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Psychological Impact of Testing Positive for Human Papillomavirus at Cervical Cancer Screening

McBride, Emily Patricia; (2021) Psychological Impact of Testing Positive for Human Papillomavirus at Cervical Cancer Screening. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

In the UK and elsewhere, cervical cancer screening has changed to incorporate primary human papillomavirus (HPV) testing. This means all women who attend screening are told whether they test positive or negative for high-risk HPV. Testing positive for HPV has been associated with elevated anxiety and distress; and can also carry a negative label due to its sexually transmitted nature. Prior to this PhD, there had been no major studies assessing the psychological impact of routine HPV primary screening, or the impact of testing HPV-positive with normal cytology, a result unique to these screening methods. Four studies were conducted: 1) mixed-method systematic review to synthesise emotional response to testing HPV-positive at cervical cancer screening (33 studies); 2) cross-sectional survey comparing anxiety and distress between different test result groups at routine HPV primary screening (n=1127); 3) cross-sectional survey exploring distinct illness representation profiles and anxiety in women testing HPV-positive with normal cytology (n=646); and 4) comparative qualitative interview study to explore reasons for variations in anxiety in women testing HPV-positive with normal cytology (n=30). Overall, testing HPV-positive at cervical screening was sometimes associated with adverse emotional, cognitive, behavioural, and physiological sequelae. These impacts appeared to differentially affect subgroups of the population in terms of intensity, duration, and clinical significance. For women testing HPV-positive with normal cytology, maladaptive illness representations may partially account for clinically significant anxiety. Highly anxious women primarily expressed fear of developing cervical cancer and had concerns about potential relationship infidelity and fertility issues. Cognitive Behavioural Theory and Leventhal’s Common-Sense Model of Self-Regulation were used to formulate overarching findings, providing a preliminary theoretical literature in an otherwise atheoretical domain. The findings of this PhD begin to develop an evidence-base for specific messages which could be used by policymakers in routine patient communication materials, to alleviate unnecessary anxiety at HPV primary screening.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Psychological Impact of Testing Positive for Human Papillomavirus at Cervical Cancer Screening
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Behavioural Science and Health
URI: https://discovery.ucl.ac.uk/id/eprint/10118115
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