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ObjectiveAccording to the precaution adoption process model, cervical screening nonparticipants represent a heterogeneous group including those who are unaware of, unengaged with, or undecided about screening, as well as intenders and decliners. We aimed to explore beliefs about cervical screening among these different types of nonparticipant.MethodsSemistructured interviews were carried out with women aged 26 to 65 years living in Britain (n = 29). Women were purposively sampled to represent different nonparticipant types. Interviews were transcribed verbatim, and data were analysed thematically using framework analysis.ResultsThe salience of some barriers to screening varied between different types of nonparticipant. Bad experiences were prominent in the discussions of women who had decided not to attend, while practical barriers were more prominent among intenders. There was also some overlap between nonparticipant types. For example, many of the undecided women described not wanting to go for screening, but with less certainty than decliners. Some intenders (particularly those who had not been screened before) described not really wanting to attend but feeling they ought to. Women's views on the invitation/reminder process also varied; intenders and maintainers appreciated written reminders and general practitioner (GP) prompts but decliners sometimes perceived these as “badgering.” Throughout the interviews, women described changing views on screening in the wider context of ageing and motherhood.ConclusionsThe salience of screening barriers varies by nonparticipant type, offering possibilities for tailored interventions. However, the fluidity of women's stage of screening adoption might have implications for this approach to intervention design.

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 As uptake of cervical screening continues to decline, this systematic review synthesises the qualitative literature on women's perceptions and experiences of cervical screening in the context of an organised call–recall programme, in order to understand the barriers to informed uptake. Methods We searched nine databases for English language peer‐reviewed publications reporting on qualitative data from screening‐eligible women, exploring barriers to cervical screening in countries that offer a nationally organised call–recall programme. Evidence was integrated using thematic synthesis. Results Thirty‐nine papers from the UK, Australia, Sweden and Korea were included. The majority of participants had attended screening at least once. Two broad themes were identified: (a) should I go for screening? and (b) screening is a big deal. In considering whether to attend, women discussed the personal relevance and value of screening. Women who had previously attended described how it was a big deal, physically and emotionally, and the varied threats that screening presents. Practical barriers affected whether women translated screening intentions into action. Conclusions The variation in women's understanding and perceptions of cervical screening suggests that interventions tailored to decisional stage may be of value in increasing engagement with the invitation and uptake of screening in those who wish to take part. There is also a need for further research with women who have never attended screening, especially those who remain unaware or unengaged, as their perspectives are lacking in the existing literature. © 2016 The Authors. Psycho‐Oncology Published by John Wiley & Sons Ltd.

Background Vaccination is a vital public health intervention and high uptake is crucial for disease prevention. Although uptake of childhood immunisations is high in the UK, it is not complete and disease outbreaks occur. Systematic reviews and narrative reviews have been conducted to understand vaccination uptake, but novel systematic methods have rarely been used when reviewing the qualitative literature. We conducted a qualitative systematic review of UK studies to understand factors that affect parental decisions about vaccination. Methods We searched PsycINFO, Medline, CINAHL plus, Embase, Social Policy and Practice, and Web of Science for studies published in English at any time using the terms "UK" and "vaccination" and "qualitative methods" (and variations of these). Thematic synthesis methods were used to develop descriptive and then higher order themes. Findings 38 papers were included; they were published between 1999 and 2014 and comprised a cumulative total of 2395 participants. Most participants (>85%) were mothers with children under the age of 5 years. Most studies used interviews (n=19) or focus groups (12). The synthesis identified two types of decision making that parents had adopted: deliberative and less deliberative. Less deliberative decisions were those where parents felt that they had no choice but to vaccinate, were happy to comply, or relied on social norms. Deliberative decisions involved weighing up the risks and benefits of vaccination, considering others' advice or experiences, and social judgment. Parents felt judged for not immunising or they judged others who did not immunise, and some felt a social responsibility to protect the community. Trust was integral to both less deliberative and deliberative decisions and was affected by the media. Parents' emotions affected their deliberative decision making, and this was also sometimes influenced by the media. Finally, practical issues (eg, lack of time) affected parents who intended to vaccinate their children. Interpretation Our synthesis highlighted two different approaches to decision making about childhood vaccinations. Future research should consider the demographic profile of parents adopting these approaches. By understanding the psychological processes underpinning parents' vaccination behaviour and who these individuals are, we can better design interventions to enhance uptake. Funding ASF and LR are funded by a Cancer Research UK – BUPA cancer prevention Fellowship awarded to ASF (C49896/A17429). JW, LAVM, and AJC are funded by a Cancer Research UK Career Development Fellowship awarded to JW (C7492/A17219). HB is funded by the Higher Education Council for England. SGS is funded by a Cancer Research UK post-doctoral Fellowship (C42785/A17965). None of the funders had any role in the study design; in the collection, analysis and interpretation of data; in the writing of the article; and in the decision to submit for publication.