oru.sePublikationer
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Från inbjudan till uppföljning: kvinnors erfarenheter av att delta eller inte delta i cervixcancerscreening
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.ORCID iD: 0000-0002-9209-5179
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. , 86 p.
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-26495ISBN: 978-91-7409-571-5 (print)OAI: oai:DiVA.org:oru-26495DiVA: diva2:571516
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: 2015-01-27Bibliographically approved
List of papers
1. How do women who choose not to participate in population-based cervical cancer screening reason about their decision?
Open this publication in new window or tab >>How do women who choose not to participate in population-based cervical cancer screening reason about their decision?
2008 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 17, no 6, 561-569 p.Article in journal (Refereed) Published
Abstract [en]

In Stockholm, Sweden, women are invited to a cost-free population-based cervical cancer screening programme (PCCSP) at regular intervals. Despite this, many women choose not to attend screening at all or to take opportunistic tests instead. This study explores bow women who actively declined participation in the PCCSP reasoned about their choice. Qualitative telephone interviews and fax, messages from women who actively declined participation in the PCCSP were analysed inductively. The manner in which women defined and conceptualized distinctions between, and the roles and responsibilities of, both private and public spheres were found to be central in explanations of decision making. Factors related to women's decisions not to participate in screening at all include a lack of confidence in the benefits of screening, previous negative health care and preventive experiences, a belief in one's own ability to discern health changes or a belief that one was not at risk for cervical cancer, as well as a number of unconventional standpoints on social and political issues. Women who chose not to participate in the organized PCCSP, but who did use private opportunistic screening, generally motivated this with direct or indirect criticism of the screening programme itself. Not only was the examination itself sensitive but also all facets of the PCCSP, from invitation letter on, were found to influence women's decisions. Using Jepson et A's ethical framework to peruse the evidence-base underlying women's 'informed decision-making' about CCS is suggested to be more constructive than discussing potential participants' knowledge versus lack of knowledge.

National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-19558 (URN)10.1002/pon.1270 (DOI)000257874100006 ()
Available from: 2011-10-12 Created: 2011-10-06 Last updated: 2015-01-27Bibliographically approved
2. From 'silent' to 'heard': professional mediation, manipulation and women's experiences of their body after an abnormal Pap smear
Open this publication in new window or tab >>From 'silent' to 'heard': professional mediation, manipulation and women's experiences of their body after an abnormal Pap smear
2009 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 68, no 3, 479-486 p.Article 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.

National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-19293 (URN)10.1016/j.socscimed.2008.11.007 (DOI)000263424600012 ()
Available from: 2011-10-05 Created: 2011-10-04 Last updated: 2015-01-27Bibliographically approved
3. Between youth and adulthood: focus group discussions with 30-year-old women about cervical cancer and its prevention in urban Sweden
Open this publication in new window or tab >>Between youth and adulthood: focus group discussions with 30-year-old women about cervical cancer and its prevention in urban Sweden
Show others...
2011 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 34, no 3, e11-e20 p.Article in journal (Refereed) Published
Abstract [en]

Background: Although there is a significant amount of research on cervical cancer screening (CCS), few studies address screening experiences of women related to reasoning about health maintenance and disease prevention in general. Research tends to neglect experiences in different phases of life and experiences of women with different screening histories. Recent literature primarily focuses on adolescents targeted for human papilloma virus vaccinations, whereas perspectives of women who need continued CCS are lacking.

Objective: The aim of the study was to explore how 30-year-old women reason about health, ill health, health maintenance, and disease prevention, in relation to cervical cancer, its prevention, and screening.

Methods: Through a population-based CCS registry, we randomly sampled women to attend focus group discussions stratified by previous patterns in screening history and test results. Data from 38 attendees were inductively analyzed.

Results: Women’s discussions encompassed temporal aspects of the past and the future, with youth in the rearview mirror and the demands of adulthood ahead. Matters related to sickness, including cancer and its prevention, were described as distant and not prioritized in this phase of life. This situation was compounded by lack of relevant information about cervical cancer and screening.

Conclusions: The manner 30-year-old women self-defined themselves in the transition between youth and adulthood appears to strongly influence their reasoning about CCS and other forms of health maintenance and disease prevention.

Implications for Practice: Cervical cancer screening programs are challenged to adapt both information and organizations to new cohorts of women with different needs and life situations.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2011
Keyword
Cervical cancer, Cervical smear, Focus group, Health, Prevention, Screening, Transition, Women, Young adult
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-17069 (URN)10.1097/NCC.0b013e3181f70f83 (DOI)000289772200002 ()20890134 (PubMedID)2-s2.0-79955566503 (Scopus ID)
Available from: 2011-09-06 Created: 2011-09-02 Last updated: 2017-02-09Bibliographically approved
4. How can young women be encouraged to attend cervical cancer screening?: Suggestions from face-to-face and internet focus group discussions with 30-year-old women in Stockholm, Sweden
Open this publication in new window or tab >>How can young women be encouraged to attend cervical cancer screening?: Suggestions from face-to-face and internet focus group discussions with 30-year-old women in Stockholm, Sweden
Show others...
2011 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 50, no 1, 112-120 p.Article in journal (Refereed) Published
Abstract [en]

Background. Cervical cancer screening (CCS) using Pap-smears has been carried out for decades and is still an essential tool for secondary cancer prevention. Focus has traditionally been on what hinders women's attendance, instead of researching this issue from a positive standpoint, i.e. what factors encourage women to take a Pap-smear? In this article, we therefore explore issues that 30-year-old women have addressed as encouraging CCS attendance, with particular focus on aspects susceptible to intervention. Material and methods. Through the population-based cervical cancer screening (PCCSP) registry in Stockholm, Sweden, a stratified random sampling technique was used to recruit women from the same birth cohort with varied CCS histories and results. Nine face-to-face focus groups discussions (FGDs) and 30 internet-based FGDs were conducted with a total of 138 women aged 30. Qualitative analysis was inspired by interpretative description, to generate clinically relevant and useful data. Results. In general, these women expressed positive views about the PCCSP as an existing service, regardless of screening history. They described a wide range of factors encompassing the entire screening trajectory from invitation through follow-up which could motivate young women to CCS participation, including social marketing. Many of the suggestions related to individualization of the PCCSP, as well as a need to understand the relationship between human papilloma virus (HPV) and cervical cancer. Discusssion. These results are discussed in terms of the inherent tension between population-based public health initiatives and individually-oriented health care provision. Many suggestions given are already incorporated into the existing Stockholm-Gotland screening program, although this information may not reach women who need it. New research should test whether systematic information on HPV may provide a missing link in motivating young women to attend CCS, and which of their suggestions can serve to increase CCS participation.

National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-18804 (URN)10.3109/0284186X.2010.528790 (DOI)000285554200014 ()
Available from: 2011-09-29 Created: 2011-09-29 Last updated: 2015-01-27Bibliographically approved

Open Access in DiVA

fulltext(463 kB)595 downloads
File information
File name FULLTEXT01.pdfFile size 463 kBChecksum SHA-512
794fe4f0c6fbab0b2aed2bf4d49223d8315e8b98cab2e1b6efa99b251779b205507e72748e4db0a7a6c39d9a536968d7173d7501c296e65e696dc57c8dbaa954
Type fulltextMimetype application/pdf

Search in DiVA

By author/editor
Blomberg, Karin
By organisation
School of Health and Medical Sciences, Örebro University, Sweden
Nursing

Search outside of DiVA

GoogleGoogle Scholar
Total: 595 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Total: 1441 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf