Psychological factors aﬀecting participation in cervical screening for young women: a qualitative study Mabel O Okoeki, Alison Steven, Lesley Geddes
Abstract Published Online November 25, 2016 Faculty of Health and Life Sciences, Coach Lane Campus East, Northumbria University, Newcastle upon Tyne, UK (M O Okoeki MSc, A Steven PhD, L Geddes MSc) Correspondence to: Miss Mabel O Okoeki, Faculty of Health and Life Sciences, Coach Lane Campus East, Northumbria University, Newcastle upon Tyne NE7 7XA, UK [email protected]
Background There is a continuous decline in cervical cancer screening uptake, especially in young women, even though screening saves 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 aﬀecting participation and non-participation in young women aged 25–34 years. 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. Funding None. Contributors MOO contributed to the literature search, data collection, study design, data analysis, data interpretation, and writing of the study. AS and LG were involved in development of the design of the study, and contributed to (reviewed and corrected) the writing. Declaration of interests We declare no competing interests.