Psychological factors affecting participation in cervical screening for young women: a qualitative study

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Abstract

Background: There is a continuous decline in cervical cancer screening uptake, especially in young women, despite saving over 4500 lives annually in the UK. Psychological factors that could influence participation identified in previous studies included anxiety, embarrassment and fear. The context of these factors is broad and ill-defined. This study aimed to unpick the deeper issues and factors influencing participation and non-participation in young women aged 25-34. Methods: The method drew on the principles of grounded theory to understand how participants form meanings and make decisions on issues such as screening. Maximum variation purposive sampling was used to recruit 26 participants from communities (cervical cancer screening call and recall register, three universities, community centre). Data were obtained by semi-structured interviews (16 participants) and a focus group (eight). Analysis aided by mind mapping software (MindGenius Business 6) led to the organisation of data into codes, themes, and categories. Findings: Data analysis showed that sexual association was the core underlying category. This association was drawn from four elements: awareness, human issues, emotional attribution, and acceptability. Low awareness was mainly about screening procedure and body anatomy (location of the cervix). Overall, perception of the screening was positive and acceptability was expressed. Factors within emotional attribution and human issues were major impacts on screening behaviour and decision. Non-participation or delayed participation were strongly linked to the basic social psychological process, associating screening with sex, and created negative emotions such as embarrassment and anxiety. These associations included the screening procedure mimicking sex (penetration), the intrusive nature of screening (exposure, intimate, private), and sociocultural beliefs (promiscuity, taboo, and body insecurities). Screening that touched on fundamental human issues such as reproduction (infertility) and mortality (death from cancer) affected participation. These identified issues were sometimes unspoken and unconsciously influenced screening decision in some participants. Interpretation: Our findings suggest that sexual association is a hidden issue affecting participation in cervical screening. This research is expected to inform future practices and policy implementation towards increasing screening uptake. Suggested service improvement strategies included alternative screening methods (eg, home self-testing), educating health professionals on sensitivity, and an invitation letter explaining in-depth details of the procedure. These changes could help improve the perception of screening among women of all ages.
Original languageEnglish
Pages (from-to)S82
JournalThe Lancet
Volume388
DOIs
Publication statusPublished - 1 Nov 2016

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