Advancing understanding of influences on cervical screening (non)‐participation among younger and older women: A qualitative study using the theoretical domains framework and the COM‐B model

Abstract

Background Effective screening can prevent cervical cancer, but many women choose not to attend their screening tests. Objective This study aimed to investigate behavioural influences on cervical screening participation using the Theoretical Domains Framework (TDF) and COM‐B models of behaviour change. Design A 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 Participants Forty‐eight women aged 25–65 years were recruited from the national screening register. Results Seven 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. Conclusions This study provides insight into screening participation and will aid development of theoretically informed interventions to increase uptake. Patient or Public Contribution Women 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.

Trust and cancer screening: Effects of a screening controversy on women’s perceptions of cervical cancer screening

“…Methods are described in detail elsewhere ( O’Donovan et al, 2021 ). In brief, since 2008, CervicalCheck has offered free cervical screening tests to women in Ireland aged 25–65 years.…”

“…In 2019 we conducted a qualitative study on influences on cervical screening participation ( O’Donovan et al, 2021 ). We interviewed women with a variety of ages and screening histories from the general population.…”

Factors promoting breast, cervical and colorectal cancer screenings participation: A systematic review

“…39,46,47,54,[56][57][58][59][60][61][62][63][64][65][66][67] Furthermore, for colorectal cancer screening only, also disgust and worries about completing the faecal occult blood test (FOBt) incorrectly are additional barriers that should be carefully addressed. 68 Still considering the factor under the label "fears", some studies highlight those fears related to the screening in itself, namely fears related to the unknown procedure, 62,64 previous negative experiences, 66 test pain, 57,61 perceived mistrust in providers' confidentiality 63 and in the safety of the screening procedure. 67 However, nearly all the studies emphasize those "fears for the results", since many people consider cancer as a "deadly" diagnosis.…”

“…67 However, nearly all the studies emphasize those "fears for the results", since many people consider cancer as a "deadly" diagnosis. 39,47,57,[61][62][63][64][65][66][67] In particular, when asked to think/recall about barriers to screening, some people often report future fears related to cancer diagnosis (e.g., fear of suffering, changes in appearance, and death). 69 Furthermore, research suggests that unwillingness to screen is also linked to fears about the impact of a potential cancer diagnosis on relationships, that is, losing friends/job, being stigmatized and isolated by the society and even by own family.…”

“…The majority of research highlights the role of high knowledge/ awareness about cancer etiology, and screening recommendation/ procedure/types in effectively promoting cancer screening attendance, mainly among first-time attenders. 30,33,39,43,47,57,66,74,82,[88][89][90][91][92] This is particularly true considering the great number of misunderstandings (e.g., the person lose part of uterus during biopsy) and false myths (e.g., application of social norms which foster the overestimation of personal ability to prevent cancer by lifestyle choices such as monogamy for cervical cancer and breastfeeding for breast cancer). 21,61,63,75…”