Physician-Level Determinants of Cervical Cancer Screening Practices: A Socio-Ecological Model-Based Study from Adjara, Georgia

Background/Objectives: Cervical cancer is widely recognized as a preventable disease; however, participation in screening programs remains insufficient in many transitional health systems. In the Georgia, organized screening services are available, yet utilisation remains low, indicating barriers to screening extend beyond access alone. This study, therefore, examined physician-level factors influencing the promotion of cervical cancer screening in the Adjara region of Georgia, with focus on routine clinical practice and organizational conditions. Methods: A cross-sectional survey was carried out among physicians providing outpatient and preventive services in six municipalities of the Adjara region. The analysis was guided by a socio-ecological framework and examined individual, inter-personal, and organizational factors in relation to physicians’ recent cervical cancer screening recommendation practices. Multivariable logistic and ordinal regression analyses were used to identify factors associated with screening promotion. Results: Despite a generally high level of support for cervical cancer screening among physicians, regular screening recommendations were not consistently reported. Limited consultation time, uncertainty regarding screening-related harms, and rural practice settings were independently associated with a lower probability of having recently recommended screening. In contrast, favourable attitudes toward screening on their own were not sufficient to translate into routine preventive practice. Conclusions: These findings indicate that gaps between physician attitudes and screening promotion are largely driven by structural and organizational factors rather than a lack of professional support. Efforts to reduce workflow constraints, improve clarity around screening guidance, and integrate preventive counselling into routine clinical practice may be essential for improving screening uptake in similar healthcare system contexts.