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Advancing understanding of influences on cervical screening (non)-participation among younger and older women: A qualitative study using the theoretical domains framework and the COM-B model

Lookup NU author(s): Ben RimmerORCiD, Professor Linda Sharp



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2021 The Authors. Health Expectations published by John Wiley & Sons Ltd.Background: Effective screening can prevent cervical cancer, but many women choose not to attend their screening tests. Objective: This study aimed to investigate behavioural influences on cervical screening participation using the Theoretical Domains Framework (TDF) and COM-B models of behaviour change. Design: A qualitative study and semistructured phone interviews were conducted with women invited for routine screening tests within the national cervical screening programme in Ireland. Setting and Participants: Forty-eight women aged 25–65 years were recruited from the national screening register. Results: Seven core themes were identified that mapped to three COM-B components and 11 TDF domains: (1) knowledge of cervical cancer and screening, (2) coping with smear tests, (3) competing motivational processes—automatic and reflective, (4) cognitive resources, (5) role of social support, (6) environmental influences and (7) perceputal and practical influences. A range of knowledge about screening, perceived risk of cervical cancer and human papillomavirus infection was evident. Factors that influenced screening behaviours may be hierarchical—some were assigned greater importance than others. Positive screening behaviours were linked to autonomous motivation. Deficits in physical and psychological capability (inadequate coping skills) were barriers to screening, while physical and social opportunity (e.g. healthcare professional ‘champions’) could facilitate participation. Older women raised age-related issues (e.g. screening no longer necessary) and had more negative attitudes to screening, while younger women identified practical barriers. Conclusions: This study provides insight into screening participation and will aid development of theoretically informed interventions to increase uptake. Patient or Public Contribution: Women invited for screening tests through the national screening programme were interviewed. A Public & Patient Involvement (PPI) Panel, established to provide input into all CERVIVA research projects, advised the research team on recruitment materials and were given the opportunity to review and comment on the interview topic guide. This panel is made up of six women with various cervical screening histories and experiences.

Publication metadata

Author(s): O'Donovan B, Mooney T, Rimmer B, Fitzpatrick P, Flannelly G, Doherty L, Martin C, O'Leary J, O'Connor M, Sharp L

Publication type: Article

Publication status: Published

Journal: Health Expectations

Year: 2021

Volume: 24

Issue: 6

Pages: 2023-2035

Print publication date: 29/11/2021

Online publication date: 02/09/2021

Acceptance date: 26/07/2021

Date deposited: 16/09/2021

ISSN (print): 1369-6513

ISSN (electronic): 1369-7625

Publisher: John Wiley and Sons Inc


DOI: 10.1111/hex.13346


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Funder referenceFunder name
Health Research Board Applied Partnership Awards. Grant Number: APA-2016-1874