title: A qualitative study to assess the potential of the human papillomavirus vaccination programme to encourage under-screened mothers to attend for cervical screening.
abstract: BACKGROUND
  Coverage of the UK National Health Service Cervical Screening Programme is declining. Under-screened women whose daughters participate in the human papillomavirus (HPV) vaccination programme could be stimulated to attend. We investigated whether factors associated with the vaccination programme changed mothers' intentions for future screening.
  
  
  METHODS
  Questionnaires were sent to mothers of girls aged 12-13 years across two North West primary care trusts (n=2387) to assess the effect of the HPV vaccination programme on screening intentions. This identified mothers whose intentions had changed. Consent was sought to contact them for a semi-structured interview to discuss their screening intentions. Key themes were identified using framework analysis.
  
  
  RESULTS
  97/606 women responding to the questionnaire had changed their views about cervical screening. 23 women were interviewed, 10 of whom expressed a positive change and 13 no change. Most had discussed the vaccine information, including cervical screening, with their daughters. Mothers who made a positive change decision recognised their daughters' risk of cervical cancer, the need for future screening, and the importance of their own example. In this way daughters became 'significant others' in reinforcing their mothers' cervical screening motivation.
  
  
  CONCLUSIONS
  A daughter's invitation for HPV vaccination instigates a reassessment of cervical screening intention in some under-screened mothers.
authors.affiliation: Research Assistant/PhD Student, Manchester Urban Collaboration on Health, Institute of Population Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
authors.forename: Angela M
authors.identifier: http://orcid.org/0000-0001-8928-5767
authors.initials: AM
authors.lastname: Spencer
authors.affiliation: Reader in Women's Health, Women's Cancer Centre, Institute of Cancer Sciences, Manchester Academic Health Sciences Centre, St Mary's Hospital, University of Manchester, Manchester, UK.
authors.forename: Loretta
authors.initials: L
authors.lastname: Brabin
authors.affiliation: Senior Lecturer in Medical Statistics, Centre for Biostatistics, Institute of Population Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Roberts
authors.affiliation: Director, Public Health England/NHS Cancer Screening Programmes, Sheffield, UK.
authors.forename: Julietta
authors.initials: J
authors.lastname: Patnick
authors.affiliation: Clinical Director, Greater Manchester, Lancashire, South Cumbria Strategic Clinical Network, Manchester, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Elton
authors.affiliation: Senior Lecturer and Honorary Consultant in Public Health (SRFT) and Director, Manchester Urban Collaboration on Health, Institute of Population Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
authors.forename: Arpana
authors.initials: A
authors.lastname: Verma
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D002648:Child; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data; D009313:National Health Programs; D009679:Nuclear Family; D030361:Papillomavirus Infections / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D006113:United Kingdom; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology; D014611:Vaccination / Q000706:statistics & numerical data*
keywords: cervical screening; human papillomavirus; qualitative research