Background In December 2017, the Australian cervical screening program implemented changes, which women have shown significant concerns about. One of the main changes was from a two-yearly Pap test to a five-yearly human papillomavirus (HPV) test. Previous research has shown women to overlook the change in the screening test, which is the basis for many of the changes made to the program. Due to the change in screening test, women now receive different results from the previous program.
This study aimed to examine after 12 months, the psychosocial impact of HPV test results and understanding of these results in a sample of women residing in Australia who have undergone screening under the renewed cervical screening program.
Methods Participants were women residing in Australia aged 25 – 74 years who received cervical screening since December 2017 under the new guidelines. Participants were recruited through a market research company panel, Dynata and completed an online survey. Primary outcome measures were anxiety and general distress. Qualitative interviews were conducted with a sub-sample (n=26) of these women with different test results (HPV+, HPV-, don’t know).
Results 1004 women completed the online survey, with the majority testing HPV negative (81%) and only 47% of these knew that they were to screen again in five years’ time. 6% tested HPV positive and 13% did not know their test result. HPV positive women were significantly more anxious (53.03 vs 43.58, p<0.001), distressed (3.94 vs 2.52, p=0.004) and concerned about their test result (5.02 vs 2.37, p<0.001) than HPV negative women. Concern regarding test results was also significantly higher in women who did not know their test result (3.20 vs 2.37, p<0.001) compared with HPV negative women. HPV positive women expressed greater distress about their test result (7.06 vs 4.74, p<0.001) and cancer worry (2.28 vs 1.73, p<0.001) than HPV negative women. HPV positive women also had greater knowledge of HPV (9.25 vs 6.62, p<0.001) and HPV testing (2.44 vs 1.30, p<0.001).
Qualitative findings showed some women understood the HPV test is earlier detection and that HPV is common. A number of women said they had not been told about the changes when they went for their cervical screen. A greater understanding of the program changes was shown in HPV positive women. A degree of trust in the changes was demonstrated by some women by expressing faith in the rationale behind the renewal and in their doctor.
Conclusion Receiving an HPV positive test result as part of the revised cervical screening program, was associated with significantly higher anxiety, general distress, concern about test results and distress about test results in women. Although qualitative findings showed HPV positive women had a greater understanding of the program changes, this may not suffice in mitigating this impact in these women. Not all women were told their results, which was also associated with concern about test results. Ensuring all women receive their results and information about what their results mean, could go some way to mitigate distress and concern in these women.
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