Cervical Screening in Young Women: an exploration of issues associated with participation and non-participation using a grounded theory

Okoeki, Mabel (2016) Cervical Screening in Young Women: an exploration of issues associated with participation and non-participation using a grounded theory. Doctoral thesis, Northumbria University.

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Abstract

Introduction
Cervical cancer is 11th most common cancer among young women in the UK. Early detection through screening is thought to have resulted in a 75% decrease in cervical cancer and saves over 4,500 lives each year. However, recent years have seen a continuous decline in screening uptake, especially among young women. Scientific literature reviews show little research in this area. There is therefore a need for a qualitative exploration into the reasons and motives for low uptake of cervical cancer screening from service users’ viewpoints in England. This study explores factors that influence the participation and non-participation of young women aged 25-34 in the NHS cervical cancer screening programme in the Northeast. Findings are expected to inform age-specific interventions aimed at increasing participation.

Methodology
Employing the qualitative approach of grounded theory (GT) enabled the development of an understanding of participants’ behaviours and factors affecting participation, including health beliefs and other associations that influence the decision to attend screening. Twenty-four research participants were recruited purposively and theoretically from universities in the Northeast and a community centre in Newcastle, as well as through the Northeast Call and Recall Centre in accordance with ethical approval. Data was collected through semi-structured face-to-face interviews and a focus group session. The analysis was done using the GT techniques of the constant comparative method and theoretical sampling, aided by individual sorting and use of Mind Genius software.

Findings
Awareness of cervical cancer prior to receiving a screening invitation was found to be relatively low and there was an overall lack of understanding of what the screening entails. There was no direct correlation between health beliefs and participation, however, health beliefs were influenced by cultural, environmental and social factors. The findings from both the interviews and the focus group led to the creation of three contextual categories, which are: health views relative to self; knowledge/awareness; and health service influences and practicalities associated with participation in cervical cancer screening. The three main categories and their subcategories were further conceptualized to create a core category, ‘sexual association’, made up of four elements: awareness, human issues, emotional attribution, and acceptability. Decisions to participate in the cervical cancer screening were largely influenced by the elements within ‘sexual association’, showing the psychosocial or cognitive impact of the association between sex and the cervical cancer screening procedure. Sexual association seemed to be a key influence in participation, with factors from the three main categories feeding into it.

Discussion
All participants, particularly in relation to health protection, viewed the screening positively. Within the sexual association and practicality issues, there are facilitators and potential barriers. The psychosocial impact (fear, embarrassment, intrusiveness and taboos) of sex being associated with cervical screening, as well as practical issues, tends to dissuade people from participating in the screening. An explanatory model was developed to understand the factors influencing participation and non-participation and this has commonalities with the health belief model and social cognitive theory, which are typically used to explain health behaviours. This is one of the few studies investigating factors that affect the uptake of cervical cancer in the Northeast of England. The results obtained in this study are likely to have high importance to policy and practice, as they represent user-focused perspectives. Recommendations and implications for further research, policy, practice and education are provided.

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