Patient factors

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SCREENING
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PSYCHOLOGICAL PREDICTORS OF THE UPTAKE
OF SCREENING
The numbers of individuals who attend different screening programmes vary
enormously according to factors such as the country, the illness being screened and time
of the screening programme. For example, uptake for neonatal screening for phenylketonuria is almost 100 per cent. However, whereas up to 99 per cent of pregnant
women in Sweden and France undertake HIV testing (Larsson et al. 1990; Moatti et al.
1990), in the UK and North America only a small minority elect to take the test. Marteau
(1993) suggested that there are three main factors that influence uptake of screening:
patient factors, health professional factors and organizational factors.
Patient factors
Several studies have been carried out to examine which factors predict the uptake of
screening. These have included demographic factors, beliefs, emotional factors and contextual factors.
Demographic factors: MacLean et al. (1984) reported that women who attended
for breast screening were more likely to be of high socio-economic status and Owens
et al. (1987) reported that older women were more likely to attend for breast screening
than younger women. Similarly, Simpson et al. (1997) concluded that older women were
more likely to attend a worksite screening programme for cardiovascular disease than
either younger women or men. In addition, Waller et al. (1990) suggested that those
individuals who are the most healthy are more likely to attend for an HIV test and Sutton
et al. (2000) reported that men, homeowners, non-smokers, those who have regular
check-ups at the dentist and those with better subjective health were more likely to
attend for flexible sigmoidoscopy which screens for colorectal cancer.
Health beliefs: Health beliefs have also been linked to uptake and have been
measured using models (see Chapter 2). For example, Bish et al. (2000) used the health
belief model (HBM) and the theory of planned behaviour (TPB) to predict uptake of a
routine cervical smear test. The results showed that the TPB was a better predictor of
behavioural intentions but that neither model successfully predicted actual uptake at
follow-up. Pakenham et al. (2000) also used the health belief model in conjunction with
knowledge and sociodemographic variables to predict reattendance for mammography
screening. The results showed that although the reattenders were older and more likely
to be married the HBM variable of perceived benefits of the mammography were a better
predictor overall of reattendance than sociodemographic variables. Similarly, Sutton
et al. (2000) also included measures of beliefs and reported that a perception of fewer
barriers and more benefits predicted attendance for sigmoidoscopy screening.
Emotional factors: Emotional factors such as anxiety, fear, uncertainty and feeling
indecent have also been shown to relate to uptake. For example, Simpson et al. (1997)
indicated that non-attenders at a worksite screening programme reported more fear of
the results and MacLean et al. (1984) reported that women who attended for breast
screening had suffered less anxiety following the invitation to attend. Further, Shiloh
et al. (1997) examined the predictors of uptake for four screening programmes (a dental
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