Abstract
Pap smear rates have been declining in recent years, highlighting the need for effective public health messaging to encourage regular screenings. This study examines how Pap smears and cervical cancer screenings are discussed on TikTok, a key focus of public health messaging efforts. Using the Extended Parallel Process Model (EPPM), we analyzed threat and efficacy messages in 155 TikTok videos tagged with #PapSmear and #FirstPapSmear. Our sample included content from health care professionals and non-health care creators, with diverse racial and ethnic representation. Findings reveal a low prevalence of threat messaging, with only 3.2% of videos addressing the susceptibility to or severity of cervical cancer. In contrast, efficacy messaging was more common: 12.3% of videos provided strategies to make Pap smears more comfortable, and 18.1% discussed the diagnostic benefits of Pap smears. Black creators were more likely to share negative experiences and promote Pap smear importance compared to all other creators, whereas White creators emphasized the diagnostic value of the Pap smear. Hispanic creators most frequently mentioned preparatory strategies, and messages from Asian creators did not include self-efficacy messages. Health sources were more likely than non-health sources to offer preparation tips for Pap smears and emphasize their diagnostic value. Engagement data analyses showed that videos highlighting diagnostic benefits received more likes, while those offering Pap smear preparation tips garnered more likes, comments, and saves. Addressing racial and ethnic differences in the creation of Pap smear content may improve public health education.
Cervical cancer screening is crucial in reducing disease incidence and mortality. Since the 1970s, diagnoses and deaths have declined due to increased prevention and screening (American Cancer Society, 2024). New cases fell from 13.9 per 100,000 in 1975 to 6.6 in 2021, while deaths dropped from 5.5 to 2.3 per 100,000 (National Cancer Institute, 2023). The Pap smear, a key screening tool, detects abnormal cervical cell changes that may indicate pre-cancer or cancer (American Cancer Society, 2024). Most cervical cancer cases occur in individuals without a recent Pap smear (American Cancer Society, 2021).
Screening rates declined across all age groups from 2005 to 2019 (Suk et al., 2022). Between 2019 and 2021, rates for women aged 21 to 65 years fell from 75% to 73.9%, below the Healthy People 2030 (2024) target of 79.2%. Younger women (21â29) are more likely to be overdue for screening than those 30â65 (Suk et al., 2022). In 2021, screening rates were lowest among American Indian or Alaska Native women (53.8%), followed by Asian (62.7%), Hispanic (67.4%), and Black women (72.9%); the highest rates were among White women (78.3%) (Healthy People 2030, 2024). Research also suggests that Black individuals report lower screening rates than White individuals (Ford et al., 2021; Juntamongkol et al., 2024; Spencer et al., 2023).
The U.S. Preventive Services Task Force (2018) recommends that cervical cancer screening begin at age 21, with a Pap smear every 3 years until age 29 years. For women aged 30 to 65 years, screening should continue every 3 years with a Pap smear or every 5 years with a combination of Pap and human papillomavirus (HPV) testing. Research suggests that TikTok videos about Pap smears can increase viewersâ intentions to engage with similar content, particularly when these videos are perceived as autonomy-supportive (i.e., acknowledging fears associated with getting the Pap smear) (Kirkpatrick & Lawrie, 2024). However, because there is limited knowledge about the type of Pap smear content circulating on social media platforms like TikTok, this study aims to examine the nature of Pap smear content on TikTok to better understand its role in health education and screening behavior.
Social Media and Womenâs Health
The rise of social media has elevated womenâs health practices into the spotlight, with womenâs health content gaining popularity on platforms like TikTok. According to Zou et al. (2021), Obstetrics/Gynecology (OB/GYN) topics are some of the most widely discussed topics among health influencers on social media, although the reliability and accuracy of that content remain a concern. For example, TikTokers encourage the discontinuation of hormonal contraceptives and cite rare side effects as the main culprit for these decisions (Cummings et al., 2025; Pfender et al., 2024). In addition, health coaches and influencers on TikTok who post about menstrual cycles encourage viewers to eat and exercise in alignment with the menstrual cycle phases (Pfender et al., 2025), which is a recommendation that goes against current research (Colenso-Semple et al., 2023).
More broadly, social media functions as a form of sex education grounded in the dissemination of embodied knowledge, or personal lived experiences that offer inclusive and emotionally resonant perspectives, especially for marginalized groups (Duggan, 2023; Pfender et al., 2024; Wellman, 2023). Users often evaluate content creators based on perceived authenticity, trustworthiness, and expertise, with experimental evidence linking these perceptions to intentions to enact sexual health behaviors (Pfender & Caplan, 2024). TikTokâs unique affordances amplify emotional and disenfranchised narratives, such as those surrounding premenstrual dysphoric disorder, resulting in higher engagement (Martino et al., 2024; Romann & Pfender, 2024).
One of the less investigated womenâs health topics on social media is Pap smears and cervical cancer screening. Individual accounts and health influencers posting Pap smear content have recorded high engagement, with individual videos reaching up to 1.1 M likes, over 2,000 comments, and nearly 20,000 saves (Lace, 2023) and large followings (ex: Gyno_girls, 2022, 1 million followers). Kirkpatrick and Lawrieâs (2024) preliminary research found that young women perceive doctor-created TikTok content about Pap smears as more credible than peer content. In addition, previous Pap smear content analysis work finds that most videos tagged with #PapSmear are negative, compared to positive or neutral, and are low in actionability and quality of health information (McElrath et al., 2024). McElrath et al. (2024) also found that negative videos primarily focus on personal patient experiences (i.e., 60%). Given their widespread popularity and negative tone, Pap smear-related TikTok videos may have an impact on perceptions of and attitudes toward cervical cancer screening. The Extended Parallel Process Model (EPPM) can help assess whether social media content about Pap smears effectively communicates both the threat of cervical cancer and the efficacy of screenings. By highlighting the severity and susceptibility of the disease, along with the ease and effectiveness of Pap smears, this messaging may increase intentions to get screened, especially in populations with declining rates.
EPPM
The EPPM (Witte et al., 1996) is a framework for understanding health, risk, and fear communication (Maloney et al., 2011). It posits that when exposed to a fear appeal, individuals assess the message based on perceived threat and efficacy (Witte, 1992). Perceived threat consists of severity (belief in the seriousness of a threat) and susceptibility (belief in personal risk) (Witte et al., 1996). Efficacy includes perceived self-efficacy (belief in oneâs ability to act) and response efficacy (belief in the effectiveness of the response) (Witte et al., 1996). This evaluation determines whether individuals accept or reject the message (Witte et al., 1998). When messages contain both a threat and an efficacy component, individuals engage in protective behaviors (Witte, 1992). Yet, when the message is too fear-based and contains little efficacy, individuals may ignore the message entirely (Witte, 1992).
The EPPM has been widely used in health communication research to examine the effect of fear appeals on reducing risk behaviors, with applications in smoking cessation (Wong & Cappella, 2009), drug use (Allahverdipour et al., 2007), and cardiovascular disease (McKay et al., 2004). It has also been applied to social media health messages in womenâs health, including HPV screenings (Chen et al., 2021; Li et al., 2022; Reno & Dempsey, 2023), breast cancer prevention (Chen & Yang, 2019; Luo et al., 2023), pelvic floor disorders (Spiers, 2019), and pregnancy care (Hajian et al., 2015; Jasemzadeh et al., 2016).
Sex education content on TikTok exhibits a mix of message features, including threat-based (fear appeals), efficacy-based (preventive recommendations), and disenfranchised narratives. EPPM has previously been used as a framework in social media content analyses of health-related posts (Pfender & Fowler, 2025; Zou et al., 2021). For example, prior research has demonstrated the prevalence of EPPM messaging on social media, with nearly half (48.4%) of the top health influencer posts containing self-efficacy information (Zou et al., 2021). Although, among OB/GYN content specifically, severity information was less likely to be included compared to cancer-related and dermatological-related posts (Zou et al., 2021). Pfender and Fowlerâs (2025) analysis of birth control discontinuation found the use of both efficacy and threat-based messages. However, threat and fear-based messages were more popular among influencers, and efficacy messages were more popular among health care providers (Pfender & Fowler, 2025). In addition, reels containing messages about medical disenfranchisement (e.g., silenced, stereotyped, ignored) receive significantly more comments and saves compared to reels without medical disenfranchisement features (Romann & Pfender, 2024). Understanding how these message features operate in Pap smear and other womenâs health content on TikTok is essential for designing effective interventions that leverage the platformâs reach. Given EPPMâs relevance to womenâs health messaging on social media, high engagement with Pap smear content, and the influence of health sources on cervical cancer screening intentions (Kirkpatrick & Lawrie, 2024), we propose the following research questions:
Method
Sample Selection
Our unit of analysis was TikTok videos about Pap smears. Videos were selected based on (1) keywords and (2) ranking in terms of user engagement. On May 7, 2024, the authors searched #PapSmear and #FirstPapSmear on TikTok and pulled the top 100 ranked videos for each hashtag. There were 82 videos from #PapSmear and 78 videos from the hashtag #FirstPapSmear after removing duplicates (n = 160). During coding, five videos became unavailable, leaving a final sample of 155 videos. We used #PapSmear to understand womenâs experiences with getting a Pap smear, which has been used in previous work (McElrath et al., 2024) and #FirstPapSmear to understand first impressions. Videos about a first Pap smear might provide reasons why young women do not follow guidelines and delay cervical cancer screening (i.e., age 21â29; Suk et al., 2022) and provide insight into the type of information women receive when they search for health information online. Data collection did not involve human subjects and did not require review at the last authorâs institution.
Coding Categories
The authors created the codebook by reviewing cervical cancer literature (Suk et al., 2022) and by watching sample videos on TikTok. The researchers met to discuss the codes, including their definitions and inclusion and exclusion criteria, and develop exemplars. The final codebook included four sections: video information, creator characteristics, Pap smear experience information, and EPPM variables. We recorded the engagement data on the same day we collected the final sample.
Coding Categories
Creator Characteristics
Creator type
We coded creator type based on the creatorâs number of followers and niche. Content creators included users who had more than 10,000 followers, as this is when TikTok creators can join the creator fund. We characterized the user as a health care provider if they listed medical credentials in their bio (e.g., physician) and separated them into health care providers who are content creators (i.e., > 10k followers) or regular users (i.e., < 10k followers). Regular users included those who were not health care providers and who had less than 10,000 followers. When the profile was a business or organization, we coded it as organization/other health source. For the analysis, we created a variable where 1 = health source (i.e., health care provider, health organization) and 2 = non-health source (i.e., content creator, regular user).
Observed racial identity
We coded the observed racial identity of the creator based on previous content analysis work that utilized the recorded observed racial identity of media characters (Bleakley et al., 2018; Ellithorpe et al., 2017). To determine racial identity, we employed a multiple step process. First, coders identified the racial identity of the creator through observation and checking the creatorâs profile. After achieving reliability, a racial identity verification process proceeded. The first author reviewed hashtags from each creatorâs most recent 20 posts. Many creators used hashtags or post descriptions that suggested their racial identity such as #BlackGirlMagic, #LatinaBlogger, or captioning the post, âMy beautiful Asian family.â Finally, each creatorâs racial identity was verified through a Google search. Many high-profile creators have personal websites or Wikipedia with racial/ethnic identity information. When Google could not provide verification, a creatorâs last name was not available on TikTok, or coders could not achieve intercoder reliability, we grouped the creator as âotherâ (n = 20, 13.3%).
Demonstration
The demonstration code captured videos that visually displayed a demonstration of a Pap smear by a provider (whether a demonstration was present (1) or absent (2)). Providers primarily conducted demonstrations of a Pap smear on dummies.
Location
We coded the location of the filmed video. Options included doctorâs office, car, bedroom, no location, and unknown. Coders could select multiple items.
Pap Smear Experience (Fear-Based Appeals)
Film facial expression
When creators filmed their facial expressions during their Pap smear, we selected present (1). When the creator did not film their face but filmed other parts of the room, such as the medical tools, we coded absent (0).
Reaction
We coded creatorsâ verbal and written reactions to their Pap smear. Options included painful, uncomfortable, pressure, not that bad, and silence. Coders could select multiple descriptions for this code.
EPPM Variables
Threat: susceptibility/severity
We coded susceptibility and severity as one variable. When creators talk about the number of diagnoses or deaths, they are inherently discussing both the likelihood of occurrence (susceptibility) and the potential serious outcomes (severity). Separating them might not accurately reflect the way these concepts are naturally presented and perceived in the videos. Thus, when creators discussed the number of diagnoses or deaths, extreme or unwanted side effects, unpleasant treatment related to cervical cancer, or commonality, we coded present (1).
Self-efficacy: often
We coded how often creators suggested women should get a Pap smear. Options included, once a year, it depends on the results, every 3 years, and every 5 years.
Self-efficacy: prepare
We coded whether the creator provided ways to make the Pap smear more comfortable. When they provided ways to improve the Pap smear, we coded present (1). When we coded present (1), we identified the specific strategy which included: request a smaller speculum, take Ibuprofen or a painkiller, do research on available doctors, watch othersâ experiences on social media, talk to others who have had a Pap smear, and other.
Response efficacy: detect/diagnose
We coded whether the content creator verbally mentioned that Pap smears helped detect abnormalities (e.g., HPV, cervical cancer) in her own experiences or among others who she knows. For example, one creator said, âI had a Pap smear that showed some abnormalities.â If the creator indicated that the test works to diagnose or detect, we coded present (1).
Response efficacy: recommend
We aimed to capture whether creators recommended getting a Pap smear. If the creator verbally stated, âI recommend getting a Pap smear,â we selected present (1).
Coding Protocol
Coders trained in two separate sessions using 24 videos not included in the final sample. The training sample was selected using the same inclusion criteria except they were not part of the top 100 videos. Once the coders reached ⼠.75 using Gwetâs agreement coefficient (AC) (Gwet, 2002) on all training videos, they moved to the final sample. Gwetâs AC is an inter-rater reliability measure that is advantageous because it adjusts for rare codes and corrects bias (Gwet, 2002). Next, the coders double-coded 30% of the final sample. After reaching reliability on the final sample, coders split the remaining videos and coded independently. Table 1 contains reliability statistics.
Final Sample Reliability and Descriptive Statistics
Statistical Analysis
We calculated frequencies for each variable. To test for associations between categorical or binary variables, we used chi-square analyses (e.g., racial identity and susceptibility). Due to skewed engagement data (i.e., likes, comments, saves), we analyzed relationships between categorical and continuous items using nonparametric MannâWhitney U-tests. We conducted all analyses using STATA 18.0.
Results
Sample
Creators were female (n = 153) or trans men (n = 2). Some creators verbally provided their exact age (10.3%, n = 16) with a mean age of 23.4 (SD = 2.33). In addition, creators were Asian (8.6%, n = 13), Black (19.9%, n = 30), Hispanic (11.3%, n = 17), White (47.0%, n = 71), and other or unknown (13.3%, n = 20). While many videos focused on a creatorâs lived experience, 15% (n = 24) of the videos were demonstrations of a Pap smear on a manikin or dummy. In addition, 60.6% of the videos were filmed in a doctorâs office, followed by a car (17.4%, n = 27), bedroom (12.9%, n = 20), or other space (7.7%, n = 12). Finally, creators suggested that female individuals should get a Pap smear every year (3.9%, n = 6), every 3 years (2.6%, n = 4), and/or that it may depend on the results (1.3%, n = 2); most videos did not provide guidance (92.2%, n = 142).
Research Questions
The first research question asked how TikTok videos about Pap smears present threat and efficacy messages. Few TikTok videos contained threat appraisals. Compared to threat appraisals, more TikTok videos contained self-efficacy and response efficacy messages. For response efficacy, creators suggested that a Pap smear can help detect or diagnose cervical cancer. In addition, some creators recommended scheduling a Pap smear. Descriptive statistics can be found in Table 1.
The second research question sought to understand differences in Pap smear content by racial/ethnic identity. We examined differences in threat and efficacy appraisals, reactions to the Pap smear, and whether they filmed their face during their Pap smear for social media (i.e., pap experiences), by creatorsâ racial/ethnic identity. Chi-square tests were used to examine differences between self-efficacy and response efficacy by racial/ethnic identity, but cells were less than 5, so the significance results were unstable (Camilli & Hopkins, 1978). However, frequencies revealed differences among racial and ethnic groups. Differences can be found in Table 2.
Proportions (%) of Race/Ethnicity of Creators by Message Features Used in Videos
The third research question sought to understand differences in threat and efficacy message by video source. Chi-square tests revealed a significant difference in self-efficacy (i.e., strategies to prepare for a Pap smear) by source type, Ď2(1) = 6.37, p = .01. Specifically, 22.7% of health sources provided ways to prepare for a Pap smear, whereas 8.0% of non-health sources provided ways to prepare for a Pap smear. However, only 47.4% of providers recommended ways to make the exam more comfortable, whereas 52.6% of non-providers made recommendations to increase comfort, Ď2(1) = 6.11, p = .01. Chi-square tests revealed a significant difference in response efficacy (e.g., Pap smears can detect and diagnose abnormalities) by source type, Ď2(1) = 11.18, p = .001. That is, 34.3% of health sources suggested that Pap smears can detect abnormalities, whereas only 11.7% of non-health sources suggested that Pap smears can detect abnormalities. There were no significant differences in susceptibility/severity or recommendations to schedule a Pap smear by source type.
Finally, we investigated which types of Pap smear messages were associated with the greatest engagement (RQ4). Medians for threat and efficacy messages can be found in Table 3. The MannâWhitney U-tests revealed no significant differences in engagement for threat or efficacy messages. However, videos that provided tips for preparing for a Pap smear had the most likes, comments, and saves compared to other threat and efficacy messages. Finally, videos involving filming facial expressions during the Pap smear had a high number of likes (range = 66â1,700,000) compared to threat and efficacy messages.
Median Engagement Statistics for Threat and Efficacy Appraisals, and Pain Experience
Discussion
This study examined TikTok content related to Pap smears through the lens of the EPPM to better understand how creators communicate messages about cervical cancer screening. Previous research documents that Pap smear TikToks can be negative in tone and score low on actionability and quality of health information (McElrath et al., 2024). Building on previous work, the current study explores how threat and efficacy messages are embedded in TikTok content and identifies differences in the portrayal of these messages based on the racial and ethnic identity of the content creators. Below, we contextualize three key findings within the extant literature and provide implications for practice, research, and policy.
The TikTok videos analyzed in this study generally presented low threat and efficacy messages, which may limit their ability to effectively promote health behaviors, such as increasing intentions to attend Pap smear appointments. Only 3.2% of videos contained threat appraisals, with a small number of creators addressing the susceptibility to or severity of cervical cancer. In contrast, more videos included efficacy messages, with 12.3% providing strategies to prepare for and make Pap smears more comfortable, such as communicating with the doctor or requesting a smaller or plastic speculum. However, relative to the entire sample, there were still few efficacy-related messages present in Pap smear and cervical cancer content. These findings contrast with previous health behaviors on TikTok. For example, Pfender and Fowler (2025) found that 21% of creators used severity messages and 22% used susceptibility messages. In addition, 36% of creators provided ways to manage birth control discontinuation and 33% said symptoms are reversible (Pfender & Fowler, 2025). Zou et al. (2021) found that 48% of health messages contained self-efficacy information. It is possible that cervical cancer is not recognized as a threat online.
Black creators posted the most content promoting Pap smears while also sharing negative experiences and pain during exams. They frequently disclosed painful experiences not only through narratives and comments but also by filming facial expressions (e.g., wincing) during exams. Depictions of pain align with research on Black womenâs higher reported pain levels in health care, reflecting systemic racism and the false belief that Black patients feel less pain than White patients (Trawalter & Hoffman, 2015). In addition, filming painful facial experiences had the second highest range of likes (up to 1.7 million likes) compared to other message features in this study, aligning with previous research findings that viewers are more likely to engage with emotional and disenfranchising messaging (Romann & Pfender, 2024). Posting about pain on social media serves as health advocacy, amplifying shared experiences to highlight broader issuesâsimilar to social media advocacy for intrauterine device (IUD) insertion pain, which led the Centers for Disease Control and Prevention (CDC) to update its pain control protocol (Healthline, 2024). Black creators also posted the most content recommending Pap smears, using social media to counter negative medical experiences and emphasize screening importance.
Results indicate differences in the content posted by health sources (i.e., physicians, nurses, health organizations) and non-health sources (i.e., individual users, influencers, etc.). Health source content, or content posted by medical provider influencers and health organization accounts, was more likely to use efficacy strategies in TikTok content pertaining to Pap smears, compared with non-health sources. This aligns with findings from Kirkpatrick and Lawrie (2024), who reported that doctor-created TikToks are perceived by young women as more credible and effective than those created by peers. Together, these findings suggest that not only do health sources more frequently use messaging strategies known to support health behavior change (e.g., efficacy messaging), but they are also more trusted by audiences. TikTok and similar social media platforms may serve as effective, credible, and accessible tools for medical professionals and health organizations to educate and empower patients.
However, an additional comparison was made between organizations, influencers, health coaches, and regular users (i.e., non-providers) and providers. Non-providers were more likely to provide tips for increasing comfort during the Pap smear exam, compared with providers. This finding contrasts with previous research, which finds that providers are more likely to use efficacy messages and make recommendations (Pfender & Fowler, 2025). Despite this discrepancy, tips for managing Pap smear exams received the highest median engagement compared to other EPPM features, which is in line with previous research (Pfender & Fowler, 2025). Tips for preparing for and making Pap smears more comfortable was the highest engaged message feature, including likes, comments, and saves, which should signal to credible providers that more of this type of content is warranted on social media.
Implications for Practice
The limited use of threat appraisals and modest inclusion of efficacy messaging may reduce the potential of these videos to generate sufficient fear and efficacy to drive behavior change and act as a form of health promotion even though, however, that may not be the creatorsâ intent (Witte, 1992). Furthermore, results suggest that content from medical professionals and health organizations was more likely to include efficacy strategies, reinforcing the role of health providers as credible sources of information (Kirkpatrick & Lawrie, 2024). To improve access to accurate and actionable health information, public health agencies should encourage medical professionals to engage in social media content creation or partner with influencers to disseminate evidence-based messages about cervical cancer screenings. Health promotion practitioners and public health organizations should consider partnering with content creators to co-develop messages that integrate both threat and efficacy elements to encourage cervical cancer screenings (Motta et al., 2024).
Results also demonstrate differences in presentations of threat and efficacy by racial/ethnic identity of content creators. Cervical cancer screening rates (Fuzzell et al., 2021), attitudes, and knowledge about screening (Ford et al., 2021; Johnson et al., 2008; Yoo et al., 2011) vary by racial identity groups. Social media messages about cervical cancer screenings varying by the racial identity may reveal access points for public health messaging, education, and intervention. Hispanic creators posted the highest number of videos utilizing self-efficacy messages, or videos which help increase perceptions of being able to carry out the target behavior. Hispanic women have higher rates of cervical cancer mortality compared to White women (Gauss et al., 2013) and are least likely to report not knowing about cervical cancer screening (Suk et al., 2022). Efficacy messages from creators in their community have potential implications for increasing cervical cancer screening behavior. Health promotion practitioners should partner with Hispanic influencers, in particular, to amplify empowering and action-oriented content related to cervical cancer screening disparities, as well as educational content explaining what a Pap smear does. To compare, results also found that Asian creators did not use any self-efficacy messages in their content. As Asian women are the racial identity group that is least up to date on their Pap smears (Suk et al., 2022), health promotion practitioners should aim to increase social media messages and campaigns about how to make appointments more comfortable and specific directions for scheduling a screening.
Implications for Research
Building on Kirkpatrick and Lawrieâs (2024) work, future research should experimentally test the impact of TikTok videos created by health professionals and non-health sources (e.g., influencers or health coaches) on viewersâ attitudes, perceived credibility, and behavioral intentions related to cervical cancer screening. This work could assess whether efficacy-based messaging from credible medical voices leads to greater perceived self-efficacy, intention to get screened, and message sharing. Investigating differences in the impact of message features like efficacy is important because emerging social media research suggests that posts that perform best are highly emotional, rather than educational (Romann & Pfender, 2024).
While this study does not examine viewer demographics, future research could explore how creator messaging, especially pain-based messaging when filming facial expressions, influences Pap smear intentions within racial communities. Understanding how race, representation, and emotional expression intersect in Pap smear content may help tailor more effective cervical cancer screening campaigns for historically underserved populations.
Implications for Policy
Finally, these findings have two important implications for social media policy. First, to reduce cervical cancer disparities and promote preventive care, platform-based policies should prioritize and promote credible and actionable content created by verified medical professionals. Specifically, posts that promote proactive behaviors, such as getting screened for cervical cancer, should be pushed further into user feeds to increase engagement, especially when they contain efficacy-based messaging. Second, TikTok should consider implementing health-promoting infrastructure by linking hashtags such as #PapSmear with directories of OB/GYNs in the United States currently accepting new patients in various geographical areas. These features could reduce structural barriers, increase efficacy, and promote health equity. TikTok has done this in the past by linking certain hashtags with nutrition and mental health-related benefits (Singleton, 2025).
Limitations
Although this study has several strengths, there are limitations that serve as guidance for future research. Although the study sampled a diverse group of content creators, we were still unable to run significance tests (i.e., chi-square tests) because there were fewer than five individuals per cell (Camilli & Hopkins, 1978). Currently, the study only provides racial and ethnic differences using descriptive statistics. In addition, this study sampled content at one point in time, and a larger sample might account for fluctuations in the algorithm. Finally, although content analysis is useful for understanding Pap smear and cervical cancer messaging, it cannot determine how the messages affect behavior.
Conclusion
This study examines Pap smear content on TikTok, revealing both its effectiveness and limitations. While some creators stress screening importance, threat and efficacy messages are often lacking. Content varies by race and ethnicity: Hispanic creators highlight self-efficacy, White creators emphasize response efficacy, and Asian creators rarely include self-efficacy messages. Black creators emphasize pain during the exam but are most likely to recommend scheduling a Pap smear. These findings underscore the need for culturally tailored health messaging on social media, developed collaboratively with content creators and health professionals, to boost Pap smear uptake and enhance cervical cancer prevention.
