Attitudes to screening for cervical cancer: a population-based study in Sweden.
OBJECTIVE
To investigate how attitudes and beliefs about Pap smear screening affect women's choice to participate in organized or opportunistic screening.


METHODS
Telephone interviews were conducted with 430 (69.0%) non-attenders and 514 (80.7%) attenders to Pap smear screening, sampled from a population-based database. The interviews were conducted during 1998 in Uppsala County, Sweden.


METHODS
odds ratios (OR) and 95% confidence intervals (CI).


RESULTS
Non-attendance was negatively associated with perceived severity of cervical cancer compared to other malignancies (OR = 1.9, 95% CI 1.1-3.4) as well as with satisfactory benefits (OR = 0.7, 95% CI 0.6-0.8), but positively associated with time-consuming and economical barriers (OR = 1.2, 95% CI 1.1-1.5 and OR = 1.7, 95% CI 1.2-2.5, respectively). Non-attendance was also negatively associated with anxiety, but was of borderline significance (OR = 0.9, 95% CI 0.8-1.0). The results were strengthened with increasing time since last smear or if self-reported attendance status was used instead of true attendance. Non-attenders kept holding harder to their preferences than did attenders, stating they would not participate if their preferences were not met.


CONCLUSIONS
Important differences in attitudes and beliefs exist between non-attenders and attenders in Pap smear screening. Rather than being emotional, the main barriers are either practical or rooted in misunderstandings and lack of relevant information. These insights offer opportunities to increase attendance rates considerably.
Eaker
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Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden. Sonja.Eaker@mep.ki.se
Adami
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Sparén
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D000328:Adult; D016001:Confidence Intervals; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D016017:Odds Ratio; D065006:Papanicolaou Test; D011795:Surveys and Questionnaires; D013548:Sweden; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears / Q000523:psychology*