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Title: Understanding the relationship between sexual assault and cervical smear uptake
Author: Madden, Katherine
ISNI:       0000 0004 8500 4544
Awarding Body: Royal Holloway, University of London
Current Institution: Royal Holloway, University of London
Date of Award: 2018
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Cervical cancer (CC) is the fourth most common cancer in women worldwide. The most effective strategy for detecting, and therefore treating it, is through CS, which can detect potentially cancerous cells. Despite the effectiveness of CS, the current attendance rates are declining. Organised screening programmes encourage CS attendance by reducing some extrinsic barriers such as cost and a lack of health insurance. To continue to reduce mortality rates from CC, understanding intrinsic barriers that can be targeted through interventions is likely to be most beneficial. An SR was conducted on quantitative studies exploring the relationship between psychological variables, and intention to and actual attendance (uptake) of CS in countries with organised screening programmes. For the empirical paper (EP), a study was conducted to identify psychological factors related to CS uptake in women who have experienced sexual assault. Women who have experienced sexual assault have lower levels of CS uptake than the general population. One explanation is fears around CS triggering traumatic memories due to similarities between the two experiences, such as insertion of the vaginal speculum. At present, no theory-driven literature exists to facilitate understanding as to why women do or do not attend their CS following an experience of sexual assault. The Health Action Process Approach (HAPA) is a health behaviour model which has previously been applied to inform interventions to increase CS uptake. The model includes three types of self-efficacy, which facilitates understanding of the relationship between intention and on going attendance to health-promoting behaviours. The current study aimed to explore whether the HAPA could explain CS uptake in women who have experienced sexual assault, over and above other potentially confounding variables, which relate to CS uptake. The study also aimed to explore whether trauma variables (severity of trauma symptoms, nature of trauma and age trauma occurred at) explain CS uptake better than HAPA variables. The findings indicate that variables in the HAPA model can help explain intention and attendance of CS in women who have experienced sexual assault. Findings were generally consistent with previous research, however risk perception did not explain intention, and recovery self-efficacy did not explain attendance. These may be due to possible interactions of these variables with trauma variables. Interestingly, trauma variables did not offer a significant contribution to understanding CS. The relationship between trauma symptoms on CS uptake was suggested to be due to the association of self-efficacy with both of these variables. Maintenance and task self-efficacy both predicted intention and attendance. This suggests that for women who have experienced sexual assault, the belief and confidence in their ability to continually attend their CS, even when faced with challenges, is the best predictor of CS uptake. This implies that helping women believe they can successfully attend on going CS, is likely to lead to increased CS uptake. Overall, it can be concluded that CS uptake is related more to self-efficacy, than to the details of the sexual trauma (age and nature) and level of trauma symptoms. This offers a strong argument for the importance of self-efficacy for understanding CS uptake in women with a history of sexual assault, indicating that women can experience trauma symptoms and attend their CS, if they have high self-belief in their abilities.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: sexual assault ; cervical smear ; trauma ; HAPA ; health action process approach ; systematic review ; quantitative