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Reasons for non-attendance at cervical screening as described by non-attendees in Sweden
Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
Kalmar University.
Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
2008 (English)In: Journal of Psychosomatic Obstetrics and Gynecology, ISSN 0167-482X, Vol. 29, no 11, 23-31 p.Article in journal (Refereed) Published
Abstract [en]

Purpose. To describe reasons for non-attendance at cervical screening, as reported by non-attendees, in Sweden. Methods. Four hundred women were randomized from a population-based register, of which 133 non-attendees answered the Cervical Screening Questionnaire (CSQ) in telephone interviews. Pearson's Chi2 and Mann-Whitney U-test were used to analyze differences between groups. Logistic regression was used to study the relationship between explanatory variables and a binary response variable. Results. The most common reasons for non-attendance were: feeling healthy, lack of time, and feelings of discomfort with the gynecologic examination. Non-attendees, who reported non-attendance due to experiences of discomfort associated with the gynecologic examination, estimated great discomfort at their latest examination. A history of sexual abuse was reported by 16.5%, but there were no differences regarding non-attendance due to experiences of discomfort associated with the gynecologic examination, between non-attendees who had no history of sexual abuse and those who had. Conclusion. It seems as though non-attendees did not attend cervical screening as they felt healthy, and thereby did not give time to preventive efforts. Earlier negative experiences such as discomfort during earlier gynecologic examinations seem to guide their decision not to attend.

Place, publisher, year, edition, pages
2008. Vol. 29, no 11, 23-31 p.
Keyword [en]
Cervical screening; non-attendance; gynecologic examination; sexual abuse; questionnaire
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-12674DOI: 10.1080/01674820701504619OAI: oai:DiVA.org:liu-12674DiVA: diva2:16830
Available from: 2007-10-24 Created: 2007-10-24 Last updated: 2012-04-06
In thesis
1. Healthy women or risk patients?: Non-attendance in a cervical cancer screening program
Open this publication in new window or tab >>Healthy women or risk patients?: Non-attendance in a cervical cancer screening program
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Women afflicted with cervical cancer who have the highest morbidity and mortality rates have been the least likely to be screened. The overall aim of this research project was to investigate non-attendance in a cervical cancer screening (CCS) program among women with no registered cervical smear during the previous five years. Both quantitative (I,III) and qualitative methods (II) as well as costeffectiveness analysis (IV) were used in this research project. In Kalmar County women (aged 23-65 years) are invited to CCS every third year. All cervical smears taken both in opportunistic and organised CCS are coordinated in a register called Sympathy. The coverage is 88.4 %. From Sympathy, a random sample of 400 women served as a study group and another 400 women as a control group (III,IV). From the study group, 133 women participated in study I and 14 women in study II. Data was collected by telephone interviews based on a questionnaire (I), qualitative face-to-face interviews (II), questionnaire, promotive efforts and outcome (III), costs and effectiveness (IV). Quantitative data was analysed by descriptive and analytic statistics (I,III), qualitative data was analysed by content analysis. In study IV, cost-effectiveness analysis was used.

The women believed that CCS was a good idea for all other women, but tended to refer to various circumstances resulting in their own non-attendance. One of the most common reasons for non-attendance was the feeling of being healthy. The women prioritized family and work commitments, and the invitation to attend CCS was sometimes experienced as a stressful disturbance. The feeling of discomfort was related to the gynaecologic examination, or to health care visits in general (I,II). Of 133 women, 120 could consider having a cervical smear taken and their two most common requirements for doing so were to be assured they would be treated in a friendly way (19%) and to find a suitable time (18%) for having the cervical smear. Fifty women wanted to be helped to have a cervical smear taken. Promotive efforts ranged from making a simple telephone call to arranging an appointment time to a combination of promotive efforts including repeated encounters in order to create a trusting relationship with respect to taking the smear. In the study group, 29.5% (n=118) had a registered cervical smear at follow-up compared to 18.5% (n=74) in the control group, (p<0.001) (III). In the study group, the cost per cervical smear taken was 66.87 €, and in the control group it was 16.62 €. The incremental cost per additional cervical smear taken was 151.36 € (IV). In conclusion, women’s reasons for not attending CCS are complex and are influenced by both present and earlier circumstances. In settings with high coverage, further contact in order to promote women’s attendance at CCS seems to be associated with high costs in relation to the number of additional cervical smears taken.

Place, publisher, year, edition, pages
Institutionen för klinisk och experimentell medicin, 2007. 63 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1021
Keyword
Non-attendance, screening, cervical cancer, health promotion, improverment, informed consent
National Category
Clinical Science
Identifiers
urn:nbn:se:liu:diva-10092 (URN)978-91-85895-71-7 (ISBN)
Public defence
2007-11-09, Aulan, Hälsans hus, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Note
On the day of the defence data the status of article I was: In press; article II: Submitted; article II: Accepted and artile IV: In press.Available from: 2007-10-24 Created: 2007-10-24 Last updated: 2009-08-22

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Oscarsson, MariaWijma, Barbro

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Gender and medicineFaculty of Health SciencesDepartment of Gynecology and Obstetrics in Linköping
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