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Objectives: Primary human papillomavirus (HPV) testing in cervical screening offers the opportunity for women to be given a choice between HPV self-sampling and traditional clinician screening. This study assessed attitudes towards a choice and anticipated future preference among women who had collected a vaginal self-sample alongside their usual cervical screen., Setting: Thirty-eight general practices across five areas in England., Methods: Overall, 2323 women (24-65 years; response rate: 48%) completed a survey after collecting a self-sample and having a clinician screen at their GP practice. We asked which test they preferred and assessed attitudes to being offered a choice. We explored age, education, ethnicity and screening experience as predictors of attitudes towards a choice and anticipated future choice., Results: Most participants felt they would like a choice between self-sampling and clinician screening (85%) and thought this would improve screening for them (72%). However, 23% felt it would be difficult to choose, 15% would worry about making a choice, and nearly half would prefer a recommendation (48%). Compared with women with degree-level education, those with fewer qualifications were more likely to say they would worry about having a choice or would not want a choice (p < 0.001). The majority said they would choose to self-sample at home if offered a choice in the future (69%; n = 1602/2320)., Conclusions: Self-sampling is likely to be popular, but offering a choice could cause worry for some people and many would prefer a recommendation. Supporting people to make a choice will be important, particularly for those with lower levels of education., Competing Interests: Declaration of conflicting interestsJW received travel, subsistence and consultancy fees (to her institution) from Hologic (manufacturers of an HPV self-sample kit) to attend a cervical cancer patient advocacy meeting in May 2024. The other authors declare no conflicts of interest.

Objectives: Human papillomavirus (HPV) primary testing for cervical screening is being implemented around the world. We explored HPV awareness, and knowledge about primary screening in Great Britain (England, Scotland and Wales), where it has been in place for several years, ahead of extended screening intervals being implemented in England., Setting/methods: Women aged 18-70 ( n  = 1995) were recruited by YouGov from their online panel in August 2022. The weighted sample ( n  = 1930) was population-representative by age, region, education and social grade. We measured HPV awareness, knowledge (excluding those unaware of HPV) using eight true/false items, and understanding of the role of HPV testing in cervical screening., Results: Overall, 77.6% (1499/1930) of women were aware of HPV. When asked to identify the statement describing how cervical screening works, only 12.2% (236/1930) correctly selected the statement reflecting HPV primary screening (13.5% (194/1436) in screening-eligible women). Excluding those unaware of HPV, most participants had heard about the virus in the context of cervical screening (981/1596; 61.5%) or HPV vaccination (1079/1596; 67.6%). Mean knowledge score was 3.7 out of 8 (SD = 2.2) in this group. Most knew that an HPV-positive result does not mean a woman will definitely develop cervical cancer (1091/1499; 72.8%) but far fewer were aware of the long timeline for HPV to develop into cervical cancer (280/1499; 18.7%)., Conclusions: Only three-quarters of women in Britain are aware of HPV, and knowledge of primary screening is very low, even among screening-age women. This points to continued need for awareness-raising campaigns to ensure informed choice about screening and mitigate public concern when screening intervals are extended., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Objectives: This study assessed preferences for human papillomavirus (HPV) self-sampling if offered as an alternative to clinician-based screening at the point of invitation for cervical screening., Setting and Methods: An online questionnaire was completed by screening-eligible women living in England (n = 3672). Logistic regressions explored associations between demographic characteristics and screening preferences, stratified by previous screening attendance. Reasons for preferences were also assessed., Results: Half of participants (51.4%) intended to choose self-sampling, 36.5% preferred clinician screening, 10.5% were unsure, and <2% preferred no screening. More irregular and never attenders chose self-sampling, compared with regular attenders (71.1% and 70.1% vs. 41.0% respectively). Among regular attenders, self-sampling was preferred more frequently by the highest occupational grade, older and lesbian, gay and bisexual women, and those with experience of blood self-tests. In the irregular attender group, older women and those with experience of blood self-tests were more likely to choose self-sampling. In 'never attenders', self-sampling was less popular in ethnic minority groups., Conclusions: If offered a choice of screening, around half of women in England may choose self-sampling, but a substantial proportion would still opt for clinician screening. Screening providers will need to manage a high take-up of self-sampling if many regular attenders switch to self-sampling.

Objectives: To describe cervical cancer screening participation among women who have sex exclusively with women (WSEW) and women who have sex with women and men (WSWM) compared with women who have sex exclusively with men (WSEM), and women who have never had sex and compare this with bowel (colorectal) and breast screening participation. To explore whether there is evidence of differential stage 3 cervical intraepithelial neoplasia (CIN3) or cervical cancer risk., Methods: We describe cervical, bowel and breast cancer screening uptake in age groups eligible for the national screening programmes, prevalent CIN3 and cervical cancer at baseline, and incident CIN3 and cervical cancer at five years follow-up, among 218,674 women in UK Biobank, a cohort of healthy volunteers from the UK., Results: Compared with WSEM, in adjusted analysis [odds ratio (95% confidence interval)], WSEW 0.10 (0.08-0.13), WSWM 0.73 (0.58-0.91), and women who have never had sex 0.02 (0.01-0.02) were less likely to report ever having attended cervical screening. There were no differences when considering bowel cancer screening uptake ( p  = 0.61). For breast cancer screening, attendance was lower among WSWM 0.79 (0.68 to 0.91) and women who have never had sex 0.47 (0.29-0.58), compared with WSEM. There were incident and prevalent cases of both CIN3 and cervical cancer among WSEW and WSWM. Compared with WSEM with a single male partner, among WSEW there was a twofold increase in CIN3 1.91 (1.01 to 3.59); among WSWM with only one male partner, this was 2.25 (1.19 to 4.24)., Conclusions: These findings highlight the importance of improving uptake of cervical screening among all women who have sex with women and breast screening among WSWM and women who have never had sex.

Objective: The NHS Cervical Screening Programme plans to increase the screening interval from 3 to 5 years for women aged 25-49 who test negative for human papillomavirus (HPV). This exploratory cross-sectional online survey tested the impact of different levels of information about the proposed change on acceptability of a longer interval., Methods: Women aged 18-45 (n = 585) were individually randomised to one of three information exposure groups differing in the level of information provided about the screening interval change: (1) basic information; (2) basic information with additional detail about timeline of HPV infection; (3) as (2) but with the addition of a diagram. Acceptability of the change ( favourable and unfavourable attitudes ) was assessed post-exposure alongside HPV timeline beliefs. We used ANOVA and regression analyses to test for between-group differences., Results: Women in Group 3 had higher scores on the favourable attitudes sub-scale compared with Group 1. Women in Groups 2 and 3 had more accurate timeline beliefs than those in Group 1. There were no between-group differences in unfavourable attitudes . After adjusting for demographic factors, a higher favourable attitudes score was independently predicted by being in Group 3 compared to Group 1, more accurate HPV timeline beliefs, and previous irregular or non-attendance at screening., Conclusions: Overall, acceptability of an increased screening interval was moderate, but providing women with information about the safety and rationale for this change may improve acceptability. In particular, communicating the long timeline from HPV exposure to cervical cancer may reassure women about the safety of the proposed changes.

Objectives: Risk stratification may improve the benefit/harm ratio of breast screening. Research on acceptability among potential invitees is necessary to guide implementation. We assessed women's attitudes towards and willingness to undergo risk assessment and stratified screening., Methods: Women in England aged 40-70 received summary information about the topic, and completed face-to-face computer-assisted interviews. Questions assessed willingness to undergo multifactorial breast cancer risk assessment, more frequent breast screening (if at very high risk), or less frequent or no screening (if at very low risk), and preferences for delivery of assessment results., Results: Among 933 women, 85% considered breast cancer risk assessment a good idea, and 74% were willing to have it. Among 125 women unwilling to have risk assessment, reasons commonly related to 'worry' (14%) and 'preferring not to know' (14%). Among those willing to have risk assessment ( n  = 689), letters/emails were generally preferred (42%) for results about very low-risk status. Face-to-face communication was most commonly preferred for results of very high-risk status (78%). General practitioners were most commonly preferred sources of assessment results (≈40%). Breast cancer specialists were often preferred for results of very high-risk status (38%). Risk-stratified breast screening was considered a good idea by 70% and 89% were willing to have more frequent screening. Fewer would accept less (51%) or no screening (37%) if at very low risk., Conclusions: Women were generally in favour of multifactorial breast cancer risk assessment and risk-stratified screening. Some were unwilling to accept less or no screening if at very low risk.

Objective: To assess the feasibility of offering women who are overdue for cervical screening the use of a smartphone app to book their appointment., Methods: Women who were at least six months overdue for cervical screening in three general practice surgeries in a deprived East London borough were identified from practice records. Staff sent batches of text messages informing women that they were overdue for screening, and inviting them to download an app to book their appointment., Results: Across the three practices, 2632 eligible women were identified. Valid mobile phone numbers were available for 1465 women. One woman had opted out of receiving text messages, so messages were sent to 1464 women. Of these, 158 (11%) booked a screening appointment within five months. The majority of these women booked without using the app (72%; 113/158); just over a quarter booked via the app (28%; 45/158)., Conclusions: Just over 10% of cervical screening non-attenders booked an appointment in response to a text message with a link to a downloadable app; however, only one in four of these women booked using the app. This suggests that the text message reminder was likely to have been the key 'active ingredient' for most women, rather than the app itself. Future research could explore the optimal message for a text reminder in this context and evaluate the inclusion of a link to existing online booking systems.

Objectives: Population-based cancer screening has been described as a teachable moment for behaviour change. This research examined the effect of faecal occult blood testing (FOBT) participation on smoking, alcohol consumption, fruit and vegetable consumption and physical activity., Setting: Data were from screening-naïve men within the English Longitudinal Study of Ageing, receiving their first FOBT invitation (n = 774). Four waves of data were included in analyses (wave 4, 2008/2009 - wave 7, 2014/2015). Baseline data were from the wave prior to FOBT invitation, and follow-up data were from the next consecutive wave (two years later)., Methods: The effects of FOBT participation, time and group-by-time interactions on health behaviours were investigated using generalised estimating equations. Almost two-thirds of the sample (62.5%; n = 484) had participated in FOBT., Results: Screening participants were less likely to smoke (odds ratio (OR): 0.45, 95% confidence interval (CI): 0.29-0.68) and more likely to meet fruit and vegetable consumption guidelines (OR: 1.70, 95% CI: 1.14-2.55). Smoking decreased over time (OR: 0.74, 95% CI: 0.62-0.89), but adherence to alcohol guidelines also decreased (OR: 0.71, 95% CI: 0.53-0.91). A group-by-time interaction was found for vigorous physical activity; the odds of taking part in vigorous physical activity increased for FOBT participants, but decreased for non-participants (OR: 1.40, 95% CI: 1.01-1.95)., Conclusions: This research provides tentative support for FOBT as a teachable moment for increasing vigorous physical activity. However, overall, there was limited evidence for spontaneous improvement in multiple health behaviours following participation.

Objectives: A large proportion of women have a preference for a same-gender endoscopy practitioner. We tested how information about practitioner gender affected intention to have bowel scope screening in a sample of women disinclined to have the test., Methods: In an online experimental survey, women aged 35-54 living in England who did not intend to participate in bowel scope screening (N = 1060) were randomised to one of four experimental conditions: (1) control (practitioner's gender is unknown), (2) opposite-gender (male practitioner by default), (3) same gender (female practitioner by default), and (4) active choice (the patient could choose the gender of the practitioner). Intention was measured following the interventions., Results: Of 1010 (95.3%) women who completed the survey, most were White-British (83.6%), and working (63.3%). Compared with control, both active choice and same-gender conditions increased intention among disinclined women (9.3% vs. 16.0% and 17.9%; OR: 1.85; 95% CI: 1.07-3.20 and OR: 2.07; 95% CI: 1.23-3.50). There were no differences in intention between the opposite-gender and control conditions (9.8% vs. 9.3%; OR: 1.06; 95% CI: 0.60-1.90) or the active choice and same-gender conditions (16.0% vs. 17.9%: OR: 0.89; 95% CI: 0.55-1.46, using same gender as baseline)., Conclusions: Offering disinclined women a same-gender practitioner, either by choice or default, increased subsequent intention, while an opposite gender default did not negatively affect intention. Reducing uncertainty about gender of practitioner could positively affect uptake in women, and should be tested in a randomised controlled trial.

Objective: Some degree of general worry about cancer may facilitate screening participation, but specific worries about the potential consequences (e.g. treatment, death) may act as deterrents. No studies have examined these associations in the same sample. We assessed associations between general versus specific cancer worries and cancer screening participation., Methods: In 2016, a population-based cross-sectional survey of adults living in England was carried out. This paper reports analyses of a subsample (n = 1694). Measures included (i) frequency of general cancer worry, (ii) specific worries about the emotional and physical consequences of a cancer diagnosis, and (iii) specific worries about the social consequences of a cancer diagnosis. Logistic regression analyses examined their association with self-reported screening uptake among participants eligible for cervical (n = 671), breast (n = 323), and colorectal (n = 368) cancer screening., Results: Frequency of general cancer worry was not associated with screening participation. Specific worry about the emotional and physical consequences increased the odds of participants reporting regular uptake of colorectal screening (OR 1.41, 95% CI 1.04-1.90). Specific worry about the social consequences of diagnosis was negatively associated with regular attendance for cervical and breast screening in unadjusted analyses only. In adjusted models, the associations were no longer statistically significant for cervical (OR 0.82, 95% CI 0.65-1.03) or breast (OR 0.69, 95% CI 0.45-1.04) screening., Conclusions: Specific worries about cancer may be differentially associated with participation across screening programmes. Further research is needed, as interventions to optimise informed participation may be improved if the specific worries associated with low participation in each programme are understood.

Objectives: Understanding why some women actively decline cervical screening could contribute to tailored intervention development. We explored reasons for non-participation in cervical screening among women who had made an active decision not to attend in the future. We also explored interest in human papillomavirus self-sampling., Methods: In a population-based survey of women in Great Britain, home-based computer-assisted interviews were carried out with screening eligible women. Women reported their intention to attend for screening when next invited. They endorsed predefined barriers to screening and indicated their interest in human papillomavirus self-sampling., Results: Women who had actively declined screening and those who intended to go but were currently overdue (n=543) were included in this analysis. Women who had made an active decision not to be screened in the future were more likely to endorse the barriers 'I have other more important things to worry about' and to perceive screening to be of low relevance based on their sexual behaviour. Most participants (70%) indicated that they would be interested in human papillomavirus self-sampling. Interest in self-sampling was greater among those who reported having had a bad experience of screening in the past, were too busy or embarrassed to attend, or would not want a man to carry out the test., Conclusions: Women who had made an active decision not to attend screening felt it was of low relevance to them and that they had more important things to worry about. Shifting the perceived cost-benefit ratio for these women by offering human papillomavirus self-sampling might increase screening participation in this group.

Objectives: One reason that women over age 50 report avoiding cervical screening is increased discomfort postmenopause. This study aimed to explore the acceptability of human papillomavirus testing on clinician-collected vaginal samples without a speculum ('non-speculum') for cervical screening among older women., Methods: Thirty-eight women in England aged 50-64 with a range of cervical screening experience ('up-to-date' n = 17, 'overdue screening' n = 18, 'never screened' n = 3) were identified via a recruitment agency. Women participated in focus groups or interviews about the potential for using clinician-collected samples without a speculum. Discussions were analysed using Framework Analysis., Results: The two main themes identified were women's perceptions of the speculum and attitudes towards non-speculum screening. Many women reported negative experiences with the speculum, including increased pain after the menopause. Women generally had positive attitudes towards non-speculum clinician sampling and felt it would be a less intrusive option, but expressed concern that it could be less accurate than screening with a speculum. Women who were 'up-to-date' preferred conventional screening, while overdue and never screened women welcomed the option to be screened without a speculum., Conclusions: Human papillomavirus testing on non-speculum clinician-collected vaginal samples could be an acceptable alternative cervical screening method for older women. Offering this approach could increase screening uptake in older women who find conventional cervical screening to be less acceptable with ageing or the menopause.

Objectives In examining informed choice in cancer screening, we investigated public awareness that some screening programmes aim to prevent cancer, while others seek to detect cancer at an early stage. Methods A population-based survey of adults aged 50-70 in England (n = 1433), including data on demographic characteristics and screening experience. Participants were asked to select the main purpose of cervical, breast, and colorectal cancer screening (both faecal occult blood testing and flexible sigmoidoscopy). Results Across all four screening programmes, most people thought the main aim was to catch cancer early (71-78%). Only 18 and 14% knew that cervical screening and flexible sigmoidoscopy, respectively, are primarily preventive. Knowledge of the preventive aspect of these two programmes was low across the board, with few demographic patterns. By contrast, 78 and 73% of the sample were aware that breast screening and the faecal occult blood test, respectively, predominantly aim to detect cancer early. For these programmes, accurate knowledge was socially graded, lower in ethnic minority groups, and positively associated with previous participation in the programmes. Conclusions Our findings suggest that although awareness of the purpose of early detection screening is high, awareness that screening can prevent cancer is low across all demographic groups. Understanding the purpose of screening is a key aspect of informed choice but despite current communication strategies highlighting these differences, people do not seem to have a nuanced understanding of these differing aims. Our findings may be indicative of a broader public scepticism about the preventability of cancer.

Objective: Health policy in the UK is committed to tackling inequalities in cancer screening participation. We examined whether socioeconomic inequalities in breast and cervical cancer screening participation in England have reduced over five years., Methods: Cross-sectional analyses compared cervical and breast screening coverage between 2007/8 and 2012/13 in Primary Care Trusts (PCTs) in England in relation to area-level income deprivation., Results: At the start and the end of this five year period, there were socioeconomic inequalities in screening coverage for breast and cervical screening. Inequalities were highest for breast screening. Over time, the coverage gap between the highest and lowest quintiles of income deprivation significantly reduced for breast screening (from 12.3 to 8.3 percentage points), but not for cervical screening (5.3 to 4.9 percentage points)., Conclusions: Efforts to reduce screening inequalities appear to have resulted in a significant improvement in equitable delivery of breast screening, although not of cervical screening. More work is needed to understand the differences, and see whether broader lessons can be learned from the reduction of inequalities in breast screening participation., (© The Author(s) 2015.)

Objective: To compare self-reported with objectively recorded participation in Faecal Occult Blood testing (FOBt) colorectal cancer (CRC) screening in a national programme., Methods: Survey respondents living in England who were eligible for screening were asked in face-to-face interviews if they had ever been invited to do a CRC screening test, how many times they had been invited, and how many times they had participated. National Health Service (NHS) Bowel Cancer Screening Programme (BCSP) records were consulted for respondents who had consented to a record check. The outcome measures were 'ever uptake' (responded to ≥1 invitation), 'repeat uptake' (responded to ≥2 invitations), and 'consistent uptake' (responded to all invitations)., Results: In the verified group, self-reported ever uptake was highly consistent with recorded ever uptake (87.0% vs. 87.8%). Among those who indicated that they had been invited more than once, self-reported repeat uptake was 89.8% compared with 84.8% recorded repeat uptake. Among those with more than one recorded invitation, self-reported repeat uptake was 72.7% compared with 77.2% recorded repeat uptake, and self-reported consistent uptake was 81.6% compared with 65.6% recorded consistent uptake., Conclusion: Our results suggest that people can accurately report whether they have ever taken part in CRC screening. The vast majority of those whose records were verified could also accurately report whether they had taken part in screening at least twice. They were somewhat less accurate in reporting whether they had responded to all screening invitations., (© The Author(s) 2015.)

Objective: Uptake of cancer screening tends to be lower for colorectal cancer (CRC) than cervical or breast cancer. Dislike of the test itself has often been identified as a barrier to CRC screening with the Faecal Occult Blood (FOB) test, but there have been no head-to-head comparisons of the three tests., Methods: Women aged 50-80 (n = 890) were recruited in spring 2012 as part of a population-based TNS Research International survey in Great Britain. Those in the eligible age range were asked if they had ever participated in breast, cervical or CRC screening. For each screening test, women who had never participated were asked for their 'main reason' using a checklist of barriers., Results: Among eligible women, 67%, 83% and 90% reported ever having been screened for CRC, cervical and breast cancer respectively. More socioeconomically deprived women were less likely to report any screening, and single women were less likely to report CRC or breast screening than married women. Age was not associated with participation. Overall there were few differences between tests in the reported barriers, but dislike of the test was endorsed more often for CRC screening., Conclusion: This was the first study to compare barriers to participation in organised screening programmes for CRC, breast and cervical cancer. Cancer screening tests share many barriers, but dislike of the test appears to be a stronger barrier to CRC screening. Women who are non-participants in more than one programme may have more global barriers to screening, such as cancer fatalism. The findings suggest that uptake of CRC screening could be improved by targeting the unpleasantness of stool sampling.

Objectives: In 2009 more women attended cervical screening in England and Wales than in the previous year. Described as the 'Jade Goody Effect' this was attributed to the death from cervical cancer of a UK celebrity. The present study aimed to establish which sociodemographic characteristics were associated with being influenced by Jade Goody's story., Methods: Data were collected as part of a Taylor Nelson Sofres (TNS) omnibus survey using random location sampling. Women in England aged 26-64 years were asked to report whether they felt Jade Goody's story had influenced their decisions about cervical screening over the 18 months between her death and the time of the survey., Results: Data from 890 participants was included in analysis. Over a third of women felt Goody's story had influenced their decisions about cervical screening (40%). Younger women (aged 26-35 years) were more likely to have been influenced by Goody's story than older women (56-64 year olds). There was also evidence of socioeconomic variation with women from lower socioeconomic class groups and those with fewer educational qualifications more likely to say they had been influenced by Goody's story., Conclusions: The 'Jade Goody Effect', as acknowledged by women themselves, was more pronounced among young women and influenced screening decisions more markedly among those from lower socioeconomic backgrounds. Narrative communication may be an effective way to encourage attendance at cervical cancer screening and reach groups of the population that are difficult to reach using traditional intervention methods.

Objectives: To examine the relationship between cervical screening uptake and political engagement, and to test whether political engagement and voting behaviour mediate the association between age and cervical screening uptake., Setting: A population-based survey of women in England in 2010., Methods: Women aged 26-64 took part in home-based computer-assisted interviews (n = 890). Women were classified as 'up to date' or 'overdue/never been screened' for cervical screening., Results: Most women (81%) were up-to-date with screening; 19% were overdue. Age and marital status were associated with screening status. Women who were not registered to vote, had not voted in previous general elections, and those who showed less interest in elections and lower intention to engage in political activities were more likely to be overdue for screening. In multivariate analyses (adjusting for all significant measures) 'being on the electoral register' was the only significant independent predictor of screening status. 'Being on the electoral register' was also the only measure of voting behaviour that mediated the association between age and screening status., Conclusion: We found limited evidence for the hypothesis that falling attendance for cervical screening could be associated with a broader phenomenon of disillusionment as indexed by reported voting behaviour and other measures of political engagement. Alternative explanations should be considered in order to better understand falling cervical screening uptake, particularly among younger women.

Objective: The aim of the study was to examine awareness of the three National Cancer Screening Programmes (breast, cervical, bowel) among white and ethnic minority groups in the UK., Setting: Data were from two surveys in which the screening questions were added: (i) the Office of National Statistics (ONS) Opinions Survey, carried out in September and October 2008; and (ii) the Ethnibus™ survey of the main ethnic minority groups in England, conducted in October and November 2008., Methods: The ONS sample consisted of 2216 adults selected using stratified probability sampling to obtain a population-representative sample. The Ethnibus™ sample was obtained by quota sampling and included 1500 adults from the six largest ethnic minority groups in England (Indian, Pakistani, Bangladeshi, Caribbean, African and Chinese). Participants completed questions on awareness of cancer screening programmes as part of the wider Cancer Awareness Measure (CAM) in home-based, face-to-face interviews., Results: Awareness of breast and cervical cancer screening was high in the white ONS participants (89% breast and 84% cervical), lower in the ONS ethnic minority sample (74% for both breast and cervical) and lowest in the Ethnibus™ sample (69% breast and 66% cervical). Ethnic disparities persisted after controlling for age, gender and occupational group. In both groups, knowledge of breast and cervical screening was lower among men and more socioeconomically deprived groups. Awareness of the new bowel cancer screening programme was less than 30% in both white and ethnic minority groups., Conclusions: Ethnic disparities in knowledge of breast and cervical cancer screening should be addressed. Strategies to engage ethnic minority and socioeconomically deprived groups in bowel cancer screening should be instigated to avoid the emergence of disparities.

Objectives: To explore barriers to cervical screening attendance in a population-based sample, and to compare barriers endorsed by women who were up-to-date with screening versus those who were overdue. We also tested the hypothesis that women who were overdue for screening would be more generally disillusioned with public services, as indexed by reported voting behaviour in elections., Setting: A population-based survey of women in England., Methods: Face-to-face interviews were carried out with 580 women aged 26-64 years, and recruited using stratified random probability sampling as part of an omnibus survey. Questions assessed self-reported cervical screening attendance, barriers to screening, voting behaviour and demographic characteristics., Results: Eighty-five per cent of women were up-to-date with screening and 15% were overdue, including 2.6% who had never had a smear test. The most commonly endorsed barriers were embarrassment (29%), intending to go but not getting round to it (21%), fear of pain (14%) and worry about what the test might find (12%). Only four barriers showed significant independent associations with screening status: difficulty making an appointment, not getting round to going, not being sexually active and not trusting the test. We found support for our hypothesis that women who do not attend for screening are less likely to vote in elections, even when controlling for barrier endorsement and demographic factors., Conclusions: Practical barriers were more predictive of screening uptake than emotional factors such as embarrassment. This has clear implications for service provision and future interventions to increase uptake. The association between voting behaviour and screening uptake lends support to the hypothesis that falling screening coverage may be indicative of a broader phenomenon of disillusionment, and further research in this area is warranted.

Objectives: We explored Muslim women's attitudes to self-sampling for human papillomavirus (HPV) in the context of cervical cancer screening and their responses to two self-sampling devices., Setting: A Muslim community centre in north-east London., Methods: Following a talk given on the subject of cervical cancer and HPV at the community centre, 28 women were recruited to take part in three focus group discussions. The discussion covered cervical screening, self-sampling and HPV testing. Women were also asked for their responses to a swab self-sampling kit and a cervico-vaginal lavage device. Discussions were recorded and transcribed verbatim and the qualitative data were analysed using Framework Analysis., Results: Participants were generally positive about cervical screening but acknowledged that some women in their community were reluctant to attend because of embarrassment, language difficulties, fear or because they were unmarried and did not want to communicate implicit messages about being sexually active. Self-sampling met a mixed response - women were concerned about not doing the test correctly, but thought that it might overcome barriers to screening for some women. HPV testing itself was thought to raise potentially difficult issues relating to trust and fidelity within marriages. Although most women said they would prefer to continue to have screening by a health professional, if they were to perform self-sampling, there was overwhelming preference for the swab over the lavage kit., Conclusions: There was limited enthusiasm for self-sampling in this group of Muslim women who had mostly attended for cervical screening, but a clear preference for a swab rather than a cervico-vaginal lavage.

Objectives: To examine sociodemographic predictors of self-reported screening attendance, intention to accept human papillomavirus (HPV) testing and willingness to accept vaccination for a daughter under 16., Setting: Home-based, computer-assisted interviews with a population representative sample of British women., Methods: Participants were selected using random probability sampling of the Postcode Address File, 994 women aged 25-64 were included in these analyses. Women reported their attendance at cervical screening and intention to accept an HPV test. A subsample of those with a daughter under 16 years (n = 296) reported their willingness to accept HPV vaccination for their daughter., Results: Screening attendance was associated with education level (odds ratio [OR] = 1.66, confidence interval [95% CI]: 1.07-2.56) and being married (OR = 2.04, 95% CI: 1.37-3.03). Acceptance of HPV testing was predicted by regular attendance for cervical screening (OR = 1.58, 95% CI: 1.03-2.42) and being from a white background (OR = 2.20, 95% CI: 1.18-4.13). Daughter's age was the only predictor of HPV vaccine acceptance, with mothers whose youngest daughter was 13-16 years old being the most likely to accept vaccination (OR = 2.91, 95% CI: 1.27-6.65)., Conclusion: In contrast to screening attendance, ethnicity plays an important role in HPV testing. Specific cultural barriers should be identified and addressed to ensure ethnic disparities in testing are limited. While marital status is associated with screening attendance, HPV testing could overcome this bias. Sociodemographic variables seem to play a limited role in HPV vaccine acceptance among mothers making vaccine decisions for their daughters, but as with other studies, age of daughter is important. The scientific reasons for vaccinating at 12-13 years should be emphasized in HPV information.