<![CDATA[Cervical cancer screening remains suboptimal in Indonesia, and women whose livelihoods depend on tourism-linked microenterprises may face additional constraints related to work schedules, mobility, privacy, and access to preventive services. This study evaluated a two-cycle participatory action research intervention in which peer-led health communication was progressively refined to improve cervical cancer screening among women in tourism-linked communities. Eighty-four women aged 30-50 years and eight peer facilitators participated in the community-based action research process. Baseline co-diagnosis was followed by Cycle 1, consisting of small-group peer education, myth clarification, risk-benefit discussion, and referral information. Reflection after Cycle 1 identified persistent barriers, leading Cycle 2 to add peer-buddy support, reminder messages, family-oriented communication, flexible appointment coordination, and facilitated navigation to screening services. Repeated-measures analyses assessed changes in knowledge, self-efficacy, perceived barriers, social support, and screening intention, while service records were used to verify screening completion. Mean knowledge increased from 54.6 ± 12.9 at baseline to 64.8 ± 13.3 after Cycle 1 and 72.1 ± 12.0 after Cycle 2. Self-efficacy increased from 2.74 ± 0.63 to 3.19 ± 0.74 and 3.66 ± 0.68, whereas perceived barriers decreased from 3.64 ± 0.64 to 3.19 ± 0.66 and 2.77 ± 0.62. All repeated-measures effects were statistically significant (p < 0.001). Verified screening completion increased from 0% at baseline to 29.8% (25/84) after Cycle 1 and 66.7% (56/84) after Cycle 2. These findings show that peer-led communication was more effective when combined with social support, flexible access, and practical service navigation informed by participant reflection.]]>
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