Elsevier

Social Science & Medicine

Volume 61, Issue 11, December 2005, Pages 2460-2465
Social Science & Medicine

Sociodemographic and attitudinal correlates of cervical screening uptake in a national sample of women in Britain

https://doi.org/10.1016/j.socscimed.2005.07.017Get rights and content

Abstract

Sociodemographic and attitudinal correlates of self-reported cervical screening uptake were investigated among 1307 women in the target age group who participated in two national surveys conducted in Britain in 1999. Evidence for inequalities in screening uptake was mixed. Of the socioeconomic indicators, only age of completed full-time education showed a significant effect in the multivariate analysis. The strong effects of car ownership and housing tenure in the univariate analyses were eliminated by controlling for marital status, which showed a robust association with uptake. Uptake was highest among married and separated women and lowest among single and widowed women. There was no evidence that the effects of marital status and education were mediated by the attitudinal variables. Anticipated embarrassment and attitudes to screening (e.g., “There's no point going for screening if you don’t have any symptoms”) were significant independent predictors of uptake. These findings suggest that information campaigns need to address feelings of embarrassment and lack of understanding of the rationale for screening and that efforts should be made to encourage single and widowed women to attend.

Introduction

Mortality figures for the UK show a sharp gradient towards higher mortality from cervical cancer in women of lower socioeconomic status (SES) (Quinn, Babb, Brock, Kirby, & Jones, 2000). Socioeconomic differences in cervical screening uptake may be one factor contributing to this gradient (Wardle et al., 1999), and it is therefore important to investigate the extent of, and reasons for, such differences.

In the UK, the relationship between SES and cervical screening coverage or uptake has been examined at three different levels: health district (e.g., Baker & Middleton, 2003), general practice (e.g., Ibbotson, Wyke, McEwen, Macintyre, & Kelly, 1996) and individual (e.g., Coulter & Baldwin, 1987). This paper reports an individual level study that differed from previous studies in examining a range of indicators of SES, as well as other sociodemographic variables. In addition, we included measures of women's beliefs about cervical cancer and cervical screening and attitudes towards screening and health. The selection of variables was guided by the Health Belief Model (Janz & Becker, 1984) and by previous studies of cervical screening uptake (e.g., Bish, Sutton, & Golombok, 2000; Orbell, Crombie, & Johnston, 1996).

We hypothesised that any associations between sociodemographic variables and uptake would be explained at least in part by attitudes and beliefs. To our knowledge, the present study is the first to estimate the independent contributions of these different classes of variables to cervical screening uptake in a national sample of women in Britain.

Section snippets

Participants, design and procedure

Two similar surveys of adults aged 16 and over living in private households in Britain were conducted in March and May 1999 through the Office for National Statistics. The response rate to both surveys was 70%. There were 1469 women in the target age group for cervical screening (20–64 in England and Wales; 20–60 in Scotland). Analysis was restricted to the 1307 women who stated that they had not had a hysterectomy and who said whether or not they had had a smear test in the last 5 years.

Measures

  • (1)

Results

Five sociodemographic variables showed a significant association with uptake in univariate logistic regression analyses: age, marital status, age completed full-time education, number of cars and housing tenure (Table 1). Age showed a curvilinear effect. Of the attitude and belief variables, perceived effectiveness, anticipated pain and embarrassment, and the three attitudinal components were significantly associated with uptake.

In a multiple logistic regression analysis of the sociodemographic

Discussion

This study had a number of limitations. First, it used a cross-sectional design. Second, although the response rate was quite high (70%), we had no information about non-responders. We therefore cannot rule out the possibility of selection bias. Non-responders may be of lower SES on average and may be less likely to attend for screening. Third, the measure of behaviour was based on self-report. It was not possible to verify self-reports against medical records. Strengths of the study are that

Acknowledgements

This study was funded by the National Breast and Cervical Screening Programmes. We thank Mrs. Julietta Patnick, the National Screening Coordinator, for her interest and support.

References (11)

  • D. Baker et al.

    Cervical screening and health inequality in England in the 1990s

    Journal of Epidemiology and Community Health

    (2003)
  • A. Bish et al.

    Predicting uptake of a routine cervical smear test: A comparison of the health belief model and the theory of planned behaviour

    Psychology and Health

    (2000)
  • L.A. Brinton

    Epidemiology of cervical cancer—overview

  • A. Coulter et al.

    Survey of population coverage in cervical cancer screening in the Oxford region

    Journal of the Royal College of General Practitioners

    (1987)
  • T. Ibbotson et al.

    Uptake of cervical screening in general practice: Effect of practice organisation, structure, and deprivation

    Journal of Medical Screening

    (1996)
There are more references available in the full text version of this article.

Cited by (63)

  • Female preventive practices: Breast and smear tests

    2014, Health Policy
    Citation Excerpt :

    Smoking is a negative health behaviour that serves as a proxy for poor health habits such as lack of exercise, bad diet and alcohol abuse [19]. Age, smoking and health care access are inversely related to screening, whilst education, income, insurance and perceived risk of cancer are directly related [19–21]. Women who are strongly influenced by the advice of their General Practitioners tend to take regular tests, women who do not receive this advice screen less frequently, or not at all [21].

View all citing articles on Scopus
View full text