Women's knowledge of and attitude towards organized cervical smear screening

Objective. To describe women's barriers to cervical screening by asking about their experience with and knowledge of smear tests and by examining the women's contact and relationship with their GP. Setting. Questionnaires sent to women in Aarhus County, Denmark. Methods. A case control study in a cohort. The cohort, 133,500 women, represents women aged 23-60 years who were invited to the organized cervical screening program between 1.10.90 and 1.4.94. A case group, non-attenders (n=694), who had not had a smear within the previous 42 months, and a control group, attenders (n=1131), who had at least one smear test within the previous 42 months, were compared with each other. Predictor variables in the two groups were analyzed by univariate and multivariate (logistic regression) analysis. Results. Non-attenders more often had insufficient contact with the GP (having a bad relationship, feeling of not receiving sufficient information) and associated a gynecological examination with more psychological unpleasantness. Most non-attenders (65.5%) and at tenders (88.5%) intended to attend next rime they were invited for cervical screening, and resistance to mass screening on principle did not seem to have great influence on the number of non-attenders. Both non-attenders and attenders had poor knowledge of the smear test. No significant difference was found concerning the characteristics of the general practice used by non-attenders and attenders. Conclusions. The main barriers to regular cervical screening are insufficient contact with the GP and psychological unpleasantness associated with the gynecological examination. Resistance to cervical screening on principle does not seem to have a great influence on attendance.