Understanding different types of cervical screening non-participant: a population-based survey


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Jo Waller1,Jessica Haddrell2,Amanda Chorley2,Rebecca Ferrer3,Laura Marlow2
1University College London,2UCL,3NCI

Abstract

Background

Uptake of cervical screening in England is around 75% and is trending downwards. This study took a novel approach to characterising screening non-participants using the Precaution Adoption Process Model (PAPM), which describes the stages through which people move before engaging in a health protective behaviour. We aimed to establish the prevalence of different non-participant types and to explore demographic differences between types.

Method

Home-based computer assisted interviews were carried out with screening-eligible women in Britain.  Survey items assessed PAPM stage for cervical screening uptake and a range of demographic factors.

Results

Of the 3133 women included in analyses, 2,258 women were up-to-date with screening and intended to be screened in the future (‘maintainers’; 73%).  Among non-participants (n=855), the three most prevalent non-participant types were 1) those who were unaware of screening (30% of non-participants), 2) those who had decided to be screened, but had not yet attended (50%) and 3) those who had decided not to be screened (14%).  Compared with ‘maintainers’, the unaware group and those who had decided to act but had not yet done so tended to be younger.  Those who had decided against screening were more likely to be older.  Non-white British ethnicity and living in an urban area were associated with being unaware of screening.  All three non-participant types were more likely than ‘maintainers’ to be unmarried and from lower socioeconomic status backgrounds.

Conclusion

We found that a substantial proportion of cervical screening non-participants are unaware of screening, and another large group are inclined to attend but have not yet done so. These findings challenge the notion that screening non-participants have made an informed choice not to take part, and point to the need for targeted interventions to raise awareness and facilitate participation in women who would like to attend.