consultation in terms of its aims, the skills involved and patient expectations. The
analyses showed that the interviewees described the consultations in terms of four
main themes which were often contradictory. These were providing information that
is both objective and full and tailored to the needs of the individual; dealing with emotion
by both eliciting it and containing it; communicating both directively and non direc-
tively; and performing sophisticated skills whilst having only minimal training. These
themes and their contradictions suggest that consultations would vary enormously
between patients and between clinicians. For example, whilst a clinician may offer full
information for one patient the same clinician might limit the information for another.
Similarly, whilst one clinician might tend to be more directive another might be less so.
Such variation in health professional beliefs about the consultation and their subsequent
behaviour could influence the patient’s decision about whether or not to have a particular
test (see Chapter 4 for more details on communication).
FOCUS ON RESEARCH 9.1: TESTING A THEORY – PREDICTING SCREENING
A study to examine the role of the health belief model, health locus of control
and emotional control in predicting women’s cancer screening behaviour
(Murray and McMillan 1993).
This study examines the role of three social psychological models in predicting breast
self-examination and cervical screening behaviour. The study illustrates how theories
can be empirically tested and how research results can be used to develop interventions
to promote screening behaviour.
Background
It is generally believed that early detection of both breast and cervical cancer may
reduce mortality from these illnesses. Therefore, screening programmes aim to help the
detection of these diseases at the earliest possible stages. However, even when invited to
attend for cervical screening, or when encouraged to practise breast self-examination
many women still do not carry out these health protective behaviours. Social psychology
models have been used to predict cancer screening behaviour. This study examined the
health belief model and health locus of control (see Chapter 2) in the context of cancer
screening. In addition, the authors included a measure of emotional control (sometimes
described as expressed emotion, repression and defensiveness). Individuals with high
emotional control are sometimes described as having a cancer prone personality (see
Chapter 13), which has been linked to cancer onset.
Methodology
Subjects A letter informing residents about a regional health survey was sent to
1530 randomly selected addresses in Northern Ireland. An interviewer then visited
SCREENING 217