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Original research
Increasing the perceived relevance of cervical screening in older women who do not plan to attend screening
  1. Laura A V Marlow,
  2. Mairead Ryan,
  3. Jo Waller
  1. Department of Behavioural Science and Health, University College London, London, UK
  1. Correspondence to Dr Laura A V Marlow, Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK; l.marlow{at}


Objectives Uptake of cervical screening among women aged 50–64 years is declining. Not feeling at risk because of current sexual behaviour is a reason some older women give for not being screened. We hypothesised that explaining the long interval between acquiring human papillomavirus (HPV) and developing cervical cancer would increase the relevance of screening in older women.

Methods Women aged 50–64 years (n=597) who did not intend to go for screening were recruited through an online panel and randomised to one of three information conditions: cause only (basic information about HPV and cervical cancer), cause with basic timeline (also read a sentence describing the long interval between acquiring HPV and developing cervical cancer) and cause with explicit timeline (read the same as the timeline group alongside an explanation of what this means for older women). Perceived risk of cervical cancer, screening intention strength and understanding of HPV were assessed preinformation and postinformation exposure.

Results Information condition was significantly associated with risk perceptions and intention strength postintervention (F(2,593)=6.26, p=0.002 and F(2,593)=4.98, p=0.007 respectively). Women in the cause with explicit timeline condition were more likely to increase their risk perceptions and intention strength compared with cause only (24% vs 9% and 25% vs 13% for risk perceptions and intention, respectively). In the cause with explicit timeline group, women with 4–10 lifetime partners had higher odds of increasing their perceived risk and intention strength postintervention compared with those with 0–1 partners (OR=2.27, 95% CI 1.01 to 5.12 and OR=3.20, 95% CI 1.34 to 7.67, respectively).

Conclusions Providing a clear explanation that decouples women’s perceived cervical cancer risk from their current sexual behaviour has the potential to increase perceived risk of cervical cancer and intentions to be screened among older women. Providing women with a clear cognitive representation of the aetiology of cervical cancer may be one approach to increasing screening uptake.

  • risk perceptions
  • non-attenders
  • older
  • cervical screening
  • pap smear
  • salience
  • timeline

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  • Handling editor Dr Sevgi O Aral

  • Contributors LAVM and JW conceived the study. JW, MR and LAVM developed the measures. MR and LAVM managed the project. LAVM conducted the analyses and drafted the paper. All authors contributed to the final version of the manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding This work was supported by a Cancer Research UK career development fellowship awarded to JW (grant reference: C7492/A17219).

  • Disclaimer The funder played no role in the study.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Consent and ethical approval The study was approved by the UCL Research ethics committee (ref: 10353/004). All responses were collected anonymously.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement An anonymous dataset is available on request from the corresponding author: Dr Laura Marlow,, OCRID: 0000-0003-1709-2397.

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