Anne Eardley

Attendance for cervical screening—Whose problem?

Despite the existence of an effective screening technique for cancer of the cervix, incidence and mortality from this disease have not declined in the United Kingdom. The basic problem is that women most at risk of the disease are under-represented in the screened population. The evidence for two different points of view to explain this situation is examined. These viewpoints are the failure of the women to attend, and the failure of the service to meet the needs of women. This paper argues that the evidence supports the view that the organisation of the existing screening service impedes the maximum participation of at-risk women. We discuss the features that an effective service needs to incorporate, and put forward principles for the development of a more effective screening system, namely, that it should be provider-initiated and user-oriented.

Reasons for non-attendance for computer-managed cervical screening: Pilot interviews

A pilot interview study looked at reasons why women did not attend a clinic following an invitation for a cervical smear test offered via a computer-managed scheme. Three broad issues were identified. First, the inaccuracy of the computer database (the FPC register) meant some women were inaccessible because they no longer lived at the address recorded. Other women were ineligible or unsuitable within the criteria of the scheme but had been sent invitations inappropriately because their screening records were incomplete or out of date. Second, aspects of service organisation and provision led to misclassification of some attenders as non-attenders and to various failures of communication such as non-receipt of the invitation or health education leaflet or unsuccessful attempts to rearrange appointments. In addition, the appointment or venue offered could be unsatisfactory. The third issue concerned the characteristics of the women which sometimes interacted with practical problems connected with service provision. Other women believed the test to be inappropriate for themselves while some were deterred by the prospect of the test itself. In general, embarrassment was pervasive and reflected in preferences for different types of service provision. Women who had neither attended nor been otherwise tested were particularly likely to express feelings of fear and fatalism. General attitudes to the test were favourable but this was not always applied personally. A typology of reasons for non-attendance for computer-managed cervical screening is presented.

A pilot study of attendance for breast cancer screening

Previous research has identified some characteristics related to attendance for breast cancer screening, but few research findings carry practical implications for the optimum organisation of the service. The present study describes the reactions of women attending one of the first breast screening units to be established in the U.K. following government directives. Responses to the invitation to be screened and reasons for attendance suggest ways in which the idea of screening can be conveyed in health education. Practical problems were few, but some negative features of the design of the screening unit and of the experience of being screened were identified. Recommendations for the organisation of breast cancer screening are presented using the typology of factors influencing health behaviour developed by Green et al.

HEA guidelines for a letter to invite women for a smear test: theory and practice

INVITATION letters used in computer-managed cer vical screening schemes in the 190 health districts of England were assessed in relation to the Health Edu cation Authoritys guidelines for a cervical screening invitation letter. A scoring system was developed. Three types of letter were identified - call, recall and combined (used for both call and recall). Many items of information were missing from the letters, and the mean score was disappointingly low. We discuss the reasons for this, and end with a set of recommen dations for health authorities keen to improve their health education material.

Ethical issues in psychosocial research among patients with cancer

The ethical implications of psychosocial research among patients with cancer are discussed. Two key issues were identified: obtaining informed consent and the impact of participating in research. Barriers to obtaining genuinely informed consent are described, as well as the costs and benefits of participation in research. Recommendations are made for the conduct of future research, relating to the removal of barriers to informed consent and monitoring the impact of the research process on its subjects.

A computer-managed call and recall system for cervical screening

Abstract In order to maximine the response of women to cervical screening the service needs to be re-oriented towards the needs of the consumer, with a greater initiative coming from the service provider. These considerations imply that the system should take account of various barriers and in order to do so systematically and comprehensively requires a database and a management system. This paper described the development of a computer-managed scheme for cervical screening using the Family Practitioner Committee (FPC) register as a database to identify women for screening. This system can be used for calling previously unscreened women as well as for recall.

How district health authorities organise cervical screening

OBJECTIVES--To examine how district health authorities organised cervical screening with respect to Department of Health guidelines and to determine their assessment of the problems encountered. DESIGN--Postal questionnaire sent to all 190 district health authorities in England in 1989. PARTICIPANTS--190 District health authorities in England. MAIN OUTCOME MEASURES--Population coverage of screening, quality of smear testing, and follow up of abdominal test results in comparison with national guidelines for district cervical screening services, and problems encountered by districts. RESULTS--Replies were received from 178 (94%) of districts, in 143 of which the person named as responsible for cervical screening contributed. All districts implemented a computer managed scheme, 150 by the target date of 31 March 1988, but not all of these conformed with the guidelines. At the time of the survey only just over half called women in the target age group of 20-64 and only 70% expected to meet the target date of 13 March 1993 for completing the call. Considerable variation was evident among the schemes with regard to how they dealt with issues related to population coverage, quality of testing, and follow up of abnormal results. The problems most commonly identified by the districts (n = 174) were laboratory workload (107, 61%), computer software (104, 60%), availability of resources (78, 45%), non-attendance (77, 44%), rate of opportunistic screening (62, 36%), and investigation and treatment (60, 34%). CONCLUSIONS--Current practice in running cervical screening schemes needs to be examined to determine the extent to which it contributes to the goal of reducing mortality from cervical cancer.

Health education in a computer-managed cervical screening programme:

IN designing health education material for a cervical screening programme, attention needs to be given to those features identified by research as influencing womens use of screening services. These include not only womens attitudes and beliefs about cervical screening, but also organisational and administra tive barriers that can deter women from attending for a smear test. Health information may be presented through a variety of media and at different stages in the cervical screening decision-making process. This paper describes the specific health education used in a computer-managed scheme and how it was modi fied in the light of findings from research which monitored and evaluated the scheme.

Encouraging participation in breast-screening:

BREAST cancer is the most common form of cancer among women in the UK resulting in 15,000 deaths annually. The recommendations of the Forrest Report 1 inaugurated the development of the first national breast screening service in the world. How ever, a minimum uptake of seventy per cent is required if the scheme is to achieve its objective of significantly reducing mortality from breast cancer by detecting the disease at an earlier stage. Green 2 identifies three sets of factors — predisposing, en abling and reinforcing — which combine to influence health behaviour. In this paper, we use Greens fac tors as a framework to examine how the breast screening service was set up in Manchester and we report the findings of a pilot consumer satisfaction survey to illuminate the issues involved.

Trends in the organization of cervical cancer screening.

CERVICAL CYTOLOGICAL screening has been available in the UK for several decades, but has not achieved a significant reduction in the incidence of and mortality from cervical cancer. In this paper we describe past problems of cervical screening, discuss the impact of recent innovations to computerize call and recall, and suggest further improvements for the future.