Cervical screening: what are the communication problems?

Computer-managed call and recall schemes offer the opportunity for effective cervical screening. However, such schemes involve several different agencies, often independent of one another. As a result, problems of communication can arise. This paper discusses potential areas of difficulty and presents some suggestions for improvement.

Well you can come in but i'm not having it. The role of the health visitor in computer-managed cervical screening.

Health visitors called on women who had not attended for a cervical smear test, following an invitation via a computer-managed scheme. Reasons for non-attendance were identified and the study showed that health visitors can be successful in encouraging some non-attenders to be screened. However, there are problems involved in undertaking such a role, which must be acknowledged if the health visitors's time is to be used effectively.

Do nurses smoke because of stress?

A comparison of learner nurses and student teachers indicated that occupational differences in smoking prevalence were established prior to entry. However, learner nurses experienced higher stress for the greater part of their first year of training and this was one factor contributing to the consolidation of smoking among them. In general, smoking was seen as a way of dealing with negative feelings and although smokers did not experience greater stress than non-smokers, the former were more likely to feel anger. Lower levels of perceived stress were associated with moves to lesser smoking, suggesting that stress prevents smoking being given up. Some non-smokers were vulnerable in that they both experienced higher stress and saw smoking as a solution. The use of maladaptive intrapsychic coping techniques and the absence of social support outside nursing were both associated with movements to greater smoking.

Reasons for non-attendance for computer-managed cervical screening: pilot interviews.

A pilot interview study looked at reasons why women did not attend a clinic following an invitation for a cervical smear test offered via a computer-managed scheme. Three broad issues were identified. First, the inaccuracy of the computer database (the FPC register) meant some women were inaccessible because they no longer lived at the address recorded. Other women were ineligible or unsuitable within the criteria of the scheme but had been sent invitations inappropriately because their screening records were incomplete or out of date. Second, aspects of service organisation and provision led to misclassification of some attenders as non-attenders and to various failures of communication such as non-receipt of the invitation or health education leaflet or unsuccessful attempts to rearrange appointments. In addition, the appointment or venue offered could be unsatisfactory. The third issue concerned the characteristics of the women which sometimes interacted with practical problems connected with service provision. Other women believed the test to be inappropriate for themselves while some were deterred by the prospect of the test itself. In general, embarrassment was pervasive and reflected in preferences for different types of service provision. Women who had neither attended nor been otherwise tested were particularly likely to express feelings of fear and fatalism. General attitudes to the test were favourable but this was not always applied personally. A typology of reasons for non-attendance for computer-managed cervical screening is presented.

Smoking and the female professions: pre-occupational influences on the behaviour of recruits to nursing and teaching.

A questionnaire and interview study of female recruits to nursing and teaching showed that occupational differences in the prevalence of smoking are already established at entry to training. The social characteristics of the smokers in the sample corresponded to those of women smokers generally. Differences in education and social origin contributed to occupational variations in behaviour. The influence of sibling behaviour and parental opinion operated differently within the two occupational groups. The psychological attributes of individuals attracted to a particular profession may also contribute to occupational patterns, specifically risk-taking and a concern for personal freedom.

The effect of training on knowledge and opinion about smoking amongst nurses and student teachers.

At their entry to training, student teachers and nurses (pupils, general students and paediatric students) completed a questionnaire and were interviewed about their knowledge and opinion of smoking as a health hazard. This was repeated a year later. The nurses and student teachers did not differ in their knowledge of eight smoking-related diseases at their entry to training, but the nurses were less willing to acknowledge the importance of smoking as a health problem. This was in part related to differences in their smoking behaviour, smokers being less likely to perceive smoking as a hazard than non-smokers. Smokers were also more likely to express doubts about the role of smoking in illness. In general at entry the pupil nurses were the least likely to accept that smoking is harmful to health. After a year of training little change was evident among the student teachers. Among the nurses knowledge had improved for some conditions and decreased for others. Improved knowledge was most evident among the general students but scores declined consistently among the pupils. The uptake of knowledge was also related to the nurses' smoking behaviour, non-smokers tending to become better informed and smokers less certain. In general, the nurses had also become less likely to acknowledge the importance of smoking as a health issue, and again, this was most marked among the pupils. Smoking behaviour did not account for these changes. The nurses applied their training experience to their views, the effect usually being to confirm existing ideas. Not all experience had a positive impact and training had not enhanced understanding of the causal relationship between smoking and illness. One explanation could lie in the way the subject of smoking is dealt with during teaching.

Synthesising research findings and practical experience to formulate principles in cervical screening.

Compared particularly with Scandinavian countries, the effects of cervical screening in the United Kingdom have been disappointing, both in terms of women screened and in relation to incidence and mortality. The underlying problem is the under-representation of women most at risk of cervical cancer in the screened population. In this paper we examine two possible hypotheses for such under-representation: one concerns the behavioural aspects of women's failure to attend and the second the effect of the organisation of current screening services on their attendance. We outline the features that an effective service would need to incorporate and propose principles for the development of a screening system designed to maximise the potential of the cervical smear test.

Attendance for cervical screening--whose problem?

Despite the existence of an effective screening technique for cancer of the cervix, incidence and mortality from this disease have not declined in the United Kingdom. The basic problem is that women most at risk of the disease are under-represented in the screened population. The evidence for two different points of view to explain this situation is examined. These viewpoints are the failure of the women to attend, and the failure of the service to meet the needs of women. This paper argues that the evidence supports the view that the organisation of the existing screening service impedes the maximum participation of at-risk women. We discuss the features that an effective service needs to incorporate, and put forward principles for the development of a more effective screening system, namely, that it should be provider-initiated and user-oriented.

The social definition of women's smoking behaviour.

The history of women's smoking behaviour is one of changing normative definitions. Recent trends have been explained in terms of the symbolic value of smoking, representing for women freedom and independence. This view is emphasised by advertising. However, other evidence suggests the continued existence of an older, more negative cultural stereotype. A two-part study of young women undergoing professional training for nursing and teaching throws some light on the way in which female smoking behaviour is currently socially interpreted. The first phase indicated that among the minority of parents who had expressed their attitudes towards their daughter's smoking in relation to sex-role norms, smoking was presented as unacceptable for women. More than half the sample perceived a negative cultural stereotype to be operating in contemporary society and two-thirds recognised its existence in the past. This stereotype presents smoking as a male behaviour and hence inappropriate for women. Women who do smoke are liable to be labelled as having unfeminine or degrading attributes. The stereotype operated more strongly in the general social background rather than in reference to personal relationships and hence its influence on contemporary behaviour is likely to be limited. It was rejected as out-dated or a male belief by some but nevertheless it represented the personal opinion of others. In terms of a more favourable definition the female smoker was perceived in terms of an elegant/sophisticated dimension and in relation to an extrovert personality. The view of sample members that the growing acceptability of women's smoking was related to social change indirectly supported the view that sees smoking as symbolic of independence. Those who saw smoking in neutral terms, i.e. as not having sex-role attributes, perceived smoking in this sense as normal social behaviour for men and women alike. The second phase suggested that smokers and non-smokers have divergent views about the image of the female smoker. The non-smoker's image was based on the older cultural stereotype ('unladylike'), whereas the smokers were more likely to take a view corresponding to the perspective that sees women's smoking as symbolic of social change and greater independence ('liberated'). The non-smokers had a clear and positive image of 'girls who don't smoke' ('feminine'), whereas for smokers the female non-smoker lacked a distinctive identity. The study thus suggests that traditional concepts of appropriate female behaviour continue to inhibit smoking among some women, whereas others perceive it as an aspect of independent behaviour.(ABSTRACT TRUNCATED AT 400 WORDS)

Changes in the smoking behaviour, knowledge and opinion of medical students, 1972-1981.

To examine changes in medical students' smoking behaviour, knowledge and opinion over the last decade, a survey first conducted at the University of Manchester Medical School in 1972 was repeated in 1981. A postal questionnaire was sent to 1163 students, of whom 1112 (96%) replied. A substantial decline in cigarette smoking among medical students has occurred. This largely follows trends in the general population, medical education itself having made little contribution to the change. In 1972, 29% of students were cigarette smokers compared with 17% in 1981. The fall in cigarette smoking was more marked among men students rather than women, older rather than younger students, clinical rather than pre-clinical students. Cigarette consumption had also decreased as had the use of cigars and pipes among male students. The decline was already evident prior to students beginning their medical studies. A smaller expansion of smoking experience at medical school had occurred among the 1981 students, but, as in 1972, those who took up smoking or increased their consumption exceeded those who gave up or cut down. In 1981 the likelihood of taking up smoking or becoming a regular smoker at medical school was somewhat greater for women students than for men, although the numbers concerned were small. The survey reconfirmed the importance of the social environment in smoking behaviour. Modest changes had occurred in knowledge and opinion about smoking. Both the accuracy and scope of knowledge of students about the health hazards increased between 1972 and 1981, particularly among clinical students, who remained considerably better informed than their pre-clinical colleagues. As in 1972, knowledge had little impact on smoking behaviour. By 1981 nine out of ten students regarded smoking as a major risk to health, both clinical students and smokers being more likely to take this view than in 1972. Almost all students, irrespective of their smoking behaviour, found the evidence linking smoking to serious illness to some extent convincing, and by 1981 a somewhat greater proportion, 60%, found it very convincing, the tendency to do so increasing as they progressed through their course.

Nurses' views about cancer.

To examine the impression of cancer the nurse in likely to convey to the public, 785 female hospital nurses were asked by means of postal questionnaire to give their opinion of the curability and treatment of cancer and the extent to which they regard the disease as alarming. Seven out of ten nurses disagreed with the statement that a patient who had had cancer can never really be cured. Characteristics leading to a better appreciation of the curability of cancer included training, increasing age and length of service and accurate knowledge of survival rates. Positive, personal experience of cancer was more important than professional experience of cancer nursing, suggesting it is the nature of the experience that is important. Young learners had a very poor understanding of the curability of cancer. The majority of nurses considered it at least sometimes true that treatment could do more harm than good and this conclusion is reached very early on in the nurse's career. Trained nurses had a better appreciation of palliative treatment. Nurses, like women generally, tend to regard cancer as the most alarming condition, although this view is less prevalent among trained or experienced nurses. While characterizing nurses' views about cancer as optimistic or pessimistic is not necessarily helpful, it is clear that the minority of nurses would find it difficult to present anything other than a negative view of cancer to their social network.

The accuracy of nurses' knowledge about survival rates for early cancer in four sites.

To consider the role of nurse education in the development of a body of professional knowledge about cancer, trained nurses (n = 372), learners (n = 160) and auxiliaries (n = 238) were asked, by means of a postal questionnaire, to estimate the 5-year survival rates for early cancers in four sites: breast, cervix, skin and lung. Among trained nurses only a minority had accurate knowledge; four to five out of ten answering accurately for breast, cervix and lung, but only two in ten for skin. All three grades were less well informed about skin cancer. For all sites trained nurses were more likely to be accurate than learners or auxiliaries, but the variations were statistically significant only for skin and cervix. Taking auxiliaries as a baseline the degree of differentiation between their knowledge and that of the SRNs was disappointing. Nurses' reliance on bedside experience as their major source of information about cancer is suggested as one explanation for their levels of knowledge. The implications both for the nurse's role in health education and for nursing education are discussed.

The nurse as health educator: the prevention and early detection of cancer.

To assess their potential as health educators 785 female hospital nurses (trained nurses, learners, auxiliaries and nursery nurses) were asked, by means of a postal questionnaire, to give their opinion of three measures of cancer control--the cervical smear test, breast self-examination (BSE) and not smoking. Eighty-four % thought the cervical smear test of definite value, 68% had this opinion of BSE, but only 59% thought that it was of definite value not to smoke. Most nurses saw all three measures as having some degree of benefit as few rejected any measure as being of no value. Factors related to whether they regarded a particular measure as being of definite, rather than a lesser degree of value, included (but not necessarily always for all measures) grade, training, age, professional experience of cancer nursing, acceptance of the curability of cancer, knowledge of survival rates, likelihood of reading an article about cancer, and smoking behaviour. It is suggested that nurses' relative assessment of the measures is not based on the intrinsic value of the measures themselves, but on the nurses' personal health behaviour and on the perceived difficulty in undertaking a measure. Furthermore, additional barriers to nurses' likelihood of recommending such measures to others include: lack of understanding of, and skills in health education and an inadequate knowledge base. Thus, simply exhorting nurses to engage in health education is unlikely to succeed. The barriers described have to be taken into account and in particular nurses need to be taught health education skills.