The Economic & Social Research Institute (ESRI) has published the findings of a new study investigating the impact of the 2018 CervicalCheck controversy on levels of trust and attributions of blame for interval cancers - cancers developed after taking part in screening.
We worked with the ESRI in an advisory capacity on this research, which is aligned with the recommendations of the Interval Cancer Expert Reference Group reports:
- the provision of information to participants to help them make an informed choice to participate in screening
- the necessity to build and promote understanding of, and trust in, screening programmes.
The aim of the research was to assess how well people understand screening and how they perceive screening services, and to use this knowledge to design more targeted communications to enhance informed decision-making.
The study is the first in a series of findings from a research programme we began with the ESRI’s Behavioural Research Unit in 2021. We established the research programme to apply behavioural insights to the information materials we use to communicate to people about our screening services.
Background to this study
The success of population-based screening depends on high participation rates which require high levels of public trust in screening. The screening process has inherent limitations, and achieving zero-error screening in standard practice is impossible, no matter how high the quality is. While some false positive and false negative results are inevitable these results can damage trust in screening. This first study aimed to understand the implications of these results, and to find ways to restore lost trust.
Overview
A comparative study was set up between Ireland (where the controversy happened) and Scotland (where it did not). Study participants represented people eligible or soon-to-become eligible for cervical screening – women aged 23 to 65 in Ireland; and women aged 23 to 64 in Scotland. 872 participants in Ireland and 400 participants in Scotland took part in the study.
Study methods
The study used an experiment to test the impact of new detailed information materials updated to correct misconceptions and improve understanding about cervical screening.
Study participants in Ireland were randomly put into two groups:
- a treatment group – who received information materials about cervical screening
- a control group – who did not receive the information materials.
All participants answered questions about their trust in the cervical screening programme and completed a quiz assessing their understanding of the screening programme’s purpose, benefits and limitations. Participants then read (fictional) vignettes describing individual experiences of women who developed cervical cancer after taking part in screening. The experiences varied in relation to a woman’s history of attending screening, having received false negative results, and how advanced a cancer diagnosis was.
Participants then evaluated to what extent they had feelings of ‘blame’ towards different organisations or people for the cancers described in the vignettes.
Results
- Levels of trust in the screening programme were significantly lower in Ireland compared to Scotland, indicating that the CervicalCheck controversy negatively impacted on trust in screening.
- Levels of trust towards the laboratories analysing screening samples, and in the screening results, were particularly low among Irish participants.
- Study participants in Ireland assigned more blame to the screening programme in cases of false negative results and advanced cancer stages than participants in Scotland.
- New information materials improved trust in screening.
- A better understanding of screening reduced feelings of ‘blame’ for interval cancers.
Conclusion
The findings of the study demonstrate the positive impact new information materials had on improving trust in screening and highlights the role open and transparent communications have in mitigating the adverse effects of a controversy. A better understanding of screening reduced feelings of blame for cancers that develop after screening, highlighting the importance of improving public understanding of screening.
Next steps
This is the first study to be published from this large-scale research project. Further studies will focus on the impact of existing and new cervical screening information materials on understanding and intention to participate in screening.
As a result of the research programme, we’re developing a decision-making aid to make it easier for women to understand the choice they will make when deciding to take part in cervical screening.
- This study was funded by the National Screening Service/ESRI Research Programme investigating public perceptions of screening.
- Poluektova O., Robertson D.A., Papadopoulos A., and Lunn P.D. “Trust in Cervical Screening and Attributions of Blame for Interval Cancers Following a National Controversy”, British Journal of Health Psychology. Available at: http://doi.org/10.1111/bjhp.12727
(updated 23 May 2024)