Abstract
BackgroundEffective screening can prevent cervical cancer, but many women choose not to attend their screening tests.ObjectiveThis study aimed to investigate behavioural influences on cervical screening participation using the Theoretical Domains Framework (TDF) and COM‐B models of behaviour change.DesignA qualitative study and semistructured phone interviews were conducted with women invited for routine screening tests within the national cervical screening programme in Ireland.Setting and ParticipantsForty‐eight women aged 25–65 years were recruited from the national screening register.ResultsSeven core themes were identified that mapped to three COM‐B components and 11 TDF domains: (1) knowledge of cervical cancer and screening, (2) coping with smear tests, (3) competing motivational processes—automatic and reflective, (4) cognitive resources, (5) role of social support, (6) environmental influences and (7) perceputal and practical influences. A range of knowledge about screening, perceived risk of cervical cancer and human papillomavirus infection was evident. Factors that influenced screening behaviours may be hierarchical—some were assigned greater importance than others. Positive screening behaviours were linked to autonomous motivation. Deficits in physical and psychological capability (inadequate coping skills) were barriers to screening, while physical and social opportunity (e.g. healthcare professional ‘champions’) could facilitate participation. Older women raised age‐related issues (e.g. screening no longer necessary) and had more negative attitudes to screening, while younger women identified practical barriers.ConclusionsThis study provides insight into screening participation and will aid development of theoretically informed interventions to increase uptake.Patient or Public ContributionWomen invited for screening tests through the national screening programme were interviewed. A Public & Patient Involvement (PPI) Panel, established to provide input into all CERVIVA research projects, advised the research team on recruitment materials and were given the opportunity to review and comment on the interview topic guide. This panel is made up of six women with various cervical screening histories and experiences.
Highlights
Cervical cancer is a global public health issue with an estimated worldwide incidence of approximately 570,000 new cases in 2018, of which over 116,000 occurred in Europe.[1]
We aimed to identify factors that influence women's decisions on cervical screening‐participation using the Theoretical Domains Framework (TDF) and COM‐B models, with a secondary objective of comparing and contrasting factors relevant for younger and older women
Many older women who considered screening unnecessary because of their age or current sexual activity positively assessed cervical screening. These findings suggest that a hierarchy of influences could exist in determining screening behaviours among older women—the perceived personal relevance of screening was more important than their knowledge of its overall health benefits
Summary
Cervical cancer is a global public health issue with an estimated worldwide incidence of approximately 570,000 new cases in 2018, of which over 116,000 occurred in Europe.[1]. It is important to encourage older women to attend screening as the incidence of and mortality due to cervical cancer remain high in this age group.[2] Screening older women can reduce their cancer risk—women who are screened in their early 50s have a 75% lower risk of developing cervical cancer between 55 and 59 years.[6] Considerable research has investigated the factors that are associated with women's screening participation Demographic factors such as ethnicity[7,8]; practical and environmental factors such as accessible appointments and female smear takers[6,9,10]; and psychosocial influences such as trust,[10,11] embarrassment, anxiety[7,12,13] and concerns about pain/discomfort[6,13] have been identified as being related to screening participation. Older women raised age‐related issues (e.g. screening no longer necessary)
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