Predicting Pap-Test Noncompletion in Kazakhstan Using a Brief Questionnaire Derived from Screening-History Data

Background/Objectives: Brief assessments may help identify women requiring support after a cervical-screening recommendation. We investigated whether a questionnaire model estimated against a historical screening-history proxy could rank subsequent 90-day Pap-test noncompletion, and whether its probabilities required updating. Methods: Of 743 historical records, 601 met the analytical age criterion of 30–74 years; observed ages were 30–60. A 12-item questionnaire represented six content domains encoded as seven predictors in ridge logistic regression. The frozen equation was evaluated in 372 women with a Pap-test recommendation and prospectively recorded 90-day outcomes. Recalibration was assessed with repeated cross-validation. Additional analyses compared cohort characteristics, predictor contributions and simpler assessments. Results: The historical proxy comprised 36 never-screened and 102 uncertain-history responses, versus 463 affirmative histories. Prospectively, 126/372 women (33.9%) did not complete testing. Frozen AUC was 0.866, mean predicted risk 19.8% and Brier score 0.166. The updating slope was 0.448; the mean cross-validated Brier score after updating was approximately 0.134. Prevention attitude alone ranked outcomes with an AUC of 0.846; the paired AUC difference of 0.019 had a 95% bootstrap interval of −0.011 to 0.053. An exploratory attitude-only model had lower prediction error after matched cross-fitted updating. Conclusions: Questionnaire-based ranking transferred between related but different outcomes, whereas absolute probabilities required substantial updating. Comparative prospective evaluation is needed to establish the added value and clinical utility of the brief model.