This study conducted a cross-sectional study among communities in Wuxi City from March 1st to 30th, 2022. Affected by COVID-19, the questionnaire was distributed online.

The sampling method adopted convenience sampling and calculated the sample quantity according to the international scale formulation principle (24). One item in the scale corresponded to 5–10 samples. This scale contained 23 items and four variables, Considering the inefficiency of 10%-20% samples, and 10%-20% of sample inefficiency was considered. The sample size was calculated as follows:

Entries corresponded to sample size: (23 + 4) × 5 = 135 (23 + 4) × 10 = 270

Invalid quantity: 135 × 0.1 = 13.5 135 × 0.2 = 27 270 × 0.1 = 27 270 × 0.2 = 54

Sample size ranged: (135 + 13.5) = 148.5 (135 + 27) = 162 (270 + 13.5) = 283.5 (270 + 27) = 297

Therefore, the sample size ranged from 149 to 297, and the sample size finally selected for this survey was 300.

Due to the impact of COVID-19, participants were recruited online in Wuxi City. Introduction and guidance were provided to each participant before filling in the questionnaire, The questionnaire was anonymous and collected in the online software “Questionnaire Star.”

To ascertain the intentions of Chinese women about CCS, this questionnaire was developed based on a literature review and expert panel recommendations. And semi-structured interviews were conducted with 20 female participants recruited from health facilities that were not part of the actual study. To investigate the study population's salient beliefs about the expected outcomes of utilizing CCS services, the perceived impact of social norms, and personal autonomy to seek services. Participants were invited to present their views on the benefits of using CCS services, who they believed would promote or dissuade them to use CCS services, and what hindered or facilitated their use of CCS services. In addition, the cultural relevance and linguistic intelligibility of items in the structured questionnaire were explored through pre-tests conducted before data collection.

The questionnaire was divided into two sections. The first part was the characteristics of the participants, including age, place of residence, marital status, occupation, monthly income, education level, medical insurance, and family history of cancer and cervical disease. The second part included four dimensions of the TPB structure to measure CCS willingness. Answers ranged from “strongly agree” to “strongly disagree.”

Jiangnan University's Medical Ethics Committee approved this study (No: JNU20220901IRB03). All investigators provided oral consent. The Ethics Committee of the Jiangnan University School of Medicine approved and waived the need for a written informed consent signature, because this study was in the form of a questionnaire survey, the risk to the subjects was less than the minimum risk, and the exemption of written signature of informed consent would not adversely affect the rights and health of the subjects. All methods were carried out in accordance with relevant guidelines and regulations.

A pilot study was conducted with 20 participants. The layout of the questionnaire was improved based on participant comments.

In “Behavior attitude,” “I feel that having regular cervical cancer screenings gives me peace of mind about my health” was changed to “I believe regular cervical cancer screening can provide me with peace of mind about my health.”

In addition, “I think cervical cancer screening can help reduce the death rate of women” was modified to “I think cervical cancer screening can help reduce mortality.”

In “Subjective norm,” “I am willing to listen to the advice of people around me to get cervical cancer screening” was adjusted to “I would like to take advice from someone close to me for cervical cancer screening.”

In “Perceived behavioral control,” “If cancer is found, I choose not to know” was changed to “I choose not to know if cancer is detected.”

In “Behavioral intention,” “After knowing the relevant information, I am willing to undergo cervical cancer screening” was modified to “I'm willing to have a cervical cancer screening now that I have learned the necessary details.”

All data analyses were conducted using Statistical Package for Social Science version 26 (SPSS 26.0) (25). Descriptive statistics were used to describe demographic and components of the planned behavior model of the sample. Univariate analysis was performed by calculating relative frequencies, means, and standard deviations.

As a bivariate analysis, the relationship between the theoretical constructs of intention and planned behavior was examined using Pearson's correlation analysis. Multiple linear regression models were applied to identify independent factors related to the intention to use CCS services. P < 0.05 was considered statistically significant.

Reliability referred to the stability and consistency of the results measured by the questionnaire. Internal consistency of the subscales and the entire instrument was assessed by Cronbach's alpha coefficient and split-half reliability. Generally, Cronbach's alpha coefficient of 0.70 or above was considered acceptable, and 0.80 or more was recommended.

A total of 300 participants responded to the questionnaire, excluding low-quality questionnaires with repeated responses, and the final sample included 286 participants. The mean age was 31.62 (±8.27) years, most people (85.7%) lived in cities, and 66.4% were married. Of the participants, 8% were workers, 16.4% were technicians, 7.7% were service workers, and the rest accounted for 67.8%. 127 people (44.4%) had a monthly income of < 3,000-yuan, 3,000–5,000 yuan accounted for 24.1%, and 112 people (39.1%) had a monthly income of more than 5,000 yuan. More than half of the participants (82.2%) had an associate degree, 86.7% had health insurance, the majority (86.7%) had no family history of cancer, and 95.8% had no history of cervical disease. Table 1 displayed demographic information about the participants.

The construction of the TPB was assessed through four items and was assessed using the Likert five-scale scale. According to the measurement results, in terms of behavior attitude, 72.7% of the respondents said that it was crucial to learn about CCS, 56.3% of the respondents said that they would regret if they missed or failed to engage in CCS, and 68.9% of respondents believed that CCS for all eligible women should be conducted. In terms of subjective norms, 61.2% of the respondents said that they were more willing to get screened for cervical cancer on the advice of someone close to them, and 65.7% of the respondents believed that it was important to follow the doctor's advice to do CCS. In terms of PBC, 50.3% of the respondents believed that CCS was entirely up to them, and 55.2% of the respondents indicated that they would do CCS even if they were healthy. In terms of behavioral intentions, 53.8% of the respondents indicated that they would have regular CCS. The statistical table of cervical cancer screening based on TPB in Chinese women's intentions was shown in Table 2.

The mean score of TPB structures was calculated using descriptive statistics. The mean scores for direct attitude, subjective norm, and PBC were 32.5 (SD = 3.3), 22.6 (SD = 2.8), and 29.6 (SD = 3.4), respectively. The mean score for the intention was 13.5 (SD = 1.8). The descriptive statistical table of the components of the planned behavior model of Chinese women was shown in Table 3.

To predict behavior intentions for CCS use, a simple linear regression analysis was conducted using all TPB constructs and variables that were significant in the bivariate analysis. Attitudes, subjective norms, and PBC of CCS were included in a multivariate linear analysis. Standardized regression coefficient subjective norm was found to be the best factor (B = 0.234, p < 0.01) followed by PBC (B = 0.171, p < 0.01). These showed that women who believed significant others would support their use of CCS services were 23.4% more likely to use CCS than their peers, holding other things constant. A 17.1% increase in positive unit-changed intentions for perceived control of environmental facilitators' beliefs about using CCS services. Similarly, a unit-positive shift in women's perceptions of the benefits of using CCS services would boost someone's intention to utilize them by 11% if all other variables remained constant. In this study, it was discovered that attitude was the least component connected with the intention to utilize CCS. (B = 0.110, p < 0.01). Table 5 showed the independent factors related to the behavioral intention of cervical cancer screening.

Cronbach's alpha reliability and split-half reliability of the whole questionnaire were 0.912 and 0.894, and the coefficients of each subscale ranged from 0.903 to 0.931, showing a certain internal consistency.