues to be a critical concern among the population of Middle Eastern (ME) countries, as it has low rates of screening uptake, resulting in elevated incidence and mortality rates despite effective preventive interventions. Educational and behavioural interventions have demonstrated some potential in filling in the gaps of awareness and encouraging participation but have limited evidence specific to the area. OBJECTIVE To determine the efficacy of educational and behavioral-based intervention versus usual care or no treatment in raising CC screening among women in the ME countries. METHODS An overview search was done in PubMed, Embase, and Web of Science from January 2000 to December 2025, with the addition of grey literature and reference verification. Based on study selection, a title/abstract screen was done by a single reviewer, and a full-text evaluation was done by two independent reviewers. Two reviewers conducted data extraction using a piloted template. The quality of methodology was assessed through the Effective Public Health Practice Project tool by two reviewers. Heterogeneity led to the use of narrative synthesis. RESULTS The research included sixteen (16) articles (n=4,922 participants), and most of these organizations were in Iran (n=9) and Turkey (n=5). Any positive effect, and absolute screening uptake increases of 8-85% in intervention groups compared to 0-8% in control groups. The greatest gains were achieved with multi-component, theory-based interventions (e.g., those based on the Health Belief Model). There was continuous improvement in the secondary outcomes. The overall quality was moderate (1 strong, 11 moderate, 4 weak), with the predominant biases related to blinding and selection. CONCLUSIONS There is moderate-certainty evidence that educational and behavioural interventions, and especially multi-component and theory-based interventions, are effective in raising CC screening uptake compared with usual care in the ME context. Culturally designed programs should be implemented, but more high-quality studies are needed to ensure long-term sustainability and generalisability.