br T br Rhonda Frances Browna
Rhonda Frances Browna,∗, Tanya Rebecca Mullera, Anna Olsenb
a Research School of Psychology, Australian National University, Canberra, Australia b Research School of Population Health, Australian National University, Canberra, Australia
Cervical cancer screening
Rationale: Cervical cancer screening registry data indicate that 43% of eligible Australian women did not screen in the latest reporting 252917-06-9 (2014–2015). However, few prior empirical studies have examined whether the screening barriers and facilitators experienced by women can affect their screening attendance. Such informa-tion 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 psycho-logical 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.
Cervical cancer is the fourth most common cancer and a leading cause of cancer death in women (International Agency for Research on Cancer [IARC], 2014). It is a largely preventable cancer inasmuch as the routine screening of asymptomatic women is effective in preventing its' occurrence and cancer-related mortality (World Health Organization, 2014). However, 43% of eligible Australian women failed to screen in the most recent published reporting period (2014–2015) (Australian Institute of Health & Welfare [AIHW], 2017). Few prior studies have elucidated the screening barriers and facilitators pre-dicting women's screening attendance, upon which tailored health promotion strategies could be based (Sadler et al., 2013). Australia's National Cervical Screening Program operates as a part of a woman's routine primary health care. Most screening (80%) is
performed by general practitioners (GP), but nurses and gynecologists can conduct the procedure; and it is subsidized by the Australian Medicare Benefits Schedule. If a woman is three months overdue for human papillomavirus (HPV) testing, she is sent a letter from the na-tional screening reminder system to remind her to have the test; which is first performed at 25-years of age and repeated every five years (Australian Department of Health, 2018). However, prior to May 2017, Australian women received a Pap test every two years (AIHW, 2017), as did the female participants in this study. In this study, women were deemed overdue for screening if they had not screened in the past 27 months (i.e., overdue by more than three months). Only a small literature has previously examined cervical cancer screening barriers and facilitators experienced by women. A distinction has been made between emotional and practical factors (Eaker et al., 2001; Waller et al., 2009). Emotional (or psychological) barriers are
∗ Corresponding author. Research School of Psychology, ANU College of Health and Medicine, Australian National University, Canberra, ACT 2601, Australia. E-mail address: [email protected] (R.F. Brown).
Available online 28 November 2018
factors that are related to emotional state (e.g., anxiety, embarrass-ment), personal attitudes/perceptions (e.g., test is ineffective), and knowledge about the procedure, which make a person less likely to screen; whereas emotional facilitators include emotional state and at-titudes/perceptions (e.g., perceived cancer risk) that increase the like-lihood of screening. In contrast, practical barriers are external to a person or logistical in nature (e.g., lack of time, expense of test), whereas practical facilitators are factors external to a person (e.g., nearby GP clinic) that increase the likelihood of screening (Waller et al., 2009).