best predictor of the dependent variable. The results suggest that the best predictor of
breast self-examination was confidence in carrying out the examination (self-efficacy)
and the best predictor of attending for cervical smears was having a lower fear of the
consequences of the investigation (barriers).Conclusion
The results from this study provide some support for the individual components of the
health belief model and health locus of control in predicting screening behaviour for
both cervical and breast cancer. In particular, the results suggest that self-efficacy (added
to the recent version of the HBM, see Chapter 2) and barriers are the most powerful
predictors of behaviour. However, the results provide no support for a role of emotional
control in screening behaviour. The authors conclude that health promotion aimed at
increasing breast self-examination ‘must consider how to improve women’s confidence
in how to practise it’ and education aimed at promoting attendance for cervical smears
should ‘reduce the anxiety felt among many women about the possible consequences of
the investigation’. This paper therefore illustrates how a theory can be tested, and how
the results from such a study could be turned into practice.Organizational factors
Many organizational factors may also influence the uptake of screening. Research has
examined the effects of the means of invitation on the uptake rate and indicates that if
the invitation is issued in person, and if the individual is expected to opt out, not in, the
rates of uptake are higher (Mann et al. 1988; Smith et al. 1990). The place of the
screening programme may also be influential with more accessible settings promoting
high uptake. In addition, making attendance at a screening programme mandatory
rather than voluntary will also obviously have an effect (Marteau 1993). Uptake may
also be influenced by education and media campaigns. For example, Fernbach (2002)
evaluated the impact of a large media campaign designed to influence women’s self-
efficacy and uptake of cervical screening. The media campaign was called the ‘Papscreen
Victoria’ campaign and took place in Australia. It was evaluated by face-to-face inter-
views with 1571 women at baseline and two follow-ups. The results showed that women
reported an increase in awareness of cervical screening and rated this as a greater health
priority than before the campaign. However, the results were not all positive. The women
also stated after the campaign that they would find it more difficult to ring up for test
results and reported lowered self-efficacy.SCREENING AS PROBLEMATIC
Over the past decade, however, a new dimension has emerged in the screening literature,
namely, the negative elements of screening. There are now debates about the following
aspects of screening: (1) ethics, in terms of the relevance of the four main ethical
principles (beneficence, non-maleficence, autonomy and justice); (2) the cost effectiveness220 HEALTH PSYCHOLOGY