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From 'silent' to 'heard': professional mediation, manipulation and women's experiences of their body after an abnormal Pap smear
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0002-9209-5179
Örebro University, School of Health and Medical Sciences.
2009 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 68, no 3, p. 479-486Article in journal (Refereed) Published
Abstract [en]

While there is a large body of research on cervical cancer screening, fewer studies address the experiences of women receiving abnormal Pap smear results after routine screening. Those studies highlighting such experiences tend to concentrate on resulting psychosocial distress, with an absence in the literature about women's experiences of their bodies during medical follow-up for dysplasia, and no studies were found that explore such experiences over time. In this article, we focus on bodily experiences over time during medical follow-up of an abnormal Pap smear among a group of women in Sweden. This qualitative analysis is based on interview data from a total of 30 women, and with in-depth analysis of the content of 34 transcribed interviews with nine women who were followed longitudinally. We found that medical follow-up involved an experience of both "having" and "being" a body, which changed over time. Women described a process that ranged from having a cervix that was neither felt, 'heard', nor seen, to having a body that became known to them first indirectly through professional mediation and later through direct experience after professional manipulation. The conceptualization of bodily boundaries appeared to change, e.g. through visualization of the previously unfamiliar cervix, pain, vaginal discharge, and bleeding, as well as linkages to the bodies of women in their extended families through the generations. Thus, bodily experiences appear to be an intrinsic part of medical follow-up of an abnormal Pap smear through which health, disease, and risks in the past, present, and future were reconceptualised. (C) 2008 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
2009. Vol. 68, no 3, p. 479-486
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-19293DOI: 10.1016/j.socscimed.2008.11.007ISI: 000263424600012OAI: oai:DiVA.org:oru-19293DiVA, id: diva2:445827
Available from: 2011-10-05 Created: 2011-10-04 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Från inbjudan till uppföljning: kvinnors erfarenheter av att delta eller inte delta i cervixcancerscreening
Open this publication in new window or tab >>Från inbjudan till uppföljning: kvinnors erfarenheter av att delta eller inte delta i cervixcancerscreening
2009 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Population-based cervical cancer screening programs (PCCSPs) were introduced in Stockholm in the 1960s; today all women residents aged 23-60 are invited to a cost-free Pap smear at regular intervals. A shift in scientific knowledge has occurred, with clarification of the link between human papilloma virus (HPV) and cervical cancer (CC), and the introduction of HPV-vaccines for primary prevention of CC. While there is a large body of research on CC screening, fewer studies address screening experiences of women in different phases of life with different screening histories. The aim of this thesis was to explore how women reason about CC, its causes, prevention and participation in CC screening. Method: These studies were guided by the inductive approach interpretive description . Sub-study I is based on qualitative analysis of 12 telephone interviews and 86 fax messages sent to the screening organisation by women who actively chose not to participate in PCCSP. Sub-study II is based on longitudinal interview data from 30 women, who underwent medical follow-up of an abnormal Pap smear. Sub-studies III and IV are based on data from 30-year old women with varied screening background and experiences, derived from 9 face-to-face focus group discussions (FGD) (sub-studies III, IV) and 30 internet-based FGDs (sub-study IV). Results: Women s ways of conceptualizing health, illness, and risk for disease in general impacted on their decision-making about attending PCCSP. Matters related to sickness, including CC and its prevention, were generally described as distant and unprioritized by many women. The manner 30-year old women self-defined themselves in the transition between youth and adulthood appears to strongly influence their reasoning not only about PCCSP, but also about other forms of health maintenance and disease prevention. How women defined and conceptualized distinctions between, and roles and responsibilities of, the private and the public was also found to be central in explanations of decision-making, especially among women who actively chose not to take a Pap smear. Women described a wide range of factors which could motivate them to participate in PCCSP, related to all aspects of the program, from invitation through follow-up, and a need for different types and forms of information. Many suggestions were related to individualization of the PCCSP; a need to understand the relationship between HPV and CC also was addressed. We also found that medical follow-up of an abnormal Pap smear involved an experience of both having and being a body, which changed over time. The conceptualization of bodily boundaries appeared to change, e.g. through vaginal discharges and bleeding, as well as linkages to the bodies of women in their extended families through the generations. Conclusion: All facets of the PCCSP and social marketing were found to influence women s experiences of and decisions about screening attendance. Women s views of the PCCSP as a comprehensive system suggest a need for increased collaboration among the many professionals with direct and indirect involvement in the PCCSP. These studies suggest that coordination with and information about PCCSP is an important implication for when initiating HPV vaccination programs, as a means of aiding women in integration of different types of knowledge and information.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2009. p. 86
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-26495 (URN)978-91-7409-571-5 (ISBN)
Public defence
Hörsal 1, röd, Alfred Nobels Allé 23 Karolinska Institutet, Stockholm (Swedish)
Opponent
Supervisors
Available from: 2012-11-23 Created: 2012-11-22 Last updated: 2017-10-17Bibliographically approved

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Blomberg, KarinTernestedt, Britt-Marie

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