Artificial neural networks (ANNs) for modeling efficient factors in predicting pap smear screening behavior change stage

BACKGROUND AND OBJECTIVES: Cervical cancer is ranked as the third most prevalent cancer that affects women all over the world and Pap smear seems to be the single most critical intervention to prevent cervical cancer. In the present study, the effects of demographic factors (age, education level, job, income level, marriage age, pregnancy, child number, breastfeeding, and menopause), insurance type, disease history and screening (sono and mammography, breast problem) and cancer information on Pap smear screening and behavior stage of change were investigated and modeled using an artificial neural network model (ANN). MATERIALS AND METHODS: Data were collected from a descriptive-analytical cross-sectional study. This research was conducted on 1898 female employees of governmental agencies of Birjand, a city located in the east of Iran. The questionnaire consisted of four parts (socioeconomic, reproductive characteristics, information about cervical cancer screening, and stage of change for cervical cancer screening). Multilayer feed-forward back-propagation neural networks were used to detect the patterns between variables using a neural network with 14 inputs and one output. To find out the neural network with the minimum sum of squared errors, we evaluated the performance of all neural networks using varying algorithms and numbers of neurons in the hidden layer. For this purpose, the data collected from 1898 women were analyzed using SPSS-22 software. RESULTS: In the optimal ANN model, the variables of marriage age, age, breastfeeding, and the number of children were identified as the most significant factors with 18.3, 16.3, 7.3, and 7.3 percent, respectively, whereas the history of cancer, job, pregnancy, and menopause had importance of lower than 5 percent. CONCLUSION: Our findings showed that among many associated variables, the marriage age, age, breastfeeding, and the number of children were the most important predictors for the behavioral stage of change. Thus, it seems, focusing on these factors may lead to the adoption of effective programs and policies to improve cervical cancer screening practices in women.