check-up, blood pressure measurement and cholesterol testing, a cervical smear,
mammography) and suggested that both the cognitions derived from a range of models
and emotional factors such as reassurance predicted uptake. However, they also argued
that although beliefs and emotions predict screening uptake, the nature of these beliefs
and emotions is very much dependent upon the screening programme being considered.
Some research has also focused on patients need to reduce their uncertainty and to
find ‘cognitive closure’. For example, Eiser and Cole (2002) used a quantitative method
based upon the stages of change model and explored differences between individuals
at different stages of attending for a cervical smear in terms of ‘cognitive closure’
and barriers to screening. The results showed that the precontemplators reported most
barriers and the least need for closure and to reduce uncertainty. One qualitative study
further highlighted the role of emotional factors in the form of feeling indecent. Borrayo
and Jenkins (2001) interviewed 34 women of Mexican descent in five focus groups about
their beliefs about breast cancer screening and their decision whether or not to take part.
The analyses showed that the women reported a fundamental problem with breast
screening as it violates a basic cultural standard. Breast screening requires women to
touch their own breasts and to expose their breasts to health professionals. Within the
cultural norms of respectable female behaviour for these women, this was seen as
‘indecent’.
Contextual factors: Finally contextual factors have also been shown to predict
uptake. For example, Smith et al. (2002) interviewed women who had been offered
genetic testing for Huntington’s disease. The results showed that the women often
showed complex and sometimes contradictory beliefs about their risk status for the
disease which related to factors such as prevalence in the family, family size, attempts
to make the numbers ‘add up’ and beliefs about transmission. The results also showed
that uptake of the test related not only to the individual’s risk perception but also to
contextual factors such as family discussion or a key triggering event. For example, one
woman described how she had shouted at the cats for going onto the new stair carpet
which had been paid for from her father’s insurance money after he had died from
Huntington’s disease. This had made her resolve to have the test.Health professional factors
Marteau and Johnston (1990) argued that it is important to assess health professionals’
beliefs and behaviour alongside those of the patients. In a study of general practitioners’
attitudes and screening behaviour, a belief in the effectiveness of screening was associ-
ated with an organized approach to screening and time spent on screening (Havelock
et al. 1988). Such factors may influence patient uptake. In addition, the means of
presenting a test may also influence patient uptake. For example, uptake rates for HIV
testing at antenatal clinics are reported to vary from 3 to 82 per cent (Meadows et al.
1990). These rates may well be related to the way in which these tests were offered by
the health professional, which in turn may reflect the health professional’s own beliefs
about the test. Some research has used qualitative methods to further analyse health
professional factors. For example, Michie et al. (1999) used structured interviews to
explore how clinical geneticists and genetic counsellors view the function of a genetic216 HEALTH PSYCHOLOGY