Abstract
Abstract.Background: Cervical screening helps prevent cervical cancer (NHS, 2019). Women who have experienced sexual assault have lower cervical screening attendance, however, no theory-driven research explores reasons for this. The Health Action Process Approach (HAPA) explains intention and ongoing attendance to health-promoting behaviors. Aims: The HAPA was used to identify and explore how sexual assault impacts cervical screening uptake. Method: An online study of 247 women aged 21–63 explored whether HAPA variables (task, maintenance, and recovery self-efficacy, outcome expectancies, risk perception, action, and coping planning), trauma variables (nature and age of abuse, and level of post-traumatic stress disorder symptoms [PTSD]), and other potentially confounding factors related to cervical screening uptake in women who have experienced sexual assault. Regression and mediation analyses were conducted to explore predictive variables of intention and attendance. Results: Self-efficacy beliefs predicted both intention and attendance of cervical screening. Task self-efficacy predicted intention and mediated relationships between HAPA variables and intention. Maintenance self-efficacy predicted attendance and mediated relationships between HAPA variables and attendance. Trauma variables did not predict more variance in intention or attendance over HAPA variables. Limitations: The cross-sectional nature of the study means causality was not established. Conclusion: Self-efficacy develops an understanding of cervical screening in women with experience of sexual assault, over and above the trauma variables of type of assault and PTSD symptoms. Focusing on self-efficacy to improve cervical screening uptake in women who have experienced sexual assault is considered for clinical implications.
References
(2012). A history of interpersonal trauma and the gynaecological exam. Qualitative Health Research, 22(5), 679–688. https://doi.org/10.1177/1049732311424730
(2008). Personal influencing factors associated with pap smear testing and cervical cancer. Policy, Politics & Nursing Practice, 9(1), 50–60. https://doi.org/10.1177/1527154408318097
. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
(2014). Development and reliability testing of a health action process approach inventory for physical activity participation among individuals with schizophrenia. Frontiers in Psychiatry, 5, Article
68 . https://doi.org/doi.org/10.3389/fpsyt.2014.00068(1964). An introduction to motivation. Van Nostrand.
(2016). Factors affecting cervical cancer screening behaviors based on the precaution adoption process model: A qualitative study. Global Journal of Health Science, 8(6), 211–218. https://doi.org/10.5539/gjhs.v8n6p211
(1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191
(1997). Self-efficacy: The exercise of control. Freeman.
(2004). Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy. Behaviour Research and Therapy, 42(10), 1129–1148. https://doi.org/10.1016/j.brat.2003.08.008
(1999). Conservation of resources and coping self-efficacy predicting distress following a natural disaster: A causal model analysis where the environment meets the mind. Anxiety, Stress and Coping, 12(2), 107–126. https://doi.org/10.1080/10615809908248325
(2002). Coping self-efficacy as a target variable in the treatment of psychological distress in domestic violence survivors (Unpublished manuscript)
(2000). Predicting uptake of a routine cervical smear test: A comparison of the health belief model and the theory of planned behaviour. Psychology & Health, 15(1), 35–50. https://doi.org/10.1080/08870440008400287
(2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17–31. https://doi.org/10.1016/j.cpr.2005.07.003
(2012). Barriers to cervical screening in women who have experienced sexual abuse: An exploratory study. Journal of Family Planning and Reproductive Health Care, 38(4), 214–220. https://doi.org/10.1136/jfprhc-2012-100378
. (2007). Cervical Cancer Awareness Measure. http://www.cancerresearchuk.org/health-professional/awareness-and-prevention/the-cancer-awareness-measures-cam#CAM0
. (2015). Cervical cancer statistics. http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cervical-cancer#heading-Zero
(2002). Effects of posttraumatic stress disorder and child sexual abuse on self-efficacy development. American Journal of Orthopsychiatry, 72(2), 262–265. https://doi.org/10.1037/0002-9432.72.2.262
(2006). Participant responses to retrospective surveys of child maltreatment: Does mode of assessment matter? Violence and Victims, 21(4), 410–424.
(2004). A large population-based randomized controlled trial to increase attendance at screening for cervical cancer. Cancer Epidemiology and Prevention Biomarkers, 13(3), 346–354.
(2013). Sociodemographic factors associated with cervical cancer screening coverage and follow-up of high grade abnormal results in a population-based cohort. Gynaecologic Oncology, 128(1), 95–100.
(2002). Is a history of trauma associated with a reduced likelihood of cervical cancer screening? The Journal of Family Practice, 51(10), 827–831.
(1991). Understanding the uptake of cervical cancer screening: The contribution of the health belief model. The British Journal of General Practice, 41(353), 510–513.
(1996). The theory of planned behavior: A review of its applications to health-related behaviors. American Journal of Health Promotion, 11(2), 87–98.
(2020). Application of the health action process approach to social distancing behavior during COVID-19. Applied Psychology: Health and Well-Being, 12(4), 1244–1269. https://doi.org/10.1111/aphw.12231
. (2017). Barriers to cervical screening among 25–29 year olds. https://www.jostrust.org.uk/sites/default/files/ccpw17_survey_summary.pdf
(1993). Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychological Bulletin, 113(1), 164–180.
(2002). The Sexual and Physical Abuse Questionnaire (SPAQ): A screening instrument for adults to assess past and current experiences of abuse. Child Abuse & Neglect, 26(9), 939–953. https://doi.org/10.1016/S0145-2134(02)00363-0
(2016). Impact of cervical screening on cervical cancer mortality: Estimation using stage-specific results from a nested case-control study. British Journal of Cancer, 115(9), 1140–1146. https://doi.org/10.1038/bjc.2016.290
(2005). Stage-specific adoption and maintenance of physical activity: Testing a three-stage model. Psychology of Sport and Exercise, 6(5), 585–603. https://doi.org/10.1016/j.psychsport.2004.11.002
(2011). Enhancing intentions to attend cervical cancer screening with a stage-matched intervention. British Journal of Health Psychology, 16(1), 33–46. https://doi.org/10.1348/135910710X499416
(2007). Recovery self-efficacy and intention as predictors of running or jogging behavior: A cross-lagged panel analysis over a two-year period. Psychology of Sport and Exercise, 8(2), 247–260. https://doi.org/10.1016/j.psychsport.2006.03.010
(2003). Planning and self-efficacy in the adoption and maintenance of breast self-examination: A longitudinal study on self-regulatory cognitions. Psychology and Health, 18(1), 93–108. https://doi.org/10.1080/0887044021000019358
(1990). Inner-city women at risk for cervical cancer: Behavioral and utilization factors related to inadequate screening. Preventive Medicine, 19(4), 363–376. https://doi.org/10.1016/0091-7435(90)90036-J
(2016). Applied multivariate research: Design and interpretation. Sage Publications.
(2021). Predicting psychological factors affecting regular physical activity in hypertensive patients: Application of health action process approach model. Nursing Open, 8(1), 442–452. https://doi.org/10.1002/nop2.645
(1993). Health beliefs, locus of control, emotional control and women’s cancer screening behaviour. British Journal of Clinical Psychology, 32(1), 87–100. https://doi.org/10.1111/j.2044-8260.1993.tb01032.x
. (2019). When You’ll be Invited, cervical screening. https://www.nhs.uk/conditions/cervical-screening/when-youll-be-invited/
. (2020). Cervical Screening Programme, England – 2019–2020. https://digital.nhs.uk/data-and-information/publications/statistical/cervical-screening-annual/england—2019-20/section-1-call-and-recall
(2015).
Psychological and social theories of PTSD . In U. SchnyderM. CloitreEds., Evidence based treatments for trauma-related psychological disorders (pp. 41–61). Springer.. (2021). Sexual offences prevalence and trends, England and Wales: year ending March 2020. https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/sexualoffencesprevalenceandtrendsenglandandwales/yearendingmarch2020
(2006). Comparing two theories of health behavior: A prospective study of noncompletion of treatment following cervical cancer screening. Health Psychology, 25(5), 604–615. https://doi.org/10.1037/0278-6133.25.5.604
(1998). Self-efficacy expectation, behavior performance, and mood status in early recovery from percutaneous transluminal coronary angioplasty. Heart & Lung: The Journal of Acute and Critical Care, 27(1), 37–46. https://doi.org/10.1016/S0147-9563(98)90067-X
(2017). Cancer screening in the European Union (2017). Report on the implementation of the council recommendation on cancer screening. https://ec.europa.eu/health/sites/default/files/major_chronic_diseases/docs/2017_cancerscreening_2ndreportimplementation_en.pdf
(2021). Application of the health action process approach model in predicting mammography among Iranian women. https://assets.researchsquare.com/files/rs-80108/v1/163bf2e4-afff-47bf-b361-294672cdaf3a.pdf?c=1631870039
. (2021). Cervical Screening: Support for people who feel anxious about attending. https://www.gov.uk/government/publications/cervical-screening-support-for-people-who-find-it-hard-to-attend/cervical-screening-support-for-people-who-feel-anxious-about-attending
(1996). The gynaecological care experience of adult survivors of childhood sexual assault: A preliminary investigation. Women and Health, 24(3), 59–75. https://doi.org/10.1300/J013v24n03_04
(1988). Social learning theory and the health belief method. Health Education Quarterly, 13, 73–92.
(2009). A mere measurement effect for anticipated regret: Impacts on cervical screening attendance. British Journal of Social Psychology, 48(2), 221–236. https://doi.org/10.1348/014466608X347001
(2001). Factors associated with breast and cervical cancer screening behaviours. Health Education, 101(4), 176–186. https://doi.org/10.1108/09654280110398761
(1990). Goal setting and self-efficacy during self-regulated learning. Educational Psychologist, 25(1), 71–86. https://doi.org/10.1207/s15326985ep2501_6
(1992).
Self-efficacy in the adoption and maintenance of health behaviors: theoretical approaches and a new model . In R. SchwarzerEd., Self-efficacy: Thought control of action (pp. 217–243). Routledge.(2008). Modeling health behavior change: How to predict and modify the adoption and maintenance of health behaviors. Applied Psychology, 57(1), 1–29. https://doi.org/10.1111/j.1464-0597.2007.00325.x
(2016). Health Action Process Approach (HAPA) as a theoretical framework to understand behavior change. Actualidades en Psicología, 30(121), 119–130. https://doi.org/10.15517/ap.v30i121.23458
(1996).
Self-efficacy and health behaviours . In M. ConnerP. NormanEds., Predicting health behaviour (pp. 163–196). Open University Press.(2020).
Changing behavior using the health action process approach . In M. S. HaggerL. D. CameronK. HamiltonN. HankonenT. LintunenEds., The handbook of behavior change (pp. 89–103). Cambridge University Press.(2011). Mechanisms of health behavior change in persons with chronic illness or disability: The Health Action Process Approach (HAPA). Rehabilitation Psychology, 56(3), 161–170. https://doi.org/10.1037/a0024509
(2008). How to overcome health-compromising behaviors: The health action process approach. European Psychologist, 13(2), 141–151. https://doi.org/10.1027/1016-9040.13.2.141
(2015).
Health action process approach . In M. ConnerP. NormanEds., Predicting health behaviours (3rd ed., pp. 252–278). Oxford University Press.(2003). On the assessment and analysis of variables in the health action process approach: Conducting an investigation. Freie Universität Berlin.
(1988). The theory of reasoned action: A meta-analysis of past research with recommendations for modifications and future research. Journal of Consumer Research, 15(3), 325–343. https://doi.org/10.1086/209170
(2018). Evaluation of the effects of receiving trauma-informed practices on domestic violence shelter residents. American Journal of Orthopsychiatry, 88(5), 563–570. https://doi.org/10.1037/ort0000286
(2011). The role of planning and self-efficacy in condom use among men who have sex with men: An application of the Health Action Process Approach model. Health Psychology, 30(1), 119–128. https://doi.org/10.1037/a0022023
(2007). Psychosocial correlates of PTSD symptom severity in sexual assault survivors. Journal of Traumatic Stress, 20(5), 821–831. https://doi.org/10.1002/jts.20290
(2003). Factors affecting attendance for cervical smear test: A prospective study. http://www.cervicalcheck.ie/_fileupload/Publications/Factors%20affecting%20attendance%20at%20smear%20tests%20Sept%2003.pdf
(2016). Re-traumatization of sexual trauma in women’s reproductive health care. University of Tennessee Honors Thesis Projects. http://trace.tennessee.edu/cgi/viewcontent.cgi?article=2983&context=utk_chanhonoproj
(2013). The PTSD Checklist for DSM-5 (PCL-5). National Center for PTSD. Scale available from the National Center for PTSD.
(2010). Sexual violence, posttraumatic stress disorder, and the pelvic examination: How do beliefs about the safety, necessity, and utility of the examination influence patient experiences? Journal of Women’s Health, 19(7), 1271–1280. https://doi.org/10.1089/jwh.2009.1673
