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