Abstract
ObjectiveAccording to the precaution adoption process model, cervical screening nonparticipants represent a heterogeneous group including those who are unaware of, unengaged with, or undecided about screening, as well as intenders and decliners. We aimed to explore beliefs about cervical screening among these different types of nonparticipant.MethodsSemistructured interviews were carried out with women aged 26 to 65 years living in Britain (n = 29). Women were purposively sampled to represent different nonparticipant types. Interviews were transcribed verbatim, and data were analysed thematically using framework analysis.ResultsThe salience of some barriers to screening varied between different types of nonparticipant. Bad experiences were prominent in the discussions of women who had decided not to attend, while practical barriers were more prominent among intenders. There was also some overlap between nonparticipant types. For example, many of the undecided women described not wanting to go for screening, but with less certainty than decliners. Some intenders (particularly those who had not been screened before) described not really wanting to attend but feeling they ought to. Women's views on the invitation/reminder process also varied; intenders and maintainers appreciated written reminders and general practitioner (GP) prompts but decliners sometimes perceived these as “badgering.” Throughout the interviews, women described changing views on screening in the wider context of ageing and motherhood.ConclusionsThe salience of screening barriers varies by nonparticipant type, offering possibilities for tailored interventions. However, the fluidity of women's stage of screening adoption might have implications for this approach to intervention design.
Highlights
Regular cervical screening participation is associated with lower risk of cervical cancer and earlier‐stage diagnosis when the disease does occur.[1]
In a recent survey[3] based on the precaution adoption process model (PAPM),[4] we found that among cervical screening nonparticipants, 50% intended to take part, 28% were not aware of the programme, and 15% had decided not to go
Seven women were in the earlier stages of the PAPM, 16 were decliners, seven were intenders, and six were maintainers
Summary
Regular cervical screening participation is associated with lower risk of cervical cancer and earlier‐stage diagnosis when the disease does occur.[1]. There is an urgent need to better understand women's reasons for nonparticipation, to reduce barriers to attendance in those who would like to take part, and to ensure that nonparticipants have made an informed choice not to attend. In a recent survey[3] based on the precaution adoption process model (PAPM),[4] we found that among cervical screening nonparticipants, 50% intended to take part (intenders), 28% were not aware of the programme (unaware), and 15% had decided not to go (decliners). A smaller minority were unengaged with the decision, and very few were undecided about screening (for a detailed description of the PAPM, see Marlow et al[3]). In terms of psychological differences, unaware women were the most fatalistic, unengaged were most likely to avoid health information, and decliners had the lowest perceived risk of cervical cancer.[5]
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