Understanding the heterogeneity of cervical cancer screening non-participants: Data from a national sample of British women

Abstract

Background: Uptake of cervical cancer screening in the United Kingdom (UK) is falling year on year, and a more sophisticated understanding of non-participation may help design interventions to reverse this trend. This study ascertained the prevalence of different non-participant types using the Precaution Adoption Process Model (PAPM).

Methods: Home-based computer-assisted interviews were carried out with 3113 screening-eligible women in Britain. Survey items assessed self-reported screening uptake and intention to attend in future. Responses to these items were used to classify women into one of five different types of non-participants.

Results: Of 793 non-participants, 28% were unaware of screening, 15% had decided not to attend and 51% were intending to have screening but were currently overdue. Younger women were more likely to be unaware of screening or to intend to be screened, while older women were more likely to have decided not to be screened. Women from ethnic minority backgrounds were more likely to be unaware of screening than white women. Being in a lower social grade was associated with increased odds of all three types of non-participation.

Conclusion: The majority of cervical cancer screening non-participants are not making an active decision not to attend but rather are either unaware or unable to act. There are clear sociodemographic differences between non-participant types, which could be used to identify where tailored interventions may be best targeted.

Keywords: Age; Cervical cancer screening; Inequalities; Intention; Interventions; PAPM; Readiness; Stages; Uptake.

Fig. 1

An adapted version of the Precaution Adoption Process Model (PAPM) (Weinstein et al., 2008) demonstrating its use for explaining cancer screening behaviour in the context of an organised programme. Screening eligible men/women may be unaware of screening and once they become aware they may remain unengaged. After engaging with the screening decision they may remain undecided for an unspecified time before forming an intention to be screened or taking the decision not to be screened. People who intend to be screened may also remain at this stage for an unspecified time before actually participating. The need for repeated screening is indicated by the solid arrows which illustrate how those who have been screened may then become undecided, may decide not to participate next time, or may intend to participate in the next screening round.

Fig. 2

Algorithm allocating women to one of six stages in line with the PAPM.