Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2008 Mar;16(1):17-30.
doi: 10.1007/s10728-007-0056-6. Epub 2007 Jun 28.

Social patterning of screening uptake and the impact of facilitating informed choices: psychological and ethical analyses

Rachel Crockett  1 , Timothy M Wilkinson, Theresa M Marteau
Affiliations

Social patterning of screening uptake and the impact of facilitating informed choices: psychological and ethical analyses

Rachel Crockett et al. Health Care Anal. 2008 Mar.

Abstract

Screening for unsuspected disease has both possible benefits and harms for those who participate. Historically the benefits of participation have been emphasized to maximize uptake reflecting a public health approach to policy; currently policy is moving towards an informed choice approach involving giving information about both benefits and harms of participation. However, no research has been conducted to evaluate the impact on health of an informed choice policy. Using psychological models, the first aim of this study was to describe an explanatory framework for variation in screening uptake and to apply this framework to assess the impact of informed choices in screening. The second aim was to evaluate ethically that impact. Data from a general population survey (n = 300) of beliefs and attitudes towards participation in diabetes screening indicated that greater orientation to the present is associated with greater social deprivation and lower expectation of participation in screening. The results inform an explanatory framework of social patterning of screening in which greater orientation to the present focuses attention on the disadvantages of screening, which tend to be immediate, thereby reducing participation. This framework suggests that an informed choice policy, by increasing the salience of possible harms of screening, might reduce uptake of screening more in those who are more deprived and orientated to the present. This possibility gives rise to an apparent dilemma where an ethical decision must be made between greater choice and avoiding health inequality. Philosophical perspectives on choice and inequality are used to point to some of the complexities in assessing whether there really is such a dilemma and if so how it should be resolved. The paper concludes with a discussion of the ethics of paternalism.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Expectations of participation in screening and (a) social deprivation, (b) present orientation, High and low present orientation calculated by means of a mean split
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1111/1467-8721.01245', 'is_inner': False, 'url': 'https://doi.org/10.1111/1467-8721.01245'}]}
    2. Adler, N. E., & Snibbe, A. C. (2003). The role of psychosocial processes in explaining the gradient between socioeconmic status and health. Current Directions in Psychological Science, 12, 119–123.
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1046/j.1365-2303.1999.00198.x', 'is_inner': False, 'url': 'https://doi.org/10.1046/j.1365-2303.1999.00198.x'}, {'type': 'PubMed', 'value': '10458498', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/10458498/'}]}
    2. Anderson, C., & Nottingham, J. (1999). Bridging the knowledge gap and communicating uncertainties for informed consent in cervical cytology screening. Cytopathology, 10, 221–228. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1046/j.1464-5491.2003.01050.x', 'is_inner': False, 'url': 'https://doi.org/10.1046/j.1464-5491.2003.01050.x'}, {'type': 'PubMed', 'value': '14632718', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/14632718/'}]}
    2. Bachmann, M. O., Eachus, J., Hopper, C. D., Davey, Smith, G., Propper, C., & Pearson, N. J., et al. (2003). Socio-economic inequalities in diabetes complications, control, attitudes and health service use: a cross-sectional study. Diabetes Medicine, 20, 921–929. - PubMed
    1. None
    2. Bandura, A. (1997). Self efficacy: The exercise of control. New York: WH Freeman and Company.
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1023/A:1021381616824', 'is_inner': False, 'url': 'https://doi.org/10.1023/a:1021381616824'}, {'type': 'PubMed', 'value': '12546165', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/12546165/'}]}
    2. Blacksher, E. (2002). On being poor and feeling poor: Low socioeconomic status and the moral self. Theoretical Medicine and Bioethics, 23, 455–470. - PubMed

Publication types