Table 2.
The direct, indirect, and total impacts of factors associated with cervical cancer screening in India using generalized structural equation modeling. NFHS-4, 2015–2016.
| Endogenous Variables | Exogenous Variables | Direct Effect on Respective Endogenous Variable | Indirect Effect on Screening * | Total Effect on Screening ** | |||
|---|---|---|---|---|---|---|---|
| PC (95% CI) | p | PC (95% CI) | p | PC (95% CI) | p | ||
| Screening (n = 82,533) | Age—15:34 | Ref | - | - | - | - | - |
| Age—35:49 | 0.148 (0.112, 0.183) | <0.001 | - | - | - | - | |
| BMI—Underweight | Ref | - | - | - | - | - | |
| BMI—Normal | 0.022 (−0.022, 0.066) | 0.317 | |||||
| BMI—Overweight | 0.125 (0.071, 0.180) | <0.001 | |||||
| BMI—Obese | 0.187 (0.112, 0.261) | <0.001 | |||||
| Visiting health facility—not a big problem | Ref | - | - | - | - | - | |
| Visiting health facility—only distance a big problem | 0.012 (−0.048, 0.073) | 0.695 | - | - | - | - | |
| Visiting health facility—only transport a big problem | 0.010 (−0.063, 0.082) | 0.795 | - | - | - | - | |
| Visiting health facility—transport and distance a big problem | 0.006 (−0.033, 0.046) | 0.749 | - | - | - | - | |
| Contraception use—none | Ref | - | - | - | - | - | |
| Contraception use—condom | 0.046 (−0.018, 0.110) | 0.156 | - | - | - | - | |
| Contraception use—others | 0.169 (0.135, 0.203) | <0.001 | - | - | - | - | |
| Children—none | Ref | - | - | - | - | - | |
| Children—one or two | 0.221 (0.162, 0.280) | <0.001 | - | - | - | - | |
| Children—three or four | 0.126 (0.060, 0.192) | <0.001 | - | - | - | - | |
| Children-more than four | 0.009 (−0.071, 0.089) | 0.821 | - | - | - | - | |
| Autonomy—respondent decides on health care alone | Ref | - | - | - | - | - | |
| Autonomy—respondent decides on health care along with husband | 0.016 (−0.034, 0.066) | 0. 521 | - | - | - | - | |
| Autonomy—husband and family decides on health care | 0.016 (−0.040, 0.072) | 0.576 | - | - | - | - | |
| Sex partners—one | Ref | - | - | - | - | - | |
| Sex partners—two | −0.002 (−0.117, 0.114) | 0.974 | - | - | - | - | |
| Sex partners—more than two | −0.209 (−0.367, −0.052) | 0.009 | - | - | - | - | |
| STI awareness—no | Ref | - | - | - | - | - | |
| STI awareness—yes | 0.327 (0.285, 0.370) | <0.001 | - | - | - | - | |
| Years of schooling | −0.014 (−0.017, −0. 010) | <0.001 | - | - | - | - | |
| Religion—Hindu | Ref | - | - | - | - | - | |
| Religion—Muslim | 0.161 (0.117, 0.206) | <0.001 | - | - | - | - | |
| Religion—Christian | 0.015 (−0.053, 0.083) | 0.669 | - | - | - | - | |
| Religion—others | 0.224 (0.015, 0.295) | <0.001 | - | - | - | - | |
| Wealth Index—poorest | Ref | - | - | - | - | - | |
| Wealth Index—poorer | 0.309 (0.254, 0.364) | <0.001 | - | - | - | - | |
| Wealth Index—middle | 0.528 (0.472, 0.584) | <0.001 | - | - | - | - | |
| Wealth Index—richer | 0.698 (0.639, 0.757) | <0.001 | - | - | - | - | |
| Wealth Index—richest | 0.916 (0.851, 0.981) | <0.001 | - | - | - | - | |
| Contraception Use—No usage versus condom (n = 699,686) | Religion—Hindu | Ref | - | Ref | - | Ref | - |
| Religion—Muslim | 0.197 (0.165, 0.229) | <0.001 | 0.009 (−0.004, 0.022) | 0.158 | Via no.of child level 1 | ||
| 0.056 (−0.001, 0.112) | 0.051 | ||||||
| Via no.of child level 2 | |||||||
| 0.149 (0.102, 0.198) | <0.001 | ||||||
| Via no.of child level 3 | |||||||
| 0.175 (0.117, 0.233) | <0.001 | ||||||
| Religion—Christian | −1.719 (−1.807, −1.631) | <0.001 | −0.080 (−0.190, 0.030) | 0.156 | Via no.of child level 1 | ||
| −0.153 (−0.279, −0.028) | 0.017 | ||||||
| Via no.of child level 2 | |||||||
| −0.089 (−0.214, 0.036) | 0.162 | ||||||
| Via no.of child level 3 | |||||||
| −0.062 (−0.191, 0.066) | 0.339 | ||||||
| Religion—others | 0.506 (0.461, 0.551) | <0.001 | 0.023 (−0.009, 0.060) | 0.156 | Via no.of child level 1 | ||
| 0.240 (0.162, 0.318) | <0.001 | ||||||
| Via no.of child level 2 | |||||||
| 0.237 (0.159, 0.316) | <0.001 | ||||||
| Via no.of child level 3 | |||||||
| 0.245 (0.162, 0.327) | <0.001 | ||||||
| Years of schooling | 0.065 (0.062, 0.067) | <0.001 | 0.003 (−0.001, 0.007) | 0.156 | Via STI 0.053 (0.045, 0.063) |
<0.001 | |
| Contraception Use—No usage versus Others (n = 699,686) | Religion—Hindu | Ref | - | Ref | - | Ref | - |
| Religion—Muslim | −0.636 (−0.653, −0.620) | <0.001 | −0.108 (−0.130, −0.086) | <0.001 | Via no.of child level 1 | ||
| −0.061 (−0.115, −0.007) | 0.027 | ||||||
| Via no.of child level 2 | |||||||
| 0.033 (−0.015, −0.081) | 0.179 | ||||||
| Via no.of child level 3 0.058 | |||||||
| (−0.005, 0.122) | 0.070 | ||||||
| Religion—Christian | −0.773 (−0.796, −0.751) | <0.001 | −0.131 (−0.158, −0.104) | <0.001 | Via no.of child level 1 | ||
| −0.204 (−0.277, −0.132) | <0.001 | ||||||
| Via no.of child level 2 | |||||||
| −0.140 (−0.211, −0.069) | <0.001 | ||||||
| Via no.of child level 3 | |||||||
| −0.113 (−0.187, −0.040) | 0.003 | ||||||
| Religion—others | 0.029 (0.005, 0.054) | 0.017 | 0.005 (0.001, 0.009) | 0.021 | Via no.of child level 1 | ||
| 0.222 (0.150, 0.293) | <0.001 | ||||||
| Via no.of child level 2 | |||||||
| 0.219 (0.147, 0.291) | <0.001 | ||||||
| Via no.of child level 3 | |||||||
| 0.226 (0.151, 0.301) | <0.001 | ||||||
| Years of schooling | −0.065 (−0.067, −0.062) | <0.001 | −0.015 (−0.019, −0.012) | <0.001 | Via STI 0.035 (0.026, 0.045) |
<0.001 | |
| Children (One–two) (n = 699,686) | Wealth Index—poorest | Ref | - | Ref | - | Ref | - |
| Wealth Index—poorer | 0.104 (0.084, 0.123) | <0.001 | 0.023 (0.015, 0.030) | <0.001 | 0.332 (0.276, 0.387) | <0.001 | |
| Wealth Index—middle | 0.190 (0.171, 0.209) | <0.001 | 0.042 (0.030, 0.054) | <0.001 | 0.570 (0.513, 0.627) | <0.001 | |
| Wealth Index—richer | 0.302 (0.283, 0.321) | <0.001 | 0.068 (0.048, 0.085) | <0.001 | 0.765 (0.703, 0.827) | <0.001 | |
| Wealth Index—richest | 0.383 (0.365, 0.403) | <0.001 | 0.085 (0.062, 0.108) | <0.001 | 1.001 (0.932, 1.069) | <0.001 | |
| Religion—Hindu | Ref | - | Ref | - | Ref | - | |
| Religion—Muslim | −0.518 (−0.535, −0.500) | <0.001 | −0.115 (−0.145, −0.084) | <0.001 | - | - | |
| Religion—Christian | −0.399 (−0.421, −0.377) | <0.001 | −0.088 (−0.112, −0.064) | <0.001 | - | - | |
| Religion—others | −0.032 (−0.058, −0.005) | 0.017 | −0.007 (−0.013, −0.001) | 0.024 | - | - | |
| Children (three–four)(n = 699,686) | Wealth Index—poorest | Ref | - | Ref | - | Ref | - |
| Wealth Index—poorer | −0.134 (−0.154, −0.114) | <0.001 | −0.017 (−0.026, −0.008) | <0.001 | 0.292 (0.236, 0.348) | <0.001 | |
| Wealth Index—middle | −0.287 (−0.307, −0.267) | <0.001 | −0.036 (−0.055, −0.017) | <0.001 | 0.492 (0.433, 0.551) | <0.001 | |
| Wealth Index—richer | −0.440 (−0.460, −0.419) | <0.001 | −0.055 (−0.084, −0.026) | <0.001 | 0.643 (0.577, 0.708) | <0.001 | |
| Wealth Index—richest | −0.692 (−0.714, −0.671) | <0.001 | −0.087 (−0.133, −0.042) | <0.001 | 0.829 (0.750, 0.907) | <0.001 | |
| Religion—Hindu | Ref | - | Ref | - | Ref | - | |
| Religion—Muslim | −0.165 (−0.183, −0.146) | <0.001 | −0.021 (−0.032, −0.0097) | <0.001 | - | - | |
| Religion—Christian | −0.192 (−0.216, −0.168) | <0.001 | −0.024 (−0.037, −0.011) | <0.001 | - | - | |
| Religion—others | −0.079 (−0.110, −0.048) | <0.001 | −0.010 (−0.016, −0.003) | 0.003 | - | - | |
| Children (more than four) (n = 699,686) | Wealth Index—poorest | Ref | - | Ref | - | Ref | - |
| Wealth Index—poorer | −0.518 (−0.543, −0.494) | <0.001 | −0.005 (−0.046, 0.037) | 0.821 | 0.304 (0.236, 0.372) | <0.001 | |
| Wealth Index—middle | −0.994 (−1.020, −0.967) | <0.001 | −0.009 (−0.089, 0.070) | 0.821 | 0.519 (0.425, 0.613) | <0.001 | |
| Wealth Index—richer | −1.470 (−1.501, −1.439) | <0.001 | −0.014 (−0.131, 0.104) | 0.821 | 0.684 (0.556, 0.812) | <0.001 | |
| Wealth Index—richest | −2.098 (−2.137, −2.058) | <0.001 | −0.019 (−0.187, 0.149) | 0.821 | 0.896 (0.721, 1.072) | <0.001 | |
| Religion—Hindu | Ref | - | Ref | - | Ref | - | |
| Religion—Muslim | 0.507 (0.484, 0.531) | <0.001 | 0.005 (−0.036, 0.045) | 0.821 | - | - | |
| Religion—Christian | 0.262 (0.229, 0.294) | <0.001 | 0.002 (−0.019, 0.023) | 0.821 | - | - | |
| Religion—others | −0.306 (−0.361, −0.250) | <0.001 | −0.003 (−0.027, 0.022) | 0.821 | - | - | |
| STI | Schooling | 0.197 (0.194, 0.200) | <0.001 | 0.064 (0.056, 0.073) | <0.001 | - | - |
* Via the respective endogenous variable level (The rows in which values are reported). ** Via one or more endogenous variable levels (The row in which values are reported along with the “via”, if specified).