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Charlton C, Rodrigues AM. How do young women approaching screening age interpret the NHS cervical screening leaflet? A mixed methods study of identifying interpretation difficulties, barriers, facilitators, and leaflet interpretation, engagement and future screening behaviour. Health Psychol Behav Med 2024; 12:2361005. [PMID: 38831975 PMCID: PMC11146246 DOI: 10.1080/21642850.2024.2361005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Cervical cancer is a common cancer among young women aged 25-29 in England, and the NHS cervical screening leaflet is the first point of contact for those being invited for their first screening. This study aimed to explore how young women (18-24) understand and engage with the leaflet, as well as the barriers and facilitators associated with its interpretation, engagement, and screening intentions. METHODS The study used a mixed-methods approach, including a survey (n = 120) to identify interpretation difficulties and how they were affected by different characteristics, and a follow-up interview (n = 10) to assess the utility of the leaflet, identify issues with its practicality, and determine the factors that influence screening intentions. RESULTS The survey results showed that interpretation difficulties were common, particularly regarding HPV assessment, screening results, additional tests/treatment, and screening risks. Lower interpretation accuracy was associated with lower numeracy scores and non-white ethnicity. Despite these difficulties, participants had high confidence and motivation to engage with the leaflet. The interviews revealed knowledge gaps, issues with the leaflet's practicality, and a preference for digital information. Factors that were identified as barriers and facilitators of leaflet interpretation, engagement, and screening intentions included knowledge, social influence, beliefs about consequences, environmental context and resources, social role and identity, emotions and intentions. CONCLUSION The current leaflet does not provide enough information for young women to make an informed decision about screening attendance. Implementing a digital invitation featuring simplified gist representation, targeted behaviour change techniques (BCTs), videos, and interactive tools can enhance education and promote screening behaviour. Future research should consider using digital tools and strategies to address existing barriers related to interpretation and engagement.
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Affiliation(s)
- Caroline Charlton
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
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Collins KE, Myers LS, Goodwin BC, Taglieri-Sclocchi A, Ireland MJ. The implementation and mechanisms of advance notification for cancer screening: A scoping review. Psychooncology 2024; 33:e6340. [PMID: 38588033 DOI: 10.1002/pon.6340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE To describe and synthesise information on the content and delivery of advance notifications (information about cancer screening delivered prior to invitation) used to increase cancer screening participation and to understand the mechanisms that may underlie their effectiveness. METHODS Searches related to advance notification and cancer screening were conducted in six electronic databases (APA PsycINFO, CINAHL, Cochrane Library, Embase, PubMed, Web of Science) and results were screened for eligibility. Study characteristics, features of the advance notifications (cancer type, format, delivery time, and content), and the effect of the notifications on cancer screening participation were extracted. Features were summarised and compared across effective versus ineffective notifications. RESULTS Thirty-two articles were included in this review, reporting on 33 unique advance notifications. Of these, 79% were sent via postal mail, 79% were distributed prior to bowel cancer screening, and most were sent 2 weeks before the screening offer. Twenty-two full versions of the advance notifications were obtained for content analysis. Notifications included information about cancer risk, the benefits of screening, barriers to participation, social endorsement of cancer screening, and what to expect throughout the screening process. Of the 19 notifications whose effect was tested statistically, 68% were found to increase screening (by 0.7%-16%). Effectiveness did not differ according to the format, delivery time, or content within the notification, although some differences in cancer type were observed. CONCLUSION Future research should explore the effectiveness of advance notification via alternative formats and for other screening contexts and disentangle the intervention- and person-level factors driving its effect on screening participation.
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Affiliation(s)
- Katelyn E Collins
- Cancer Council Queensland, Fortitude Valley, Queensland, Australia
- School of Psychology and Wellbeing, University of Southern Queensland, Springfield, Queensland, Australia
| | - Larry S Myers
- Cancer Council Queensland, Fortitude Valley, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
| | - Belinda C Goodwin
- Cancer Council Queensland, Fortitude Valley, Queensland, Australia
- School of Psychology and Wellbeing, University of Southern Queensland, Springfield, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
| | | | - Michael J Ireland
- School of Psychology and Wellbeing, University of Southern Queensland, Springfield, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
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Groves S, Brooks J. What do young women below national screening age in England think about cervical cancer and cervical screening? A qualitative study. J Clin Nurs 2021; 31:1588-1597. [PMID: 34418192 DOI: 10.1111/jocn.16012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore what women aged below the national screening age in the UK know and think about cervical cancer and cervical screening. BACKGROUND The efficacy of cervical cancer screening is well established. However, cervical screening attendance in the United Kingdom has decreased, with especially low rates at the first screening opportunity at age 25. Research has not yet explored knowledge and beliefs underpinning young women's intention to screen before first screening invitation. DESIGN Qualitative exploratory study. METHODS Qualitative email interviews were undertaken with 16 participants, using questions derived from the Health Belief Model. Data were analysed using template analysis. The COREQ were followed. RESULTS Analysis generated three themes; (1) Learning about cervical cancer and cervical screening: sources of information and (missed) opportunities; (2) Young women know screening is important - but they don't always know why; (3) Screening intentions: a cost/benefit analysis of the available information. CONCLUSIONS Young women had varied knowledge and beliefs about cervical cancer and screening which were underpinned by several sources of information available to them. Most women expressed an intention to attend screening when invited; however, some participants were unsure, with low screening-based knowledge and low perceived susceptibility of cervical cancer identified as key barriers. Social media, familial interactions and interventions within education were highlighted as being suited to interventions aimed at increasing cervical cancer- and screening-based knowledge in young women. RELEVANCE TO CLINICAL PRACTICE Findings suggest that women below screening age could be better informed about cervical cancer and screening. Tailored interventions addressing common concerns and misconceptions around screening may be acceptable to young women and could help to promote screening attendance at first invitation.
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Affiliation(s)
- Samantha Groves
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, England
| | - Joanna Brooks
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, England
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Australian women's cervical cancer screening attendance as a function of screening barriers and facilitators. Soc Sci Med 2018; 220:396-402. [PMID: 30529797 DOI: 10.1016/j.socscimed.2018.11.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 10/16/2018] [Accepted: 11/26/2018] [Indexed: 01/12/2023]
Abstract
RATIONALE Cervical cancer screening registry data indicate that 43% of eligible Australian women did not screen in the latest reporting period (2014-2015). However, few prior empirical studies have examined whether the screening barriers and facilitators experienced by women can affect their screening attendance. Such information is required to inform the development of future tailored health promotion strategies. OBJECTIVE This study examined whether the cervical cancer screening barriers and facilitators identified by women were related to their screening history, from November 2015 and January 2016. At this time, Australian women typically undertook a Pap test every two years. They were deemed overdue for screening if they have not screened in the past 27 months (i.e., overdue by more than three months). METHOD In this study, a large sample (N = 338) of women were asked about their screening history including screening status (i.e., up-to-date vs. overdue) and prior screening (i.e., never screened vs. screened), and the psychological and practical screening barriers or facilitators they had experienced. RESULTS Logistic regression analysis indicated that screening status was related to a greater number of psychological barriers, but not practical barriers or facilitators. In contrast, prior screening was related to more practical and psychological screening barriers and fewer practical facilitators, but not psychological facilitators. Some individual psychological screening barriers (e.g., anxiety, embarrassment), practical barriers (e.g., lack of time) and practical facilitators (e.g., low cost of test) were related to women's screening status and prior screening. CONCLUSIONS Results suggest that addressing practical cervical cancer screening facilitators (e.g., reminder prompts) and psychological screening barriers may help to optimize screening attendance in women who have never screened or are overdue for cervical cancer screening.
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Kitchener HC, Gittins M, Rivero-Arias O, Tsiachristas A, Cruickshank M, Gray A, Brabin L, Torgerson D, Crosbie EJ, Sargent A, Roberts C. A cluster randomised trial of strategies to increase cervical screening uptake at first invitation (STRATEGIC). Health Technol Assess 2018; 20:1-138. [PMID: 27632816 DOI: 10.3310/hta20680] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Falling participation by young women in cervical screening has been observed at a time that has seen an increase in the incidence of cervical cancer in the UK in women aged < 35 years. Various barriers to screening have been documented, including fear, embarrassment and inconvenience. OBJECTIVES To measure the feasibility, clinical effectiveness and cost-effectiveness of a range of interventions to increase the uptake of cervical screening among young women. DESIGN A cluster randomised trial based on general practices performed in two phases. SETTING Primary care in Greater Manchester and the Grampian region in Scotland. PARTICIPANTS Phase 1: 20,879 women receiving their first invitation for cervical screening. Phase 2: 10,126 women who had not attended by 6 months. INTERVENTIONS Phase 1: pre-invitation leaflet or not, and access to online booking (Manchester only). Phase 2: (1) vaginal self-sampling kits (SSKs) sent unrequested (n = 1141); or (2) offered on request (n = 1290); (3) provided with a timed appointment (n = 1629); (4) offered access to a nurse navigator (NN) (n = 1007); or (5) offered a choice between a NN or a SSK (n = 1277); and 3782 women in control practices. MAIN OUTCOME MEASURES Uplift in screening compared with control practices, cost-effectiveness of interventions, and the women's preferences explored in a discrete choice experiment. RESULTS The pre-invitation leaflet and offer of online booking were ineffective when compared with control practices at 3 months, 18.8% versus 19.2% [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.88 to 1.06; p = 0.485] and 17.8% versus 17.2% (OR 1.02, 95% CI 0.87 to 1.20; p = 0.802), respectively. The uptake of screening at 3 months was higher among previously human papillomavirus (HPV)-vaccinated women than unvaccinated women, 23.7% versus 11% (OR 2.07, 95% CI 1.69 to 2.53; p < 0.001). Among non-attenders, the SSK sent intervention showed a statistically significant increase in uptake at 12 months post invitation, 21.3% versus 16.2% (OR 1.51, 95% CI 1.20 to 1.91; p = 0.001), as did timed appointments, 19.8% versus 16.2% (OR 1.41, 95% CI 1.14 to 1.74; p = 0.001). The offer of a NN, a SSK on request, and a choice between timed appointments and NN were ineffective. Overall, there was a gradual rather than prompt response, as demonstrated by uptake among control practices. A discrete choice experiment indicated that women invited who had not yet attended valued the attributes inherent in self-sampling. The health economic analysis showed that both timed appointments and unsolicited SSK sent were likely to be cost-effective at a cost per quality-adjusted life-year (QALY) gained of £7593 and £8434, respectively, if extended across the national 25-year-old cohort throughout the duration of screening. The certainty of these being cost-effective at a ceiling ratio of £20,000 per QALY gained was > 90%. CONCLUSION Women receiving their initial screening invitation frequently delay taking up the offer and the net impact of interventions was small. Timed appointments and SSKs sent to non-attenders at 6 months are likely to be a cost-effective means of increasing uptake and should be considered further. HPV vaccination in the catch-up programme was associated with an increased uptake of cervical screening. Future work should focus on optimising self-sampling in terms of age range, timing of offer for non-attenders and use of urine testing instead of vaginal samples. TRIAL REGISTRATION Current Controlled Trials ISRCTN52303479. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 68. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Henry C Kitchener
- Institute of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Matthew Gittins
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Margaret Cruickshank
- Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Aberdeen, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Loretta Brabin
- Institute of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | | | - Emma J Crosbie
- Institute of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Alexandra Sargent
- Virology Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Chris Roberts
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
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Kitchener H, Gittins M, Cruickshank M, Moseley C, Fletcher S, Albrow R, Gray A, Brabin L, Torgerson D, Crosbie EJ, Sargent A, Roberts C. A cluster randomized trial of strategies to increase uptake amongst young women invited for their first cervical screen: The STRATEGIC trial. J Med Screen 2017; 25:88-98. [PMID: 28530513 PMCID: PMC5956569 DOI: 10.1177/0969141317696518] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives To measure the feasibility and effectiveness of interventions to increase cervical screening uptake amongst young women. Methods A two-phase cluster randomized trial conducted in general practices in the NHS Cervical Screening Programme. In Phase 1, women in practices randomized to intervention due for their first invitation to cervical screening received a pre-invitation leaflet and, separately, access to online booking. In Phase 2, non-attenders at six months were randomized to one of: vaginal self-sample kits sent unrequested or offered; timed appointments; nurse navigator; or the choice between nurse navigator or self-sample kits. Primary outcome was uplift in intervention vs. control practices, at 3 and 12 months post invitation. Results Phase 1 randomized 20,879 women. Neither pre-invitation leaflet nor online booking increased screening uptake by three months (18.8% pre-invitation leaflet vs. 19.2% control and 17.8% online booking vs. 17.2% control). Uptake was higher amongst human papillomavirus vaccinees at three months (OR 2.07, 95% CI 1.69–2.53, p < 0.001). Phase 2 randomized 10,126 non-attenders, with 32–34 clusters for each intervention and 100 clusters as controls. Sending self-sample kits increased uptake at 12 months (OR 1.51, 95% CI 1.20–1.91, p = 0.001), as did timed appointments (OR 1.41, 95% CI 1.14–1.74, p = 0.001). The offer of a nurse navigator, a self-sample kits on request, and choice between timed appointments and nurse navigator were ineffective. Conclusions Amongst non-attenders, self-sample kits sent and timed appointments achieved an uplift in screening over the short term; longer term impact is less certain. Prior human papillomavirus vaccination was associated with increased screening uptake.
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Affiliation(s)
- H Kitchener
- 1 Institute of Cancer Sciences, The University of Manchester, St. Mary's Hospital, Manchester, UK
| | - M Gittins
- 2 Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester, UK
| | - M Cruickshank
- 3 Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Aberdeen, UK
| | - C Moseley
- 1 Institute of Cancer Sciences, The University of Manchester, St. Mary's Hospital, Manchester, UK
| | - S Fletcher
- 1 Institute of Cancer Sciences, The University of Manchester, St. Mary's Hospital, Manchester, UK
| | - R Albrow
- 1 Institute of Cancer Sciences, The University of Manchester, St. Mary's Hospital, Manchester, UK
| | - A Gray
- 4 Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - L Brabin
- 1 Institute of Cancer Sciences, The University of Manchester, St. Mary's Hospital, Manchester, UK
| | - D Torgerson
- 5 Department of Health Sciences, University of York, York, UK
| | - E J Crosbie
- 1 Institute of Cancer Sciences, The University of Manchester, St. Mary's Hospital, Manchester, UK
| | - A Sargent
- 6 Virology Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - C Roberts
- 2 Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester, UK
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Cross SL, Suharwardy SH, Bodavula P, Schechtman K, Overton ET, Onen NF, Lane MA. Improving cervical cancer screening rates in an urban HIV clinic. AIDS Care 2014; 26:1186-93. [PMID: 24625234 PMCID: PMC4065211 DOI: 10.1080/09540121.2014.894610] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Human immunodeficiency virus (HIV)-infected women are at increased risk of invasive cervical cancer; however, screening rates remain low. The objectives of this study were to analyze a quality improvement intervention to increase cervical cancer screening rates in an urban academic HIV clinic and to identify factors associated with inadequate screening. Barriers to screening were identified by a multidisciplinary quality improvement committee at the Washington University Infectious Diseases clinic. Several strategies were developed to address these barriers. The years pre- and post-implementation were analyzed to examine the clinical impact of the intervention. A total of 422 women were seen in both the pre-implementation and post-implementation periods. In the pre-implementation period, 222 women (53%) underwent cervical cancer screening in the form of Papanicolaou (Pap) testing. In the post-implementation period, 318 women (75.3%) underwent cervical cancer screening (p < 0.01). Factors associated with lack of screening included fewer visits attended (pre: 4.2 ± 1.5; post: 3.4 ± 1.4; p < 0.01). A multidisciplinary quality improvement intervention was successful in overcoming barriers and increasing cervical cancer screening rates in an urban academic HIV clinic.
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Affiliation(s)
- Sara L Cross
- a Division of Infectious Diseases , Washington University School of Medicine , St. Louis , MO , USA
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