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Table 1 Factors of the SEM and TTI modified and applied in this study

From: The impact of the social environment on Zambian cervical cancer prevention practices


TTI b Environment level

(Stakeholders, Special interest groups, Policy makers)

Factors that influence behaviour as applied in the interview guides of the current study


(Stakeholders) - Social institutions with organizational characteristics, and formal/informal rules and regulations for operation.


Aspects of women’s immediate surroundings, neighbourhoods, social institutions, and culture that, although beyond the personal control of women, put them at risk

• availability of servicesc

• employment ratesc

• inadequate schoolsc

• media depictionsc

• (worksite) policies that vaccination and screeningd


(Special interest groups) - Relationships among organisations, institutions and informal networks within defined boundaries.


Values and behaviours of women that contribute to their attitudes toward screening and vaccination

• information opportunities (media and advertisements)

• interaction with social institutions (conducting campaigns)

• knowledgec

• stigma, values and evaluations (religious beliefs, cultural norms, barriers/uptake, priority, prevalence)

Public policy

(Policy makers) - Local, state, and national laws and policies


Beliefs and evaluations about the benefits of cervical cancer prevention

• age recommendations of screening and vaccination

• possibility of self-screening and cost

• possibility of vaccinating girls and boys

  1. aSEM definitions of levels from [3]; [9]
  2. bTTI definitions of levels from [19]
  3. cOnly the TTI mentions this factor
  4. dThe factor “policy”, is mentioned in the SEM at both organizational and public policy level