Understanding Young Women’s Cervical Cancer Screening Attendance

Cervical screening to identify pre-cancerous changes, and their subsequent treatment, prevents most cervical cancers. However, recent data from Australian screening registries indicates that 42% of eligible women did not attend cervical screening in 2013-14. The rates of screening non-attendance are high and increasing among young women in Australia and other developed countries. However, there is little research to explain why young women are less likely to screen than older women. The mixed-methods research presented in this thesis was designed to better understand the reasons why young women aged 25-35 years may not attend cervical screening. Study 1 involved the collection of qualitative interview data from 20 young women to explore their experiences of cervical screening and the barriers and facilitators they encountered to screening attendance. Using thematic analysis, the results indicated that practical factors were more salient barriers to screening than psychological factors in the women who had screened before, whereas psychological barriers were most salient to women’s first screening experience. In addition, the women identified the importance of General Practitioners (GPs) in facilitating their cervical screening. In Study 2, survey data from 338 women was analysed to test the findings of the previous study. The women provided information on their screening history and nominated screening barriers and facilitators they encountered. These factors were categorised post hoc as either psychological or practical in nature. Results showed that reporting a greater number of psychological (but not practical) barriers was associated with being overdue for cervical screening. In addition, the women who had never screened before endorsed a greater number of psychological barriers to screening than women who had screened before. Having a regular GP was associated with older age, timely screening attendance, and fewer psychological barriers to screening. In Study 3, two theoretical models of health behaviour, the Theory of Planned Behaviour (TPB) and Health Belief Model (HBM) were examined for their utility in predicting intentions to screen and screening behaviour, using survey data from Study Two. The women completed a series of measures that were adapted to assess the TPB and HBM in relation to cervical screening intentions and behaviour. Hierarchical multiple linear and logistic regression models indicated that the TPB predicted greater variance in intention to screen than the HBM, although the models performed similarly in predicting recent screening behaviour. In addition, having a regular GP was again highlighted as a strong predictor of screening behaviour. The results suggest that women who have not previously screened may require additional psychological support to overcome the barriers they experience and thereby facilitate their first screening attendance. Further, having a regular GP was an important facilitator to screening attendance for all women. However, young women were less likely to have a regular GP, and this may at least partly explain their lower rates of screening attendance. Thus, encouraging young women to engage with a regular GP may improve the screening rates in this group as well as other health outcomes