br Finally prior screening i e never
Finally, prior screening (i.e., never screened vs. screened) was
examined in relation to the number and type of screening barriers and facilitators listed by women. In the first analysis, the number of prac-tical and psychological screening barriers listed by women was related to prior screening, after controlling for age group; and practical barriers were the strongest predictor. Each practical barrier nearly tripled the odds of prior screening in women, whereas each psychological barrier increased the odds of never screening by 33%. In the analysis of facil-itators, only the number of practical facilitators was related to prior screening, after controlling for age group; and each individual practical facilitator more than doubled the odds of prior screening. Specifically, the women who had never screened were more likely to report em-barrassment and anxiety as screening barriers, whereas prior screeners were more likely to report both a lack of time as a screening barrier and having a regular GP. No earlier studies have examined prior screening in regard to screening barriers and facilitators experienced by women, but the results are consistent with other results showing that 3X FLAG Peptide worry is a key screening barrier in women who have mostly not screened before (Al-Naggar et al., 2010).
In summary, the results show that the number of psychological barriers listed by women was related to screening status (up-to-date vs. overdue), but not practical barriers or facilitators. In particular, em-barrassment (screening barrier) was linked to being overdue for screening, whereas having a regular GP and the low cost of the test (screening facilitator) were linked to up-to-date screening. In contrast, the number of practical barriers was more strongly linked to prior screening than the number of psychological barriers. Women who had never screened were more likely to report embarrassment and anxiety (screening barriers), whereas prior screeners were more likely to report having a regular GP (facilitator) and a lack of time to screen (barrier). However, each psychological screening barrier only increased the odds of being overdue for screening or never screening by about 30%, whereas each practical barrier and facilitator more than doubled the odds of prior screening in women.
Taken together, the results suggest several implications for clinical practice. First, women who had screened before tended to list practical screening barriers and facilitators, likely reflecting their knowledge of the practicalities of screening. In contrast, women who had not screened before or were overdue for screening tended to name psy-chological screening barriers. Thus, psychological screening barriers may interfere the most with first-time screening and timely screening; and specifically targeting the barriers may encourage women to screen for the first time or in a timely fashion. However, targeting practical barriers and facilitators (e.g., regular GP, lack of time) may result in a larger improvement in first-time screening and timely screening, based on the size of the odds-ratios, although such an assertion requires verification in intervention studies. Finally, the study results should be referenced to the newly-implemented National Cervical Screening Program, which started after the data collection phase of this study. In 2017, HPV testing replaced Pap testing (Arbyn et al., 2012), which is performed less often than the Pap test (every five years vs. every two years). However, screening reminders have been shown to effectively increase women's cervical screening uptake (Albrow et al., 2014; Everett et al., 2011), but psychological interventions are still required to address psychological screening barriers, which may adversely im-pact on future screening behavior.
4.1. Study limitations
The results should be interpreted in light of several study limita-tions. First, a high proportion of participants were tertiary educated, which may have been due to the online study design. Online studies typically skew the recruitment towards younger adults with higher educational attainment (Howard et al., 2001); and higher educational attainment is linked to higher screening rates (Breslow et al., 1997). Second, two narrow age groups were sampled, rather than evaluating age on a continuum, and women aged older than 55-years were Social Science & Medicine 220 (2019) 396–402
excluded, thus, limiting the ability to generalize results to older women. Third, a larger proportion of women were up-to-date with screening than Australian screening rates by age (AIHW, 2017), and only a small proportion of them (7%) had not screened before. However, given the large number of prior screeners and the conservative p-value applied to the results; acetyl CoA are likely to reflect significant differences in women who had or had not screened before. Fourth, screening behavior was retrospectively assessed via women's self-reports, rather than verifying the attendance with cervical screening registries. Self-reports likely underestimate the number of women who are overdue for screening, relative to registry records (Bowman et al., 1991); but much of the research in this field relies on self-reported data, due to the difficulty in obtaining identifiable registry data to link to participant responses. Fifth, the two models predicted modest variance in women's screening status and prior screening, suggesting that other factors are likely to be relevant (Bish et al., 2000). Finally, the results were only cross-sectional in nature, thus precluding any causal inferences to be drawn.