Cervical Screening Attendance Research Articles

Factors associated with participation in cervical cancer screening among young Koreans: a nationwide cross-sectional study

ObjectivesDespite the possibility of early detection of cervical cancer, participation in screening programmes among young Koreans is low. We sought to identify associations between risk factors and participation in screening...

Association of Cervical Cancer Screening with Knowledge of Risk Factors, Access to Health Related Information, Health Profiles, and Health Competence Beliefs among Community-Dwelling Women in Japan

Objective:The aim of this study was to evaluate the past attendance for cervical cancer screening with knowledge of risk factors, access to health-related information, health profiles and health competence beliefs among Japanese women.Methods:Women ages 25, 30, 35, 40, 45, 50, 55, and 60 were contacted cross-sectionally as part of a project for the Japanese Ministry of Health, Labour and Welfare in Nikaho, Akita prefecture Japan between June 2010 and March 2011, and 249 women were analyzed for the current study. The questionnaire asked about past cervical cancer screening. Knowledge of each cervical cancer risk factor was determined on a four-point scale. A barriers to information access scale was utilized to assess the degree of difficulty in accessing health-related information. Health profiles were measured using the EuroQOL EQ-5D. Perceived health competence was measured using a scale (PHCS). The association was evaluated with odds ratios with 95% confidence interval were calculated from a logistic regression analysis after adjustment for age and potential confounders. The trend across the level was also assessed.Results:Women who knew that sexual intercourse at young age was a risk factor were significantly more likely to have participated in cervical cancer screening sometime in their lives (p for trend =0.02). Women who had pain/discomfort and those who had anxiety/depression were significantly more likely to have participated in cervical screening within the past two years (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.04–3.94; OR: 2.32, 95% CI: 1.05–5.16, respectively). Women with higher PHCS were significantly more likely to have attended for cervical screened at some point in their lives (p=0.04).Conclusion:This study observed that specific knowledge of cervical cancer risk factors, health profiles and PHCS were associated with the past attendance for cervical cancer screening among women in a community. Further researches are warranted.

Message framing in invitation letters for cervical screening: a randomised controlled trial

BackgroundCervical screening saves 4500 lives in England annually and is offered nationally to women aged 24–64 years. A successful screening programme relies among other factors on uptake by the at-risk population. National coverage fell from 80·3% in 2005 to 77·2% in 2015. How health information is framed, in terms of potential gains (eg, lives saved) versus losses (eg, lives lost) of taking part in screening, can affect uptake. This study aimed to investigate the effect of framing in invitation letters for cervical screening on attendance in a low uptake urban area of London. MethodsIn a randomised controlled trial, two simplified invitation letters were compared with the existing invitation letter (control). Women living in the trial area, who were due for screening between Oct 21 and Dec 16, 2015, were randomised to receiving a gain framed message, a loss framed message, or the existing invitation letter (1:1:1, by computer-generated random number). Participants but not investigators were masked to allocation. Primary outcome was attendance for cervical screening at 15 and 32 weeks. Association between framing and attendance was measured with logistic regression. Analysis was by intention to treat. This trial is registered with ISRCTN, number ISRCTN93653543. Findings6223, 6223, and 6202 women were allocated to the control, gain framed, and loss framed groups, respectively. Mean age was 35·4 years (SD 9·9). Median number of invitations previously received was 4 (IQR 2–6) and past attendances was 1 (0–4). At 15 weeks no significant difference in uptake between the groups was found. Attendance at 32 weeks was 32·7% (n=2032) in the control compared with 32·3% (2011) in the gain framed group and 33·5% (2079) in the loss framed group. Logistic regression showed a significant increase in uptake in the loss framed group (adjusted odds ratio 1·1, 95% CI 1·0–1·21; p=0·04). No adverse events were observed. InterpretationOverall, the use of loss framing in invitation letters for cervical screening can increase the uptake of cervical screening at little or no extra cost. This study highlights one example of how information in invitation letters can be made more salient. Further research to explore these techniques is required. How changes in content might affect uptake is difficult to predict, so further trials in diverse populations are needed to ensure that new interventions are effective and not detrimental to uptake. FundingDepartment of Health.

Poor Cervical Cancer Screening Attendance and False Negatives. A Call for Organized Screening.

ObjectiveThe objective of this study was to describe prior negative screening history and symptoms around the time of diagnosis of incident cervical cancer (CC) cases diagnosed between 2000 and 2010 within the Asturias public health system.MethodsRecords from 374 women diagnosed with CC between 2000 and 2010 from all public hospitals in Asturias were retrieved. Clinical information, FIGO stage and all previous cytological data were extracted from clinical and histopathological records. Proportional differences were assessed using chi-square tests. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Inter-observer agreement in cytology was checked by comparing concordance values using k-statistics.ResultsNo prior screening history was recorded in 60.7% of CC cases and its absence increased with age and advanced stage. Advanced stage (e.g., ≥ II) at diagnosis was associated with age (>50 years) and adenocarcinoma (ADC) compared to younger women and those with a squamous cell carcinoma (SCC). False negative smears were identified in 27.1% of women with CC (ADC 52.6% vs. SCC 16.2%, p<0.05).ConclusionsAbsence of prior screening history was common among CC cases. Organized actions to reduce “under screening” and the use of highly sensitive HPV-based tests could be useful strategies in reducing the burden of CC in Asturias.

Abstract 2582: Cervical cancer screening in rural East Africa

Abstract Purpose: Cervical cancer screening (CCS) programs in rural east African communities often go unused by a majority the women residing in these areas. Most HIV-positive and HIV-negative women don't go for cervical cancer screening despite referrals at Bagamoyo District Hospital (BDH), Tanzania. The focus of this study was to understand what the patient barriers are to attending cervical cancer screening clinics. Methods: Questionnaires were distributed to 114 female patients over the age of 18 within the BDH's Care and Treatment Center (CTC). A small sample of 15 patients was also approached from within the reproductive health clinic (RHC). Participants were asked about their age, religion, parity, marital status, village of birth, village of residence, education, and number of previous screens, why they decided to go (or not go) to screening, and how they first heard of cervical cancer as well as cervical cancer screening. We also gathered data on the number of times each patient had been previously screened, the date of the most recent screen, as well as the referral date for the next screen. Using this information, we then attempted to match the individual's records with that of the CCS clinic's records. Results: The average age of women varied significantly between HIV-Positive and HIV-Negative patients (43 and 31, respectively). HIV-Positive women significantly varied among their education status. Parity and age varied significantly when comparing the screened women to those never before screened. When comparing by screen history, 22% of HIV-positive women had never been screened and all 15 (100%) of HIV-negative women had never had prior screening. Of the reasons given as to why women had not attended prior screening HIV-positive women reported that 36 (31.58%) think they were at risk; 25 (21.93%) had no reason; 20 (17.54%) didn't know when to go; and 19 (16.67%) didn't know where to go. As for the HIV-negative women, 11 (73.33%) said they didn't know where to go; 4 (26.67%) reported they didn't know when to go; 6 (40%) didn't think they were at risk. When analyzing reasons for not attending screening by whether or not prior screening had occurred, we found that most of the women who had never been screened reported to not know when or where to go for screening (36%). Conclusion: There are many potential explanations that play a role in the low cervical cancer screening attendance rates. There are issues surrounding education, accessibility, and funding. Due to the high prevalence of HIV in these areas, it is important to address these issues in order to minimize the impact of cervical cancer. We found lack of education and knowledge about the screening program at BDH was the main explanation for why women did not utilize the screening services. Citation Format: Autumn Cummings, Brianna Rooney, Robert Chamberlain, Amr Soliman, Crispin Kahesa. Cervical cancer screening in rural East Africa. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2582.

Effect of Fee on Cervical Cancer Screening Attendance--ScreenFee, a Swedish Population-Based Randomised Trial.

BackgroundAttendance in the cervical cancer screening programme is one of the most important factors to lower the risk of contracting the disease. Attendance rates are often low in areas with low socioeconomic status. Charging a fee for screening might possibly decrease attendance in this population. Screening programme coverage is low in low socio-economic status areas in Gothenburg, Sweden, but has increased slightly after multiple interventions in recent years. For many years, women in the region have paid a fee for screening. We studied the effect of abolishing this fee in a trial emanating from the regular cervical cancer screening programme.MethodIndividually randomised controlled trial. All 3 124 women in three low-resource areas in Gothenburg, due for screening during the study period, were randomised to receive an offer of a free test or the standard invitation stating the regular fee of 100 SEK (≈11 €). The study was conducted during the first six months of 2013. Attendance was defined as a registered Pap smear within 90 days from the date the invitation was sent out.ResultsAttendance did not differ significantly between women who were charged and those offered free screening (RR 0.93; CI 0.85–1.02). No differences were found within the districts or as an effect of age, attendance after the most recent previous invitation or previous experience of smear taking.ConclusionAbolishment of a modest screening fee in socially disadvantaged urban districts with low coverage, after previous multiple systematic interventions, does not increase attendance in the short term. Other interventions might be more important for increasing attendance in low socio-economic status areas.Trial RegistrationClinicalTrials.gov NCT02378324

Attitudes and knowledge among parents or guardians of 12-year-old girls about HPV vaccination - A population-based survey in Iceland.

To assess attitude and knowledge among parents or guardians of 12-year-old girls about human papillomavirus (HPV), cervical cancer, and HPV vaccination. Material andMethods: A mail survey was sent to a randomized sample of 1,000 parents or guardians of 12-year-old girls from a cohort of total 2,092 girls born in 1995 and registered in the Icelandic National Register by the end of December 2007. Of the 994 eligible parents, 583 (59%) returned the questionnaire. Majority of the respondents were mothers who had two or three children. More than one-third of respondents had university education and 84% were married or living with a partner. Over two-thirds did not know that HPV causes cervical cancer and genital warts. Almost all (> 90%) would vaccinate theirs daughters with a HPV vaccine, 73% said they would vaccinate their sons, or themselves if the vaccine was effective for them. Only 11% believed HPV vaccination would increase promiscuity or decrease cervical screening attendance. In Iceland, willingness to vaccinate young girls with HPV vaccine is high, however, knowledge about HPV infections is limited.

Lifestyle and health-related predictors of cervical cancer screening attendance in a Swiss population-based study

BackgroundSince the implementation of cervical cancer (CC) screening, incidence and mortality rates have decreased worldwide. Little is known about lifestyle and health-related predictors of cervical cancer screening attendance in Switzerland. Our aim was to examine the relationship between lifestyle and health-related factors and the attendance to CC screening in Switzerland. MethodsWe analyzed data of 20–69 years old women (n=7319) of the Swiss Health Survey (SHS) 2012. Lifestyle factors included body mass index, smoking status, alcohol consumption, physical activity and attention to diet. Health-related factors of interest were diabetes, hypertension, high cholesterol levels, chronic diseases, self-perceived health, and psychological distress.We performed multivariable logistic regression analyses with the dichotomized CC screening status as outcome measure and adjusted for demographic factors. ResultsObesity, low physical activity, and not paying attention to diet were statistically significantly associated with lower CC screening participation. High cholesterol levels and history of chronic diseases were statistically significantly positively associated with screening participation. ConclusionBeing obese, physically inactive and non-attention to diet are risk factors for CC screening attendance. These findings are of importance for improving the CC screening practices of low-user groups.

Cervical cancer prevention practices through screening and vaccination: A cross-sectional study among Hong Kong Chinese women

ObjectiveNo published data are available that currently evaluate Chinese adult women's cervical cancer prevention practices through screening and vaccination using population-based samples. This study describes patterns and correlates of these behaviors among Hong Kong Chinese women aged 30–59years. MethodsFrom February to November 2014 a random sample of 1482 Hong Kong Chinese women having at least one 12–17year-old daughter, who had heard of HPV vaccine before but had not sought HPV vaccination for daughter(s) completed structured telephone interviews. Multiple logistic regression analyses were conducted to examine factors associated with participants' cervical screening attendance, HPV vaccination uptake and intention to uptake. ResultsOverall, 80.8% of the participants reported attending asymptomatic cervical screening and 73% had regular screening. Family income and attitudes to cervical smear testing were associated with asymptomatic cervical screening attendance. Only 3.0% (45/1482) of all participants had received HPV vaccination. Among those who had not received HPV vaccination, 12.3% (183/1437) indicated positive intentions. Age below 50, household income and encouragement from family/friends were significantly associated with women's intended and actual uptake of HPV vaccination. Trusting formal and informal HPV vaccination information was positively associated with vaccination intention, while lack of concrete recommendation from doctors was negatively associated with vaccination uptake. ConclusionsInformation trust was associated with vaccination intention but not actual uptake whereas encouragement from family/friends facilitates women's HPV vaccination. Continued efforts are needed to ensure Chinese women adopting cervical cancer preventive behaviors, and must consider different specific needs of population subgroups.

Colposcopy attendance and deprivation: A retrospective analysis of 27,193 women in the NHS Cervical Screening Programme.

Background:Attendance for cervical screening is socially graded, but little is known about patterns of attendance for colposcopy following an abnormal screening result.Methods:Logistic regression was used to regress colposcopy attendance status for 27 193 women against age and area-level deprivation, adjusting for ethnicity.Results:Colposcopy attendance was high at 8 weeks (89%) and 4 months post-referral (94%) but women living in the most deprived areas were significantly less likely to attend.Conclusions:The high overall attendance rates at colposcopy are encouraging but lower attendance among women in the most income-deprived areas indicates that even when these women attend primary cervical screening, they remain at higher risk of missing out on the benefits of the programme.

Correlates of HPV vaccine uptake in school-based routine vaccination of preadolescent girls in Norway: A register-based study of 90,000 girls and their parents

ObjectiveTo assess demographic, socioeconomic and behavioural correlates of HPV vaccination of preadolescent girls in a publicly funded, school-based vaccination programme. MethodsData for all Norwegian girls born 1997–1999, eligible for routine school-based HPV vaccination in 2009–2011 (n=90,842), and their registered mother and father, were merged from national registries. Correlates of girl vaccination status were analysed by unadjusted and multivariable logistic regression. ResultsIn total, 78.2% of the girls received the first dose of the HPV vaccine, 74.6% received three doses, and 94.8% received the MMR vaccine. Correlates associated with initiation of HPV vaccination included parental age, income and education, maternal occupational status and cervical screening attendance, and girl receipt of the MMR vaccine. Rates of completion of HPV vaccination among initiators were high, and disparities in completion were negligible. Maternal and paternal correlates of daughter HPV vaccination status were similar. ConclusionsRoutine school-based vaccination generally provides equitable delivery, yet some disparities exist. Information campaigns designed to reach the sub-groups with relatively low vaccine uptake could reduce disparities. In none of the sub-groups investigated did uptake of the HPV vaccine approach that of the MMR vaccine, further demonstrating a general potential for improvement in HPV vaccine uptake.

Uptake of Cervical Screening in a Sample of Uk Female Psychiatric Inpatients

Introduction There is little information on cervical screening attendance in the psychiatric population. 78.3% of the general population have been screened once in five years. Evidence suggests that women with mental illness are less likely to engage in recommended health screening programmes. Reasons for non-attendance include shame and embarrassment, lack of knowledge, fear of a positive result, beliefs that the procedure may cause cancer and a high rate of sexual abuse, rendering the procedure too traumatic. Standard Cervical screening in the UK- recommended every 3 years for women aged 25-49 and every 5 years for women aged 50-64. Expected standard 100% Method Cross-sectional survey of psychiatric inpatient sample, including ages 25-64, inpatient sample size 28. Questioned individuals about awareness of cervical screening programme, last/next screening date and cross-correlated with primary care records Results 25 (90%) were aware of cervical screening programme. 20 (70%) claimed correspondence from their doctor and had accepted the screening. Further analysis of primary care records indicated only 8(36%) had actually had the screening, with 20 (64%) being non responders. Conclusion Women with mental illness are 50% less likely to attend a cervical screening programme, compared to general population. Level of education appears to be an important indicator of uptake, regardless of severity and duration of illness. Recommendations Further exploration of identifying barriers to accepting such important screening tests needs to be conducted in the psychiatric population and raising awareness of such screening should not only be the domain of primary care, but also mental health services.

Barriers to cervical cancer screening among ethnic minority women: a qualitative study

BackgroundEthnic minority women are less likely to attend cervical screening.AimTo explore self-perceived barriers to cervical screening attendance among ethnic minority women compared to white British women.DesignQualitative interview study.SettingCommunity groups in...

Knowledge of cervical cancer and attendance at cervical cancer screening: a survey of Black women in London.

BackgroundWomen from ethnic minority backgrounds are less likely to attend cervical screening, but further understanding of ethnic inequalities in cervical screening uptake is yet to be established. This study aimed to explore the socio-demographic and ethnicity-related predictors of cervical cancer knowledge, cervical screening attendance and reasons for non-attendance among Black women in London.MethodsA questionnaire was completed by women attending Black and ethnic hair and beauty specialists in London between February and April 2013. A stratified sampling frame was used to identify Black hair specialists in London subdivisions with >10% Black population (including UK and foreign-born). Fifty-nine salons participated. Knowledge of cervical cancer risk factors and symptoms, self-reported screening attendance and reasons for non-attendance at cervical screening were assessed.ResultsQuestionnaires were completed by 937 Black women aged 18–78, describing themselves as being predominantly from African or Caribbean backgrounds (response rate 26.5%). Higher educational qualifications (p < .001) and being born in the UK (p = .011) were associated with greater risk factor knowledge. Older age was associated with greater symptom knowledge (p < .001). Being younger, single, African (compared to Caribbean) and attending religious services more frequently were associated with being overdue for screening. Women who had migrated to the UK more than 10 years ago were less likely to be overdue than those born in the UK. Of those overdue for screening who endorsed a barrier (67/133), ‘I meant to go but didn’t get round to it’ (28%), fear of the test procedure (18%) and low risk perception (18%) were the most common barriers.ConclusionsEthnicity, migration and religiosity play a role in predicting cervical screening attendance among women from Black backgrounds. African women, those born in the UK and those who regularly attend church are most likely to put off attending. Additional research is needed to explore the attitudes, experiences and beliefs that explain why these groups might differ.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1096) contains supplementary material, which is available to authorized users.

Improving cervical cancer screening attendance in Finland.

High attendance is essential to cervical cancer screening results. Attendance in the Finnish program is currently at 70%, but extensive opportunistic screening occurs beside the organized. A shift from opportunistic to organized screening is imperative to optimize the costs and impact of screening and minimize potential harms. We evaluated the effect of reminder letters (1st reminder) and self-sampling test (2nd reminder) on program attendance. The study population consisted of 31,053 screening invitees in 31 Finnish municipalities. 8,284 non-attendees after one invitation received a reminder letter and 4,536 further non-attendees were offered a self-sampling option. Socioeconomic factors related to participation were clarified by combining screening data to data from Statistics Finland. Reminder letters increased participation from 72.6% (95% CI 72.1, 73.1) to 79.2% (95% CI 78.8, 79.7) and self-sampling further to 82.2% (95% CI 81.8, 82.7). Reminder letters with scheduled appointments resulted in higher increase than open invitations (10 vs. 6%). Screening of original non-attendees increased the yield of CIN3+ lesions by 24%. Non-attendance was associated with young age, immigrant background, lower education level and having never been married. We showed that a total attendance of well over 80% can be achieved within an organized program when the invitational protocol is carefully arranged.

Celebrities and screening: a measurable impact on high-grade cervical neoplasia diagnosis from the ‘Jade Goody effect’ in the UK

Background:The celebrity Jade Goody's cervical cancer diagnosis was associated with increased UK cervical screening attendance. We wanted to establish if there was an increase in high-grade (HG) cervical neoplasia diagnoses, and if so, what the characteristics of the women with HG disease were.Methods:We analysed prospective data on 3233 consecutive colposcopy referrals in North East London, UK, from 01 April 2005 to 30 June 2010. Characteristics and outcomes of pre- and post-Goody cohorts were compared.Results:Goody's diagnosis was associated with an increased incidence of colposcopy referrals in all subsequent annual quarters (incidence rate ratio (IRR) 1.3–1.9, P<0.002–P<0.0005) and increased HG disease diagnoses in the fourth quarter 2008/2009 (IRR 1.3, P=0.05) and first quarter 2009/2010 (IRR 1.3, P=0.07). We observed 1.90-fold (CI: 1.06–3.39), 2.06 (CI: 1.13–3.76) and 2.13-fold (CI: 1.07–4.25) respective increases in the odds of HG disease women being screening-naive in the first and second quarter 2009/2010, and the first quarter 2010/2011 (P<0.04, P<0.02 and P<0.04, respectively). There was a 2.23-fold increase in the odds of screening-naive HG disease women being symptomatic post-Goody's diagnosis (P=0.023). The age distributions of the pre- and post-Goody cohorts did not differ in any study group.Conclusion:Continued publicity about celebrities' diagnoses might encourage screening in at-risk populations.

Review of Strategies in Promoting Attendance for Cervical Screening

The importance of cervical screening has been addressed in numerous studies. However, reviews conducted to explore of strategies to promoting attendance for cervical screening have been limited. This study aimed to explore strategies to promote attendance for cervical screening. A literature search from databases (1994-2011) was undertaken to include papers that identified strategies related to the cervical screening. Twenty-four papers were included in this review. The review of existing strategies identified valuable information on cervical screening and areas that could be improved in meeting womens' needs. The review highlighted important aspects of cervical screening that could be further addressed by promoting strategies to attendance. Assessing women's health beliefs, inpatient cervical cancer screening, nurse-led screening, and cognition-emotion focused programs are among the strategies to promote attendance for pap smear testing.

Mothers’ screening histories influence daughters’ vaccination uptake: An analysis of linked cervical screening and human papillomavirus vaccination records in the North West of England

AimAchieving high human papillomavirus (HPV) vaccine coverage is important because cervical screening coverage is declining. As key decision makers, mothers’ experiences of, and participation in, the cervical screening programme could affect vaccination consent. We investigate whether mother’s screening history influences daughter’s participation in the HPV vaccination programme. MethodsMothers’ cervical screening records from the National Health Authority Information System were linked to the daughters’ HPV vaccination records from the Child Health System in North West England by address. Odds ratios for daughter’s vaccination were computed using Logistic Regression, adjusting for age, Primary Care Trust and vaccine cohort (AOR). ResultsDaughters in both the routine and catch up programmes were more likely to have initiated vaccination and completed the course if their mothers had attended screening. The association was strongest when mothers had attended within the last 5years (AOR in routine group: 3.5 (95% confidence interval (CI) 3.1–4.0) for initiation and 2.2 (1.6–2.9) for retention). Mothers who had personally decided to cease screening were less likely to have vaccinated daughters than those who had ceased for medical indications. Daughters were more likely to have been vaccinated if their mothers had received an abnormal smear result. ConclusionsDaughter’s HPV vaccination uptake was associated with mother’s cervical screening attendance. Daughters of mothers who are not engaged with preventive services are less likely to be vaccinated and may be less likely to engage with screening. This makes mothers central to health interventions to promote both cervical screening and HPV vaccination.

Cervical Screening Uptake, Political Interest and Voter Turnout: A Population-Based Survey of Women in England

To examine the relationship between cervical screening uptake and political engagement, and to test whether political engagement and voting behaviour mediate the association between age and cervical screening uptake. A population-based survey of women in England in 2010. Women aged 26-64 took part in home-based computer-assisted interviews (n = 890). Women were classified as 'up to date' or 'overdue/never been screened' for cervical screening. Most women (81%) were up-to-date with screening; 19% were overdue. Age and marital status were associated with screening status. Women who were not registered to vote, had not voted in previous general elections, and those who showed less interest in elections and lower intention to engage in political activities were more likely to be overdue for screening. In multivariate analyses (adjusting for all significant measures) 'being on the electoral register' was the only significant independent predictor of screening status. 'Being on the electoral register' was also the only measure of voting behaviour that mediated the association between age and screening status. We found limited evidence for the hypothesis that falling attendance for cervical screening could be associated with a broader phenomenon of disillusionment as indexed by reported voting behaviour and other measures of political engagement. Alternative explanations should be considered in order to better understand falling cervical screening uptake, particularly among younger women.

Development of a pre-notification leaflet to encourage uptake of cervical screening at first invitation: a qualitative study

Cervical screening attendance among women aged 25-29 years in England is lower than at older ages. There is some evidence that pre-notification leaflets motivate women who have not yet considered their response to a health intervention. We aimed to identify key information to motivate young women at their first cervical screening invitation. Six focus groups were conducted, five with young women aged 17-25 registered with a General Practice in Manchester, UK, and one with Practice nurses. Some women took part in two further groups to discuss leaflet design. There was low awareness of the purpose or procedures of cervical screening, and most women were de-motivated by reports of bad experiences. Some intended to be screened, but not immediately after invitation. Screening was viewed as a test for a cancer that affected older women. Since none of the participants believed that they had cervical cancer, screening seemed unnecessary. We conclude that the perception that screening is unimportant when you are young needs to be challenged. Women also need to be better informed of screening procedures. A pre-notification leaflet incorporating key information was designed and will be tested in a randomized trial of complex interventions within the routine cervical screening programme.