British Journal of Health Psychology

Relevance of the common‐sense model for people living with a genetic predisposition for breast and ovarian cancer

Abstract Objectives BRCA1/2 pathogenic variants have been associated with an increased risk for breast, ovarian, pancreatic, prostate cancer as well as melanoma. The present research uses the Leventhal's common‐sense model of self‐regulation (CSM), a theoretical framework highlighting the role of mental representations on responses to a health‐threat. We aim at understanding the personal meaning and representation of living with an hereditary breast and ovarian cancer predisposition. Method Semi‐structured interviews of 15 BRCA carriers were analysed using the interpretative phenomenological analysis. Results Mental representations develops in childhood and are influenced by childhood emotional responses to the familial experience of the BRCA predisposition. Pre‐existing beliefs about BRCA, even erroneous, are deeply anchored and not called into question by medical informations given during the genetic counselling. This is particularly true when medical information is perceived as too complex, inconsistent or in contradiction with familial experience. These beliefs about the consequences of being carriers of the BRCA gene influence emotional and behavioural experiences leading to experience fear, anxiety, lack of hope for future or self‐identity change. For participants with a traumatic familial experience of cancer, the lack of treatment for this genetic disease generates a perpetual overestimation of cancers’ risk and the feeling of an unending danger associated with early death despite breast and ovarian prophylactic surgery. When strong negative representations of the BRCA predisposition are experienced, dysfunctional health behaviours, such as drugs consumption or overuse of medical consultations, could appear consecutively to emotional disorders.

Cervical screening attendance in young women and people with a cervix: An application of the COM ‐B model

Abstract Objectives Cervical cancer (CC), which is caused by the human papillomavirus (HPV), results in around 3000 new cancer cases yearly in the UK. According to recent figures, rates in the UK have increased by 13% in young women over the last decade; screening attendance has fallen to a 10‐year low. As the majority of women now reaching the screening age (24.5 years old) will be HPV vaccinated, research is needed to assess the possible impact of this successful immunisation programme on screening behaviours as well as to further our understanding of the current barriers and facilitators to screening and how these may differ between attendees and non‐attendees. Design Cross‐sectional survey. Methods Participants comprised 200 young women (attendees n  = 100, non‐attendees n  = 100) aged 25–30 years old living in the UK. Participants completed an online questionnaire assessing COM‐B model components and HPV vaccination status. Results A multiple logistic regression analysis revealed that reflective motivation was the only COM‐B component that was a significant independent predictor of screening attendance, such that higher reflective motivation scores increased the odds of having attended cervical screening. In addition, HPV‐vaccinated individuals had significantly greater odds of having attended screening when compared to non‐vaccinated individuals. Conclusions Reflective motivational factors are crucial in encouraging young women to attend CC screening. Future work should focus on developing interventions that enhance reflective motivation.

Trust in cervical screening and attributions of blame for interval cancers following a national controversy

Abstract Objectives This study investigated levels of trust and attributions of blame in connection with a cervical screening programme following a controversy related to the programme's audit, incorporating an experimental test of the effectiveness of new information materials. Design We compared responses in Ireland ( N  = 872) to equivalent responses in Scotland ( N  = 400). Participants in Ireland were randomly assigned to either a treatment group that received the information materials or a control group that did not. Participants then responded to questions about their trust in cervical screening and to whom they would attribute blame in a range of scenarios describing women diagnosed with cervical cancer between screening rounds. Results Results showed that the control group in Ireland had lower trust and attributed higher blame towards screening services than participants in Scotland. However, exposure to information materials in the treatment group improved trust and reduced blame. Conclusions The findings suggest that public controversies influence perceptions of screening programmes and underscore the importance of transparent, choice‐based communication in mitigating these effects. The findings have valuable implications for screening services worldwide as all screening programmes will have associated false negative and false positive results.

Exploring the psychosexual impact and disclosure experiences of women testing positive for high‐risk cervical human papillomavirus

Abstract Objectives To examine the psychosexual impact and disclosure experiences of women testing HPV‐positive following cervical screening. Design In‐depth semi‐structured interviews. Methods Interviews were conducted with 21 women of screening age (i.e. those aged 24–65 years) in England who self‐reported testing HPV‐positive in the context of cervical screening in the last 12 months. Data were analysed using Framework Analysis. Results The sexually transmitted nature of HPV, and aspects relating to the transmission of HPV and where their HPV infection had come from, had an impact on women's current, past and future interpersonal and sexual relationships. Most women had disclosed their HPV infection to others, however the factors influencing their decision, and others' reactions to disclosure differed. The magnitude and extent of psychosexual impact was influenced by how women conceptualized HPV, their understanding of key aspects of the virus, concerns about transmitting HPV and having a persistent HPV infection. Conclusions Increasing knowledge of key aspects of HPV, such as its high prevalence and spontaneous clearance, and the differences between HPV and other STIs, may increase women's understanding of their screening result and reduce any negative psychosexual consequences of testing HPV‐positive. Referring to HPV as an infection that is passed on by skin‐to‐skin contact during sexual activity, rather than an STI, may help to lessen any psychosexual impact triggered by the STI label.

The impact of age‐relevant and generic infographics on knowledge, attitudes and intention to attend cervical screening: A randomized controlled trial

Abstract Objectives Cervical screening uptake in England is falling. Infographics could strengthen intention to attend, increase positive attitudes and improve knowledge. Age targeting could improve these outcomes further. We tested the impact of generic and age‐targeted infographics. Design A randomized controlled trial using an age‐stratified, parallel‐group design. Methods Women aged 25–64 ( n  = 2095) were recruited through an online panel and randomized to see one of the three infographics. We tested: (i) impact of a generic cervical screening infographic compared to a control infographic on an unrelated topic with all screening age women and (ii) impact of an age‐targeted infographic compared to a generic cervical screening infographic with older women (50–64 years). Intentions, knowledge and attitudes were measured. Results Women aged 25–64 years who viewed the generic infographic had significantly higher intentions [ F (1, 1513) = 6.14, p  = .013,  = .004], more accurate beliefs about the timeline of cervical cancer development (OR: 5.18, 95% CI: 3.86–6.95), more accurate social norms (OR: 3.03, 95% CI: 2.38–3.87) and more positive beliefs about screening benefits (OR: 2.23, 95% CI: 1.52–3.28) than those viewing the control infographic. In the older age group, there was no significant difference in intention between those viewing the generic versus age‐targeted versions [ F (1, 607) = .03, p  = .853,  < .001], but the age‐targeted version was more engaging [ F (1, 608) = 9.41, p  = .002,  = .015]. Conclusions A cervical screening infographic can result in more positive attitudes and better knowledge and may have a small impact on intentions. Although age targeting did not affect intention, it had a positive impact on engagement and may therefore be useful in encouraging women to read and process materials.

“Knowing that I had HPV , I literally just shut down”: A qualitative exploration of the psychosocial impact of human papillomavirus ( HPV ) in women living with mental health conditions

Abstract Objective Psychological distress after testing positive for human papillomavirus (HPV) at cervical cancer screening is well documented in the general population. However, little is known about the impact of an HPV‐positive result on those with pre‐existing mental health conditions, who may be at higher risk of experiencing clinically significant distress. This study explored the psychosocial impact of HPV in women with co‐morbid mental health conditions, as well as their experience of cervical screening during the COVID‐19 pandemic. Methods Semi‐structured telephone interviews were conducted with 22 women aged 27–54 who had tested positive for HPV at routine cervical screening in England, and who reported having at least one mental health condition. Data were analysed using thematic analysis. Results Being informed of an HPV‐positive result increased distress and heightened pre‐existing psychological challenges. Psychosocial response and duration of HPV‐related distress appeared to be influenced by the ability to regulate emotions, number of consecutive HPV‐positive results, interactions with health care professionals, and other life stressors. The experience added further complexity to many women's perceptions of self and self‐esteem. Women who had received psychological treatment for their mental health condition were best able to self‐manage HPV‐related distress by applying learned coping skills. Conclusions Receiving an HPV‐positive result at cervical screening appears to be a distressing experience for women with co‐morbid mental health conditions. Future hypothesis‐driven research is needed to confirm findings and develop effective interventions to reduce psychosocial burden.

Testing the content for a targeted age‐relevant intervention to promote cervical screening uptake in women aged 50–64 years

Objectives Low uptake of cervical screening in women in their 50s and 60s leaves them at elevated risk of cancer in older age. An age‐targeted intervention could be an effective way to motivate older women to attend cervical screening. Our primary objective was to test the impact of different candidate messages on cervical screening intention strength. Design A cross‐sectional online survey with randomized exposure to different candidate messages. Methods Women aged 50–64 years who were not intending to be screened when next invited were recruited through an online panel. Those meeting the inclusion criteria ( n  = 825) were randomized to one of three groups: (1) control group, (2) intervention group 1, (3) intervention group 2. Each intervention group saw three candidate messages. These included a descriptive social norms message, a diagram illustrating the likelihood of each possible screening outcome, a response efficacy message, a risk reduction message and an acknowledgement of the potential for screening discomfort. We tested age‐targeted versions (vs. generic) of some messages. The primary outcome was screening intention strength. Results After adjusting for baseline intention, social norms ( p  = .425), outcome expectancy ( p  = .367), risk reduction ( p  = .090), response efficacy ( p  = .136) and discomfort acknowledgement messages ( p  = .181) had no effect on intention strength. Age‐targeted messages did not result in greater intention than generic ones. Conclusions There was no evidence that a single message used to convey social norms, outcome expectancy, risk reduction or response efficacy had an impact on intention strength for older women who did not plan to be screened in future.